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Arteaga-Muller GY, Flores-Treviño S, Bocanegra-Ibarias P, Robles-Espino D, Garza-González E, Fabela-Valdez GC, Camacho-Ortiz A. Changes in the Progression of Chronic Kidney Disease in Patients Undergoing Fecal Microbiota Transplantation. Nutrients 2024; 16:1109. [PMID: 38674803 PMCID: PMC11055146 DOI: 10.3390/nu16081109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive loss of renal function in which gut dysbiosis is involved. Fecal microbiota transplantation (FMT) may be a promising alternative for restoring gut microbiota and treating CKD. This study evaluated the changes in CKD progression in patients treated with FMT. Patients with diabetes and/or hypertension with CKD clinical stages 2, 3, and 4 in this single-center, double-blind, randomized, placebo-controlled clinical trial (NCT04361097) were randomly assigned to receive either FMT or placebo capsules for 6 months. Laboratory and stool metagenomic analyses were performed. A total of 28 patients were included (15 FMT and 13 placebo). Regardless of CKD stages, patients responded similarly to FMT treatment. More patients (53.8%) from the placebo group progressed to CKD than the FMT group (13.3%). The FMT group maintained stable renal function parameters (serum creatinine and urea nitrogen) compared to the placebo group. Adverse events after FMT treatment were mild or moderate gastrointestinal symptoms. The abundance of Firmicutes and Actinobacteria decreased whereas Bacteroidetes, Proteobacteria and Roseburia spp. increased in the FMT group. CKD patients showed less disease progression after FMT administration. The administration of oral FMT in patients with CKD is a safe strategy, does not represent a risk, and has potential benefits.
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Affiliation(s)
- Giovanna Yazmín Arteaga-Muller
- Department of Nephrology, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo Leon, Monterrey 64460, Nuevo Leon, Mexico;
| | - Samantha Flores-Treviño
- Department of Infectious Diseases, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo Leon, Monterrey 64460, Nuevo Leon, Mexico; (S.F.-T.); (P.B.-I.); (G.C.F.-V.)
| | - Paola Bocanegra-Ibarias
- Department of Infectious Diseases, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo Leon, Monterrey 64460, Nuevo Leon, Mexico; (S.F.-T.); (P.B.-I.); (G.C.F.-V.)
| | - Diana Robles-Espino
- Department of Clinical Pathology, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo Leon, Monterrey 64460, Nuevo Leon, Mexico;
| | - Elvira Garza-González
- Department of Biochemistry, School of Medicine, Autonomous University of Nuevo Leon, Monterrey 64460, Nuevo Leon, Mexico;
| | - Graciela Catalina Fabela-Valdez
- Department of Infectious Diseases, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo Leon, Monterrey 64460, Nuevo Leon, Mexico; (S.F.-T.); (P.B.-I.); (G.C.F.-V.)
| | - Adrián Camacho-Ortiz
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Dr. José Eleuterio González, Autonomous University of Nuevo Leon, Monterrey 64460, Nuevo Leon, Mexico
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202
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Uchida T, Oda T. Concept and Diagnostic Challenges of Renal-Limited Hemophagocytic Syndrome/Macrophage Activation Syndrome. J Clin Med 2024; 13:2161. [PMID: 38673434 PMCID: PMC11050812 DOI: 10.3390/jcm13082161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Hemophagocytic syndrome/macrophage activation syndrome (HPS/MAS) is a serious clinical condition that frequently leads to multiple organ failure, including acute kidney injury (AKI). Although the pathogenesis of AKI is not yet fully understood, it is believed to result from uncontrolled activation of the immune system involving macrophages and cytotoxic lymphocytes. Renal histology in HPS/MAS often presents with characteristic foamy glomerular lesions (glomerular lipidosis) with massive macrophage infiltration, known as histiocytic glomerulopathy. In this review, we introduce the recently proposed concept of renal-limited HPS/MAS as a novel etiology of histiocytic glomerular lipidosis. Patients with renal-limited HPS/MAS often develop AKI but do not fulfill the diagnostic criteria for HPS/MAS because their systemic manifestations are less severe. Therefore, the diagnosis largely depends on characteristic histological findings, that is, diffuse and global glomerular accumulation of foamy macrophages and cytotoxic lymphocytes accompanied by the interaction of these cells as well as the exclusion of various differential diseases. Although there are no established therapeutic regimens, these patients receive various types of therapies, including high-dose glucocorticoids, immunosuppressants, or anti-interleukin-1 drug, and generally achieve favorable outcomes. We summarized the concept, diagnostic challenges, and recent topics of this disease entity and discussed treatment options based on our own experiences.
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Affiliation(s)
- Takahiro Uchida
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Tokyo 193-0998, Japan;
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203
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Barone B, Napolitano L, Reccia P, Calace FP, De Luca L, Olivetta M, Stizzo M, Rubinacci A, Della Rosa G, Lecce A, Romano L, Sciorio C, Spirito L, Mattiello G, Vastarella MG, Papi S, Calogero A, Varlese F, Tataru OS, Ferro M, Del Biondo D, Napodano G, Vastarella V, Lucarelli G, Balsamo R, Fusco F, Crocetto F, Amicuzi U. Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction-A Comprehensive Review. J Pers Med 2024; 14:392. [PMID: 38673019 PMCID: PMC11051023 DOI: 10.3390/jpm14040392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer ranks as the 10th most prevalent cancer globally with an increasing incidence. Radical cystectomy combined with urinary diversion represents the standard treatment for muscle-invasive bladder cancer, offering a range of techniques tailored to patient factors. Overall, urinary diversions are divided into non-continent and continent. Among the first category, cutaneous ureterostomy and ileal conduit represent the most common procedures while in the second category, it could be possible to describe another subclassification which includes ureterosigmoidostomy, continent diversions requiring catheterization and orthotopic voiding pouches and neobladders. In this comprehensive review, urinary diversions are described in their technical aspects, providing a summary of almost all alternatives to urinary diversion post-radical cystectomy.
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Affiliation(s)
- Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Pasquale Reccia
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Francesco Paolo Calace
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Luigi De Luca
- Division of Urology, Department of Surgical Multispecialty, AORN Antonio Cardarelli, 80131 Naples, Italy;
| | - Michelangelo Olivetta
- Urology Unit, Gaetano Fucito Hospital, AOU San Giovanni di Dio e Ruggi d’Aragona, 84085 Mercato San Severino, Italy;
| | - Marco Stizzo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Andrea Rubinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Giampiero Della Rosa
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Arturo Lecce
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Lorenzo Romano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | | | - Lorenzo Spirito
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Gennaro Mattiello
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Maria Giovanna Vastarella
- Gynaecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Salvatore Papi
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Filippo Varlese
- Department of Advanced Biomedical Sciences, Section of General Surgery, University of Naples Federico II, 80131 Naples, Italy; (A.C.); (F.V.)
| | - Octavian Sabin Tataru
- Department of Simulation Applied in Medicine, The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy;
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (D.D.B.); (G.N.)
| | - Vincenzo Vastarella
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
- Division of Cardiology, Cardiovascular Department, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;
| | - Raffaele Balsamo
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (F.P.C.); (R.B.)
| | - Ferdinando Fusco
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.)
| | - Felice Crocetto
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.N.); (A.R.); (G.D.R.); (A.L.); (L.R.); (G.M.); (S.P.); (F.C.)
| | - Ugo Amicuzi
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy; (F.F.); (U.A.)
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204
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Seida I, Al Shawaf M, Mahroum N. Fecal microbiota transplantation in autoimmune diseases - An extensive paper on a pathogenetic therapy. Autoimmun Rev 2024; 23:103541. [PMID: 38593970 DOI: 10.1016/j.autrev.2024.103541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Abstract
The role of infections in the pathogenesis of autoimmune diseases has long been recognized and reported. In addition to infectious agents, the internal composition of the "friendly" living bacteria, (microbiome) and its correlation to immune balance and dysregulation have drawn the attention of researchers for decades. Nevertheless, only recently, scientific papers regarding the potential role of transferring microbiome from healthy donor subjects to patients with autoimmune diseases has been proposed. Fecal microbiota transplantation or FMT, carries the logic of transferring microorganisms responsible for immune balance from healthy donors to individuals with immune dysregulation or more accurately for our paper, autoimmune diseases. Viewing the microbiome as a pathogenetic player allows us to consider FMT as a pathogenetic-based treatment. Promising results alongside improved outcomes have been demonstrated in patients with different autoimmune diseases following FMT. Therefore, in our current extensive review, we aimed to highlight the implication of FMT in various autoimmune diseases, such as inflammatory bowel disease, autoimmune thyroid and liver diseases, systemic lupus erythematosus, and type 1 diabetes mellitus, among others. Presenting all the aspects of FMT in more than 12 autoimmune diseases in one paper, to the best of our knowledge, is the first time presented in medical literature. Viewing FMT as such could contribute to better understanding and newer application of the model in the therapy of autoimmune diseases, indeed.
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Affiliation(s)
- Isa Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Maisam Al Shawaf
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
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205
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Takata K, Omae T, Hamano Y, Ishikawa T, Nogami K. Peritoneal dialysis-associated infection caused by Mycobacterium abscessus in a pediatric patient on continuous peritoneal dialysis without switching to hemodialysis. CEN Case Rep 2024:10.1007/s13730-024-00875-1. [PMID: 38581567 DOI: 10.1007/s13730-024-00875-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/31/2024] [Indexed: 04/08/2024] Open
Abstract
Most peritoneal dialysis (PD)-associated infections caused by Mycobacterium abscessus (M. abscessus) require a transfer from PD to hemodialysis (HD). Here, we report a pediatric case of exit-site and tunnel infections caused by M. abscessus, for whom PD was continued with catheter replacement, debridement of the infected site, and the administration of multiple antibacterial agents. A 10-year-old boy with end-stage kidney disease secondary to juvenile nephronophthisis with NPHP1 deletion, for whom PD was initiated at the age of 9 years, was admitted to the hospital with complaints of fever, pus at the exit-site of the PD catheter, and poor PD drainage. The dialysis effluent culture results were negative; however, M. abscessus was detected in the pus at the exit-site of the PD catheter. The management of HD was expected to be challenging owing to the presence of developmental disorders. Therefore, PD was continued with the simultaneous removal of the PD catheter, reinsertion of a new catheter at a new site, and debridement of the infected site. Multiple antibacterial therapies were administered for 2 months, and the patient was eventually discharged without switching to HD. To the best of our knowledge, this is the first pediatric case of a PD-associated infection caused by M. abscessus, for whom PD was continued without switching to HD. This treatment strategy is not generally recommended but may be an option for patients without peritonitis who have difficulty switching to HD.
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Affiliation(s)
- Koji Takata
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
- Department of Pediatrics, Minami-Nara General Medical Center, 8-1 Hukugami, Oyodo-cho, Yosino, Nara, 638-8551, Japan
| | - Takashi Omae
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yuri Hamano
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoaki Ishikawa
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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206
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Andeen NK, Hou J. Diagnostic Challenges and Emerging Pathogeneses of Selected Glomerulopathies. Pediatr Dev Pathol 2024:10935266241237656. [PMID: 38576387 DOI: 10.1177/10935266241237656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Recent progress in glomerular immune complex and complement-mediated diseases have refined diagnostic categories and informed mechanistic understanding of disease development in pediatric patients. Herein, we discuss selected advances in 3 categories. First, membranous nephropathy antigens are increasingly utilized to characterize disease in pediatric patients and include phospholipase A2 receptor (PLA2R), Semaphorin 3B (Sema3B), neural epidermal growth factor-like 1 (NELL1), and protocadherin FAT1, as well as the lupus membranous-associated antigens exostosin 1/2 (EXT1/2), neural cell adhesion molecule 1 (NCAM1), and transforming growth factor beta receptor 3 (TGFBR3). Second, we examine advances in techniques for paraffin and light chain immunofluorescence (IF), including the former's function as a salvage technique and their necessity for diagnosis in adolescent cases of membranous-like glomerulopathy with masked IgG kappa deposits (MGMID) and proliferative glomerulonephritis with monotypic Ig deposits (PGNMID), respectively. Finally, progress in understanding the roles of complement in pediatric glomerular disease is reviewed, with specific attention to overlapping clinical, histologic, and genetic or functional alternative complement pathway (AP) abnormalities among C3 glomerulopathy (C3G), infection-related and post-infectious GN, "atypical" post-infectious GN, immune complex mediated membranoproliferative glomerulonephritis (IC-MPGN), and atypical hemolytic uremic syndrome (aHUS).
