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Tuesday, October 25, 2011

CLINICAL CASE 45: Answers and Summary



A 15 Y OLD MALE PRESENTS WITH 23GM OF PROTEINURIA. A COURSE OF STEROIDS LEADS TO NO IMPROVEMENT. RENAL FUNCTION IS NOW DECLINING. A KIDNEY BIOPSY IS PERFORMED. SMPDL-3B EXPRESSION on THE PODOCYTE HAS BEEN STUDIED IN ONLY THIS GLOMERULAR DISEASE.

Minimal Change     9%
FSGS                    70%
Membranous GN   3%
IgA Nephropathy  1%
Immunotactoid GN   9%
IgM Nephropathy   5%


The correct answer is FSGS. It has been suggested that rituximab might treat recurrent FSGS through an unknown mechanism. Rituximab not only recognizes CD20 on B lymphocytes, but might also bind sphingomyelin phosphodiesterase acid-like 3b (SMPDL-3b) protein and regulate acid sphingomyelinase (ASMase) activity. A recent study of 41 patients  at high risk for recurrent FSGS, 27 of whom were treated with rituximab at time of kidney transplant. SMPDL-3b protein, ASMase activity, and cytoskeleton remodeling were studied in cultured normal human podocytes that had been exposed to patient sera with or without rituximab. 


Look at a prior post regarding this
http://www.nephronpower.com/2011/08/in-news-rituximab-targeting-podocytes.html

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