Letter to the Editor
A familial Mediterranean fever patient with double homozygous mutations treated with anakinra after kidney transplantation
Un paciente con poliserositis familiar recurrente con mutaciones homocigóticas dobles tratado con anakinra tras un trasplante renal
Nuri Baris Hasbala,
, Yener Kocb, Mustafa Sevincc, Abdulkadir Unsald, Taner Basturkd
Corresponding author
a Hakkari State Hospital, Nephrology Unit, Turkey
b Demiroglu Bilim University Medical Faculty, Department of Internal Medicine, Division of Nephrology, Turkey
c Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Nephrology, Turkey
d Health Sciences University Medical Faculty, Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Nephrology, Turkey
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=> "564" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nuri Baris Hasbal, Yener Koc, Mustafa Sevinc, Abdulkadir Unsal, Taner Basturk" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Nuri Baris" "apellidos" => "Hasbal" "email" => array:1 [ 0 => "nbhasbal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Yener" "apellidos" => "Koc" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Mustafa" "apellidos" => "Sevinc" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Abdulkadir" "apellidos" => "Unsal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Taner" "apellidos" => "Basturk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hakkari State Hospital, Nephrology Unit, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Demiroglu Bilim University Medical Faculty, Department of Internal Medicine, Division of Nephrology, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Nephrology, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Health Sciences University Medical Faculty, Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Nephrology, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un paciente con poliserositis familiar recurrente con mutaciones homocigóticas dobles tratado con anakinra tras un trasplante renal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 773 "Ancho" => 1259 "Tamanyo" => 36536 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Effects of anakinra treatment on acute phase proteins.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Familial Mediterranean fever (FMF) is a clinically well known and the most frequent monogenic auto-inflammatory disease affecting mostly people who have a Mediterranean descent. Typical self-limited attacks of fever, abdominal pain, polyserositis and also an imminent complication, amyloidosis, might be hard to manage in the clinical setting. Two decades earlier, mutations of MEFV, pyrin innate immunity regulator gene (MEFV) located on chromosome 16 were accused of being responsible of FMF; from that time on, lots of mutations have been described, but some of them were not associated with a phenotype of the disease and named ‘variants of uncertain significance.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 24-year-old female Turkish patient started peritoneal dialysis in our unit after 10-years clinical diagnosis of FMF and amyloidosis in May 2008. She was homozygous both for MEFV R202Q and M694V. After eight years on PD without any complications except a few attacks of peritonitis, she had kidney transplantation from a deceased donor with anti-thymocyte globulin as an induction immunosuppression. She discharged from the hospital when she achieved normal graft function with triple immunosuppression consisting steroid, tacrolimus, mycophenolate besides 2-mg/day dose of colchicine. After one month of discharge, she admitted to the hospital with fatigue and diarrhea, severe and treatment-resistant hyponatremia was found in her laboratory findings. Therefore first we tapered colchicine dose and changed tacrolimus to everolimus. Then we changed mycophenolate to mycophenolate sodium and had to taper dose of colchicine to 0.5<span class="elsevierStyleHsp" style=""></span>mg/day. After diarrhea and hyponatremia settled, the patient had fever, abdominal discomfort and chest pain which she had already experienced before PD and kidney transplantation. Acute kidney injury with serum creatinine level of 2.3<span class="elsevierStyleHsp" style=""></span>mg/dl (serum creatinine level was 1.1<span class="elsevierStyleHsp" style=""></span>mg/dl at the time of discharge) and increases in acute phase reactants (serum C-reactive protein (CRP) level: 9<span class="elsevierStyleHsp" style=""></span>mg/dl, normal range: <5<span class="elsevierStyleHsp" style=""></span>mg/dl) occurred without any signs or symptoms of infection at the same time. Circumferential 1-cm pericardial effusion, thickened mesenteric folds, minimal free fluid in Douglas’ pouch were found in echocardiographic and ultrasonographic evaluations, excluding the possible diagnosis of sclerosing encapsulated peritonitis and early surgical complications such as lymphocele. But position and volume of free fluid in the abdomen were not appropriate for sampling, and there were no signs of cardiac tamponade. She did not tolerate higher doses of colchicine