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Affiliation(s)
- Nicole K Andeen
- Oregon Health & Science University, Department of Pathology and Laboratory Medicine, Portland, OR, USA
| | - Jean Hou
- Cedars-Sinai Medical Center, Department of Pathology, Los Angeles, CA, USA
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207
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Todorovic Đ, Stojanovic B, Filip M, Đorđevic Đ, Stankovic M, Jovanovic I, Spasic M, Milosevic B, Cvetkovic A, Radovanovic D, Jovanovic M, Stojanovic BS, Pantic D, Cvetkovic D, Jovanovic D, Markovic V, Stojanovic MD. Small Bowel Perforation Due to Renal Carcinoma Metastasis: A Comprehensive Case Study and Literature Review. Diagnostics (Basel) 2024; 14:761. [PMID: 38611674 PMCID: PMC11011689 DOI: 10.3390/diagnostics14070761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
This case report presents a unique instance of small bowel perforation caused by solitary metastasis from renal cell carcinoma (RCC), a rare and complex clinical scenario. The patient, a 59-year-old male with a history of RCC treated with nephrectomy four years prior, presented with acute abdomen symptoms. Emergency diagnostic procedures identified a significant lesion in the small intestine. Surgical intervention revealed a perforated jejunal segment due to metastatic RCC. Postoperatively, the patient developed complications, including pneumonia and multi-organ failure, leading to death 10 days after surgery. Histopathological analysis confirmed the metastatic nature of the lesion. This case underscores the unpredictable nature of RCC metastasis and highlights the need for vigilance in post-nephrectomy patients. The rarity of small bowel involvement by RCC metastasis, particularly presenting as perforation, makes this case a significant contribution to medical literature, emphasizing the challenges in the diagnosis and management of such atypical presentations.
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Affiliation(s)
- Đorđe Todorovic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Milutinovic Filip
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Đorđe Đorđevic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Milos Stankovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Ivan Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Aleksandar Cvetkovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Dragce Radovanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Bojana S. Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Damnjan Pantic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Danijela Cvetkovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Dalibor Jovanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.J.); (M.D.S.)
| | - Vladan Markovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Milica Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.J.); (M.D.S.)
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208
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Ueno M, Kobayashi S, Asakawa S, Arai S, Nagura M, Yamazaki O, Tamura Y, Ohashi R, Shibata S, Fujigaki Y. Author's reply to "Immune complex-mediated glomerulonephritis with ANCA positivity: what should nephrologists consider?". CEN Case Rep 2024; 13:143-144. [PMID: 37656397 PMCID: PMC10982279 DOI: 10.1007/s13730-023-00817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Masaki Ueno
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Sawako Kobayashi
- Division of Nephrology, Tokyo-Kita Medical Center, Kita-ku, Tokyo, Japan
| | - Shinichiro Asakawa
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Shigeyuki Arai
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Michito Nagura
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Osamu Yamazaki
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yoshifuru Tamura
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Shigeru Shibata
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yoshihide Fujigaki
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
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209
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Chawla L, Sachdeva AS. A Rare Case of Renal Vein Thrombosis Secondary to Oral Contraceptive Pills. Cureus 2024; 16:e57604. [PMID: 38707013 PMCID: PMC11069633 DOI: 10.7759/cureus.57604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Renal vein thrombosis (RVT) is a common complication of nephrotic syndrome and renal malignancy. However, its association with oral contraceptive use has rarely been reported. We report a case of a 29-year-old female with a history of oral contraceptive use, presenting with acute flank pain. On further investigation, she was found to have unilateral RVT. Oral contraception was discontinued, and she was started on therapeutic anticoagulation, initially with low-molecular-weight heparin, and then switched to apixaban. Her symptoms improved, and she is currently doing well. This case signifies the importance of proper history-taking and how oral contraception should be considered a significant risk factor for venous thromboembolism.
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Affiliation(s)
- Lavneet Chawla
- Adult Hospitalist Services, OSF Saint Francis Medical Center, Peoria, USA
| | - Amitoj S Sachdeva
- Internal Medicine, University of Illinois School of Medicine Peoria, Peoria, USA
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210
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Dang J, Chevalier K, Letavernier E, Tissandier C, Mouawad S, Debray D, Obadia M, Poujois A. Kidney involvement in Wilson's disease: a review of the literature. Clin Kidney J 2024; 17:sfae058. [PMID: 38660122 PMCID: PMC11040517 DOI: 10.1093/ckj/sfae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 04/26/2024] Open
Abstract
Wilson's disease (WD) is a rare inherited disease due to the mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and its pathological accumulation in various organs such as the liver, the nervous system, or the kidneys. Whereas liver failure and neuropsychiatric disorders are the most common features, less is known about the renal complications. We conducted a review of the literature to define the characteristics and pathophysiology of kidney involvement during WD. This review shed light on strong evidence for direct copper toxicity to renal tubular cells. Excessive tubular copper accumulation might present with various degrees of tubular dysfunction, ranging from mild hydroelectrolytic and acid-base disorders to complete Fanconi syndrome. Proximal and distal renal tubular acidosis also favors development of nephrolithiasis, nephrocalcinosis, and bone metabolism abnormalities. Indirect complications might involve renal hypoperfusion as occurs in hepatorenal or cardiorenal syndrome, but also tubular casts' formation during acute hemolysis, rhabdomyolysis, or bile cast nephropathy. Acute kidney failure is not uncommon in severe WD patients, and independently increases mortality. Finally, specific and long-term therapy by D-penicillamin, one of the most efficient drugs in WD, can cause glomerular injuries, such as membranous nephropathy, minimal-change disease, and, rarely, severe glomerulonephritis. Altogether, our study supports the need for interdisciplinary evaluation of WD patients involving nephrologists, with regular monitoring of tubular and glomerular functions, to provide adequate prevention of renal and bone involvement.
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Affiliation(s)
- Julien Dang
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kevin Chevalier
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Emmanuel Letavernier
- AP-HP, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France
| | - Come Tissandier
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sarah Mouawad
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares «Syndrome Néphrotique Idiopathique», Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Dominique Debray
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Mickaël Obadia
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
| | - Aurélia Poujois
- Hôpital Fondation Rothschild, Service de Neurologie, Paris, France
- Centre de Référence de la Maladie de Wilson et autres Maladies Rares Liées au Cuivre, Paris, France
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211
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Lee MO, Yoo SJ. Henoch-Schönlein purpura following mRNA COVID-19 vaccination: a case report. Clin Exp Vaccine Res 2024; 13:166-170. [PMID: 38752010 PMCID: PMC11091430 DOI: 10.7774/cevr.2024.13.2.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/10/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) vaccine was developed to provide immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in 2019. The vaccine has proven to be effective in reducing severity and mortality and preventing infection. Henoch-Schönlein purpura is an autoimmune vasculitis (immunoglobulin A vasculitis). Historically, vaccines have been administered primarily to children, and Henoch-Schönlein purpura has often been reported in children following vaccination. However, since the start of COVID-19 vaccination, an increasing number of cases have been reported in adults. Here, we report a case of a patient who developed hematuria and proteinuria after receiving the messenger RNA COVID-19 vaccine. A 22-year-old man presented to the hospital with a lower extremity rash, bilateral ankle pain, and abdominal pain 18 days after receiving the COVID-19 vaccine. The man had no significant medical history and was not taking any medications. Laboratory tests showed normal platelet counts but elevated white blood cell counts and C-reactive protein and fibrinogen levels. He was treated with the non-steroidal anti-inflammatory drugs, pheniramine and prednisolone. At 40 days after starting treatment, C-reactive protein levels were within normal limits, and no hematuria was observed. Treatment was terminated when the purpura disappeared. This report is intended to highlight the need for further research to be proactive and carefully monitor for conditions associated with the COVID-19 vaccine.
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Affiliation(s)
- Mi-Ok Lee
- Department of Infectious Disease Control, Ulsan Metropolitan City Hall, Ulsan, Korea
| | - Seok-Ju Yoo
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
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212
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Taniguchi T. Immune complex-mediated glomerulonephritis with ANCA positivity: what should nephrologists consider? CEN Case Rep 2024; 13:141-142. [PMID: 37442878 PMCID: PMC10982163 DOI: 10.1007/s13730-023-00808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Tomoki Taniguchi
- Department of Rheumatology and Clinical Immunology, Kyoto University, Shogoin Kawaracho, 54, Shogoin Kawaracho, Sakyo Ward, Kyoto, 606-8507, Japan.
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213
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Rodrigues Alves Barbosa V, Maroilley T, Diao C, Colvin-James L, Perrier R, Tarailo-Graovac M. Single variant, yet "double trouble": TSC and KBG syndrome because of a large de novo inversion. Life Sci Alliance 2024; 7:e202302115. [PMID: 38253421 PMCID: PMC10803213 DOI: 10.26508/lsa.202302115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the advances in high-throughput sequencing, many rare disease patients remain undiagnosed. In particular, the patients with well-defined clinical phenotypes and established clinical diagnosis, yet missing or partial genetic diagnosis, may hold a clue to more complex genetic mechanisms of a disease that could be missed by available clinical tests. Here, we report a patient with a clinical diagnosis of Tuberous sclerosis, combined with unusual secondary features, but negative clinical tests including TSC1 and TSC2 Short-read whole-genome sequencing combined with advanced bioinformatics analyses were successful in uncovering a de novo pericentric 87-Mb inversion with breakpoints in TSC2 and ANKRD11, which explains the TSC clinical diagnosis, and confirms a second underlying monogenic disorder, KBG syndrome. Our findings illustrate how complex variants, such as large inversions, may be missed by clinical tests and further highlight the importance of well-defined clinical diagnoses in uncovering complex molecular mechanisms of a disease, such as complex variants and "double trouble" effects.
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Affiliation(s)
- Victoria Rodrigues Alves Barbosa
- https://ror.org/03yjb2x39 Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Tatiana Maroilley
- https://ror.org/03yjb2x39 Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Catherine Diao
- https://ror.org/03yjb2x39 Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Leslie Colvin-James
- https://ror.org/03yjb2x39 Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Renee Perrier
- https://ror.org/03yjb2x39 Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Maja Tarailo-Graovac
- https://ror.org/03yjb2x39 Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- https://ror.org/03yjb2x39 Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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214
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Suetsugu R, Sakuma H, Maruyama K, Matsuki M, Ogawa Y, Nakagawa N. Successful treatment of coexisting membranous nephropathy and immune thrombocytopenia by eradicating gastric Helicobacter pylori infection: a case report. CEN Case Rep 2024; 13:98-103. [PMID: 37421572 PMCID: PMC10982251 DOI: 10.1007/s13730-023-00805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome in middle-aged and older adults. MN etiology is mainly primary or idiopathic; however, it may also be secondary to infections, drugs, neoplasms, and autoimmune diseases. We present the case of a 52-year-old Japanese man with coexisting nephrotic MN and immune thrombocytopenic purpura (ITP). Renal biopsy revealed glomerular basement membrane thickening with immunoglobulin (Ig) G and complement component 3 deposition. Glomerular IgG subclass analysis revealed predominant IgG4 deposition with weak IgG1 and IgG2 deposition. IgG3 and phospholipase A2 receptor deposits were negative. Upper endoscopy revealed no ulcers, but histological examination demonstrated Helicobacter pylori infection in the gastric mucosa with elevated IgG antibodies. After gastric Helicobacter pylori eradication, the nephrotic-range proteinuria and thrombocytopenia of the patient were markedly improved without initiation of immunosuppressive treatment. Therefore, clinicians should consider the possibility of Helicobacter pylori infection in patients with coexisting MN and ITP. Further studies are required to demonstrate the associated pathophysiological aspects.
