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Néphrologie & Thérapeutique

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Influenza A: H1N1 post-viral membranoproliferative glomerulonephritis occurring in aggressive systemic mastocytosis: Case report and literature review Volume 18, issue 2, Avril 2022

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Chronic kidney disease is one of the major worldwide public health problems. Traditional Chinese medications have been widely used for chronic kidney disease treatment. As the development of modern phytochemistry technology, natural products have been isolated from traditional Chinese medications, which provide a more precise method for the investigation of traditional Chinese medications. In this article, we selected eight natural products from traditional Chinese medications for chronic kidney disease therapy to summarize the recent advances for the development of new medications.

La mastocytose systémique est caractérisée par une prolifération et une activation anormale des mastocytes, responsables d’une libération cytokinique intense et d’un infiltrat tissulaire tumoral. Nous rapportons le cas exceptionnel d’une glomérulonéphrite survenue chez un homme au diagnostic de mastocytose systémique agressive en association avec une hémopathie. Une atteinte multiviscérale, avec retentissement pulmonaire et hépatique, a justifié de traiter la mastocytose par midostaurine (inhibiteur multiple de protéine kinase) associée à un double blocage histaminique et de fortes doses de dexaméthasone, rapidement efficace. Un mois plus tard, malgré la vaccination, notre patient a présenté une détresse respiratoire aiguë en lien avec une grippe AH1N1, compliquée de syndrome néphrotique. La biopsie rénale montrait une glomérulonéphrite membrano-proliférative, traitée efficacement par mycophénolate mofétil. Très peu de cas de glomérulonéphrite post-grippale ou vaccinale sont documentés dans la littérature. Il s’agit d’une étonnante association de conditions pathologiques rares survenant en quelques mois chez un même malade.

Systemic mastocytosis is characterised by tissular infiltration and a cytokine storm due to mast cells excessive proliferation and activation. Herein, we report an extraordinary case of AH1N1 influenza post-viral glomerulonephritis occurring in the course of an aggressive systemic mastocytosis with an associated hematological neoplasm. Because of a multisystemic involvement including the liver and lungs, we treated mastocytosis with midostaurin (multiple inhibitor of kinase protein), anti H1/H2 blockers and dexamethasone as first line treatment. One month later and despite vaccination, he developed a severe acute lung injury with respiratory distress due to AH1N1 influenza in association with the nephrotic syndrome. Kidney biopsy disclosed a membranoproliferative glomerulonephritis that was successfully treated with mycophenolate mofetil. Only a few cases of influenza post-viral or post-vaccination glomerulonephritis are documented in the medical literature. This is an exceptional association of uncommon conditions occurring within only a few months in the same patient.