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Betti C, Lavagno C, Bianchetti MG, Kottanattu L, Lava SAG, Schera F, Lacalamita MC, Milani GP. Transient secondary pseudo-hypoaldosteronism in infants with urinary tract infections: systematic literature review. Eur J Pediatr 2024:10.1007/s00431-024-05676-3. [PMID: 38985174 DOI: 10.1007/s00431-024-05676-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/13/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
Infants with a congenital anomaly of the kidney and urinary tract sometimes present with hyponatremia, hyperkalemia, and metabolic acidosis due to under-responsiveness to aldosterone, hereafter referred to as secondary pseudo-hypoaldosteronism. The purpose of this report is to investigate pseudo-hypoaldosteronism in infant urinary tract infection. A systematic review was conducted following PRISMA guidelines after PROSPERO (CRD42022364210) registration. The National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar without limitations were used. Inclusion criteria involved pediatric cases with documented overt pseudo-hypoaldosteronism linked to urinary tract infection. Data extraction included demographics, clinical features, laboratory parameters, management, and course. Fifty-seven reports were selected, detailing 124 cases: 95 boys and 29 girls, 10 months or less of age (80% of cases were 4 months or less of age). The cases exhibited hyponatremia, hyperkalemia, acidosis, and activated renin-angiotensin II-aldosterone system. An impaired kidney function was found in approximately every third case. Management included antibiotics, fluids, and, occasionally, emergency treatment of hyperkalemia, hyponatremia, or acidosis. The recovery time averaged 1 week for electrolyte, acid-base imbalance, and kidney function. Notably, anomalies of the kidney and urinary tract were identified in 105 (85%) cases. CONCLUSIONS This review expands the understanding of overt transient pseudo-hypoaldosteronism complicating urinary tract infection. Management involves antimicrobials, fluid replacement, and consideration of electrolyte imbalances. Raising awareness of this condition within pediatric hospitalists is desirable. WHAT IS KNOWN • Infants affected by a congenital anomaly of the kidney and urinary tract may present with clinical and laboratory features resembling primary pseudo-hypoaldosteronism. • Identical features occasionally occur in infant urinary tract infection. WHAT IS NEW • Most cases of secondary pseudo-hypoaldosteronism associated with a urinary tract infection are concurrently affected by a congenital anomaly of the kidney and urinary tract. • Treatment with antibiotics and parenteral fluids typically results in the normalization of sodium, potassium, bicarbonate, and creatinine within approximately 1 week.
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Affiliation(s)
- Céline Betti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- Pediatric Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Camilla Lavagno
- Pediatric Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Mario G Bianchetti
- Family Medicine, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Clinical Pharmacology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Federica Schera
- Family Medicine, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | | | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
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Tagawa M, Terasaki M, Mii A, Toda E, Kajimoto Y, Kunugi S, Terasaki Y, Shimizu A. The reduced number of nephrons with shortening renal tubules in mouse postnatal adverse environment. Pediatr Res 2022:10.1038/s41390-022-02332-0. [PMID: 36302857 DOI: 10.1038/s41390-022-02332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 08/10/2022] [Accepted: 09/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The intrauterine adverse environment during nephrogenesis reduces the nephron number, probably associates with impaired ureteric bud (UB) branching. METHODS The kidneys in C57/BL6 mice were irradiated with a single dose of 10 gray (10 Gy) as adverse environment on postnatal day 3 (irradiated PND3 kidneys) after UB branching ceased. The renal functions and pathological findings of irradiated PND3 kidneys were compared with those of non-irradiated control and 10 Gy irradiation on PND14 (irradiated PND14 kidney) from 1 to 18 months. RESULTS The number and density of glomeruli in irradiated PND3 kidneys were reduced by 1 month with renal dysfunction at 6 months. The morphologically incomplete glomeruli with insufficient capillaries were involuted by 1 month in the superficial cortex. Reduced tubular numbers and developmental disability with shortening renal tubules occurred in irradiated PND3 kidneys with impaired urine concentration at 6 months. Hypertrophy of glomeruli developed, and occasional sclerotic glomeruli appeared in the juxtamedullary cortex with hypertension and albuminuria at 12 to 18 months. CONCLUSIONS The reduced number of nephrons with shortening renal tubules occurred with impaired renal functions in a postnatal adverse environment after cessation of UB branching, and glomerular hypertrophy with occasional glomerulosclerosis developed accompanied with hypertension and albuminuria in the adulthood. IMPACT The reduced number of nephrons with shortening renal tubules occurred with impaired renal functions in a postnatal adverse environment after cessation of ureteric bud branching. The reduced number of glomeruli were associated with not only the impaired formation of glomeruli but also involution of morphologically small incomplete glomeruli after an adverse environment. The insufficiently developed nephrons were characterized by the shortening renal tubules with impaired urine concentration. In addition, glomerular hypertrophy and occasional glomerulosclerosis developed with hypertension and albuminuria in adulthood. The present study can help to understand the risk of alternations of premature nephrons in preterm neonates.