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Affiliation(s)
- Reina Suetsugu
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Hirofumi Sakuma
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Keisuke Maruyama
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Motoki Matsuki
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan.
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215
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Dima D, Khouri J. The role of therapeutic plasma exchange in plasma cell disorders. Ann Hematol 2024:10.1007/s00277-024-05712-0. [PMID: 38558184 DOI: 10.1007/s00277-024-05712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Therapeutic plasma exchange (TPE) is an extracorporeal technique where patient's plasma containing pathogenic substances is separated and removed from the whole blood, while the cellular component is returned to the patient mixed with replacement solution via an apheresis machine. Due to its ability to remove pathogenic substances from plasma including immunoglobulins, TPE has proven efficacious in the management of various disorders across different medical disciplines, including plasma cell dyscrasias, which are characterized by the abundant secretion of non-functional immunoglobulins produced by an abnormally proliferating plasma cell clone. This review summarizes the current indications of TPE in plasma cell-related disorders and discusses its application, safety, and therapeutic effects.
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Affiliation(s)
- Danai Dima
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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216
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Suzuki Y, Kuriyama A. Prolonged suppressive antibiotic therapy for inferior vena cava filter infection following emphysematous pyelonephritis and cystitis: a case report. Ann Med Surg (Lond) 2024; 86:2176-2180. [PMID: 38576969 PMCID: PMC10990323 DOI: 10.1097/ms9.0000000000001886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Infections of inferior vena cava (IVC) filters are rare. The authors present a case of IVC filter infection following concurrent emphysematous urinary tract infections that was finally treated with prolonged suppressive antibiotic therapy (PSAT). Case presentation A 68-year-old man with pemphigoid and type 2 diabetes mellitus, who had undergone IVC filter placement, was transferred with decreased consciousness, respiratory failure, and hypotension. Computed tomography revealed gas in the left renal parenchyma and bladder wall, suggesting a diagnosis of concurrent emphysematous pyelonephritis and cystitis. While blood and urine cultures were positive for extended-spectrum beta-lactamase-producing Escherichia coli, and the patient's general condition improved with proper antibiotic therapy, bacteremia persisted until day 10 from symptom onset. After ruling out abscesses and infectious endocarditis, the cause of persistent bacteremia was suspected to be IVC filter infection. As the IVC had been placed 12 years before, the authors did not remove it to avoid complications. PSAT with sulfamethoxazole-trimethoprim was continued after 6 weeks of intravenous antibiotic therapy. The patient had an uneventful course over the year following hospital discharge. Clinical discussion PSAT is considered for device-related infections in patients with cardiac assist devices and artificial joints when the infection flares up or recurs even after antibiotic treatment of an adequate duration. There is no consensus regarding the optimal duration of antimicrobial therapy for IVC filter infections. Conclusion Infections of implanted devices, such as IVC filters, secondary to severe infections can cause persistent bacteremia. PSAT may be an alternative option to treat IVC filter infection, when the IVC filter is considered difficult to remove.
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Affiliation(s)
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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217
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Yu B, Atta MG, Brennan DC, Kant S. Outcomes and management of kidney transplant recipients with Fabry disease: a review. J Nephrol 2024; 37:561-571. [PMID: 38227277 DOI: 10.1007/s40620-023-01853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024]
Abstract
Fabry disease is an X-linked inheritable lysosomal storage disease caused by various mutations of the galactosidase α gene resulting in α-galactosidase deficiency. Chronic kidney disease (CKD) is one of the most significant consequences of Fabry disease, with risk of end-stage kidney disease (ESKD) in this population. Like for other patients with ESKD, kidney transplant is the optimal treatment for Fabry disease patients with ESKD. However, enzyme replacement therapy and newer Fabry disease treatments remain important to mitigate other end organ damage such as cardiomyopathy post transplantation. This review is a primer on Fabry disease, which examines the outcomes of disease in the context of kidney transplant prior to, and during, the enzyme replacement treatment era, medical treatment of kidney transplant recipients with Fabry disease, and progress in screening studies.
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Affiliation(s)
- Bo Yu
- Department of Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD, USA
| | - Mohamed G Atta
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel C Brennan
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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218
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Akar HT, Yıldız Y, Mutluay R, Tekin E, Tokatlı A. Adult-onset carnitine palmitoyl transferase II (CPT II) deficiency presenting with rhabdomyolysis and acute kidney injury. CEN Case Rep 2024; 13:81-85. [PMID: 37341884 PMCID: PMC10982194 DOI: 10.1007/s13730-023-00804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023] Open
Abstract
Metabolic myopathies are among the treatable causes of rhabdomyolysis and myoglobinuria. Carnitine palmitoyl transferase 2 (CPT II) deficiency is one of the most common causes of recurrent myoglobinuria in adults. It is an inherited disorder of fatty acid oxidation pathway, commonly associated with elevated acylcarnitine levels. In this case report, we present a 49-year-old male patient who developed acute kidney injury after rhabdomyolysis and was thus diagnosed with CPT2 deficiency after his first episode of rhabdomyolysis. Inborn errors of metabolism should be kept in mind in patients with rhabdomyolysis. Acylcarnitine profile may be normal in CPT II deficiency, even during an acute attack, and molecular genetic diagnostics should be applied if there is high index of clinical suspicion.
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Affiliation(s)
- Halil Tuna Akar
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Yılmaz Yıldız
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rüya Mutluay
- Department of Internal Medicine, Nephrology Unit, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Emel Tekin
- Department of Pathology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ayşegül Tokatlı
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
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219
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Yano S, Uematsu S, Kunimune N, Harima T, Yoshida Y, Takahashi S, Ito M, Sakamoto H, Nishizaka Y. PD-L1-negative Non-small-cell Lung Cancer Treated with Nivolumab Plus Ipilimumab during Maintenance Hemodialysis Results in Rapid Initial Progression Followed by a Long-lasting Response. Intern Med 2024; 63:985-988. [PMID: 37558475 PMCID: PMC11045368 DOI: 10.2169/internalmedicine.2270-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/02/2023] [Indexed: 08/11/2023] Open
Abstract
Nivolumab plus ipilimumab is one of the first-line treatments for advanced non-small-cell lung cancer (NSCLC), but the safety and efficacy in patients on hemodialysis (HD) is unclear. We herein report a patient with NSCLC on HD in whom nivolumab and ipilimumab were initiated. We observed general deterioration and enlarged lesions, followed by a long-term response. The patient developed secondary hypoadrenocorticism, an immune-related adverse event that was easily controlled. Nivolumab plus ipilimumab can be used safely for patients with NSCLC on HD. Long-term effectiveness can be observed after initial progression, so we should carefully assess the response.
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Affiliation(s)
- Shohei Yano
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Shinya Uematsu
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Naohiro Kunimune
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Tomoko Harima
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Yuki Yoshida
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Shota Takahashi
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Masahiro Ito
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Hiroto Sakamoto
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Yasuo Nishizaka
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
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220
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Isogai E, Iwazu Y, Akimoto T, Kuro-O M, Niki T, Nagata D. A case of paraneoplastic IgA nephropathy with glomerular capillary IgA and galactose-deficient IgA1 deposition. CEN Case Rep 2024; 13:104-109. [PMID: 37434086 PMCID: PMC10982149 DOI: 10.1007/s13730-023-00807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
Paraneoplastic IgA nephropathy (IgAN) is an underrecognized condition in which malignancy manifests as symptoms of IgAN, and it remains controversial regarding their mechanistic relation between IgAN and malignancy. Herein, we report a case of a 68-year-old Japanese man with glottic cancer who developed nephrotic syndrome as a clinical manifestation of IgAN. Renal biopsy revealed diffuse proliferative glomerulonephritis with glomerular capillary IgA deposition that is a rare subtype of IgAN. After complete remission of the glottic cancer by irradiation, proteinuria and hematuria disappeared. Based on his clinical course, we diagnosed paraneoplastic IgAN. Therefore, we should consider the possibility that IgAN with glomerular capillary IgA deposition might be paraneoplastic glomerulopathy especially before initiating immunosuppressive therapy. The patient thereafter developed prostate cancer and hepatocellular cancer, but IgAN did not recur. The association of IgAN specifically with the glottic cancer in this triple-cancer patient may suggest a potential link between IgAN and mucosal cancer. Because galactose-deficient IgA1 (Gd-IgA1) was observed in the similar pattern as IgA, Gd-IgA1 also may play an important role in the pathogenesis of paraneoplastic IgAN.
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Affiliation(s)
- Erika Isogai
- Division of Anti-Ageing Medicine, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoshitaka Iwazu
- Division of Anti-Ageing Medicine, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Makoto Kuro-O
- Division of Anti-Ageing Medicine, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Toshiro Niki
- Department of Integrative Pathology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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221
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Bembenick KN, Mathew J, Heisler M, Siddaiah H, Moore P, Robinson CL, Kaye AM, Shekoohi S, Kaye AD, Varrassi G. Hyponatremia With Anticonvulsant Medications: A Narrative Review. Cureus 2024; 16:e57535. [PMID: 38707045 PMCID: PMC11066697 DOI: 10.7759/cureus.57535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Hyponatremia is an adverse effect of many antiseizure medications (ASMs). It occurs with interference with the normal balance of electrolytes within the body. Various risk factors associated with the development of hyponatremia in patients taking these medications include age, gender, dosage, and combinations with other drugs. ASMs such as carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid have a higher risk of hyponatremia. Hyponatremia induced by an antiseizure medication can occur through various mechanisms depending on the drug's specific mechanism of action. Hyponatremia can be a potentially fatal side effect. Patients taking these medications need to be monitored closely for the signs and symptoms of hyponatremia. Acute hyponatremia, defined as developing in <48 hours, is more likely to show symptoms than chronic hyponatremia. Signs of acute hyponatremia include delirium, seizures, decerebrate posturing, and cerebral edema with uncal herniation. Chronic hyponatremia, defined as developing in >48 hours, can cause lethargy, dizziness, weakness, headache, nausea, and confusion. Hyponatremia is associated with longer hospital stays and increased mortality. Treatment varies based on the degree of severity of hyponatremia. Choosing a treatment option should include consideration of the drug causing the electrolyte disturbance, the patient's risk factor profile, and the severity of symptoms as they present in the individual patient. Healthcare providers should be aware of hyponatremia as a potential side effect of ASMs, the signs and symptoms of hyponatremia, the different treatment options available, and the potential complications associated with rapid correction of hyponatremia.
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Affiliation(s)
| | - Jibin Mathew
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Michael Heisler
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Harish Siddaiah
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Peyton Moore
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences University of the Pacific, Stockton, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Komatsumoto M, Nakazawa D, Endo T, Nishio S, Kawamura T, Miyoshi-Harashima A, Takenaka S, Shiratori-Aso S, Kurotori M, Matsuoka N, Atsumi T. Successful initiation of hemodialysis for a hemophilia A patient with factor VIII inhibitor: a case report and literature review. CEN Case Rep 2024; 13:117-120. [PMID: 37490239 PMCID: PMC10982231 DOI: 10.1007/s13730-023-00811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
We report the first case of hemophilia A with factor VIII (FVIII) inhibitor who received hemodialysis via an arteriovenous (AV) fistula. Hemophilia A is a congenital deficiency of blood coagulation FVIII that is characterized by prolonged bleeding. Approximately 30% of patients with hemophilia develop allogeneic antibodies of FVIII. The inhibitors decrease the hemostatic effect of replacement therapy; thus, the prophylaxis strategy should be well designed. Prophylactic treatment with invasive procedures is needed to prevent excessive bleeding in patients with hemophilia undergoing hemodialysis. On the contrary, hemodialysis requires attention to the development of intracircuit coagulation during dialysis. Peritoneal dialysis or hemodialysis with a long-term tunneled central venous catheter has mainly been selected as the dialysis modality for patients with hemophilia and end-stage renal disease requiring renal replacement therapy because hemodialysis with an arteriovenous fistula may result in bleeding from the puncture site after each hemodialysis session. In our patient, hemodialysis was safely performed without any anticoagulant agents, and replacement therapy with FVIII concentrates prevented bleeding after puncture of the AV fistula.
