Loss of a renal graft due to recurrence of anti‐GBM disease despite rituximab therapy

Sauter, Matthias; Schmid, Holger; Anders, Hans‐Joachim; Heller, F; Weiß, Max; Sitter, Thomas

doi:10.1111/j.1399-0012.2008.00912.x

Cited by 27 publications

(21 citation statements)

References 17 publications

(12 reference statements)

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“…Although early case series showed frequent biopsy-demonstrated recurrence in the allograft (up to 50%), 23 reports of recurrent disease leading to renal allograft failure with modern therapeutic approaches are rare. 11,24,25 In 1982, Cameron suggested that recurrence could be reduced to less than 5% if the patient was dialysed for 6-12 months before renal transplantation. 26 However, in the present study, renal allograft survival was comparable between patients with anti-GBM disease ESRD transplanted o1 year vs. X1 year after commencing dialysis.…”

Section: Discussionmentioning

confidence: 99%

Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease

Tang

McDonald

Hawley

et al. 2013

Kidney International

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There are few reports regarding outcomes of anti-glomerular basement membrane (GBM) disease in patients who underwent renal replacement therapy. To help define this we studied all patients with anti-GBM disease who started renal replacement therapy for end-stage renal disease (ESRD) in Australia and New Zealand (ANZDATA Registry) between 1963 and 2010 encompassing 449 individuals (0.8 percent of all ESRD patients). The median survival on dialysis was 5.93 years with death predicted by older age and a history of pulmonary hemorrhage. Thirteen patients recovered renal function, although 10 subsequently experienced renal death after a median period of 1.05 years. Of the 224 patients who received their first renal allograft, the 10-year median patient and renal allograft survival rates were 86% and 63%, respectively. Six patients experienced anti-GBM disease recurrence in their allograft, which led to graft failure in two. Using multivariable Cox regression analysis, patients with anti-GBM disease had comparable survival on dialysis or following renal transplantation (hazard ratios of 0.86 and 1.03, respectively) compared to those with ESRD due to other causes. Also, renal allograft survival (hazard ratio of 1.03) was not altered compared to other diseases requiring a renal transplant. Thus, anti-GBM disease was an uncommon cause of ESRD, and not associated with altered risks of dialysis, transplant or first renal allograft survival. Death on dialysis was predicted by older age and a history of pulmonary hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease

Tang

McDonald

Hawley

et al. 2013

Kidney International

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“…The European study also reported a higher frequency of recurrent disease (14%), although this may reflect differences in immunosuppressive use during an earlier era, and the study did not comment on anti-GBM titers and their relationship to timing of transplantation. In the current era, isolated case reports of recurrent disease still exist (79).…”

Section: Kidney Transplantation After Anti-gbm Diseasementioning

confidence: 99%

Anti-Glomerular Basement Membrane Disease

McAdoo¹,

Pusey²

2017

CJASN

315

303

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Anti-glomerular basement membrane (anti-GBM) disease is a rare small vessel vasculitis that affects the capillary beds of the kidneys and lungs. It is an archetypic autoimmune disease, caused by the development of directly pathogenic autoantibodies targeting a well characterized autoantigen expressed in the basement membranes of these organs, although the inciting events that induce the autoimmune response are not fully understood. The recent confirmation of spatial and temporal clustering of cases suggests that environmental factors, including infection, may trigger disease in genetically susceptible individuals. The majority of patients develop widespread glomerular crescent formation, presenting with features of rapidly progressive GN, and 40%-60% will have concurrent alveolar hemorrhage. Treatment aims to rapidly remove pathogenic autoantibody, typically with the use of plasma exchange, along with steroids and cytotoxic therapy to prevent ongoing autoantibody production and tissue inflammation. Retrospective cohort studies suggest that when this combination of treatment is started early, the majority of patients will have good renal outcome, although presentation with oligoanuria, a high proportion of glomerular crescents, or kidney failure requiring dialysis augur badly for renal prognosis. Relapse and recurrent disease after kidney transplantation are both uncommon, although de novo anti-GBM disease after transplantation for Alport syndrome is a recognized phenomenon. Copresentation with other kidney diseases such as ANCAassociated vasculitis and membranous nephropathy seems to occur at a higher frequency than would be expected by chance alone, and in addition atypical presentations of anti-GBM disease are increasingly reported. These observations highlight the need for future work to further delineate the immunopathogenic mechanisms of anti-GBM disease, and how to better refine and improve treatments, particularly for patients presenting with adverse prognostic factors.

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“…Renal recovery was not observed in either of the patients, and one of the patients developed leukoencephalopathy [23]. Sauter et al reported a case of an anti-GMB disease relapse 18 months after renal transplantation [24]. Rituximab was added after the failure of first-line treatment [24].…”

Section: Anti-gbm Diseasementioning

confidence: 99%

Use of Rituximab in Management of Rapidly Progressive Glomerulonephritis

Cancarevic

Malik

2020

Cureus

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Rapidly progressive glomerulonephritis (RPGN) is a form of glomerulonephritis characterized by loss of renal function within weeks. Although a variety of underlying causes can trigger RPGN, the ultimate pathologic mechanism is the podocyte and epithelial activation leading to the crescent formation. Rituximab has been increasingly and successfully used for autoimmune conditions in recent years. Treatment of RPGN is based on the underlying condition, but specific clinical guidelines are lacking. In this article, we have tried to establish the role of rituximab in the management of patients with RPGN. All the studies we have used were found in the PubMed database, limited to studies involving adults. Animal studies and studies involving the pediatric population were excluded. The currently available literature does not support switching to rituximab as the first-line agent. It has failed to prove consistently superior to other medications. However, combined with other commonly prescribed treatment regimens, namely corticosteroids, with or without cytotoxic drugs, rituximab has shown efficacy in many studies. Therefore, we have concluded that the most prudent use of rituximab in patients with RPGN would be in those with disease refractory to standard management with corticosteroids and cytotoxic drugs or in those who have intolerable side effects. We believe that clinicians should keep reporting any cases of RPGN treated with rituximab so that a more clear pattern emerges and more exact treatment guidelines can be made.

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Loss of a renal graft due to recurrence of anti‐GBM disease despite rituximab therapy

Cited by 27 publications

References 17 publications

Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease

Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease

Anti-Glomerular Basement Membrane Disease

Use of Rituximab in Management of Rapidly Progressive Glomerulonephritis

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