Since the beginning of mass vaccination against coronavirus disease 2019 (COVID-19), vaccine-linked immune-mediated diseases have been increasingly reported. The development of these diseases after ...COVID-19 vaccination may be attributed to the mechanisms of molecular mimicry and cross-reactivity between the viral spike protein and self-antigens. The most frequent vaccine-linked glomerular disease is immunoglobulin A nephropathy (IgAN). Cutaneous vasculitis has also been reported after COVID-19 vaccination. In both diseases, deposition of immune complexes activates the inflammatory response with end-organ damage. We report on a case of de novo IgAN in a young man and a case of severe cutaneous vasculitis in a 68-year-old woman, both after the second dose of Pfizer-BioNTech COVID-19 vaccine. Neither of the patients had a history of autoimmunity or adverse reactions to vaccines. The temporal association between vaccination and disease development in the absence of other possible intercurrent inciting events suggests a causal mechanism, although coincidental co-occurrence cannot be excluded. In both cases, immunosuppressive treatment was warranted to stop disease progression and to partially or completely resolve the disease. A timely reaction is needed if new-onset signs of an immune-mediated disease appear after vaccination.
Cilj: Ispitati pojavnost znakova ishemijske periferne arterijske bolesti (PAB), ulkusa nogu (UN) i amputacija nogu (AN) u bolesnika liječenih kroničnom intermitentnom hemodijalizom (HD) te njihovu ...povezanost s drugim kliničkim i laboratorijskim parametrima. Metode: U presječno istraživanje, provedeno od siječnja do svibnja
2023. godine, uključeno je 329 bolesnika iz 5 HD centara. Osim anamneze, pregleda dokumentacije te kliničkog pregleda (posebice pulzacija), praćeni su i zadnji laboratorijski nalazi bolesnika određivani u rutinskoj kliničkoj praksi. Za ispitivanje neovisnih rizičnih čimbenika za UN te AN korištena je multivarijatna logistička regresija. Rezultati: Uključeno je 202 muškarca (61,4%), 119 bolesnika s dijabetesom (36,2%), medijana HD liječenja 40 mjeseci. PAB nogu imalo je 98 (27,8%) bolesnika, UN 42 (12,8%), a AN 40 (12,2%) bolesnika. UN bolesnici imali su češće PAB, dijabetes, ishemijsku srčanu bolest, češće su bili pušači, češće su imali odsutne ili oslabljene pulzacije na svim lokalizacijama nogu te češće amputacije i hipoalbuminemiju. AN bolesnici češće su imali PAB, dijabetes, ulkuse nogu, češće su bili pušači i imali odsutne ili oslabljene pulzacije na svim lokalizacijama nogu i hipoalbuminemiju te su bili značajno mlađi i viši. U multivarijatnoj logističkoj regresiji kao nezavisni čimbenici rizika za UN nađeni su: PAB, dijabetes, duži HD staž i hipoalbuminemija. Nezavisni rizični čimbenici za AN bili su: PAB, UN, dijabetes, pušenje, mlađa dob i hipoalbuminemija. Zaključak: učestalost znakova PAB-a veća je u HD bolesnika u usporedbi s općom populacijom, a dijabetes, pušenje i dužina liječenja HD-om dodatni su rizični čimbenici. Potrebna su prospektivna istraživanja te kliničko praćenje statusa nogu u ovih bolesnika radi sprječavanja komplikacija.
Collapsing glomerulopathy (CG) or collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive disease with a high tendency of progression to end-stage renal disease due to common ...resistance to conventional immunosuppressants. Rituximab (RTX), a monoclonal antibody against CD20 B cells, showed some benefit in the treatment of CG. We are reporting about female patients with an idiopathic form of CG presenting with nephrotic syndrome (NS) and renal insufficiency resistant to several immunosuppressive agents such as steroids (ST), calcineurin inhibitors (CNI), and cyclophosphamide (CYC). This multidrug-resistant disease responded to RTX with complete remission. Forty-four months after initial RTX administration, a relapse of CG with severe NS and acute renal insufficiency occurred. Repeated application of RTX led to complete remission again. To the best of our knowledge, we are reporting the first case of the relapsing multidrug-resistant form of CG, which responded to RTX. Current data about the treatment of CG with RTX is lacking and is based on rare case reports and small case series. Thus, our report can contribute to determining the role of RTX in the treatment of CG.
Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Nephropathology and Electron Microscopy, Dubrava University Hospital, Zagreb. Materials and methods. The ...retrospective search of data was performed for the period from 2006 to 2018. A total of 316 zero-time renal biopsies were analyzed. Glomerular basement membrane (GBM) thickness was remeasured in 84 zero-time biopsies and 80 protocol biopsies of the same patients 12 months after transplantation. Results and conclusion. The acute tubular injury was present in 90% and glomerular pathology in 17% of zero-time biopsies, with thin basement membranes (TBM) being the most common entity (13%). Chronic graft changes were evaluated according to Banff classification. Most cases showed Banff scores ci0 (82.6%) and ct0 (65.1%). Banff scores cv2 and cv3 were present in 13% and ah2 and ah3 in 36.4% of specimens. Among 84 remeasured zero-time samples, TBM was present in 26 patients (31%). There were no differences between Banff scores and clinical parameters 12 months after transplantation between recipients with TBM and recipients with normal GBM thickness. Zero-time renal biopsy is of great importance for allograft assessment and comparison with consecutive biopsies. Further investigation is needed to determine the long-term significance of TBM on graft survival. Key words: Zero-time renal biopsies, Glomerular basement membrane, Thin basement membrane
Introduction: primary membranous nephropathy (pMN) is glomerulopathy caused in the majority of cases by autoantibodies to Phospholipase-A2 receptors (PLA2R-AB). This study aimed to evaluate the ...clinical course and outcomes of the patients with pMN regarding PLA2R-AB status. Patients and methods: 32 patients (21 males, 11 females) with renal biopsy-proven pMN were included in the study. PLA2R-AB (ELISA method) and outcomes (defined according to KDIGO) were evaluated after 21 and 64 months of follow-up in 28 patients. Results: 19 patients had positive PLA2R-AB (>20 RU/ml) (59.3%), with median titer of 97 (21-1418 RU/ml). The rate of remission in low PLA2R-AB titer group (< 200 RU/ml) after 21 months was significantly higher than in high PLA2R-AB group (> 200 RU/ml) (90% vs. 50%, p=0.045), and after 64 months the difference was not significant (80% vs. 50%, p=0.210).The relapse rate after 64 months was higher in the high PLA2R-AB group (87% vs. 63%). Multivariant linear regression found serum creatinine (beta=0.682, p<0.001) and PLA2R-AB (beta=0.527, p<0.001) as significant predictors for kidney function at the end of follow-up. Conclusion: higher titers of PLA2R-AB are related to worse kidney function outcome, higher 24-hour proteinuria, and a higher number of relapses in patients with pMN. Key words: membranous nephropathy, M-type phospholipase A2 receptor, autoantibodies, glomerulonephritis
To determine the role of immunoglobulin M (IgM) deposits in clinical manifestations, disease outcome, and treatment response of idiopathic and secondary focal segmental glomerulosclerosis (FSGS).
...Kidney biopsy specimens of 171 patients diagnosed with FSGS (primary and secondary) and 50 control patients were retrospectively included in the study. For each patient, clinical and outcome data were obtained and compared to morphological parameters, including immunofluorescence analysis of mesangial IgM and complement 3 (C3) deposits analyzed on kidney biopsy samples.
There were significant positive correlations between IgM and C3 deposition in secondary FSGS (P<0.001) and between IgM and mesangial deposits detected by electron microscopy in secondary FSGS (P=0.015), which indicated that higher IgM deposition correlated with higher C3 deposition and mesangial deposits only in secondary FSGS. Patients with secondary FSGS and the deposition of IgM showed inferior renal outcomes at earlier time points in comparison with patients with negative IgM expression (P=0.022).
We detected a positive correlation between IgM and C3 in secondary FSGS. The association between IgM deposition and worse renal outcome in secondary FSGS indicates that IgM may play a role in the progression of this disease.
Aim
Rheumatoid arthritis is associated with accelerated atherosclerosis. However, little is known about preclinical atherosclerosis in hypertensive rheumatoid arthritis patients. In this ...cross‐sectional study we assessed the expression of preclinical atherosclerosis in hypertensive rheumatoid arthritis patients in comparison with matched hypertensive non‐rheumatoid arthritis patients.
Methods
The study included 52 hypertensive rheumatoid arthritis patients and 42 hypertensive non‐rheumatoid arthritis patients. The patients were extensively examined clinically and laboratory tested. The expression of preclinical atherosclerosis was estimated by assessing ambulatory arterial stiffness index and common carotid intima‐media thickness.
Results
Arterial stiffness index and common carotid intima‐media thickness were higher in hypertensive rheumatoid arthritis patients than in hypertensive non‐rheumatoid arthritis patients. There was no correlation between arterial stiffness index and common carotid intima‐media thickness with markers of inflammation and disease activity in hypertensive rheumatoid arthritis patients.
Conclusion
The expression of subclinical atherosclerosis is more pronounced in hypertensive rheumatoid arthritis than in hypertensive non‐ rheumatoid arthritis patients.
Aim
To determinate the prognostic significance of low serum C3 at the time of diagnosis of ANCA-associated vasculitis (AAV).
Methods
Our cohort included 75 consecutive patients with AAV diagnosed ...from January 2005 to December 2015. C3 levels were measured at the time of diagnosis. Patients were divided into two groups, those with low serum C3 levels (< 0.9 g/l) and those with normal serum C3 levels (0.9–1.8 g/l). We analysed association between serum C3 levels and both combined and singularly patient and renal survival (ESRD). Small number of relapsed patients did not allow for the statistical analysis to be performed as to weather the low serum C3 is associated with relapse rate in AAV patients.
Results
Low serum C3 levels were significantly associated with worse combined end-point patient and renal survival (HR 3.079; 95% CI 1.231–7.701; p = 0.016), and on multivariate adjusted analysis association remained significant (HR 2.831; 95% CI 1.093–7.338; p = 0.032). For both end-points individually low serum C3 levels were significantly associated with poorer patient survival (HR 6.378; 95% CI 2.252–18.065; p < 0.001; on multivariate adjusted analysis HR 4.315 95% CI 1.350–13.799; p = 0.014) and renal survival (HR 3.207; 95% CI 1.040–9.830; p = 0.043; on multivariate adjusted analysis HR 3.679; 95% CI 1.144–11.827; p = 0.029). In our study there was no significant association between serological and patohistological phenotypes and serum C3 levels.
Conclusion
Lower serum C3 levels at the diagnosis is associated with poorer patient and renal outcomes in AAV patients.
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