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Affiliation(s)
- Maki Komatsumoto
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Daigo Nakazawa
- Department of Rheumatology, Nephrology and Endocrinology, Faculty of Medicine, Hokkaido University, Kita 14, Nishi 5, Kita-Ku, Sapporo, 060-8648, Japan.
| | - Tomoyuki Endo
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Saori Nishio
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Takuro Kawamura
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Shun Takenaka
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Satoka Shiratori-Aso
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Michiko Kurotori
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Naoko Matsuoka
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology and Nephrology, Hokkaido University Hospital, Sapporo, Japan
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Ford CL, McDonough AA, Horie K, Young LJ. Melanocortin agonism in a social context selectively activates nucleus accumbens in an oxytocin-dependent manner. Neuropharmacology 2024; 247:109848. [PMID: 38253222 PMCID: PMC10923148 DOI: 10.1016/j.neuropharm.2024.109848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 10/18/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
Social deficits are debilitating features of many psychiatric disorders, including autism. While time-intensive behavioral therapy is moderately effective, there are no pharmacological interventions for social deficits in autism. Many studies have attempted to treat social deficits using the neuropeptide oxytocin for its powerful neuromodulatory abilities and influence on social behaviors and cognition. However, clinical trials utilizing supplementation paradigms in which exogenous oxytocin is chronically administered independent of context have failed. An alternative treatment paradigm suggests pharmacologically activating the endogenous oxytocin system during behavioral therapy to enhance the efficacy of therapy by facilitating social learning. To this end, melanocortin receptor agonists like Melanotan II (MTII), which induces central oxytocin release and accelerates formation of partner preference, a form of social learning, in prairie voles, are promising pharmacological tools. To model pharmacological activation of the endogenous oxytocin system during behavioral therapy, we administered MTII prior to social interactions between male and female voles. We assessed its effect on oxytocin-dependent activity in brain regions subserving social learning using Fos expression as a proxy for neuronal activation. In non-social contexts, MTII only activated hypothalamic paraventricular nucleus, a primary site of oxytocin synthesis. However, during social interactions, MTII selectively increased oxytocin-dependent activation of nucleus accumbens, a site critical for social learning. These results suggest a mechanism for the MTII-induced acceleration of partner preference formation observed in previous studies. Moreover, they are consistent with the hypothesis that pharmacologically activating the endogenous oxytocin system with a melanocortin agonist during behavioral therapy has potential to facilitate social learning.
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Affiliation(s)
- Charles L Ford
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA.
| | - Anna A McDonough
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA
| | - Kengo Horie
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA
| | - Larry J Young
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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224
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Tomlinson JW. Bardet-Biedl syndrome: A focus on genetics, mechanisms and metabolic dysfunction. Diabetes Obes Metab 2024; 26 Suppl 2:13-24. [PMID: 38302651 DOI: 10.1111/dom.15480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
Bardet-Biedl syndrome (BBS) is a rare, monogenic, multisystem disorder characterized by retinal dystrophy, renal abnormalities, polydactyly, learning disabilities, as well as metabolic dysfunction, including obesity and an increased risk of type 2 diabetes. It is a primary ciliopathy, and causative mutations in more than 25 different genes have been described. Multiple cellular mechanisms contribute to the development of the metabolic phenotype associated with BBS, including hyperphagia as a consequence of altered hypothalamic appetite signalling as well as alterations in adipocyte biology promoting adipocyte proliferation and adipogenesis. Within this review, we describe in detail the metabolic phenotype associated with BBS and discuss the mechanisms that drive its evolution. In addition, we review current approaches to the metabolic management of patients with BBS, including the use of weight loss medications and bariatric surgery. Finally, we evaluate the potential of targeting hypothalamic appetite signalling to limit hyperphagia and induce clinically significant weight loss.
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Affiliation(s)
- Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK
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225
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Muhammad A, Zhang Y, Huang L, Yuan Q, Wang W, Pu J, Lin W, Tang R, Xiao X. The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review. Clin Kidney J 2024; 17:sfae054. [PMID: 38572500 PMCID: PMC10986214 DOI: 10.1093/ckj/sfae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Indexed: 04/05/2024] Open
Abstract
Acute interstitial nephritis (AIN) is a significant contributor to acute kidney injury and can be attributed to a variety of factors, including but not limited to allergens or drugs, infections, autoimmune or systemic diseases, and idiopathic forms of the disease. In some cases, AIN requires a therapeutic action according to a single specific etiology by handling the offending agent and applying an immunosuppressant. Although AIN can be diagnosed through renal biopsy, it is not able to pinpoint the precise cause when multiple causes are suspected to be present simultaneously. Such situations arise when a patient suffering from infection develops AIN during antibiotic therapy, the exact causative factor of which becomes a challenge for the clinicians to determine. This is attributed to the different approaches employed in different etiologies, wherein clinicians are required to maintain the current antibiotic therapy or augment the dose in cases of infection as AIN etiology, without resorting to immunosuppressant therapy as the primary objective is infection killing. In contrast, antibiotics as an etiology for AIN require an alternative drug from the antibiotics group, along with an immunosuppressant. In the interim, delaying the identification of the precise cause may result in interstitial fibrosis and chronic kidney disease. This narrative review highlights certain findings that can be typical of infection-associated ATIN compared with antibiotic-associated ATIN based on clinical history and physical examination, clinical presentation of different antibiotic drug classes, histopathological features, classical and novel biomarkers, serum and urine cytokines and chemokines, cellular biomarkers, and genetic biomarkers. Although these findings cannot provide conclusive and clear recommendations that can be useful in the clinical practice, they can entice researchers to conduct original research on these features to discover clear recommendations.
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Affiliation(s)
- Amir Muhammad
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Yingli Zhang
- Department of Nephrology, Third Hospital of Changsha, Changsha, China
| | - Ling Huang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiongjing Yuan
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Wang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaxi Pu
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Rong Tang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
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Parodi E, Rossi M, Bottiglieri A, Ladetto M, Merlotti G, Cantaluppi V, Quaglia M. Pharmacotherapy considerations in patients who develop acute kidney injury during anti-cancer therapy. Expert Opin Pharmacother 2024; 25:595-610. [PMID: 38646905 DOI: 10.1080/14656566.2024.2346268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) frequently develops in patients receiving cancer therapy and requires a wide differential diagnosis due to possible role of unique cancer and drug-related factors, in addition to common pre- and post-renal causes. Rapid development of new molecular targeted anti-cancer drugs and immunotherapies has opened unprecedented possibilities of treatment at the price of an increased spectrum of renal side effects. AREAS COVERED The present review aims at providing a state-of-the-art picture of AKI in cancer patient (PubMed and Embase libraries were searched from inception to January 2024), with a focus on differential diagnosis and management of diverse clinical settings. Reports of parenchymal AKI due to glomerular, microvascular, tubular and interstitial damage have been constantly increasing. Complex electrolyte and acid-base disorders can coexist. The role of renal biopsy and possible therapeutic approaches are also discussed. EXPERT OPINION Onconephrology has become an important subspecialty of clinical nephrology, requiring constantly updated skills and a high degree of interdisciplinary integration to tackle diagnostic challenges and even therapeutic and ethical dilemmas. Integrated onconephrological guidelines and availability of biomarkers may provide new tools for management of this unique type of patients in the near future.
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Affiliation(s)
- Emanuele Parodi
- Nephrology and Dialysis Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Maura Rossi
- Oncology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Achille Bottiglieri
- Oncology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Marco Ladetto
- Hematology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
| | - Guido Merlotti
- Department of Primary Care, "Azienda Socio Sanitaria Territoriale (ASST) of Pavia", Pavia, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
- Nephrology and Renal Transplant Unit, "Maggiore della Carita" University Hospital, Novara, Italy
| | - Marco Quaglia
- Nephrology and Dialysis Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
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227
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Gefen AM, Zaritsky JJ. Review of childhood genetic nephrolithiasis and nephrocalcinosis. Front Genet 2024; 15:1381174. [PMID: 38606357 PMCID: PMC11007102 DOI: 10.3389/fgene.2024.1381174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
Nephrolithiasis (NL) is a common condition worldwide. The incidence of NL and nephrocalcinosis (NC) has been increasing, along with their associated morbidity and economic burden. The etiology of NL and NC is multifactorial and includes both environmental components and genetic components, with multiple studies showing high heritability. Causative gene variants have been detected in up to 32% of children with NL and NC. Children with NL and NC are genotypically heterogenous, but often phenotypically relatively homogenous, and there are subsequently little data on the predictors of genetic childhood NL and NC. Most genetic diseases associated with NL and NC are secondary to hypercalciuria, including those secondary to hypercalcemia, renal phosphate wasting, renal magnesium wasting, distal renal tubular acidosis (RTA), proximal tubulopathies, mixed or variable tubulopathies, Bartter syndrome, hyperaldosteronism and pseudohyperaldosteronism, and hyperparathyroidism and hypoparathyroidism. The remaining minority of genetic diseases associated with NL and NC are secondary to hyperoxaluria, cystinuria, hyperuricosuria, xanthinuria, other metabolic disorders, and multifactorial etiologies. Genome-wide association studies (GWAS) in adults have identified multiple polygenic traits associated with NL and NC, often involving genes that are involved in calcium, phosphorus, magnesium, and vitamin D homeostasis. Compared to adults, there is a relative paucity of studies in children with NL and NC. This review aims to focus on the genetic component of NL and NC in children.
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Affiliation(s)
- Ashley M. Gefen
- Phoenix Children’s Hospital, Department of Pediatrics, Division of Nephrology, Phoenix, AZ, United States
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228
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Goto S, Hamano T, Fujii H, Taniguchi M, Abe M, Nitta K, Nishi S. Hypocalcemia and cardiovascular mortality in cinacalcet users. Nephrol Dial Transplant 2024; 39:637-647. [PMID: 37777840 DOI: 10.1093/ndt/gfad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Calcimimetics are widely used in hemodialysis patients and influence serum calcium levels. Although the Kidney Disease: Improving Global Outcomes guidelines argued that low calcium levels induced by calcimimetics may be harmless, large observational studies investigating the association between hypocalcemia and mortality are scarce. We investigated the association between serum calcium levels and cardiovascular mortality in calcimimetics users using the nationwide Japanese registry for dialysis patients. METHODS In this 9-year prospective cohort study, the baseline data were collected at the end of 2009. We enrolled patients on maintenance hemodialysis or hemodiafiltration. We employed three models (baseline, time-dependent and time-averaged) to conduct Cox proportional hazard regression analyses. RESULTS Cinacalcet was prescribed to 12.7% (N = 22 853) at baseline. The median observation period was 98 (interquartile range 40-108) months and 108 (interquartile range 59-108) months in the whole cohort (N = 180 136) and in cinacalcet users, respectively. Three-quarters of survivors at the end of 2019 had continued calcimimetic therapy for 10 years, corresponding to a mean annual dropout rate of 2.9%. Hypocalcemia was not associated with cardiovascular mortality in the baseline or time-averaged model. In the time-dependent model, however, the lowest calcium decile (corrected calcium <8.4 mg/dL) was significantly associated with higher cardiovascular mortality than the reference (corrected calcium 8.7-8.9 mg/dL) in both cinacalcet users and all patients [hazard ratio (95% confidence interval) 1.32 (1.00, 1.75) and 1.15 (1.05, 1.26), respectively]. Hypocalcemia was especially associated with sudden death and death due to hemorrhagic stroke, heart failure and ischemic heart disease. Higher rate of fatal and non-fatal cardiovascular events was observed in hypocalcemic patients regardless of cinacalcet usage. CONCLUSIONS Our findings suggest that transient hypocalcemia was associated with an increased risk of cardiovascular death independent of cinacalcet usage. We should pay attention to hypocalcemia transiently induced by cinacalcet.
