1
|
Ito K, Ohgi K, Kimura K, Ishitaki K, Yamashita A, Yokote H, Tsukuda S, Matsushita K, Naraoka Y, Fujioka A, Ono T. Kidney R2* Mapping for Noninvasive Evaluation of Iron Overload in Paroxysmal Nocturnal Hemoglobinuria. Magn Reson Med Sci 2024:mp.2023-0114. [PMID: 38369335 DOI: 10.2463/mrms.mp.2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
PURPOSE The kidney iron deposition can cause kidney damage and renal insufficiency in paroxysmal nocturnal hemoglobinuria (PNH) patients. Assessment of iron deposition in the kidney is essential for the early diagnosis of renal damage in PNH patients. The purpose of this study was to evaluate kidney R2* (T2* reciprocals) values in PNH patients using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ). METHODS Two radiologists measured the R2* values of the renal cortex in 14 PNH patients and 13 healthy volunteers using IDEAL-IQ. Lactate dehydrogenase (LDH), a reliable marker of intravascular hemolysis, was also measured in all participants. RESULTS The kidney R2* values were significantly higher in PNH patients compared with those in healthy volunteers (P < 0.001). High inter-operator reproducibility of the measurements was also acquired using IDEAL-IQ. LDH levels were also significantly higher in PNH patients compared with those in healthy volunteers (P < 0.001). Kidney R2* values strongly correlated with LDH levels in PNH patients. CONCLUSION IDEAL-IQ has a possibility of becoming a useful method for the noninvasive evaluation of renal iron overload in PNH patients.
Collapse
Affiliation(s)
- Koichi Ito
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazuyuki Ohgi
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Koichiro Kimura
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
- Department of Diagnostic Radiology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichi Ishitaki
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
- Department of Diagnostic Radiology, Shin-Yurigaoka General Hospital, Kanagawa, Kawasaki, Japan
| | - Akiyoshi Yamashita
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroyuki Yokote
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunji Tsukuda
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Ko Matsushita
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuko Naraoka
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Amon Fujioka
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tatsuki Ono
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| |
Collapse
|
2
|
Kim JS, Cheong JW, Mun YC, Jang JH, Jo DY, Lee JW. Clinical implication of renal dysfunction during the clinical course in patients with paroxysmal nocturnal hemoglobinuria: a longitudinal analysis. Ann Hematol 2019; 98:2273-2281. [PMID: 31256219 DOI: 10.1007/s00277-019-03735-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
Although renal dysfunction at the time of diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) is a risk factor for mortality, subsequent renal events can occur. The objective of this study was to identify clinical implication of renal dysfunction occurring during the disease course in PNH patients. One hundred one patients with a granulocyte clone size of > 10% were enrolled. Renal events were observed in 55 (54.5%) patients during a median follow-up of 94.2 months. Median time to first renal event from diagnosis of PNH was 79.3 months. Thromboembolism (TE) event and recurrent TE events were observed in 25 (24.8%) and 8 (7.9%) patients, respectively. The rate of recurrent TE was significantly higher in patients with renal events ≥ 2 compared with that in patients with renal event ≤ 1 (18.8% vs. 2.9%; P = 0.012). The rate of recurrent TE was significantly higher in patients with chronic kidney disease (CKD) + acute kidney disease (AKD) compared with the rest of the patients (27.3% vs. 5.6%; P = 0.040). CKD+AKD was the only independent risk factor for OS in multivariate analysis (hazard ratio 7.95, 95% CI 1.24-51.15, P = 0.029). Therefore, close monitoring of renal events in PNH patients during the entire clinical course is essential.
