Document Detail


Nephrotic syndrome complicating alpha-glucosidase replacement therapy for Pompe disease.
MedLine Citation:
PMID:  15466083     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We report a patient with Pompe disease who developed reversible nephrotic syndrome during prolonged, high-dose, experimental, enzyme replacement therapy with recombinant human acid alpha-glucosidase (rhGAA). Because of the development of antibodies to rhGAA and concomitant clinical decline, escalating doses of rhGAA were administered as part of an experimental immune tolerance regimen. Histologic evaluation of kidney tissue revealed glomerular deposition of immune complexes containing rhGAA itself, in a pattern of membranous nephropathy. To our knowledge, this is the first reported case of nephrotic syndrome occurring during enzyme replacement therapy. The nephrotic syndrome gradually resolved after the rhGAA dose was decreased, indicating that decreasing the antigenic load can ameliorate glomerular immune complex deposition associated with enzyme replacement in a highly sensitized patient.
Authors:
Tracy E Hunley; Deyanira Corzo; Martha Dudek; Priya Kishnani; Andrea Amalfitano; Yuan-Tsong Chen; Susan M Richards; John A Phillips; Agnes B Fogo; George E Tiller
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  114     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-06     Completed Date:  2005-02-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e532-5     Citation Subset:  AIM; IM    
Affiliation:
Division of Pediatric Nephrology, Vanderbilt University Medical Center, C-4204 Medical Center North, Nashville, TN 37232-2584, USA. tray.hunley@mcmail.vanderbilt.edu
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MeSH Terms
Descriptor/Qualifier:
Antibodies / blood,  immunology
Child, Preschool
Glycogen Storage Disease Type II / complications,  drug therapy*,  immunology
Humans
Immune Tolerance
Kidney / pathology
Male
Nephrotic Syndrome / chemically induced*,  immunology,  pathology
alpha-Glucosidases / adverse effects*,  immunology,  therapeutic use
Chemical
Reg. No./Substance:
0/Antibodies; EC 3.2.1.20/alpha-Glucosidases

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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