Engin ONAN, Dilek TORUN, Rüya ÖZELSANCAK, Hasan MİCOZKADIOĞLU

İdiopatik Membranöz Nefropatide Tedavi Öncesi Serum Kompleman 3 Seviyesi ve Rituksimab Yanıtı

Amaç: İdiyopatik membranöz nefropati (MN) hastalarında rituksimabın etkinliği rapor edilmiştir. Merkezimizde diğer tedavilere yanıt vermeyen idiyopatik MN hastalarında tanıda kullanılan biyokimyasal testler, immünhistokimyasal profil ve rituksimab yanıtı arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışmada 2017-2022 yılları arasında diğer immünsüpresif tedavileri alan ve merkezimizde böbrek biyopsisi yapılan idiyopatik MN'li dokuz hasta değerlendirildi. Tedavi öncesi fosfolipaz A2 antikor düzeyi 6 hastada pozitifti, 3 hastada ise antikor analizi yapılamadı. Tüm hastalara renin-anjiyotensin-aldosteron sistemi (RAAS) blokeri, siklofosfamid, steroid ve kalsinörin inhibitörlerinin ardından ≥2 gram rituksimab verildi. Bulgular: Çalışmaya dahil edilen dokuz hastanın 7'si (%78,2) erkek olup yaş ortalaması 39,7±13,2 yıl idi. Dört hastada rituksimab tedavisi ile tam remisyon (KR), beş hastada ise kısmi remisyon (PR) görüldü. Renal biyopside sklerotik glomerül sayısı, IgG, A, M, C1q, C3, C4d, fibrinojen, kappa ve lambda boyanması, tübüler atrofi ve interstisyel fibrozis bulguları benzerdi. Ancak serum kompleman 3 (C3) düzeyi normal sınırlar içinde anlamlı derecede düşüktü (1,22 ± 0,26 vs 1,560 ± 0,56 p=0,016). Ortalama arter basıncı kısmi remisyonda olan hastalarda tam remisyonda olanlara göre anlamlı derecede yüksekti (96.22.5 mmHg vs 84.754.27 mmHg, p: 0.018). Sonuç: İdiyopatik membranöz nefropatili hastalarda tedavi öncesinde normal sınırlar içerisinde düşük bir bazal serum C3 düzeyi, diğer immünsüpresif tedavilere yanıtsızlığın ve rituksimab tedavisine kısmi yanıtın öngörülmesinde yardımcı olabilir.

Anahtar Kelimeler:

Membranöz Nefropati, Serum Kompleman 3, Rituksimab

Pre-Treatment Serum Complement 3 Levels And Rituximab Response In Idiopathic Membranous Nephropathy

Objective: The efficacy of rituximab has been reported in patients with idiopathic membranous nephropathy (MN). We aimed to evaluate the relationship between biochemical tests at diagnosis, immunohistochemical profile, and rituximab response in patients with idiopathic MN unresponsive to other therapies in our center. Material and Methods: In this study, nine patients with idiopathic MN who received other immunosuppressive therapies between 2017-2022 and who underwent renal biopsy in our center were evaluated. Pre-treatment phospholipase A2 antibody levels were positive in 6 patients, and antibodies could not be analyzed in 3 patients. All patients received rituximab ≥2 grams after renin-angiotensin-aldosterone system (RAAS) blocker, cyclophosphamide, steroid, and calcineurin inhibitors. Results: Of the nine patients included in the study, 7 (78.2%) were male, and the mean age was 39.713.2 years. Four patients had complete remission (CR) with rituximab treatment, and five had partial remission (PR). Sclerotic glomeruli count, IgG, A, M, C1q, C3, C4d, fibrinogen, kappa and lambda staining, tubular atrophy, and interstitial fibrosis findings on renal biopsy were similar. However, the serum complement 3 (C3) level was significantly lower within normal limits (1.22  0.26 vs 1.560  0.56 p=0.016). The mean arterial pressure was significantly higher (96.22.5 mmHg vs 84.754.27 mmHg, p=0.018) in patients with partial remission compared to those with complete remission. Conclusion: A low baseline serum C3 level within normal limits before treatment in patients with idiopathic membranous nephropathy may help predicting unresponsiveness to other immunosuppressive therapies and partial response to rituximab treatment.

Keywords:

Serum Complement 3, Rituximab, membranous nephropathy,

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