Collapse
Affiliation(s)
- Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yeung-Chul Mun
- Division of Hematology and Oncology, Department of Internal Medicine, Collage of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jun Ho Jang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Deog-Yeon Jo
- Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, Republic of Korea
| | - Jong Wook Lee
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | | |
Collapse
|
3
|
Kokoris SI, Gavriilaki E, Miari A, Travlou Α, Kyriakou E, Anagnostopoulos A, Grouzi E. Renal involvement in paroxysmal nocturnal hemoglobinuria: an update on clinical features, pathophysiology and treatment. ACTA ACUST UNITED AC 2018; 23:558-566. [PMID: 29486674 DOI: 10.1080/10245332.2018.1444563] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The present review summarizes the available knowledge regarding acute and chronic kidney dysfunction in patients with paroxysmal nocturnal hemoglobinuria (PNH) focusing on its clinical features, pathophysiology and treatment. METHODS A thorough PubMed search was performed using as main keywords: 'paroxysmal nocturnal hemoglobinuria', 'acute kidney injury', 'chronic kidney disease' and 'eculizumab'. RESULTS PNH's etiopathogenesis is based on acquired mutations that lead to the reduction or absence of CD55 and CD59 complement regulators, which are responsible for some of the disease's major clinical features, like intravascular hemolysis, cytopenias and thrombosis. PNH is often underdiagnosed, mainly due to its occasional mild manifestations and to its ability to mimic other severe clinical conditions. Various mechanisms have been proposed for the kidney damage attributed to the release of cell-free heme and free iron, including inflammatory response, oxidative stress, nitric oxide depletion, renal ischemia, membrane damage and apoptosis. Eculizumab, a terminal complement inhibitor, provides a safe and effective treatment option, especially when it is initiated early in the presence of kidney damage. DISCUSSION Kidney injury is a poorly investigated clinical feature of PNH that affects a significant portion of patients. Increased awareness is needed by physicians to recognize the early signs and symptoms of acute and chronic renal insufficiency, so as to initiate the necessary therapy. It is also important to re-evaluation of PNH-specific treatments during the course of the disease. CONCLUSION Understanding the difficult but at the same time impressive mechanisms behind PNH remains a challenge for treating physicians.
Collapse
Affiliation(s)
- Styliani I Kokoris
- a Laboratory of Hematology and Hospital Blood Transfusion Department , University General Hospital 'Attikon', Medical School, National and Kapodistrian University of Athens , Chaidari Attica , Greece
| | - Eleni Gavriilaki
- b Hematology Department-BMT Unit , G. Papanicolaou Hospital , Thessaloniki , Greece
| | - Aggeliki Miari
- c Medical School , University of Athens , Athens , Greece
| | - Αnthi Travlou
- c Medical School , University of Athens , Athens , Greece.,d Laboratory of Thrombosis, Bleeding Disorders and Anticoagulation Monitoring , Medical Centre of Psychico , Athens , Greece
| | - Elias Kyriakou
- a Laboratory of Hematology and Hospital Blood Transfusion Department , University General Hospital 'Attikon', Medical School, National and Kapodistrian University of Athens , Chaidari Attica , Greece
| | | | - Elissavet Grouzi
- e Department of Transfusion Service and Clinical Hemostasis , 'Saint Savvas' Oncology Hospital , Athens , Greece
| |
Collapse
|
4
|
Nishimoto M, Matsui M, Tsushima H, Tanabe K, Tagawa M, Samejima KI, Akai Y, Saito Y. Acute kidney injury in a postpartum woman with paroxysmal nocturnal hemoglobinuria: A case report and literature review. Hemodial Int 2017; 22:E6-E10. [PMID: 28796431 DOI: 10.1111/hdi.12591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria is a rare clonal hematopoietic stem cell disorder characterized by intravascular hemolysis, hemoglobinuria, and inflammatory thrombotic state. Intravascular hemolysis in paroxysmal nocturnal hemoglobinuria (PNH) can lead to acute and chronic renal injury through hemoglobin-mediated toxicity. A 32-year-old pregnant woman with myelodysplastic syndrome was admitted to our hospital with severe preeclampsia. Shortly after an urgent caesarean section, she became obtunded and showed signs of acute kidney injury (AKI) with anuria, severe intravascular hemolysis, and hypermagnesemia. She was diagnosed with PNH with a positive Ham test and flow cytometry analysis. Renal magnetic resonance imaging revealed decreased signal intensity in the renal cortex due to hemosiderin deposition. Hemodialysis, plasma exchange, and administration of corticosteroids ameliorated her clinical condition and renal function. This case illustrates that careful management is required to prevent postpartum AKI in pregnant women with PNH.
