RESUMEN
This article presents a case of recurrent anti-GBM disease (with antibodies against the glomerular basement membrane [GBM]) in a 17-year-old patient successfully treated with rituximab. Kidney biopsy with detection of linear deposition of immunoglobulin G (IgG) along the basement membrane is the diagnostic gold standard, which should be accompanied by serological testing. However, standard assays for the detection of anti-GBM antibodies have a high rate of false-negative results. In this particular case, an increase in proteinuria despite standard therapy (plasmapheresis, steroids, cyclophosphamide) was the clinical correlate of relapsing disease. The use of rituximab completely resolved the recurrent anti-GBM disease.
Asunto(s)
Enfermedad por Anticuerpos Antimembrana Basal Glomerular/tratamiento farmacológico , Glomerulonefritis/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Rituximab/uso terapéutico , Adolescente , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/inmunología , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/patología , Anticuerpos Monoclonales , Autoanticuerpos , Biopsia , Membrana Basal Glomerular/patología , Glomerulonefritis/diagnóstico , Humanos , Inmunoglobulina G/inmunología , Riñón/patología , Intercambio Plasmático , Proteinuria , Recurrencia , Resultado del TratamientoAsunto(s)
Antígenos de Neoplasias/sangre , Antígenos de Carbohidratos Asociados a Tumores , Enfermedades de las Vías Biliares/sangre , Enfermedades de la Mama/sangre , Enfermedades del Sistema Digestivo/sangre , Cirrosis Hepática/sangre , Enfermedades Pulmonares/sangre , Adolescente , Adulto , Anticuerpos Monoclonales , Femenino , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
Knowledge of receptor status is important for therapeutic strategies in hormone-dependent tumors. Therefore, methods specifically predicting biological response to endocrine therapy are essential. We investigated the receptor modulation of two breast tumors and one endometrial tumor in the nude mice model after injection of 20 micrograms 17 beta-estradiol. To differentiate the unoccupied and the occupied receptor sites, we used the enzyme immunoassay (EIA) for estrogen receptors (ER) under low- and high-salt conditions. With low-salt extraction we found a sharp decrease of the ER-EIA values within the first hour after estradiol treatment. This decrease continued for 24 hr until recovery to pretreatment levels occurred. In contrast, the ligand-receptor complexes tightly bound to acceptor sites on the DNA increased more than three times within 1 hr. These high levels could be measured for almost 12 hr, and then pretreatment levels were reestablished. The PgR-EIA values under low-salt conditions increased 10-fold within 12 hr, indicating an intact receptor mechanism. We conclude that this immunobiochemical method is a useful tool in determining receptor sites: those both unbound and those tightly bound to nuclear acceptors.