[The 508th case: recurrent edema of bilateral lower extremities with proteinuria].
Zhonghua Nei Ke Za Zhi
; 63(8): 816-820, 2024 Aug 01.
Article
em Zh
| MEDLINE
| ID: mdl-39069874
ABSTRACT
A 31-year-old man sought medical evaluation for a 2-year history of edema and proteinuria, with prior pathology suggesting atypical membranous nephropathy (MN). Despite treatment with a combination of steroids, calcineurin inhibitors, and four courses of rituximab (1 g, intravenous injection), the patient's nephrotic syndrome showed no relief (24 h urine protein peaked at 31.18 g/d), indicating refractory nephrotic syndrome. Later in the disease course, a sudden surge of creatinine level (322.5 µmol/L) prompted a renal biopsy, which revealed concurrent acute interstitial nephritis. Further treatment involving steroids, cyclophosphamide, and a fifth rituximab infusion (1 g, intravenous injection) resulted in improvement in renal function (serum creatinine 322.5â147 µmol/L), but the MN failed to achieve partial relief. Subsequent treatment with the novel humanized CD20 monoclonal antibody obinutuzumab (1 g, intravenous injection) was initiated. In the latest follow-up, anti-phospholipase-A2-receptor antibody (PLA2R) antibody were negative, B cells were eliminated, serum albumin was 36 g/L, urine protein-to-creatinine ratio was 4 810 mg/g, and serum creatinine was 162 µmol/L. This case underscores the potential efficacy of obinutuzumab in refractory MN. For advanced MN cases, prompt identification of the cause of acute kidney injury is crucial, emphasizing the need for targeted interventions to potentially stall renal function decline.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Proteinúria
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Glomerulonefrite Membranosa
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Edema
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Síndrome Nefrótica
Limite:
Adult
/
Humans
/
Male
Idioma:
Zh
Revista:
Chung-Hua Nei Ko Tsa Chih (Chinese Journal of Internal Medicine)
/
Zhonghua Nei Ke Za Zhi
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
China