RESUMO
BACKGROUND: The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management glomerular/systemic autoimmune diseases with proteinuria in real-world clinical settings is unclear. METHODS: This is a retrospective, observational, international cohort study. Adult patients with biopsy-proven glomerular diseases were included. The main outcome was the percentage reduction in 24-h proteinuria from SGLT2i initiation to 3, 6, 9 and 12 months. Secondary outcomes included percentage change in estimated glomerular filtration rate (eGFR), proteinuria reduction by type of disease and reduction of proteinuria ≥30% from SGLT2i initiation. RESULTS: Four-hundred and ninety-three patients with a median age of 55 years and background therapy with renin-angiotensin system blockers were included. Proteinuria from baseline changed by -35%, -41%, -45% and -48% at 3, 6, 9 and 12 months after SGLT2i initiation, while eGFR changed by -6%, -3%, -8% and -10.5% at 3, 6, 9 and 12 months, respectively. Results were similar irrespective of the underlying disease. A correlation was found between body mass index (BMI) and percentage proteinuria reduction at last follow-up. By mixed-effects logistic regression model, serum albumin at SGLT2i initiation emerged as a predictor of ≥30% proteinuria reduction (odds ratio for albumin <3.5 g/dL, 0.53; 95% CI 0.30-0.91; P = .02). A slower eGFR decline was observed in patients achieving a ≥30% proteinuria reduction: -3.7 versus -5.3 mL/min/1.73 m2/year (P = .001). The overall tolerance to SGLT2i was good. CONCLUSIONS: The use of SGLT2i was associated with a significant reduction of proteinuria. This percentage change is greater in patients with higher BMI. Higher serum albumin at SGLT2i onset is associated with higher probability of achieving a ≥30% proteinuria reduction.
Assuntos
Diabetes Mellitus Tipo 2 , Glomerulonefrite , Nefropatias , Adulto , Humanos , Pessoa de Meia-Idade , Estudos de Coortes , Nefropatias/complicações , Glomerulonefrite/tratamento farmacológico , Glomerulonefrite/complicações , Proteinúria/etiologia , Proteinúria/complicações , Albumina Sérica , Sódio , Glucose , Diabetes Mellitus Tipo 2/complicaçõesRESUMO
We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.
Assuntos
COVID-19 , Glomerulonefrite , Nefrite , Anticorpos Anticitoplasma de Neutrófilos , COVID-19/complicações , Glomerulonefrite/tratamento farmacológico , Glomerulonefrite/terapia , Humanos , Masculino , SARS-CoV-2RESUMO
We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.
RESUMO
No disponible
Assuntos
Humanos , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Glomerulonefrite/diagnóstico , Hepatite C/complicações , Leishmaniose Visceral/diagnóstico , NecroseRESUMO
La relación entre parásitos y glomerulonefritis (GN) está bien documentada en determinadas parasitosis, no así en casos de Strongyloides stercolaris (S. stercolaris), donde hay pocos casos descritos, siendo la mayoría GN de cambios mínimos. Reportamos un caso de hiperinfestación por S. stercolaris en un paciente afectado de una GN membranosa tratado con corticoides por vía oral con resultado fatal para el paciente. Este caso nos aporta una doble enseñanza: en primer lugar, acerca de una asociación rara de estrongiloidiasis y GN membranosa, y en segundo lugar, sobre la importancia de establecer un diagnóstico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad clínica antes de iniciar cualquier tratamiento inmunosupresor
The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment
Assuntos
Humanos , Animais , Masculino , Pessoa de Meia-Idade , Glomerulonefrite Membranosa/complicações , Imunossupressores/efeitos adversos , Prednisona/efeitos adversos , Strongyloides stercoralis , Estrongiloidíase/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Criptococose/complicações , Diagnóstico Tardio , Quimioterapia Combinada , Equador/etnologia , Enterococcus faecium , Infecções por Escherichia coli/complicações , Evolução Fatal , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/urina , Infecções por Bactérias Gram-Positivas/complicações , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Pneumopatias Fúngicas/complicações , Meningites Bacterianas/complicações , Pneumonia Bacteriana/complicações , Prednisona/uso terapêutico , Choque Séptico/etiologia , Stenotrophomonas maltophilia , Estrongiloidíase/diagnósticoRESUMO
The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.
