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2013 ; 2
(2
): 139-143
Nephropedia Template TP
gab.com Text
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English Wikipedia
Mizoribine as a safe and effective combined maintenance therapy with prednisolone
for anti-neutrophil cytoplasmic antibody-associated vasculitis in a hemodialysis
patient
#MMPMID28509286
Nakamura G
; Homma N
; Sakamaki Y
; Toyama M
; Unno M
; Kuroda T
; Narita I
CEN Case Rep
2013[Nov]; 2
(2
): 139-143
PMID28509286
show ga
A 77-year-old man developed severe renal insufficiency due to proteinase 3
anti-neutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis, and was
started on hemodialysis (HD). Because his renal insufficiency appeared to be
irreversible, he was maintained on oral prednisolone (PSL) at 5 mg/day. However,
a disease flare-up with alveolar hemorrhage occurred. Serology revealed elevated
levels of PR3-ANCA and C-reactive protein (CRP). The patient was given pulse
therapy with a quarter dose of methylprednisolone (m-PSL) (250 mg, 3 days),
followed by oral PSL at 15 mg/day. As a supplemental treatment, he was given
25 mg of mizoribine (MZR) immediately after each HD session. Subsequently, the
levels of PR3-ANCA and CRP decreased, and the alveolar hemorrhage resolved. The
dose of MZR to be given was determined by measuring the patient's serum
concentrations of MZR at various time points after the HD session. The
maintenance dose of MZR was finally set at 50 mg. At present, the oral PSL dosage
has been tapered to 10 mg/day, and the patient has achieved a state of remission
without any side effects.