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Management of crescentic glomerulonephritis: what are the recent advances?

Abstract
Crescentic glomerulonephritis (GN) is a life-threatening clinical syndrome characterized by crescents which are morphological manifestations of severe glomerular injury. Immunologically, crescentic GN are classified as anti-glomerular basement membrane nephritis, immune complex-mediated GN and pauci-immune GN. Conventional treatment for crescentic GN mainly consists of corticosteroids, immunosuppressants and plasma exchange. Plasmapheresis is beneficial for patients with Goodpasture's syndrome and those with severe pauci-immune GN. Recently, new therapeutic agents have emerged, such as monoclonal antibodies to T cells, B cells and cytokines (e.g. anti-CD20 antibodies and TNF-α inhibitors) and signal transduction inhibitors, which may provide satisfactory alternatives. However, most of these treatments have only been established in experimental crescentic GN, described in single cases or reported in open-label trials; thus, the safety and efficacy of these agents remain to be investigated via controlled clinical trials.
AuthorsXiao Li, Nan Chen
JournalContributions to nephrology (Contrib Nephrol) Vol. 181 Pg. 229-39 ( 2013) ISSN: 1662-2782 [Electronic] Switzerland
PMID23689584 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
CopyrightCopyright © 2013 S. Karger AG, Basel.
Chemical References
  • Antibodies, Monoclonal, Murine-Derived
  • Antigen-Antibody Complex
  • Autoantibodies
  • Tumor Necrosis Factor-alpha
  • antiglomerular basement membrane antibody
  • Rituximab
  • Mycophenolic Acid
Topics
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (complications)
  • Antibodies, Monoclonal, Murine-Derived (therapeutic use)
  • Antigen-Antibody Complex (immunology)
  • Autoantibodies (immunology)
  • Glomerulonephritis (drug therapy, etiology)
  • Humans
  • Mycophenolic Acid (analogs & derivatives, therapeutic use)
  • Rituximab
  • Tumor Necrosis Factor-alpha (antagonists & inhibitors)

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