2
|
Taşdemir M, Canpolat N, Yıldız N, Özçelik G, Benzer M, Saygılı SK, Özkayin EN, Türkkan ÖN, Balat A, Candan C, Çelakıl M, Yavuz S, Akıncı N, Göknar N, Akgün C, Tülpar S, Alpay H, Sever FL, Bilge İ. Rituximab treatment for difficult-to-treat nephrotic syndrome in children: a multicenter, retrospective study. Turk J Med Sci 2021; 51:1781-1790. [PMID: 33581711 PMCID: PMC8569731 DOI: 10.3906/sag-2012-297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/13/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim This study aimed to evaluate the efficacy of rituximab in children with difficult-to-treat nephrotic syndrome,
considering the type of disease (steroid-sensitive or –resistant) and the dosing regimen. Materials and methods This multicenter retrospective study enrolled children with difficult-to-treat nephrotic syndrome on rituximab treatment from 13 centers. The patients were classified based on low (single dose of 375 mg/m2) or high (2-4 doses of 375 mg/m2) initial dose of rituximab and the steroid response. Clinical outcomes were compared. Results Data from 42 children [20 steroid-sensitive (frequent relapsing / steroid-dependent) and 22 steroid-resistant nephrotic syndrome, aged 1.9–17.3 years] were analyzed. Eleven patients with steroid-sensitive nephrotic syndrome (55%) had a relapse following initial rituximab therapy, with the mean time to first relapse of 8.4 ± 5.2 months. Complete remission was achieved in 41% and 36% of steroid-resistant patients, with the median remission time of 3.65 months. At Year 2, eight patients in steroid-sensitive group (40%) and four in steroid-resistant group (18%) were drug-free. Total cumulative doses of rituximab were higher in steroid-resistant group (p = 001). Relapse rates and time to first relapse in steroid-sensitive group or remission rates in steroid-resistant group did not differ between the low and high initial dose groups. Conclusion The current study reveals that rituximab therapy may provide a lower relapse rate and prolonged relapse-free survival in the steroid-sensitive group, increased remission rates in the steroid-resistant group, and a significant number of drug-free patients in both groups. The optimal regimen for initial treatment and maintenance needs to be determined.
Collapse
Affiliation(s)
- Mehmet Taşdemir
- Division of Pediatric Nephrology, Department of Pediatrics, Koç University School of Medicine, İstanbul, Turkey
| | - Nur Canpolat
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Nurdan Yıldız
- Division of Pediatric Nephrology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey
| | - Gül Özçelik
- Division of Pediatric Nephrology, Department of Pediatrics, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Meryem Benzer
- Division of Pediatric Nephrology, Department of Pediatrics, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Seha Kamil Saygılı
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Emine Neşe Özkayin
- Division of Pediatric Nephrology, Department of Pediatrics, Trakya University School of Medicine, Edirne, Turkey
| | - Özde Nisa Türkkan
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ayşe Balat
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul Aydın University School of Medicine, İstanbul, Turkey
| | - Cengiz Candan
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Mehtap Çelakıl
- Division of Pediatric Nephrology, Department of Pediatrics, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sevgi Yavuz
- Division of Pediatric Nephrology, Department of Pediatrics, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Nurver Akıncı
- Division of Pediatric Nephrology, Department of Pediatrics, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Nilüfer Göknar
- Division of Pediatric Nephrology, Department of Pediatrics, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Akgün
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul Medipol University School of Medicine, İstanbul, Turkey
| | - Sebahat Tülpar
- Division of Pediatric Nephrology, Department of Pediatrics, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Harika Alpay
- Division of Pediatric Nephrology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey
| | - Fatma Lale Sever
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - İlmay Bilge
- Division of Pediatric Nephrology, Department of Pediatrics, Koç University School of Medicine, İstanbul, Turkey
| |
Collapse
|
3
|
Döven SS, Tülpar S, Baştuğ F, Yıldırım ZNY, Yılmaz EK, Çiçek N, Küçük N, Çomak E, Yazıcıoğlu B, Nalçacıoğlu H, Delibaş A, Uysal B, Ağbaş A, Gemici A, Günay N, Ertan P, Bıyıklı N, Hacıhamdioğlu DÖ, Elmacı AM, Atikel YÖ, Delebe EÖÇ, Sever FL, Gökçe İ, Öner N, Akman S, Aksu B, Atmış B, Yel S, Yılmaz A, Çelik B, Dursun İ, Alpay H. A Nationwide Retrospective Study in Turkish Children With Nephrocalcinosis. Turk J Med Sci 2021; 51:2564-2569. [PMID: 34174796 DOI: 10.3906/sag-2103-347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/24/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Nephrocalcinosis (NC) is defined as calcium deposition in the kidney parenchyma and tubules. This study aims to determine the etiology, risk factors and follow-up results of patients with NC in Turkey. MATERIALS AND METHODS Patients diagnosed with NC in the Pediatric Nephrology Department Units of 19 centers from all geographical regions of Turkey over a 10-year period (2010?2019) were included in the study. The medical records from the centers were reviewed and demographic data, admission complaints, medical history, systemic and genetic disorders, risk factors for NC, treatment details and presence of NC after one year follow-up were recorded retrospectively. RESULTS The study sample included 195 patients (88 females, 107 males). The mean age at diagnosis was 39.44±47.25 (0.5?208) months; 82/190 patients (43.2%) were diagnosed incidentally; 46/195 patients (23.6%) had an underlying disease; idiopathic hypercalciuria was detected in 75/195 (38.4%) patients. The most common systemic diseases were distal renal tubular acidosis in 11/46 patients (23.9%), primary hyperoxaluria in 9/46 patients (19.6%) and Bartter syndrome in 7/46 patients (15.3%). After one year of follow-up, NC resolved in 56/159 patients (35.2%) and they all did not have an underlying systemic disease. CONCLUSION The most common presentation of NC was incidental. Distal renal tubular acidosis and primary hyperoxaluria were the main systemic diseases leading to NC, while hypercalciuria was the most common metabolic risk factor. Nephrocalcinosis was found to remain in most of the patients at a one year follow-up. It may resolve particularly in patients with no underlying systemic disease.
