Eculizumab as a New Treatment for Severe Acute Post-infectious Glomerulonephritis: Two Case Reports.
anti-c5 monoclonal antibody
case report
eculizumab
post-infectious glomerulonephritis
terminal complement pathway blockage
Journal
Frontiers in medicine
ISSN: 2296-858X
Titre abrégé: Front Med (Lausanne)
Pays: Switzerland
ID NLM: 101648047
Informations de publication
Date de publication:
2021
2021
Historique:
received:
02
02
2021
accepted:
30
06
2021
entrez:
12
8
2021
pubmed:
13
8
2021
medline:
13
8
2021
Statut:
epublish
Résumé
Acute post-infections glomerulonephritis (APIGN) is a frequent cause of glomerulonephritis and represents the most common cause of acute glomerulonephritis in children. It can evolve to severe acute renal failure and chronic kidney disease or even end-stage kidney disease. The precise pathophysiological mechanisms of APIGN are still incompletely understood. The implication of the alternative complement pathway and the potential benefits of C5 blockade have been recently highlighted, in particular in the presence of a C3 Nephritic Factor (C3Nef), anti-Factor B or H autoantibodies. We report two children with severe APIGN, successfully treated with eculizumab. The first patient presented a severe form of APIGN with advanced renal failure and anuria, associated with a decreased level of C3 and an increased level of soluble C5b-9, in the presence of a C3NeF autoantibody. The second case had a severe oliguric APIGN associated with low C3 level. Kidney biopsy confirmed the diagnosis of APIGN in both cases. Eculizumab allowed full renal function recovery and the avoidance of dialysis in both cases. In conclusion, the alternative and terminal complement pathways activation might be common in PIGN, and in severe cases, eculizumab might help.
Identifiants
pubmed: 34381795
doi: 10.3389/fmed.2021.663258
pmc: PMC8350112
doi:
Types de publication
Case Reports
Langues
eng
Pagination
663258Informations de copyright
Copyright © 2021 Chehade, Guzzo, Cachat, Rotman, Teta, Pantaleo, Sadallah, Sharma, Rosales, Tolkoff-Rubin and Pascual.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
J Pediatr. 1981 Mar;98(3):403-10
pubmed: 7205449
Pediatr Nephrol. 2009 May;24(5):1021-6
pubmed: 19096879
Kidney Int. 2013 Feb;83(2):293-9
pubmed: 23235567
Clin Nephrol. 1980 Jan;13(1):1-4
pubmed: 7363511
J Exp Med. 1986 Mar 1;163(3):588-602
pubmed: 3950543
J Nephrol. 2014 Jun;27(3):229-39
pubmed: 24777751
Acta Pathol Microbiol Immunol Scand C. 1984 Oct;92(5):265-9
pubmed: 6440413
Kidney Int. 1984 Jun;25(6):937-41
pubmed: 6236326
Int Arch Allergy Appl Immunol. 1968;33(4):368-88
pubmed: 5689777
Veroff Pathol. 1986;125:1-105
pubmed: 3541442
Am J Kidney Dis. 2012 Jul;60(1):121-5
pubmed: 22503529
J Pediatr. 1974 Jan;84(1):29-38
pubmed: 12119953
Pediatr Nephrol. 2011 Feb;26(2):165-80
pubmed: 20652330
Clin Immunol Immunopathol. 1984 Dec;33(3):324-32
pubmed: 6388925
Kidney Int. 1996 Feb;49(2):335-43
pubmed: 8821815
Pediatrics. 1975 Sep;56(3):434-42
pubmed: 1161401
Am J Kidney Dis. 2016 Dec;68(6):944-948
pubmed: 27683044
J Am Soc Nephrol. 2020 Apr;31(4):670-672
pubmed: 32144171
J Am Soc Nephrol. 2020 Apr;31(4):829-840
pubmed: 32034108
J Am Soc Nephrol. 2004 Jul;15(7):1785-93
pubmed: 15213266
J Am Soc Nephrol. 2008 Oct;19(10):1855-64
pubmed: 18667731
Nephrol Dial Transplant. 1994;9(12):1747-50
pubmed: 7708258
Lancet Infect Dis. 2005 Nov;5(11):685-94
pubmed: 16253886
Am J Kidney Dis. 1991 Mar;17(3):311-6
pubmed: 1996575
Behring Inst Mitt. 1993 Dec;(93):138-47
pubmed: 8172561