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Affiliation(s)
- Masako Tagawa
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Mika Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Akiko Mii
- Department of Nephrology, Nippon Medical School, Tokyo, Japan
| | - Etsuko Toda
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Yusuke Kajimoto
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Shinobu Kunugi
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.,Division of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.
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Ratajczyk K, Konieczny A, Czekaj A, Piotrów P, Fiutowski M, Krakowska K, Kowal P, Witkiewicz W, Marek-Bukowiec K. The Clinical Significance of Urinary Retinol-Binding Protein 4: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9878. [PMID: 36011513 PMCID: PMC9408023 DOI: 10.3390/ijerph19169878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Effective biomarkers for early diagnosis, prognostication, and monitoring in renal diseases (in general) comprise an unmet need. Urinary retinol-binding protein 4, which is the most sensitive indicator of renal tubular damage, holds great promise as a universal biomarker for renal pathologies, in which tubular injury is the driving force. Here, we summarize the most important existing data on the associations between urinary retinol-binding protein 4 and renal diseases and highlight the untapped potential of retinol-binding protein 4 in clinical use.
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Affiliation(s)
- Krzysztof Ratajczyk
- Department of Urology, Regional Specialist Hospital in Wroclaw, Kamienskiego 73a, 51-124 Wroclaw, Poland
| | - Andrzej Konieczny
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Adrian Czekaj
- Department of Urology, Regional Specialist Hospital in Wroclaw, Kamienskiego 73a, 51-124 Wroclaw, Poland
| | - Paweł Piotrów
- Department of Urology, Regional Specialist Hospital in Wroclaw, Kamienskiego 73a, 51-124 Wroclaw, Poland
| | - Marek Fiutowski
- Department of Urology, Regional Specialist Hospital in Wroclaw, Kamienskiego 73a, 51-124 Wroclaw, Poland
| | - Kornelia Krakowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Paweł Kowal
- Department of Urology, Regional Specialist Hospital in Wroclaw, Kamienskiego 73a, 51-124 Wroclaw, Poland
| | - Wojciech Witkiewicz
- Research and Development Center, Regional Specialist Hospital in Wroclaw, Kamienskiego 73a, 51-124 Wroclaw, Poland
| | - Karolina Marek-Bukowiec
- Research and Development Center, Regional Specialist Hospital in Wroclaw, Kamienskiego 73a, 51-124 Wroclaw, Poland
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4
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Sutherland MR, Malik W, Nguyen VB, Tran V, Polglase GR, Black MJ. Renal morphology and glomerular capillarisation in young adult sheep born moderately preterm. J Dev Orig Health Dis 2021; 12:975-981. [PMID: 33300490 DOI: 10.1017/s2040174420001208] [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: 11/07/2022]
Abstract
Preterm birth (delivery <37 weeks of gestation) is associated with impaired glomerular capillary growth in neonates; if this persists, it may be a contributing factor in the increased risk of hypertension and chronic kidney disease in people born preterm. Therefore, in this study, we aimed to determine the long-term impact of preterm birth on renal morphology, in adult sheep. Singleton male sheep were delivered moderately preterm at 132 days (~0.9) of gestation (n = 6) or at term (147 days gestation; n = 6) and euthanised at 14.5 months of age (early adulthood). Stereological methods were used to determine mean renal corpuscle and glomerular volumes, and glomerular capillary length and surface area, in the outer, mid and inner regions of the renal cortex. Glomerulosclerosis and interstitial collagen levels were assessed histologically. By 14.5 months of age, there was no difference between the term and preterm sheep in body or kidney weight. Renal corpuscle volume was significantly larger in the preterm sheep than the term sheep, with the preterm sheep exhibiting enlarged Bowman's spaces; however, there was no difference in glomerular volume between groups, with no impact of preterm birth on capillary length or surface area per glomerulus. There was also no difference in interstitial collagen levels or glomerulosclerosis index between groups. Findings suggest that moderate preterm birth does not adversely affect glomerular structure in early adulthood. The enlarged Bowman's space in the renal corpuscles of the preterm sheep kidneys, however, is of concern and merits further research into its cause and functional consequences.
