RESUMEN
The monoclonal antibody against TNFa (infliximab) suppresses cytokines involved in inflammatory reaction. Consequently, infliximab is a potent agent in treating refractory rheumatoid arthritis (RA). There is also evidence showing beneficial anti-TNFα therapy effect on RA-related amyloidosis AA. TNFα inhibition may, however, lead to leucopenia and, eventually, severe sepsis. We discuss a case of RA with RA-related AA amyloidosis and renal impairment which was refractory to disease-modifying anti-rheumatic drug (DMARD). The treatment led to inflammatory complications of two distinct phases: immediately after drug administration and six weeks later. Both phases were linked to an innocuous skin infection.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Artritis Reumatoide/complicaciones , Inmunosupresores/efectos adversos , Mordeduras y Picaduras de Insectos/fisiopatología , Sepsis/etiología , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inmunología , Humanos , Inmunosupresores/uso terapéutico , Infliximab , Mordeduras y Picaduras de Insectos/complicaciones , Mordeduras y Picaduras de Insectos/inmunología , Masculino , Persona de Mediana Edad , Sepsis/complicaciones , Sepsis/inmunologíaRESUMEN
Calcineurin inhibitors improve kidney allograft survival in the posttransplantation period; however, they may cause nephrotoxicity. The objective of this study was to compare the effect of cyclosporine (CsA) and tacrolimus (Tac) treatment on the transplanted kidney. The study included 219 patients aged 21 to 65 years. Of these, 120 (39 women and 81 men) were treated with CsA and 99 (38 women and 61 men) were treated with Tac. Patients were divided into 4 groups depending on the time since kidney transplantation. We evaluated urine markers of nephrotoxicity: proximal tubular cells lysosomal enzymes (N-acetyl-beta-d-glucosaminidase [NAG] and its isoform NAG-B, beta-d-galactosidase, and beta-glucouronidase) and brush border enzymes (alanyl aminopeptidase and gamma-glutamyl transpeptidase). Urine activities of nephrotoxicity markers were compared in CsA- and Tac-treated patients groups depending on the duration of treatment and allograft function as measured by serum creatinine concentration. Correlation studies between CsA and Tac levels and enzyme activities were performed in both groups and in the entire patient cohort. NAG and its isoform NAG-B seemed to be the most reliable markers of nephrotoxicity. Despite the significant correlation between NAG urine activity and serum creatinine concentration in the CsA group, there were no significant differences in NAG or NAG-B activities between CsA- and Tac-treated graft recipients.