Department of Clinical Medicine, Clinical Immunology Unit, Scleroderma Center, Sapienza University of Rome, Italy.
Department of Clinical Medicine, Nephrology Unit, Sapienza University of Rome, Italy.
Int J Immunopathol Pharmacol. 2014 Apr-Jun;27(2):305-8. doi: 10.1177/039463201402700220.
A variety of infections has been recognized as an important cause of morbidity and mortality in patients with nephrotic syndrome, and membranous nephropathy is a common cause of this in the elderly. The reasons for infection risk are due to oedema complications, urinary loss of factor B and D of the alternative complement pathway, cellular immunity, granulocyte chemotaxis, hypogammaglobulinemia with serum IgG levels below 600 mg/dL, and secondary effects of immunosuppressive therapy. Many different prophylactic interventions have been used for reducing the risks of infection in these patients but recommendations for routine use are still lacking. We report two membranous nephropathy cases in the elderly in which Intravenous immunoglobulin were useful in long-term infectious prophylaxis, showing safety in renal function. During immunosuppressant therapy in membranous nephropathy, intravenous immunoglobulin without sucrose are a safe therapeutic option as prophylaxis in those patients with nephrotic syndrome and IgG levels below 600 mg/dL. The long-term goal of infection prevention in these patients is to reduce mortality, prolong survival and improve quality of life.
已确认多种感染是肾病综合征患者发病率和死亡率的重要原因，而膜性肾病是老年人中这种疾病的常见病因。感染风险的原因包括水肿并发症、替代补体途径的因子 B 和 D 尿丢失、细胞免疫、粒细胞趋化性、血清 IgG 水平低于 600mg/dL 的低丙种球蛋白血症以及免疫抑制治疗的继发效应。为降低这些患者感染风险，已使用许多不同的预防干预措施，但仍缺乏常规使用的建议。我们报告了两例老年膜性肾病患者，静脉注射免疫球蛋白在长期感染预防中有用，肾功能安全。在膜性肾病的免疫抑制剂治疗中，不含蔗糖的静脉注射免疫球蛋白是一种安全的治疗选择，可作为 IgG 水平低于 600mg/dL 的肾病综合征患者的预防措施。这些患者感染预防的长期目标是降低死亡率、延长生存时间和提高生活质量。