Collapse
Affiliation(s)
- Serra Sürmeli Döven
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Sebahat Tülpar
- Division of Pediatric Nephrology, Department of Pediatrics, Bakırköy Dr Sadi Konuk Education and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Funda Baştuğ
- Division of Pediatric Nephrology, Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Zeynep Nagehan Yürük Yıldırım
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Esra Karabağ Yılmaz
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Cerrahpaşa University, İstanbul, Turkey
| | - Neslihan Çiçek
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Nuran Küçük
- Division of Pediatric Nephrology, Department of Pediatrics, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, İstanbul, Turkey
| | - Elif Çomak
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Mediterranean University, Antalya, Turkey
| | - Burcu Yazıcıoğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hülya Nalçacıoğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ali Delibaş
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Berfin Uysal
- Division of Pediatric Nephrology, Department of Pediatrics, Bursa Dörtçelik Children Hospital, Bursa, Turkey
| | - Ayşe Ağbaş
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul Haseki Education and Research Hospital, İstanbul, Turkey
| | - Atilla Gemici
- Division of Pediatric Nephrology, Department of Pediatrics, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Neslihan Günay
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Pelin Ertan
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Neşe Bıyıklı
- Division of Pediatric Nephrology, Department of Pediatrics, Anadolu Medical Center, İstanbul, Turkey
| | - Duygu Övünç Hacıhamdioğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Bahçeşehir University, İstanbul, Turkey
| | - Ahmet Midhat Elmacı
- Division of Pediatric Nephrology, Department of Pediatrics, Konya Dr Faruk Sukan Obstetrics and Children Hospital, Konya, Turkey
| | - Yeşim Özdemir Atikel
- Division of Pediatric Nephrology, Department of Pediatrics, Eskişehir City Hospital, Eskişehir, Turkey
| | - Emine Özlem Çam Delebe
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Fatma Lale Sever
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Cerrahpaşa University, İstanbul, Turkey
| | - İbrahim Gökçe
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Nimet Öner
- Division of Pediatric Nephrology, Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Sema Akman
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Mediterranean University, Antalya, Turkey
| | - Bağdagül Aksu
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul Haseki Education and Research Hospital, İstanbul, Turkey
| | - Bahriye Atmış
- Division of Pediatric Nephrology, Department of Pediatrics, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Sibel Yel
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Alev Yılmaz
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Binnaz Çelik
- Division of Pediatric Nephrology, Department of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - İsmail Dursun
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Harika Alpay
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Marmara University, İstanbul, Turkey
| |
Collapse
|
4
|
Oruç Ç, Canpolat N, Pehlivan E, Balcı Ekmekçi Ö, Ağbaş A, Çalışkan S, Sever FL. Anemia after kidney transplantation: Does its basis differ from anemia in chronic kidney disease? Pediatr Transplant 2020; 24:e13818. [PMID: 32797673 DOI: 10.1111/petr.13818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/21/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although similar factors play a role in both PTA and anemia in patients with CKD, additional risk factors exist in the pathogenesis of PTA. The present study aimed at comparing anemia and inflammation-related parameters between RTx recipients and CKD patients and elucidating the risk factors of PTA. METHODS This single-centered, cross-sectional study consisted of 68 participants: 48 were in the RTx group and 20 were in the CKD group. The CKD patients were comparable to the RTx recipients in terms of age, gender, and eGFR. Serum levels of EPO, hepcidin, and IL-6 were measured by enzyme-linked immunosorbent assays. The ratio of EPO/Hb was calculated to estimate endogenous EPO resistance. RESULTS The prevalence of anemia was 46% in the RTx group and 30% in the CKD group (P = .23). RTx recipients had significantly lower Hb (P = .04), higher EPO (P < .001), and ferritin levels (P = .001), and higher EPO/Hb ratios (P < .001); however, CKD patients showed a higher frequency of absolute iron deficiency (P = .008). Neither hepcidin nor IL-6 levels differed between the two groups. Hb level of RTx recipients was correlated with only eGFR (r = .437, P = .002) but not with any of the transplantation-related factors, while Fe level was the only parameter to be correlated with Hb level of CKD patients (r = .622, P = .01). CONCLUSION In the present study comparing GFR-matched RTx and CKD patients, lower GFR level appears to be the factor most strongly associated with anemia, and endogenous EPO resistance is among the contributing factors to PTA.
Collapse
Affiliation(s)
- Çiğdem Oruç
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esra Pehlivan
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Özlem Balcı Ekmekçi
- Department of Biochemistry, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşe Ağbaş
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Salim Çalışkan
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatma Lale Sever
- Department of Pediatric Nephrology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|