Collapse
Affiliation(s)
- Masatoshi Nishimoto
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Masaru Matsui
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Hideo Tsushima
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kaori Tanabe
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Miho Tagawa
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Ken-Ich Samejima
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yasuhiro Akai
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| |
Collapse
|
5
|
Eculizumab treatment improved renal hemosiderosis in a patient with paroxysmal nocturnal hemoglobinuria. Int J Hematol 2016; 105:231-232. [PMID: 27873177 DOI: 10.1007/s12185-016-2144-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
|
6
|
Schrezenmeier H, Höchsmann B. Eculizumab opens a new era of treatment for paroxysmal nocturnal hemoglobinuria. Expert Rev Hematol 2014; 2:7-16. [DOI: 10.1586/17474086.2.1.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
7
|
Veerreddy P. Hemoglobinuria misidentified as hematuria: review of discolored urine and paroxysmal nocturnal hemoglobinuria. PLASMATOLOGY 2013; 6:7-17. [PMID: 25512715 PMCID: PMC4222305 DOI: 10.4137/cmbd.s11517] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Discolored urine is a common reason for office visits to a primary care physician and urology referral. Early differentiation of the type or cause of discolored urine is necessary for accurate diagnosis and prompt management. Paroxysmal nocturnal hemoglobinuria is a clonal disorder caused by acquired somatic mutations in the PIG-A gene on the X- chromosome of hemopoietic stem cells and leads to deficiency of surface membrane anchor proteins. The deficiency of these proteins leads to an increased risk of hemolysis of erythrocytes and structural damage of platelets, resulting in a clinical syndrome characterized by complement-mediated intravascular hemolytic anemia, bone marrow failure, and venous thrombosis. Patients with this clinical syndrome present with paroxysms of hemolysis, causing hemoglobinuria manifesting as discolored urine. This can be easily confused with other common causes of discolored urine and result in extensive urologic work-up. Three commonly confused entities of discolored urine include hematuria, hemoglobinuria, and myoglobinuria. Specific characteristics in a dipstick test or urinalysis can guide differentiation of these three causes of discolored urine. This article begins with a case summary of a woman presenting with cranberry-colored urine and a final delayed diagnosis of paryxysmal nocturnal hemoglobinuria. Her hemoglobinuria was misdiagnosed as hematuria, leading to extensive urologic work-up. The article also gives an overview of the approach to diagnosing and treating discolored urine.
Collapse
Affiliation(s)
- Prashant Veerreddy
- Assistant Professor of Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA
| |
Collapse
|
8
|
Abstract
Eculizumab is a humanized monoclonal antibody indicated for the treatment of paroxysmal nocturnal haemoglobinuria (PNH). It binds specifically and with high affinity to the complement protein C5, thereby preventing the formation of the terminal complement complex C5b-9, which mediates cell lysis. In patients with PNH, eculizumab inhibits terminal complement mediated intravascular haemolysis. In clinical trials of PNH patients, eculizumab reduced intravascular haemolysis compared with baseline and placebo, as determined by significantly decreased lactate dehydrogenase (LDH) levels. Significant reductions in LDH levels were achieved within the first week of treatment, with near normal levels achieved at week 2 and maintained throughout longer term treatment, including periods of up to 36 months. Eculizumab achieved rapid and sustained efficacy, regardless of baseline LDH levels or platelet counts. In adults with PNH, eculizumab treatment for 26 weeks achieved stabilization of haemoglobin levels in significantly more patients than placebo treatment, and reduced the requirement for packed red cell transfusions to a significantly greater extent than placebo. Half of all patients in the eculizumab group became transfusion independent compared with no patients in the placebo group. Eculizumab was also associated with significant improvements in fatigue and health-related quality-of-life scores in several trials. Over the long term, the survival of PNH patients treated with eculizumab was normalized. Eculizumab was generally well tolerated in clinical trials of PNH patients, including treatment periods of up to 5.5 years. The risk of Neisseria meningitidis is increased with eculizumab and patients must be vaccinated prior to treatment and monitored throughout. Thus, eculizumab, the first targeted terminal complement inhibitor, provides an effective and generally well tolerated treatment for PNH patients, who have previously been without adequate treatment options.
Collapse
Affiliation(s)
- Kate McKeage
- Adis, a Wolters Kluwer Business, Auckland, New Zealand.