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Affiliation(s)
- Shunsuke Goto
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masatomo Taniguchi
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Fukuoka Renal Clinic, Fukuoka, Japan
| | - Masanori Abe
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kosaku Nitta
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
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Uddin MS, Alradhi AY, Alqathani FMN, Alessa OS, Alshammari ANM, Tripathy R, Alomari MA. A Rare Case of Neonatal Hypomagnesemia with Secondary Hypocalcemia Caused by a Novel Homozygous TRPM6 Gene Variant. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942498. [PMID: 38528672 PMCID: PMC10985420 DOI: 10.12659/ajcr.942498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/22/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Familial hypomagnesemia with secondary hypocalcemia (HSH) is a rare autosomal recessive disorder (OMIM# 602014) caused by mutations in the gene encoding transient receptor potential melastatin 6 (TRPM6)) on chromosome 9q22, a channel involved in epithelial magnesium resorption. While a plethora of studies have delineated various clinical manifestations pertinent to this mutation, the literature is devoid of connections between TRPM6 mutations and bleeding diathesis, or sudden infant death syndrome (SIDS). This report presents a case of familial HSH associated with the novel homozygous TRPM6 gene variant c.5281C>G p. (Arg1761Gly) chr9: 77354845. CASE REPORT This report details a 26-day-old neonate, born full term with optimal Apgar scores, who experienced an abrupt emergence of apnea, cyanosis, bilateral nasal bleeding, and diminished alertness. Despite the neonate's initially unremarkable clinical birth indicators, a meticulous assessment unveiled a pronounced family history of SIDS, including a sibling previously diagnosed with hypomagnesemia. Laboratory examination of the infant demonstrated severe hypomagnesemia and hypocalcemia, conditions which were promptly ameliorated following intravenous administration of magnesium and calcium. Whole-exome sequencing identified a homozygous TRPM6 gene mutation c.5281C>G p. (Arg1761Gly) at chr9: 77354845. This gene is crucial for magnesium regulation. The mutation involves a cytosine-to-guanine shift, resulting in an arginine to glycine amino acid substitution at position 1761 of the TRPM6 protein. CONCLUSIONS This report has highlighted that infantile hypomagnesemia may be associated with symptoms and signs that can mimic infection, or it can present with seizures. Although familial HSH is a rare genetic disorder that can be identified by genetic testing, correction of hypomagnesemia is the most important and immediate clinical management strategy.
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Affiliation(s)
- Mohammed Shahab Uddin
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
| | - AlZahra Y. Alradhi
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
| | | | - Othman Saleh Alessa
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
| | | | - Ratna Tripathy
- Department of Human Genetics, Bioscientia Institute for Medical Diagnostics GmbH, Ingelheim, Germany
| | - Mohammed Ahmed Alomari
- Department of Pediatrics, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia
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230
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Jandeleit-Dahm KAM, Kankanamalage HR, Dai A, Meister J, Lopez-Trevino S, Cooper ME, Touyz RM, Kennedy CRJ, Jha JC. Endothelial NOX5 Obliterates the Reno-Protective Effect of Nox4 Deletion by Promoting Renal Fibrosis via Activation of EMT and ROS-Sensitive Pathways in Diabetes. Antioxidants (Basel) 2024; 13:396. [PMID: 38671844 PMCID: PMC11047703 DOI: 10.3390/antiox13040396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic hyperglycemia induces intrarenal oxidative stress due to the excessive production of reactive oxygen species (ROS), leading to a cascade of events that contribute to the development and progression of diabetic kidney disease (DKD). NOX5, a pro-oxidant NADPH oxidase isoform, has been identified as a significant contributor to renal ROS in humans. Elevated levels of renal ROS contribute to endothelial cell dysfunction and associated inflammation, causing increased endothelial permeability, which can disrupt the renal ecosystem, leading to progressive albuminuria and renal fibrosis in DKD. This study specifically examines the contribution of endothelial cell-specific human NOX5 expression in renal pathology in a transgenic mouse model of DKD. This study additionally compares NOX5 with the previously characterized NADPH oxidase, NOX4, in terms of their relative roles in DKD. Regardless of NOX4 pathway, this study found that endothelial cell-specific expression of NOX5 exacerbates renal injury, albuminuria and fibrosis. This is attributed to the activation of the endothelial mesenchymal transition (EMT) pathway via enhanced ROS formation and the modulation of redox-sensitive factors. These findings underscore the potential therapeutic significance of NOX5 inhibition in human DKD. The study proposes that inhibiting NOX5 could be a promising approach for mitigating the progression of DKD and strengthens the case for the development of NOX5-specific inhibitors as a potential therapeutic intervention.
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Affiliation(s)
- Karin A. M. Jandeleit-Dahm
- Department of Diabetes, School of Translational Medicine, Monash University, Alfred Medical Research & Education Precinct, Melbourne, VIC 3004, Australia; (K.A.M.J.-D.); (S.L.-T.); (M.E.C.)
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany;
| | - Haritha R. Kankanamalage
- Department of Diabetes, School of Translational Medicine, Monash University, Alfred Medical Research & Education Precinct, Melbourne, VIC 3004, Australia; (K.A.M.J.-D.); (S.L.-T.); (M.E.C.)
| | - Aozhi Dai
- Department of Diabetes, School of Translational Medicine, Monash University, Alfred Medical Research & Education Precinct, Melbourne, VIC 3004, Australia; (K.A.M.J.-D.); (S.L.-T.); (M.E.C.)
| | - Jaroslawna Meister
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany;
| | - Sara Lopez-Trevino
- Department of Diabetes, School of Translational Medicine, Monash University, Alfred Medical Research & Education Precinct, Melbourne, VIC 3004, Australia; (K.A.M.J.-D.); (S.L.-T.); (M.E.C.)
| | - Mark E. Cooper
- Department of Diabetes, School of Translational Medicine, Monash University, Alfred Medical Research & Education Precinct, Melbourne, VIC 3004, Australia; (K.A.M.J.-D.); (S.L.-T.); (M.E.C.)
| | - Rhian M. Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H3H 2R9, Canada;
| | - Christopher R. J. Kennedy
- Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada;
| | - Jay C. Jha
- Department of Diabetes, School of Translational Medicine, Monash University, Alfred Medical Research & Education Precinct, Melbourne, VIC 3004, Australia; (K.A.M.J.-D.); (S.L.-T.); (M.E.C.)
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Andeen NK, Kung VL, Avasare RS. NELL1 membranous nephropathy: clinical associations provide mechanistic clues. FRONTIERS IN NEPHROLOGY 2024; 4:1323432. [PMID: 38596642 PMCID: PMC11002321 DOI: 10.3389/fneph.2024.1323432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
Neural epidermal growth factor-like 1 (NELL1) membranous nephropathy (MN) is notable for its segmental deposit distribution, IgG1 dominant deposits, and comparatively high rate of spontaneous remission. It has been associated with a variety of exposures and secondary conditions, specifically use of thiol-containing medications - including lipoic acid, bucillamine, and tiopronin - as well as traditional indigenous medications (TIM) particularly those with high mercury content, and non-steroid anti-inflammatory drugs (NSAIDs). Malignancies, graft vs. host disease (GVHD), infection, and autoimmune conditions have also been associated with NELL1 MN. Herein, we provide a detailed summary of the clinicopathologic features of NELL1 and associations with underlying conditions, with a focus on treatment and outcomes. Rare cases of dual NELL1 and phospholipase A2 receptor (PLA2R) positive MN are reviewed. Genome-wide association study of NELL1, role of NELL1 in other physiologic and pathologic processes, and connection between NELL1 MN and malignancy with relevance of NELL1 tumor staining are examined. Finally, relationships and potential disease mechanisms of thiol- and mercury- associated NELL1 MN are discussed.
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Affiliation(s)
- Nicole K. Andeen
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Vanderlene L. Kung
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Rupali S. Avasare
- Department of Medicine, Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, OR, United States
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232
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Gonçalves PL, Diniz H, Tavares I, Dória S, Dong J, Kyriss M, Fairbanks L, Oliveira JP. Kidney Failure Secondary to Hereditary Xanthinuria due to a Homozygous Deletion of the XDH Gene in the Absence of Overt Kidney Stone Disease. Nephron Clin Pract 2024; 148:578-583. [PMID: 38527446 DOI: 10.1159/000536248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/08/2024] [Indexed: 03/27/2024] Open
Abstract
Hereditary xanthinuria (HXAN) is a rare metabolic disorder that results from mutations in either the xanthine dehydrogenase (XDH) or the molybdenum cofactor sulfurase genes (MOCOS), respectively defining HXAN type I and type II. Hypouricemia, hypouricosuria, and abnormally high plasma and urine levels of xanthine, causing susceptibility to xanthine nephrolithiasis and deposition of xanthine crystals in tissues, are the metabolic hallmarks of HXAN. Several pathogenic variants in the XDH gene have so far been identified in patients with HXAN type I, but the clinical phenotype associated with the whole deletion of the human XDH gene is unknown. Herein, we report the case of a woman diagnosed with HXAN, whose molecular genetic testing revealed a homozygous microdeletion involving the XDH gene. Distinctive features of her medical history were the diagnosis of arterial hypertension and microalbuminuria at 22 years of age; a single pregnancy at the age of 25, complicated by proteinuria and transient kidney function deterioration in the third trimester; unexplained severe hypouricemia incidentally discovered during pregnancy; inability to breastfeed her newborn daughter due to primary agalactia; chronic kidney disease (CKD) stage 3 diagnosed at age 35; and progression to end-stage kidney disease over the next 12 years. Protocol noninvasive laboratory and imaging investigation was not informative as to the cause of CKD. This is the first description of the clinical phenotype associated with a natural knockout of the human XDH gene. Despite the lack of kidney histopathology data, the striking similarities with the phenotypes exhibited by comparable murine models validate the latter as useful sources of mechanistic insights for the pathogenesis of the human disease, supporting the hypothesis that the absence of xanthine dehydrogenase activity might represent a susceptibility factor for chronic tubulointerstitial nephritis, even in patients without kidney stones.
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Affiliation(s)
| | - Hugo Diniz
- Department of Nephrology, São João University Hospital Centre, Porto, Portugal
| | - Isabel Tavares
- Department of Nephrology, São João University Hospital Centre, Porto, Portugal
- Group of Research and Development in Nephrology and Infectious Diseases, i3S - Institute for Health Research and Innovation, University of Porto, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sofia Dória
- Unit of Genetics, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Juan Dong
- PreventionGenetics, LLC, an Exact Sciences Co., Marshfield, Wisconsin, USA
| | - McKenna Kyriss
- PreventionGenetics, LLC, an Exact Sciences Co., Marshfield, Wisconsin, USA
| | - Lynette Fairbanks
- Purine Research Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - João Paulo Oliveira
- Group of Research and Development in Nephrology and Infectious Diseases, i3S - Institute for Health Research and Innovation, University of Porto, Porto, Portugal
- Unit of Genetics, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Service of Medical Genetics, São João University Hospital Centre, Porto, Portugal
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Reiss AB, Jacob B, Zubair A, Srivastava A, Johnson M, De Leon J. Fibrosis in Chronic Kidney Disease: Pathophysiology and Therapeutic Targets. J Clin Med 2024; 13:1881. [PMID: 38610646 PMCID: PMC11012936 DOI: 10.3390/jcm13071881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Chronic kidney disease (CKD) is a slowly progressive condition characterized by decreased kidney function, tubular injury, oxidative stress, and inflammation. CKD is a leading global health burden that is asymptomatic in early stages but can ultimately cause kidney failure. Its etiology is complex and involves dysregulated signaling pathways that lead to fibrosis. Transforming growth factor (TGF)-β is a central mediator in promoting transdifferentiation of polarized renal tubular epithelial cells into mesenchymal cells, resulting in irreversible kidney injury. While current therapies are limited, the search for more effective diagnostic and treatment modalities is intensive. Although biopsy with histology is the most accurate method of diagnosis and staging, imaging techniques such as diffusion-weighted magnetic resonance imaging and shear wave elastography ultrasound are less invasive ways to stage fibrosis. Current therapies such as renin-angiotensin blockers, mineralocorticoid receptor antagonists, and sodium/glucose cotransporter 2 inhibitors aim to delay progression. Newer antifibrotic agents that suppress the downstream inflammatory mediators involved in the fibrotic process are in clinical trials, and potential therapeutic targets that interfere with TGF-β signaling are being explored. Small interfering RNAs and stem cell-based therapeutics are also being evaluated. Further research and clinical studies are necessary in order to avoid dialysis and kidney transplantation.
