[A novel approach to rapid induction of remission in primary membranous nephropathy].

AIM: То evaluate the effectiveness of a novel multi-targeted treatment approach including rituximab (RTX), cyclophosphamide (CPH) and steroids (S) to the induction of remission in patients with primary membranous nephropathy (PMN) compared to standard immunosuppression (IST). MATERIALS AND METHODS: An open-label prospective comparative study included 56 PMN patients (pts) with nephrotic syndrome (NS) and high serum level of antibodies to the phospholipase A2 receptor anti-PLA2R (mean age 5112 years, men 70%). We recorded demographic and clinical parameters at the time of kidney biopsy, data from light-optical and immunomorphological studies. All pts were on stable doses of the renin-angiotensin systems blockers. We compared the effectiveness of different treatments in the inductions of clinical and immunological remissions in pts who received experimental treatment with RTX, CPH and S (RTX+CPH+S group, n=14) and two control groups: high-dose RTX therapy (group RTX, n=12), cyclosporine and steroids (group CsA+S, n=30). RESULTS: In the RTX+CPH+S group, remission was achieved in 100% of cases (of which complete remissions CR in 21.4%). The median time-to-remission (2.5 [1.0; 3.5] months) was significantly lower compared to both control groups: RTX (8.7 [6.6; 14.0] months, p=0.005) and CsA+S (12.4 [6.5; 19.9] months, p0.001). The cumulative incidence of clinical and immunological remissions was also significantly higher in the RTX+CPH+S group than in the control groups. These results were confirmed in comparative analyzes in the same treatment groups after propensity score matching. The cumulative incidence of clinical and immunological remissions in the RTX+CPH+S group was higher than in the combined group of patients who received other therapies (p0.001). The incidence of serious adverse events was low and did not differ between groups. CONCLUSION: The use of multi-targeted therapy with rituximab, cyclophosphamide, and steroids seems to be an effective approach for the rapid induction of PMN remission and prevention of NS complications.

[Lethal outcome in a patient with pulmonary hypertension and liver cirrhosis on the 12-th week of pregnancy]. / Letal'nyi iskhod u bol'noi s legochnoi gipertenziei i ochagovym tsirrozom pecheni v 12 ned beremennosti.

A patient with pulmonary hypertension and focal liver cirrhosis was hospitalized on the 12-th week of pregnancy because of threatened abortion and died after 2 days of hospital stay during which symptoms of portal and pulmonary hypertension progressed, decompensation of pulmonary heart and hepatic cellular insufficiency ensued and syndrome of disseminated intravascular coagulation developed.

[Status of steroid receptors in the uterus, placenta and fetal membranes]. / Sostoianie steroidnykh retseptorov v matke, platsente i plodovykh obolochkakh.

Receptors of the myometrium, placenta and fetal membranes have been examined during deliveries at different gestational ages. No direct correlation was seen between plasma levels of steroid hormones and steroid receptor concentrations in target organs.