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Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report

Overview of attention for article published in BMC Nephrology, June 2018
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Title
Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report
Published in
BMC Nephrology, June 2018
DOI 10.1186/s12882-018-0949-7
Pubmed ID
Authors

Claire Harris, Judith Marin, Monica C. Beaulieu

Abstract

The diagnosis of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is rare in pregnancy but potentially life threatening. There are no randomized controlled trials to guide the management of AAV in pregnancy and fetal safety data remains limited. Rituximab administration, a treatment for AAV, has been reported in pregnant women with reassuring fetal outcomes in the oncology and rheumatology literature; however, no published reports describe its use in AAV. We present a case of de novo myeloperoxidase positive (MPO) AAV diagnosed at 22 weeks gestation. Clinical presentation included elevated serum creatinine at 177 μmol/L, hematuria and nephrotic range proteinuria along with high-titre MPO. Diagnosis was confirmed by renal biopsy. Patient was treated with methylprednisolone IV followed by oral prednisone 70 mg daily and Rituximab 650 mg IV weekly for four weeks followed by azathioprine maintenance therapy and prednisone taper. Delivery occurred at 29 weeks gestation via cesarean section for maternal neurologic symptoms concerning for preeclampsia. Maternal and fetal CD + 19 cells were depleted at time of delivery with associated fetal lymphopenia in the absence of infection or other complications related to Rituximab use. The patient experienced a reduction in proteinuria and inflammatory markers following Rituximab therapy; however, serum creatinine increased to 375 μmol/L by 11 weeks post-partum. We report the first use, to our knowledge, of Rituximab with corticosteroids for induction therapy of AAV in pregnancy.

Mendeley readers

The data shown below were compiled from readership statistics for 44 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 44 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 9 20%
Student > Bachelor 6 14%
Other 5 11%
Student > Ph. D. Student 5 11%
Student > Master 4 9%
Other 5 11%
Unknown 10 23%
Readers by discipline Count As %
Medicine and Dentistry 18 41%
Nursing and Health Professions 3 7%
Biochemistry, Genetics and Molecular Biology 2 5%
Pharmacology, Toxicology and Pharmaceutical Science 2 5%
Psychology 2 5%
Other 4 9%
Unknown 13 30%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 June 2018.
All research outputs
#11,687,826
of 13,160,482 outputs
Outputs from BMC Nephrology
#1,202
of 1,357 outputs
Outputs of similar age
#232,452
of 267,756 outputs
Outputs of similar age from BMC Nephrology
#1
of 1 outputs
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