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Affiliation(s)
- Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (B.J.); (A.Z.); (A.S.); (M.J.); (J.D.L.)
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Ma X, Pai P, Zhu W, Chen X, Cui L. Positive response of a hemodialysis patient with pure red cell aplasia on recombinant human erythropoietin therapy to cyclosporine and Roxadustat. CEN Case Rep 2024:10.1007/s13730-024-00865-3. [PMID: 38528249 DOI: 10.1007/s13730-024-00865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 03/27/2024] Open
Abstract
Recombinant human erythropoietin (rHuEPO) is commonly used to treat anemia associated with chronic kidney disease (CKD). EPO-induced Pure Red Cell Aplasia (PRCA) is a rare condition of profound anemia with EPO treatment. Upon finding the development of EPO-induced PRCA, the treatment requires immediate withdrawal of EPO therapy and initiate new treatments with immunosuppression or renal transplantation. Anti-EPO antibody assay is not always positive in EPO-induced PRCA. Here, we report a case on the sudden development of PRCA in a hemodialysis patient receiving EPO and how we treated the condition successfully with cyclosporine and subsequently maintained the hemoglobin with Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI). Even though the anti-EPO antibody was negative by Enzyme Linked Immunosorbent Assay (ELISA) in our case, the clinical course, the markedly reduced reticulocyte count < 10,000/μL, the bone marrow (BM) biopsy revealing reduced erythroblasts, and its subsequent response to cyclosporine, were similar to EPO-induced PRCA. The clinical picture of EPO-induced PRCA, the limitation of the EPO-neutralizing antibody (Ab) assay, and treatment strategies were discussed.
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Affiliation(s)
- Xuejuan Ma
- Department of Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- The First Clinical Medical College of Jinan University, Guangzhou, Guangdong, China
| | - Pearl Pai
- Department of Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- Department of Medicine, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China.
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, Guangdong, People's Republic of China.
| | - Wenjuan Zhu
- Department of Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaowei Chen
- Department of Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Liwen Cui
- Department of Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Pethő ÁG, Fülöp T, Orosz P, Tapolyai M. Magnesium Is a Vital Ion in the Body-It Is Time to Consider Its Supplementation on a Routine Basis. Clin Pract 2024; 14:521-535. [PMID: 38525719 PMCID: PMC10961779 DOI: 10.3390/clinpract14020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Abstract
The importance of maintaining proper magnesium intake and total body magnesium content in preserving human health remains underappreciated among medical professionals and laymen. This review aimed to show the importance of hypomagnesemia as a modifiable risk factor for developing disease processes. We searched the PubMed database and Google Scholar using the keywords 'magnesium', 'diabetes', 'cardiovascular disease', 'respiratory disease', 'immune system', 'inflammation', 'autoimmune disease', 'neurology', 'psychiatry', 'cognitive function', 'cancer', and 'vascular calcification'. In multiple contexts of the search terms, all reviews, animal experiments, and human observational data indicated that magnesium deficiency can lead to or contribute to developing many disease states. The conclusions of several in-depth reviews support our working hypothesis that magnesium and its supplementation are often undervalued and underutilized. Although much research has confirmed the importance of proper magnesium supply and tissue levels, simple and inexpensive magnesium supplementation has not yet been sufficiently recognized or promoted.
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Affiliation(s)
- Ákos Géza Pethő
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Tibor Fülöp
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA; (T.F.); (M.T.)
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Petronella Orosz
- Bethesda Children’s Hospital, 1146 Budapest, Hungary;
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Mihály Tapolyai
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA; (T.F.); (M.T.)
- Department of Nephrology, Szent Margit Kórhaz, 1032 Budapest, Hungary
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Hayashi E, Matuura T, Takano J, Morofushi K, Toriizuka K, Onishi H. Thiamine deficiency as a cause of anorexia in terminally ill cancer patients: A case of possible gastrointestinal beriberi. Palliat Support Care 2024:1-3. [PMID: 38504556 DOI: 10.1017/s1478951524000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Anorexia in cancer patients has a variety of causes and impairs patients' quality of life. However, there have been few reports of thiamine deficiency (TD) playing a role in anorexia during palliative care. The objective of this report was to describe such a case. METHODS An 82-year-old woman with advanced cervical cancer was admitted for palliative care because of progressive disease. One month after admission, she developed myoclonus on the left side, difficulty speaking, slurred speech, and drooping of the left corner of the mouth, with no consciousness disturbance. She also developed nausea and complained of decreased dietary intake for more than 2 weeks. RESULTS The patient's thiamine level, which had been measured 2 weeks earlier, was 27 ng/ml, which was below the normal range, and 100 mg of thiamine was administered intravenously. After 2 hours, the patient's neurological findings resolved, and her dietary intake improved from 30% to 40% of meals to 90% to 100%. Subsequently, the patient did not experience similar symptoms, and her clinical course was stable. Based on the patient's clinical course, gastrointestinal beriberi was diagnosed. SIGNIFICANCE OF RESULTS This case shows that TD may cause anorexia. Many patients who receive palliative care have decreased dietary intake. Consequently, such patients may present with gastrointestinal beriberi, as in the present case. Appropriate diagnosis and treatment may contribute to increasing such patients' quality of life. It may be necessary to differentiate TD from other conditions as a cause of anorexia in patients receiving palliative care.
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Affiliation(s)
- Eriko Hayashi
- Nursing Course, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
- Department of Nursing, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
| | - Tetsuya Matuura
- Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
| | - Junko Takano
- Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
| | - Kaori Morofushi
- Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
| | - Kaori Toriizuka
- Department of Palliative Care Unit, Fujisawa Shounandai Hospital, Fujisawa-shi, Kanagawa, Japan
| | - Hideki Onishi
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
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Minatoguchi S, Hayashi H, Umeda R, Koide S, Hasegawa M, Tsuboi N. Additional renoprotective effect of the SGLT2 inhibitor dapagliflozin in a patient with ADPKD receiving tolvaptan treatment. CEN Case Rep 2024:10.1007/s13730-024-00859-1. [PMID: 38494546 DOI: 10.1007/s13730-024-00859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney disease (ESKD). Vasopressin plays a pivotal role in ADPKD progression; therefore, the selective vasopressin V2 receptor antagonist tolvaptan is used as a key drug in the management of ADPKD. On the other hand, sodium-glucose cotransporter-2 inhibitors (SGLT2i), which may possibly stimulate vasopressin secretion due to the diuretic effect of the drug, have been shown to have both renal and cardioprotective effects in various populations, including those with non-diabetic chronic kidney disease. However, the effect of SGLT2i in patients with ADPKD have not been fully elucidated. Herein, we report the case of a patient with ADPKD on tolvaptan who was administered the SGLT2i dapagliflozin. The patient was a Japanese woman diagnosed with ADPKD at age 30. Despite the treatment with tolvaptan, eGFR was gradually declined from 79.8 to 50 ml/min/1.73 m2 in almost 5 years and 10 mg of dapagliflozin was initiated in the hope of renoprotective effects. Although a small increase in vasopressin levels was observed, eGFR decline rate was moderated after dapagliflozin initiation. This case suggested an additional renoprotective effect of dapagliflozin in patient with ADPKD receiving tolvaptan. Although there is no evidence about the renal protective effect of SGLT2i in patients with ADPKD, we hereby report a case successfully treated with dapagliflozin for approximately 2 years. Further research, including clinical trials, is needed to evaluate whether SGLT2i are effective in patients with ADPKD.
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Affiliation(s)
- Shun Minatoguchi
- Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Ryosuke Umeda
- Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Li X, Fan J, Fu R, Peng M, He J, Chen Q, Wang S, Chen C. Case report: A novel R246L mutation in the LMX1B homeodomain causes isolated nephropathy in a large Chinese family. Medicine (Baltimore) 2024; 103:e37442. [PMID: 38457557 PMCID: PMC10919518 DOI: 10.1097/md.0000000000037442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Genetic factors contribute to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Advances in genetic testing have enabled the identification of hereditary kidney diseases, including those caused by LMX1B mutations. LMX1B mutations can lead to nail-patella syndrome (NPS) or nail-patella-like renal disease (NPLRD) with only renal manifestations. CASE PRESENTATION The proband was a 13-year-old female who was diagnosed with nephrotic syndrome at the age of 6. Then she began intermittent hormone and drug therapy. When she was 13 years old, she was admitted to our hospital due to sudden chest tightness, which progressed to end-stage kidney disease (ESRD), requiring kidney replacement therapy. Whole-Exome Sequencing (WES) results suggest the presence of LMX1B gene mutation, c.737G > T, p.Arg246Leu. Tracing her family history, we found that her father, grandmother, uncle and 2 cousins all had hematuria, or proteinuria. In addition to the grandmother, a total of 9 members of the family performed WES. The members with kidney involved all carry the mutated gene. Healthy members did not have the mutated gene. It is characterized by co-segregation of genotype and phenotype. We followed the family for 9 year, the father developed ESRD at the age of 50 and started hemodialysis treatment. The rest patients had normal renal function. No extra-renal manifestations associated with NPS were found in any member of the family. CONCLUSIONS This study has successfully identified missense mutation, c.737G > T (p.Arg246Leu) in the homeodomain, which appears to be responsible for isolated nephropathy in the studied family. The arginine to leucine change at codon 246 likely disrupts the DNA-binding homeodomain of LMX1B. Previous research has documented 2 types of mutations at codon R246, namely R246Q and R246P, which are known to cause NPLRD. The newly discovered mutation, R246L, is likely to be another novel mutation associated with NPLRD, thus expanding the range of mutations at the crucial renal-critical codon 246 that contribute to the development of NPLRD. Furthermore, our findings suggest that any missense mutation occurring at the 246th amino acid position within the homeodomain of the LMX1B gene has the potential to lead to NPLRD.
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Affiliation(s)
- Xian Li
- Xinxiang Medical Univeisity, Xinxiang, China
- Puyang Oilfield General Hospital, Puyang, China
| | - Jiaojiao Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rong Fu
- Puyang Oilfield General Hospital, Puyang, China
| | - Ming Peng
- Beijing Chigene Translational Medicine Research Center Co., Ltd, Beijing, China
| | - Jujie He
- Puyang Oilfield General Hospital, Puyang, China
| | | | | | - Chong Chen
- Puyang Oilfield General Hospital, Puyang, China
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239
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Kinoshita G, Morisaki K, Okamoto D, Aoyagi T, Yoshino S, Inoue K, Yoshizumi T. Retrograde transvenous thoracic duct embolization for lymphatic leakage after retroperitoneal tumor and lymph node resection: a case report and literature review. Surg Case Rep 2024; 10:53. [PMID: 38453801 PMCID: PMC10920507 DOI: 10.1186/s40792-024-01856-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Postoperative lymphatic leakage is a complication of ineffective conservative treatment for retroperitoneal mass. Herein, we report a case of lymphatic leakage that arose after retroperitoneal tumor resection and that was treated with retrograde transvenous thoracic duct embolization. CASE PRESENTATION A 28-year-old man with persistent abdominal pain was diagnosed with a large retroperitoneal metastatic tumor measuring 10 cm and a subdiaphragmatic lymph node originating from a testicular tumor. After high orchidectomy and neoadjuvant chemotherapy, the subdiaphragmatic lymph node and retroperitoneal tumor were resected together with the abdominal aorta; the latter was reconstructed using a prosthetic graft. Postoperatively, the patient developed chylothorax. No improvement was observed after conservative treatment that included fasting and somatostatin therapy. The leakage site could not be identified using antegrade lymphangiography of the bilateral inguinal lymph nodes, but was detected using retrograde transvenous lymphangiography. The leakage site was successfully embolized. CONCLUSION This case report describes successful treatment with retrograde transvenous thoracic duct embolization for chylothorax following resection of a retroperitoneal tumor and lymph node. This approach is a less invasive and more effective mode of treatment for chylothorax and should be considered before surgical thoracic duct ligation when the leakage point cannot be identified using the antegrade approach.