because of gastrointestinal adverse effects. After attack dissolved with conservative treatment, CRP was still elevated but graft function turned to normal with serum creatinine level 1.07<span class="elsevierStyleHsp" style=""></span>mg/dl. Proteinuria was not detected before or during the attack. We added anakinra (Kineret, Sobi Inc, Stockholm, Sweden) (subcutaneously, 100<span class="elsevierStyleHsp" style=""></span>mg/day) to colchicum treatment because of intolerance to colchicine and continuous inflammatory state. In the first month of anakinra, serum amyloid A decreased from 1.12<span class="elsevierStyleHsp" style=""></span>mg/dl to 0.27<span class="elsevierStyleHsp" style=""></span>mg/dl (normal range <0.5<span class="elsevierStyleHsp" style=""></span>mg/dl) and serum CRP level from 8<span class="elsevierStyleHsp" style=""></span>mg/l to 2.49<span class="elsevierStyleHsp" style=""></span>mg/l shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Pericardial effusion decreased from 1<span class="elsevierStyleHsp" style=""></span>cm to 0.3<span class="elsevierStyleHsp" style=""></span>cm and free fluid in Douglas’ pouch disappeared. She had never experienced any other attack and anakinra was well tolerated with only minimal local irritation resolving with changing injection sites through the sixth month of treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The relationship between mutation types and disease characteristics are well known in some mutations such as a severe disease is associated with M694V but R202Q has controversial information in the literature.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Cekin et al. found that R202Q is classified as the most common polymorphism in a Turkish cohort and Yigit et al. reported that homozygous R202Q mutation was significantly higher in patients with FMF than control group.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> A study with a Turkish children cohort revealed that recurrent abdominal pain were commonly seen in patients with M694V and R202Q mutations. But as observed in this patient, chest pain was commonly seen with the R202Q mutation.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Therefore R202Q might not be a disease-causing mutation but may be a mutation that increases the severity of the disease.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Colchicine is still the principal treatment but loses its efficacy although with the maximum therapeutic dose of 3<span class="elsevierStyleHsp" style=""></span>mg/day for adults in some patients who are generally called ‘colchicine-resistant’ or ‘colchicine-refractory’.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Hopefully, anti-IL-1 therapies including anakinra, canakinumab, and rilonacept, have been an alternative strategy for resistant or refractory patients.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Recently, a randomized controlled study has shown that anakinra is a safe and effective option for patients with resistant FMF.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Although few cases were reported about treatments with anti-IL-1 agents after kidney transplantation in patients with FMF, there is still a lack of information in those patient group.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We recommend that all patients with FMF should be genetically tested and R202Q may be taken into account to assess disease severity. And also even after kidney transplantation, anakinra as a sufficient and well-tolerated agent can be added to colchicine treatment in resistant, refractory or intolerant patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 773 "Ancho" => 1259 "Tamanyo" => 36536 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Effects of anakinra treatment on acute phase proteins.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Familial Mediterranean fever: recent developments in pathogenesis and new recommendations for management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Ozen" 1 => "E.D. Batu" 2 => "S. Demir" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fimmu.2017.00253" "Revista" => array:6 [ "tituloSerie" => "Front Immunol" "fecha" => "2017" "volumen" => "8" "paginaInicial" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28386255" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0923753419374952" "estado" => "S300" "issn" => "09237534" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MEFV mutations and their relation to major clinical symptoms of Familial Mediterranean Fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Cekin" 1 => "M.E. Akyurek" 2 => "E. Pinarbasi" 3 => "F. Ozen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gene" "fecha" => "2017" "volumen" => "626" "paginaInicial" => "9" "paginaFinal" => "13" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Significance of MEFV gene R202Q polymorphism in Turkish familial Mediterranean fever patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Yigit" 1 => "N. Karakus" 2 => "T. Tasliyurt" 3 => "S.U. Kaya" 4 => "N. Bozkurt" 5 => "B. Kisacik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gene.2012.06.074" "Revista" => array:7 [ "tituloSerie" => "Gene" "fecha" => "2012" "volumen" => "506" "paginaInicial" => "43" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22771921" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673611616292" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and demographic evaluation according to MEFV genes in patients with familial Mediterranean fever" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Sönmezgöz" 1 => "S. Özer" 2 => "A. Gül" 3 => "R. Yılmaz" 4 => "T. Kasap" 5 => "Ş. Takcı" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10528-018-9889-y" "Revista" => array:3 [ "tituloSerie" => "Biochem Genet" "fecha" => "2018" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11521511" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Approach to the patients with inadequate response to colchicine in familial Mediterranean fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Gul" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.berh.2016.09.001" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Rheumatol" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "296" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27886801" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anakinra for colchicine-resistant familial Mediterranean fever: a randomized, double-blind, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Ben-Zvi" 1 => "O. Kukuy" 2 => "E. Giat" 3 => "E. Pras" 4 => "O. Feld" 5 => "S. Kivity" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.39995" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheumatol" "fecha" => "2017" "volumen" => "69" "paginaInicial" => "854" "paginaFinal" => "862" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27860460" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colchicine-resistant familial Mediterranean fever in a renal transplantation patient: successful treatment with anakinra" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Z.K. Celebi" 1 => "O. Kucuksahin" 2 => "S. Sengul" 3 => "A. Tuzuner" 4 => "K. Keven" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ckj/sft164" "Revista" => array:6 [ "tituloSerie" => "Clin Kidney J" "fecha" => "2014" "volumen" => "7" "paginaInicial" => "219" "paginaFinal" => "220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25852877" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of anakinra treatment in a patient with colchicine-resistant familial Mediterranean fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Alpay" 1 => "A. Sumnu" 2 => "Y. Caliskan" 3 => "H. Yazici" 4 => "A. Turkmen" 5 => "A. Gul" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00296-010-1474-6" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "3277" "paginaFinal" => "3279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20386914" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of familial Mediterranean fever with Anakinra and outcome after renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Moser" 1 => "G. Pohl" 2 => "I. Haslinger" 3 => "S. Knapp" 4 => "D. Rowczenio" 5 => "T. Russel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/gfn646" "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "676" "paginaFinal" => "678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19033248" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000004000000005/v1_202012090755/S2013251420301140/v1_202012090755/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000004000000005/v1_202012090755/S2013251420301140/v1_202012090755/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251420301140?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 49 | 36 | 85 |
| 2024 September | 53 | 39 | 92 |
| 2024 August | 79 | 67 | 146 |
| 2024 July | 41 | 35 | 76 |
| 2024 June | 43 | 33 | 76 |
| 2024 May | 64 | 32 | 96 |
| 2024 April | 46 | 33 | 79 |
| 2024 March | 51 | 23 | 74 |
| 2024 February | 85 | 30 | 115 |
| 2024 January | 45 | 23 | 68 |
| 2023 December | 35 | 24 | 59 |
| 2023 November | 51 | 32 | 83 |
| 2023 October | 59 | 23 | 82 |
| 2023 September | 70 | 29 | 99 |
| 2023 August | 55 | 26 | 81 |
| 2023 July | 49 | 21 | 70 |
| 2023 June | 43 | 21 | 64 |
| 2023 May | 37 | 36 | 73 |
| 2023 April | 20 | 14 | 34 |
| 2023 March | 37 | 15 | 52 |
| 2023 February | 32 | 20 | 52 |
| 2023 January | 33 | 22 | 55 |
| 2022 December | 49 | 36 | 85 |
| 2022 November | 66 | 32 | 98 |
| 2022 October | 58 | 39 | 97 |
| 2022 September | 39 | 32 | 71 |
| 2022 August | 35 | 45 | 80 |
| 2022 July | 43 | 44 | 87 |
| 2022 June | 34 | 44 | 78 |
| 2022 May | 50 | 32 | 82 |
| 2022 April | 63 | 57 | 120 |
| 2022 March | 73 | 55 | 128 |
| 2022 February | 65 | 44 | 109 |
| 2022 January | 76 | 35 | 111 |
| 2021 December | 69 | 40 | 109 |
| 2021 November | 47 | 30 | 77 |
| 2021 October | 122 | 61 | 183 |
| 2021 September | 56 | 33 | 89 |
| 2021 August | 58 | 40 | 98 |
| 2021 July | 26 | 29 | 55 |
| 2021 June | 17 | 23 | 40 |
| 2021 May | 28 | 50 | 78 |
| 2021 April | 61 | 69 | 130 |
| 2021 March | 50 | 44 | 94 |
| 2021 February | 42 | 30 | 72 |
| 2021 January | 28 | 14 | 42 |
| 2020 December | 29 | 24 | 53 |
Show all
