Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome

Groote, Thilo von; Williams, Gabrielle; Au, Eric; Chen, Yizhi; Mathew, Anna; Hodson, Elisabeth M; Tunnicliffe, David J.

doi:10.1002/14651858.cd004293.pub4

Cited by 19 publications

(13 citation statements)

References 116 publications

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“…Changes in renal hemodynamics are also one of the main reasons for the occurrence and development of DN, and GFR is one of the sensitive indicators re ecting this change [39] . In this study, noninvasive and safe ECT imaging technology was used to perform renal blood volume perfusion imaging for DR patients with different lesion degrees.…”

Section: Discussionmentioning

confidence: 99%

Applying a convolutional neural network as a statistical method to evaluate the correlation between diabetic retinopathy and diabetic nephropathy

Li¹,

Tang²,

Gao³

et al. 2023

Preprint

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Objective At present, there is no consensus on the relationship between diabetic nephropathy (DN) and diabetic retinopathy (DR), and there is a lack of imaging data to prove the correlation between them. Therefore, we aimed to investigate the common risk factors for DN and DR in patients with type 2 diabetes and used Emission Computed Tomography(ECT) imaging technology and clinical test criteria to assess the correlation between DR and DN.Purpose The convolutional neural network was employed to observe and detect pathological changes in DR and DN images. And further analyze the correlation between DR and DN through clinical test data.Results In this study, we discovered that with the aggravation of DR, SCR, BUN and ACR gradually increased while GFR decreased. The incidence of DN in the non-DR, mild-NPDR, moderate-NPDR, severe-NPDR and PDR groups was 4.17%, 28.33%, 55%, 75.83% and 91.67%, respectively. Multivariate linear regression analysis showed that duration of T2D, smoking, HbA1c, TC, TG, HDL-c, LDL-c, UAlb, Scr, BUN, UAlb, ACR, GFR, ACR and GFR were independent risk factors for DR. Renal dynamic ECT imaging analysis demonstrated that with the aggravation of DR, renal blood flow perfusion gradually decreased, thus resulting in a decrease in renal filtration function. In T2D patients, DR and DN show a linear aggravation relationship, and hypercholesterolemia and renal dysfunction are common risk factors for DR and DN.Conclusion The convolutional neural network provides a more accurate, efficient and easier way to analyze DR and DN images. Early screening of the renal function index in DR patients using ECT imaging technology will help to identify and prevent DN as early as possible.

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Section: Discussionmentioning

confidence: 99%

Applying a convolutional neural network as a statistical method to evaluate the correlation between diabetic retinopathy and diabetic nephropathy

Li¹,

Tang²,

Gao³

et al. 2023

Preprint

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“…18 Prednisone is the first-line treatment, and in the absence of remission, alternative drugs, such as cyclosporine, cyclophosphamide, mycophenolate mofetil, or azathioprine are introduced. 18,58 It is a known fact that steroids can lead to thrombosis. 59,60 There are also reports of procoagulant activity of cyclosporine 61,62 and cyclophosphamide.…”

Section: What Is Responsible For the Risk Of Thrombosis In Nephrotic ...mentioning

confidence: 99%

Nephrotic Syndrome – Different Risk of Venous Thromboembolism with Different Approaches to Justify Prophylactic Anticoagulation

Sutkowska

Fułek

et al. 2022

Angiology

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All of the circumstances influencing any of the elements of Virchow’s Triad can increase the risk of venous thromboembolism. Assessing prothrombotic factors can sometimes be difficult. One of the examples of such a condition is nephrotic syndrome. In this condition at least two elements of Virchow’s triad are affected: physiological blood composition and the venous blood flow which is slowed down by the edema. Except for the cases mentioned in KDIGO (Kidney Disease: Improving Global Outcomes), the use of anticoagulant drugs in the prophylaxis of VTE (Venous Thromboembolism) in nephrotic syndrome seems unclear. Nevertheless, due to the increased risk of VTE, it is worth implementing mechanical anticoagulant prophylaxis, which can also improve the quality of life of patients by reducing swelling. The article analyzes the current knowledge on the field and gives some proposals with low bleeding risk.

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“…25 (68) 47 ( 72) 53 (82) 28 (76) 24 (63) Weight, kg 80 (15) 76.9 (17) 75 (11) 76 (15) 96 (23) 90 (20) 76 (70-85) 76.5 (67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85) History of hypertension NA 22 (59) 26 (37) NA NA Blood pressure, mmHg Systolic 127.1 (14) 129. 4 (17.7) 126 (13) 129 (13) 125.7 (14.8) 123.3 (13.4) 124 125 (117-140) Diastolic 77 (8.8) 75.1 (10.7) 77 (8) 76 (10) 74.…”

Section: Standard Of Care In the Treatment Of Mn: Alkylating Agents And Calcineurin Inhibitors (Cnis)mentioning

confidence: 99%

“…This recommendation is consistent with the conclusions of a recent systematic review, where it is observed that immunosuppressive therapy could help prevent progression to ESKD, mainly with alkylating agents, but at the expense of clinically relevant adverse effects associated with these drugs. Importantly, it was emphasized in this review that these conclusions are based on a few high-quality studies and without an adequate long-term follow-up of patients, including with the use of CNIs and new biological agents [ 68 ].…”

Section: Unmet Needs and Potential Novel Approachesmentioning

confidence: 99%

Recent Clinical Trials Insights into the Treatment of Primary Membranous Nephropathy

Rojas-Rivera

Fervenza

Ortíz

2021

Drugs

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Immunosuppressive therapy is mandatory for primary membranous nephropathy with persistent nephrotic proteinuria or anti-phospholipase A2 receptor antibodies, reduced kidney function, or another risk factor for progression. Rituximab has demonstrated efficacy for proteinuria remission compared with renin-angiotensin system blockade or cyclosporine in two well-powered randomized controlled trials. More recently, STARMEN showed that alternating glucocorticoid-cyclophosphamide is superior to sequential tacrolimus-rituximab for proteinuria remission, although it was associated with a higher risk of non-serious adverse events. However, sequential tacrolimus-rituximab involved delayed lower dose rituximab and was the worst-performing rituximab regimen among those tested in randomized clinical trials. The RI-CYCLO pilot study did not demonstrate superiority of glucocorticoid-cyclophosphamide over rituximab and found no difference in adverse events. Overall, STARMEN and RI-CYCLO confirmed the efficacy of glucocorticoid-cyclophosphamide in patients with high-risk membranous nephropathy and the role of rituximab as a valid alternative. However, none of the trials tested an optimized rituximab protocol involving a second rituximab cycle before declaring treatment failure. Calcineurin inhibitors should be considered third-line drugs and sequential use of calcineurin inhibitor rituximab did not add over rituximab-only regimens. We critically review recent randomized controlled trials, propose a research agenda, and call for multinational pragmatic trials that enroll patients at referral centers to address unmet research needs.

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Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome

Cited by 19 publications

References 116 publications

Applying a convolutional neural network as a statistical method to evaluate the correlation between diabetic retinopathy and diabetic nephropathy

Applying a convolutional neural network as a statistical method to evaluate the correlation between diabetic retinopathy and diabetic nephropathy

Nephrotic Syndrome – Different Risk of Venous Thromboembolism with Different Approaches to Justify Prophylactic Anticoagulation

Recent Clinical Trials Insights into the Treatment of Primary Membranous Nephropathy

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