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Affiliation(s)
- Go Kinoshita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takehiko Aoyagi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kentaro Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Ahmed R, Najam N, Ramphul K, Mactaggart S, Dulay MS, Okafor J, Azzu A, Bilal M, Memon RA, Sakthivel H, Khattar R, Wells AU, Baksi JA, Wechalekar K, Kouranos V, Chahal A, Sharma R. Characteristics and clinical outcomes of patients with sarcoidosis admitted for ST-elevation myocardial infarction in the United States: a propensity matched analysis from the National Inpatient Sample. Arch Med Sci Atheroscler Dis 2024; 9:e47-e55. [PMID: 38846054 PMCID: PMC11155460 DOI: 10.5114/amsad/184701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/20/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Sarcoidosis is a systemic inflammatory disorder characterised by non-caseating granulomas. Cardiac sarcoidosis (CS) normally causes conduction abnormalities, ventricular arrhythmias, and heart failure. Little is known about the characteristics and impact of sarcoidosis in patients admitted with ST-elevation myocardial infarction (STEMI). This study aims to fill this void. Material and methods Utilising the National Inpatient Sample (NIS) database (2016-2020), individuals with STEMI were identified and categorised based on sarcoidosis presence whilst adjusting for confounders via logistic regression models. Results Among 851,290 STEMI patients, 1215 had sarcoidosis. Before propensity matching, sarcoidosis patients were notably different in demographics and comorbidities compared to non-sarcoidosis patients. After propensity score matching (PSM), sarcoidosis patients were found to have a higher incidence of supraventricular tachycardia (SVT) (2.5% vs. 1.3%, p = 0.024) and acute kidney injury (AKI) (23.3% vs. 20.8%, aOR = 1.269, 95% CI: 1.02-1.58, p = 0.033) but a lower incidence of undergoing coronary artery bypass graft (CABG) (5.5% vs. 8.5%, aOR = 0.663; 95% CI: 0.472-0.931, p = 0.018), while no significant disparities were noted in PCI, cardiogenic shock, mortality, or mean length of stay (LOS). Conclusions Using propensity-matched large real-world data of STEMI patients, sarcoidosis was associated with fewer cases of CABG and a greater incidence of AKI and SVT compared to non-sarcoidosis patients.
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Affiliation(s)
- Raheel Ahmed
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Noem Najam
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Sebastian Mactaggart
- Northumbria Hospitals, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Joseph Okafor
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Alessia Azzu
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Maham Bilal
- Dow University of Health Sciences, Karachi, Pakistan
| | - Rahat A Memon
- Abington Hosp-Jefferson Health, Horsham, United States
| | - Hemamalini Sakthivel
- One Brooklyn Health System/Interfaith Medical Ctr Program, Brooklyn, New York, United States
| | - Rajdeep Khattar
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Athol Umfrey Wells
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - John Arun Baksi
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Kshama Wechalekar
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Vasilis Kouranos
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
| | - Anwar Chahal
- Department of Cardiology, Barts Heart Centre, London, United Kingdom
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Center for Inherited Cardiovascular Diseases, Department of Cardiology, Wellspan Health, York, USA
| | - Rakesh Sharma
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, United Kingdom
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241
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Ishiga K, Kobayashi R, Kanaoka T, Harada J, Kato I, Fujii S, Wakui H, Toya Y, Tamura K. Two acute kidney injury episodes after ICI therapy: a case report. CEN Case Rep 2024:10.1007/s13730-024-00855-5. [PMID: 38453804 DOI: 10.1007/s13730-024-00855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024] Open
Abstract
A 74-year-old Japanese male with lung squamous cell carcinoma received his first dose of immune checkpoint inhibitors (ICIs): ipilimumab and nivolumab. He developed acute kidney injury (AKI) and was admitted to our department. We diagnosed kidney immune-related adverse effects (irAE), and a kidney biopsy revealed acute tubulointerstitial nephritis. We started oral prednisolone (PSL) and his AKI immediately improved. The patient maintained stable findings after PSL was tapered off. However, seven months after the ICI administration, he developed rapid progressive glomerular nephritis and was admitted to our department again. The second kidney biopsy showed findings consistent with anti-glomerular basement membrane glomerulonephritis. Although the patient was treated with pulse methylprednisolone followed by oral PSL and plasma exchange, he became dependent on maintenance hemodialysis. To our knowledge, no case report has described two different types of biopsy-proven nephritis. In cases of suspected relapsing kidney irAEs, both a relapse of previous nephritis and the development of another type of nephritis should be considered.
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Affiliation(s)
- Kohei Ishiga
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
| | - Ryu Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.
| | - Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
| | - Jotaro Harada
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ikuma Kato
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Satoshi Fujii
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
| | - Yoshiyuki Toya
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
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Zhu F, Wen R, Tan X, Nie H, Li J, Wang Q, Qin J. Cyanotic Nephropathy in an Adult Patient with Eisenmenger Syndrome: A Case Report and Literature Review. Kidney Blood Press Res 2024; 49:211-217. [PMID: 38447536 DOI: 10.1159/000538100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Cyanotic nephropathy, a rare disease characterized by proteinuria, decreased estimated glomerular filtration rate, thrombocytopenia, polycythemia, and hyperuricemia, may occasionally be secondary to cyanotic congenital heart disease (CHD). There are currently no detailed diagnostic criteria or treatments for cyanotic nephropathy, owing to its extremely low incidence. Eisenmenger syndrome (ES) was initially defined by Paul Wood in pathophysiologic terms as "pulmonary hypertension (PH) at the systemic level, caused by a high pulmonary vascular resistance, with a reversed or bidirectional shunt at the aorto-pulmonary, ventricular, or atrial level." It typically develops in the presence of large, unrepaired atrial or ventricular septal defects, arterial shunts, or complex forms of CHD and is the most severe hemodynamic phenotype of pulmonary arterial hypertension associated with CHD. This study aimed to outline the case of an ES patient who developed cyanotic nephropathy and successfully achieved clinical remission through primary disease treatment and symptomatic management. Overall, this case expands our understanding of cyanotic nephropathy and lays a theoretical reference for the treatment of ES. CASE PRESENTATION A 33-year-old Chinese female attended the outpatient department with abnormal urine test results over the past two and a half years. Following a comprehensive medical history collection, she underwent the necessary tests. Cardiac color ultrasound displayed a significant widening of the pulmonary artery and PH (severe), as well as mild tricuspid regurgitation and patent ductus arteriosus. The results of the kidney biopsy, combined with clinical findings, suggested a high risk of polycythemia-related kidney disease. She was eventually diagnosed with cyanotic nephropathy and ES. Her symptoms were relieved following symptomatic treatment, such as the administration of ambrisentan, febuxostat, and home oxygen therapy. Her follow-up visit at 6 months demonstrated improvements in hyperuricemia and a significant increase in physical strength. CONCLUSION Cyanotic nephropathy is a rare condition in adults. Kidney biopsy remains the gold standard of diagnosis for various nephropathies. Active treatment of CHD and alleviating hypoxia may be pivotal for the treatment of cyanotic nephropathy.
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Affiliation(s)
- Fanyou Zhu
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China,
| | - Rui Wen
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Xiangling Tan
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hongjun Nie
- Department of Ultrasonic Radiology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Jiali Li
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Qi Wang
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Jiao Qin
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Kechagias KS, Laleye JD, Drmota J, Geropoulos G, Kyrtsonis G, Zafeiri M, Triantafyllidis KK, Stathi D. Minimal change disease following COVID-19 vaccination: A systematic review. PLoS One 2024; 19:e0297568. [PMID: 38442131 PMCID: PMC10914286 DOI: 10.1371/journal.pone.0297568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/04/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The newly developed COVID-19 vaccines are highly effective and safe. However, a small portion of vaccine recipients experience a wide range of adverse events. Recently, glomerular disease, including the development of Minimal Change Disease (MCD), has been observed after administration of different COVID-19 vaccines, although causality remains a matter of debate. AIM The aim of this systematic review was to comprehensively examine the available literature and provide an overview of reported cases of MCD following vaccination against SARS-CoV-2. RESULTS We identified 46 eligible articles which included 94 cases with MCD following COVID-19 vaccination of which one case was reported twice due to a second relapse. Fifty-five participants were males (59.1%, 55/93) and 38 (40.9%, 38/93) were females with a mean age of 45.02 years (SD:20.95). From the included patients 50 (50/94, 53.1%) were described as new-onset and 44 (46.9%, 44/94) as relapse. On average, symptomatology developed 16.68 days (SD: 22.85) after the administration of the vaccine irrespective of the dose. Data about symptoms was reported in 68 cases with the most common being oedema (80.8%, 55/68), followed by weight gain (26.5%, 18/68) and hypertension (16.1%, 11/68). In terms of outcome, more than half of the patients went into remission (61%, 57/94), while 18 recovered or improved post treatment (19.1%, 18/94). Two people relapsed after treatment (2.1%, 2/94) and two cases (2.1%, 2/94) were reported as not recovered. CONCLUSION MCD is possibly a condition clinicians may see in patients receiving COVID-19 vaccines. Although this adverse event is uncommon, considering the limited published data and the absence of confirmed causality, increased clinical awareness is crucial for the early recognition and optimal management of these patients.
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Affiliation(s)
- Konstantinos S. Kechagias
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Joshua D. Laleye
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jan Drmota
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Georgios Kyrtsonis
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Marina Zafeiri
- School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | | | - Dimitra Stathi
- Department of Endocrinology and Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Zhang T, Huo H, Zhang Y, Tao J, Yang J, Rong X, Yang Y. Th17 cells: A new target in kidney disease research. Int Rev Immunol 2024:1-17. [PMID: 38439681 DOI: 10.1080/08830185.2024.2321901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/09/2024] [Indexed: 03/06/2024]
Abstract
Type 17 T helper (Th17) cells, which are a subtype of CD4+ T helper cells, secrete pro-inflammatory cytokines such as IL-17A, IL-17F, IL-21, IL-22, and GM-CSF, which play crucial roles in immune defence and protection against fungal and extracellular pathogen invasion. However, dysfunction of Th17 cell immunity mediates inflammatory responses and exacerbates tissue damage. This pathological process initiated by Th17 cells is common in kidney diseases associated with renal injury, such as glomerulonephritis, lupus nephritis, IgA nephropathy, hypertensive nephropathy, diabetic kidney disease and acute kidney injury. Therefore, targeting Th17 cells to treat kidney diseases has been a hot topic in recent years. This article reviews the mechanisms of Th17 cell-mediated inflammation and autoimmune responses in kidney diseases and discusses the related clinical drugs that modulate Th17 cell fate in kidney disease treatment.