| |
Collapse
|
9
|
Tsai CW, Yang FJ, Huang CC, Kuo CC, Chen YM. The administration of deferasirox in an iron-overloaded dialysis patient. Hemodial Int 2012; 17:131-3. [DOI: 10.1111/j.1542-4758.2012.00704.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Chun-Chieh Huang
- Department of Medical Imaging; Far Eastern Memorial Hospital; Taipei; Taiwan
| | | | | |
Collapse
|
10
|
Kelly R, Richards S, Hillmen P, Hill A. The pathophysiology of paroxysmal nocturnal hemoglobinuria and treatment with eculizumab. Ther Clin Risk Manag 2011; 5:911-21. [PMID: 20011245 PMCID: PMC2789686 DOI: 10.2147/tcrm.s3334] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Paroxysmal nocturnal hemoglobinuria is a rare disorder of hemopoietic stem cells. Affected individuals have a triad of clinical associations – intravascular hemolysis, an increased risk of thromboembolism, and bone marrow failure. Most of the symptoms experienced in this disease occur due to the absence of complement regulatory proteins on the surface of the red blood cells. Complement activation is thus not checked and causes destruction of these cells. Eculizumab is a monoclonal antibody treatment which specifically binds to the complement protein C5, preventing its cleavage, and so halts the complement cascade and prevents the formation of the terminal complement proteins. Eculizumab prevents intravascular hemolysis, stabilizes hemoglobin levels, reduces or stops the need for blood transfusions, and improves fatigue and patient quality of life as well as reducing pulmonary hypertension, decreasing the risk of thrombosis and protecting against worsening renal function. It is not a curative therapy but has a great benefit on those with this rare debilitating condition.
Collapse
Affiliation(s)
- Richard Kelly
- Institute of Oncology, St. James's University Hospital, Leeds, UK
| | | | | | | |
Collapse
|
11
|
Kelly RJ, Hill A, Arnold LM, Khursigara G, Kanagasundaram NS, Hillmen P. Eculizumab for patients with paroxysmal nocturnal hemoglobinuria (PNH) is effective during the maintenance of hemodialysis for end stage renal failure. Leuk Res 2010; 35:560-2. [PMID: 21145109 DOI: 10.1016/j.leukres.2010.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/20/2010] [Accepted: 10/23/2010] [Indexed: 11/17/2022]
Affiliation(s)
- R J Kelly
- Department of Haematology, St James's University Hospital, Leeds, UK.
| | | | | | | | | | | |
Collapse
|
12
|
Rakow-Penner R, Glader B, Yu H, Vasanawala S. Adrenal and renal corticomedullary junction iron deposition in red cell aplasia. Pediatr Radiol 2010; 40:1955-7. [PMID: 20852855 DOI: 10.1007/s00247-010-1824-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 07/30/2010] [Accepted: 08/16/2010] [Indexed: 01/19/2023]
Abstract
Iron deposition can occur in the kidneys as a result of hemolysis or extensive iron overload from transfusions. With T2* MRI, renal iron deposition can be visualized. In this report, renal corticomedullary junction iron deposition is noted using T2* MRI in a boy with red cell aplasia. The renal corticomedullary junction iron deposition is an indication of the severity of his iron overload. This is an unusual finding and brings clinical attention to the boy's renal function for further evaluation.
Collapse
Affiliation(s)
- Rebecca Rakow-Penner
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | |
Collapse
|
13
|
Hillmen P, Elebute M, Kelly R, Urbano-Ispizua A, Hill A, Rother RP, Khursigara G, Fu CL, Omine M, Browne P, Rosse W. Long-term effect of the complement inhibitor eculizumab on kidney function in patients with paroxysmal nocturnal hemoglobinuria. Am J Hematol 2010; 85:553-9. [PMID: 20658586 DOI: 10.1002/ajh.21757] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a debilitating and life-threatening disease in which lysis of PNH red blood cells frequently manifests with chronic hemolysis, anemia, and thrombosis. Renal damage in PNH is associated with chronic hemosiderosis and/or microvascular thrombosis. We determined the incidence of renal dysfunction or damage, defined by stages of chronic kidney disease (CKD), in a large cohort of PNH patients and evaluated the safety and efficacy of the complement inhibitor eculizumab in altering its progression. Renal dysfunction or damage was observed in 65% of the study population at baseline with 21% of patients with later stage CKD or kidney failure (glomerular filtration rate [GFR] <or=60 ml/min/1.73 m(2); Stage 3, 4, or 5). Eculizumab treatment was safe and well-tolerated in patients with renal dysfunction or damage and resulted in the likelihood of improvement as defined as categorical reduction in CKD stage (P < 0.001) compared with baseline and to placebo (P = 0.04). Improvement in renal function was more commonly seen in patients with baseline CKD Stages 1-2 (67.1% improvement, P < 0.001) although improvement was also observed in patients with CKD Stages 3-4 (P = 0.05). Improvements occurred quickly and were sustained for at least 18 months of treatment. Patients categorized at CKD Stages 3-5 did not worsen during treatment with eculizumab. Overall, 40 (21%) of 195 patients who demonstrated renal dysfunction or damage at baseline were no longer classified as such after 18 months of treatment. Administration of eculizumab to patients with renal dysfunction or damage was well tolerated and was usually associated with clinical improvement.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Complement Activation/drug effects
