Large Renal Abscess in Pregnancy: Case Report of a Rare Finding.

The incidence of renal abscesses during pregnancy has not been well-established. A renal abscess is usually secondary to the complications of acute pyelonephritis and can lead to severe consequences, including fetal and/or maternal death. Little is known about the incidence of renal abscesses in pregnant women; however, the literature consistently refers to it as an extremely rare occurrence. We report a case of a large renal abscess discovered in the early postpartum period following a recurrent urinary tract infection and flank pain during pregnancy. The patient was successfully managed with abscess drainage and prolonged antibiotics.

Anti-glomerular basement membrane disease treated with mycophenolate mofetil, corticosteroids, and plasmapheresis.

An 18-year-old woman presented with anemia, pulmonary hemorrhage, and necrotizing glomerulonephritis, and was diagnosed with anti-glomerular basement membrane (anti-GBM) disease. Treatment was undertaken with plasma exchange, mycophenolate mofetil and corticosteroids, due to patient refusal of cyclophosphamide. Clinical remission was successfully induced with this fertility-sparing regimen. A relapse due to therapy non-adherence was successfully treated with a second course of plasmapheresis, mycophenolate, and steroids. Thereafter, 6 months of directly observed therapy resulted in a favorable outcome with well-preserved pulmonary and renal function. This case suggests the possibility that mycophenolate may have a role in the treatment of anti-GBM disease.

Antibody-mediated rejection in kidney transplantation: an update.

INTRODUCTION: Acute antibody-mediated rejection (AMR) in renal-transplant recipients is generally less responsive to conventional antirejection therapy and has a worse prognosis than acute cellular rejection. AREAS COVERED: This review provides a broad understanding of the pathogenesis of AMR, recent advances in its therapy, and future directions. Conventional therapeutic approaches to AMR have minimal impact on mature plasma cells, the major source of antibody production. Emerging therapies include bortezomib, a proteasome inhibitor, and eculizumab, an anti-C5 antibody. In several reports, bortezomib therapy resulted in prompt reversal of rejection, decreased titers of donor-specific antibodies (DSA), and improved renal allograft function. Eculizumab also reversed AMR and prevented its development in patients with high post-transplantation DSA levels. EXPERT OPINION: Despite the small sample size and lack of controls, these studies are encouraging, and although larger studies and long-term follow-up are needed, bortezomib and eculizumab may play a major future role in AMR therapy.