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Affiliation(s)
- Tao Zhang
- Key Laboratory of Glucolipid Metabolic Disorder, Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Ministry of Education, Guangzhou, China
- Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou Higher Education Mega Center, Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China
| | - Hongyan Huo
- Key Laboratory of Glucolipid Metabolic Disorder, Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Ministry of Education, Guangzhou, China
- Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou Higher Education Mega Center, Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yinghui Zhang
- Key Laboratory of Glucolipid Metabolic Disorder, Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Ministry of Education, Guangzhou, China
- Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou Higher Education Mega Center, Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jie Tao
- Key Laboratory of Glucolipid Metabolic Disorder, Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Ministry of Education, Guangzhou, China
- Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou Higher Education Mega Center, Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China
| | - Junzheng Yang
- Guangdong Nephrotic Drug Engineering Technology Research Center, The R&D Center of Drug for Renal Diseases, Consun Pharmaceutical Group, Guangzhou, Guangdong, China
| | - Xianglu Rong
- Key Laboratory of Glucolipid Metabolic Disorder, Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Ministry of Education, Guangzhou, China
- Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou Higher Education Mega Center, Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yiqi Yang
- Key Laboratory of Glucolipid Metabolic Disorder, Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Ministry of Education, Guangzhou, China
- Guangdong TCM Key Laboratory for Metabolic Diseases, Guangzhou Higher Education Mega Center, Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China
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245
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Rehnberg J, Segelmark M, Ludvigsson JF, Emilsson L. Validation of IgA nephropathy diagnosis in the Swedish Renal Registry. BMC Nephrol 2024; 25:78. [PMID: 38438966 PMCID: PMC10910707 DOI: 10.1186/s12882-024-03512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
AIM The Swedish Renal Registry (SRR) is a unique national quality registry that monitors the clinical trajectory of patients with chronic kidney disease (CKD). We have validated the biopsy data registered in the SRR for IgA Nephropathy (IgAN) diagnosis. METHODS In total 25% of all patients (n = 142), registered with IgAN in the SRR after having performed a kidney biopsy during 2015-2019, were randomly selected. We obtained original biopsy and medical records for 139 (98%) patients. We evaluated the IgAN diagnosis using a standardized template, calculated its positive predictive value (PPV) with 95% confidence interval (CI) and reported clinical features at the time of diagnosis. RESULTS A histological and clinical diagnosis of IgAN was confirmed in 132 of the 139 patients, yielding a PPV of 95% (95% CI 90-98%). Median age was 46 years (range: 18-85) and the male:female ratio was 2.1:1. The median creatinine level was 123 µmol/L, with a corresponding estimated glomerular filtration rate (eGFR) level of 51 mL/min/1.73m2. Histological features of IgA deposits were seen in all patients, hypercellularity in 102/132 (77.2%), C3 deposits in 98/132 (72.4%) and C1q deposits in 27/132 (20.5%) of the cases. CONCLUSION Validating data is not research per se, but continuous validation of medical registries is an important feature necessary to ensure reliable data and the foundation of good epidemiological data for future research. Our validation showed a high PPV (95%) for IgAN diagnosis registered in the SRR. Clinical characteristics were consistent with previous reports. The biopsy data in the SRR will be a valuable resource in future IgAN research.
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Affiliation(s)
- Johanna Rehnberg
- Department of Nephrology and Centre for Clinical Research, County Council of Värmland, Central Hospital Karlstad, Karlstad, Sweden.
- School of Medical Science, University of Örebro, Örebro, Sweden.
| | - Mårten Segelmark
- Department of Endocrinology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Louise Emilsson
- School of Medical Science, University of Örebro, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Nysäter Health Care Center, Centre for Clinical Research, County Council of Värmland, Nysäter, Sweden
- Department of General Practice and General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, Norway
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246
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Ding L, Hou Y, Liu J, Wang X, Wang Z, Ding W, Zhao K. Circulating Concentrations of advanced Glycation end Products, Carboxymethyl Lysine and Methylglyoxal are Associated With Renal Function in Individuals With Diabetes. J Ren Nutr 2024; 34:154-160. [PMID: 37802233 DOI: 10.1053/j.jrn.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE Diabetic kidney disease (DKD) is one of the most severe chronic complications of diabetes and is associated with higher level of advanced glycation end products (AGEs). The aim of this study was to investigate the diagnostic potential of combined detection of multiple serum AGEs in diagnosing DKD. METHODS Serum AGEs, Nε-(carboxymethyl) lysine (CML), Nε-(carboxyethyl) lysine, and methylglyoxal (MGO) levels were measured by enzyme-linked immunosorbent assay in 176 individuals with type 2 diabetes. Participants were classified into normoalbuminuria, microalbuminuria, and macroalbuminuria group according to their urinary albumin to creatinine ratio (UACR). RESULTS Higher serum AGEs levels were found to be positively correlated with U-Alb, UACR, and blood urea nitrogen in the study of 176 individuals with type 2 diabetes. CML and MGO levels were positively correlated with U-Alb, UACR, blood urea nitrogen, Scr, and uric acid, and negatively correlated with estimated glomerular filtration rate (P < .05). Multivariate logistic regression analysis showed that elevated levels of AGEs, CML, and MGO were independent risk factors for the progression of DKD (odds ratio = 1.861, 1.016, 7.607, P < .01). The sensitivity, specificity, and area under receiver operating characteristic curve of combined detection of AGEs, MGO, and CML were higher than those of three individual detections (area under the curve = 0.952, 0.772, 0.868, 0905, respectively, P < .05). CONCLUSION The combined detection of AGEs, CML, and MGO may improve the reliability of early diagnosis of DKD.
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Affiliation(s)
- Lina Ding
- Shandong Institute of Endocrine & Metabolic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China; Jinan Key Laboratory of Translational Medicine on Metabolic Diseases, Jinan, China
| | - Yanli Hou
- Endocrine and Metabolic Diseases Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Junjun Liu
- Shandong Institute of Endocrine & Metabolic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaolei Wang
- Shandong Institute of Endocrine & Metabolic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China; Jinan Key Laboratory of Translational Medicine on Metabolic Diseases, Jinan, China
| | - Zhibin Wang
- Shandong Institute of Endocrine & Metabolic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Wenyu Ding
- Endocrine and Metabolic Diseases Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
| | - Ke Zhao
- Shandong Institute of Endocrine & Metabolic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China; Jinan Key Laboratory of Translational Medicine on Metabolic Diseases, Jinan, China; Endocrine and Metabolic Diseases Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
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247
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Siddiqui ZH, Cohen KA, Scott J. Preeclampsia With Posterior Reversible Encephalopathy Syndrome at 19 Weeks Gestation Resulting in Intrauterine Fetal Demise. Cureus 2024; 16:e55490. [PMID: 38571843 PMCID: PMC10988546 DOI: 10.7759/cureus.55490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) can be defined as a clinical syndrome of headache, seizures, visual disturbance, altered mental status, and characteristic magnetic resonance imaging (MRI) findings of vasogenic edema in the posterior subcortical parietal-occipital white matter. There are numerous potential inciting factors, including immunosuppression, renal disease, malignancy, cytotoxic medications, hypertension, preeclampsia, and eclampsia. In this paper, we present the case of a 21-year-old female at 19 weeks gestation presenting with symptoms consistent with preeclampsia with severe features and PRES. She was transferred to our facility after initial stabilization. She had an atypical course of preeclampsia prior to 20 weeks gestation, PRES lacking seizure activity, and ultimately her case resulted in intrauterine fetal demise (IUFD) at 20 weeks and six days gestation. As indicated by its name, PRES is considered a fully reversible syndrome, and the patient recovered after stabilization of her hypertensive disorder and delivery of the fetus. This case illustrates the importance of prompt recognition and treatment of hypertensive disorders in pregnant patients and the possibility of complications that can result in significant morbidity and mortality for both the mother and fetus.
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Affiliation(s)
- Zara H Siddiqui
- Obstetrics and Gynecology, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Kyle A Cohen
- Obstetrics and Gynecology, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Jonathan Scott
- Obstetrics and Gynecology, Women's Medical Center, Dothan, USA
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248
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Gant CM, Koelman CA, Nguyen TQ, Abrahams AC, Wetzels JFM, Duineveld C, Jak M, Minnema MC, Klein SK, Jacobs JFM, Bosma RJ. Cryoglobulinemic Vasculitis in Disguise: Cryofibrinogenemia as Variant of Monoclonal Gammopathy of Renal Significance. Am J Kidney Dis 2024; 83:415-419. [PMID: 37734685 DOI: 10.1053/j.ajkd.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/13/2023] [Accepted: 07/22/2023] [Indexed: 09/23/2023]
Abstract
Monoclonal gammopathy with cryoactivity (ie, cryoglobulins) that causes glomerulonephritis is considered within the spectrum of monoclonal gammopathy of renal significance. Cryofibrinogenemia (cryoactivity of coagulation factors) is very rarely associated with glomerulonephritis. We present a 39-year-old woman with a relapsing nephrotic syndrome. Laboratory investigation detected cryofibrinogen; the precipitate consisted of fibrinogen and a monoclonal immunoglobulin (M-protein; IgG-λ), and the latter was also detected in serum (4g/L). Initial conventional immunosuppressive therapy resulted in temporary renal remission. In view of the M-protein, subsequent therapy consisted of bortezomib/dexamethasone and high-dose melphalan followed by autologous hematopoietic stem cell transplantation, and resulted in a very good partial hematological response and temporary renal remission. However, after hematological and renal relapse, we performed unique experiments to clarify the role of the M-protein. Mixing patient serum with donor plasma resulted in cryoactivity, composed of M-protein+fibrinogen. Patient plasma deprived of M-protein did not have cryoactivity. Therefore, cryoactivity was dependent on the M-protein. We started lenalidomide, which resulted in very good partial hematological and renal remission. Thus, cryofibrinogenemia can be the consequence of an M-protein, which we suggest should be defined as monoclonal gammopathy of renal significance.
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Affiliation(s)
- Christina M Gant
- Internal Medicine/Nephrology, Meander Medical Centre, Amersfoort, The Netherlands.
| | - Carin A Koelman
- Laboratory Medical Immunology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Tri Q Nguyen
- Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alferso C Abrahams
- Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jack F M Wetzels
- Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline Duineveld
- Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Margot Jak
- Hematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Monique C Minnema
- Hematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Saskia K Klein
- Hematology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joannes F M Jacobs
- Laboratory Medical Immunology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Renate J Bosma
- Internal Medicine/Nephrology, Meander Medical Centre, Amersfoort, The Netherlands
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249
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Vischini G, Speciale S, Przygocka A, Martano L, La Manna G, Baraldi O. Lessons for the clinical nephrologist: acute kidney injury during therapy with apixaban. J Nephrol 2024; 37:511-513. [PMID: 38055150 PMCID: PMC11043096 DOI: 10.1007/s40620-023-01781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/03/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Gisella Vischini
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Serena Speciale
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Agnieszka Przygocka
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Laura Martano
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Via Giuseppe Massarenti 9, Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Via Giuseppe Massarenti 9, Bologna, Italy.
| | - Olga Baraldi
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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250
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Kilich G, Perelygina L, Sullivan KE. Rubella virus chronic inflammatory disease and other unusual viral phenotypes in inborn errors of immunity. Immunol Rev 2024; 322:113-137. [PMID: 38009321 DOI: 10.1111/imr.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Infectious susceptibility is a component of many inborn errors of immunity. Nevertheless, antibiotic use is often used as a surrogate in history taking for infectious susceptibility, thereby disadvantaging patients who present with viral infections as their phenotype. Further complicating clinical evaluations are unusual manifestations of viral infections which may be less familiar that the typical respiratory viral infections. This review covers several unusual viral phenotypes arising in patients with inborn errors of immunity and other settings of immune compromise. In some cases, chronic infections lead to oncogenesis or tumor-like growths and the conditions and mechanisms of viral-induced oncogenesis will be described. This review covers enterovirus, rubella, measles, papillomavirus, and parvovirus B19. It does not cover EBV and hemophagocytic lymphohistiocytosis nor lymphomagenesis related to EBV. EBV susceptibility has been recently reviewed. Our goal is to increase awareness of the unusual manifestations of viral infections in patients with IEI and to describe treatment modalities utilized in this setting. Coincidentally, each of the discussed viral infections can have a cutaneous component and figures will serve as a reminder of the physical features of these viruses. Given the high morbidity and mortality, early recognition can only improve outcomes.
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Affiliation(s)
- Gonench Kilich
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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