- Complement C5/antagonists & inhibitors
- Complement C5/immunology
- Complement Inactivating Agents/therapeutic use
- Female
- Glomerular Filtration Rate/drug effects
- Hemoglobinuria, Paroxysmal/complications
- Hemoglobinuria, Paroxysmal/drug therapy
- Hemoglobinuria, Paroxysmal/immunology
- Hemoglobinuria, Paroxysmal/physiopathology
- Hemolysis/drug effects
- Humans
- Kidney/drug effects
- Kidney/physiopathology
- Kidney Failure, Chronic/drug therapy
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/physiopathology
- Kidney Failure, Chronic/prevention & control
- Male
- Metabolic Clearance Rate/drug effects
- Middle Aged
- Pilot Projects
- Severity of Illness Index
- Treatment Outcome
- Young Adult
Collapse
Affiliation(s)
- Peter Hillmen
- Department of Hematology, St. James's Institute of Oncology, Leeds, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Guasch A. Improving renal outcomes in chronic anemia: learning from paroxysmal nocturnal hemoglobinuria. Am J Hematol 2010; 85:551-2. [PMID: 20658585 DOI: 10.1002/ajh.21800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
MESH Headings
- Adult
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Complement Activation/drug effects
- Complement C5/antagonists & inhibitors
- Complement C5/immunology
- Complement Inactivating Agents/pharmacology
- Complement Inactivating Agents/therapeutic use
- Glomerular Filtration Rate/drug effects
- Hemoglobinuria, Paroxysmal/complications
- Hemoglobinuria, Paroxysmal/drug therapy
- Hemoglobinuria, Paroxysmal/immunology
- Hemoglobinuria, Paroxysmal/physiopathology
- Hemolysis/drug effects
- Humans
- Immunotherapy
- Kidney/drug effects
- Kidney/physiopathology
- Kidney Failure, Chronic/drug therapy
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/physiopathology
- Kidney Failure, Chronic/prevention & control
- Metabolic Clearance Rate/drug effects
- Randomized Controlled Trials as Topic/statistics & numerical data
- Treatment Outcome
Collapse
|
15
|
Spectrum of renal involvement in paroxysmal nocturnal hemoglobinuria: report of three cases and a brief review of the literature. Int Urol Nephrol 2008; 40:471-5. [PMID: 18368508 DOI: 10.1007/s11255-008-9356-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 02/18/2008] [Indexed: 02/07/2023]
Abstract
Renal involvement in paroxysmal nocturnal hemoglobinuria (PNH) is usually clinically not apparent but, in cases with clinical involvement, varies from reversible acute dysfunction to chronic irreversible damage. We report two cases of acute kidney injury and one case of chronic kidney disease due to PNH. In all three cases a diagnosis of PNH was made after detection of renal dysfunction. The renal involvement was documented on both histology and on imaging studies. Finally, we briefly review the main literature data on renal involvement in PNH.
Collapse
|
16
|
Bessler M, Hiken J. The pathophysiology of disease in patients with paroxysmal nocturnal hemoglobinuria. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2008; 2008:104-110. [PMID: 19074066 DOI: 10.1182/asheducation-2008.1.104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemolytic anemia caused by the expansion of a hematopoietic progenitor cell that has acquired a mutation in the X-linked PIGA gene. PNH occurs on the background of bone marrow failure. Bone marrow failure and the presence of the abnormal cells account for the clinical phenotype of patients with PNH including hemolysis, cytopenia, and thrombophilia. PIGA is essential for the synthesis of glycosyl phosphatidylinositol (GPI) anchor molecules. PNH blood cells are therefore deficient in all proteins that use such an anchor molecule for attachment to the cell membrane. Two of these proteins regulate complement activation on the cell surface. Their deficiency therefore explains the exquisite sensitivity of PNH red blood cells to complement-mediated lysis. Complement-mediated lysis of red blood cells is intravascular, and intravascular hemolysis contributes significantly to the morbidity and mortality in patients with this condition. PNH is an outstanding example of how an increased understanding of pathophysiology may directly improve the diagnosis, care, and treatment of disease.
Collapse
Affiliation(s)
- Monica Bessler
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.
| | | |
Collapse
|