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Affiliation(s)
- Megan R Sutherland
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Waleed Malik
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Vivian B Nguyen
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Vivian Tran
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University and the Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Mary Jane Black
- Department of Anatomy and Developmental Biology and the Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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de Winter D, Salaets T, Gie A, Deprest J, Levtchenko E, Toelen J. Glomerular developmental delay and proteinuria in the preterm neonatal rabbit. PLoS One 2020; 15:e0241384. [PMID: 33166318 PMCID: PMC7652305 DOI: 10.1371/journal.pone.0241384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/14/2020] [Indexed: 01/13/2023] Open
Abstract
Recent advances in neonatal care have improved the survival rate of those born premature. But prenatal conditions, premature birth and clinical interventions can lead to transient and permanent problems in these fragile patients. Premature birth (<36 gestational weeks) occurs during critical renal development and maturation. Some consequences have been observed but the exact pathophysiology is still not entirely known. This experimental animal study aims to investigate the effect of premature birth on postnatal nephrogenesis in premature neonatal rabbits compared to term rabbits of the same corrected age. We analyzed renal morphology, glomerular maturity and functional parameters (proteinuria and protein/creatinine ratio) in three cohorts of rabbit pups: preterm (G28), preterm at day 7 of life (G28+7) and term at day 4 of life (G31+4). We found no significant differences in kidney volume and weight, and relative kidney volume between the cohorts. Nephrogenic zone width increased significantly over time when comparing G31 + 4 to G28. The renal corpuscle surface area, in the inner cortex and outer cortex, tended to decrease significantly after birth in both preterm and term groups. With regard to glomerular maturity, we found that the kidneys in the preterm cohorts were still in an immature state (presence of vesicles and capillary loop stage). Importantly, significant differences in proteinuria and protein/creatinine ratio were found. G28 + 7 showed increased proteinuria (p = 0.019) and an increased protein/creatinine ratio (p = 0.023) in comparison to G31 +4. In conclusion, these results suggest that the preterm rabbit kidney tends to linger in the immature glomerular stages and shows signs of a reduced renal functionality compared to the kidney born at term, which could in time lead to short- and long-term health consequences.
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Affiliation(s)
- Derek de Winter
- Faculty of Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- * E-mail:
| | - Thomas Salaets
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Paediatrics, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - André Gie
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Elena Levtchenko
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Paediatrics, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Paediatrics, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
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Glomeruli from patients with nephrin mutations show increased number of ciliated and poorly differentiated podocytes. Acta Histochem 2018; 120:748-756. [PMID: 30193978 DOI: 10.1016/j.acthis.2018.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/26/2018] [Accepted: 08/29/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Podocytes are postmitotic, highly specialized cells which maintain the glomerular filtration barrier (GFB). Their injury is characterized by foot processes effacement and change in protein expression leading to proteinuria and end-stage kidney disease. METHODS Our study focuses on the morphological and immunohistochemical changes of human podocytes during normal development and postnatal period, compared to congenital nephrotic syndrome of the Finnish type (CNF). Kidney tissues taken from 17 human conceptuses 8th-38th weeks old, two healthy and three CNF kidneys were embedded in paraffin for immunohistochemical or double immunofluorescence methods, or were embedded in resin for electron microscopy. Paraffin sections were stained with markers for proliferation (Ki-67), proteins nephrin and nestin, and alpha-tubulin. Quantification of positive cells were performed using Mann Whitney and Kruskal-Wallis test. RESULTS Tissue analysis showed that proliferation of podocytes gradually decreased during development and disappeared in postnatal period. Decrease in number of ciliated glomerular cells and visceral podocytes (from 47% to 3%), and parietal epithelial cells (from 32% to 7%) characterized normal development. Nestin and nephrin co-expressed in developing podocytes in different cellular compartments. During development, nephrin expression increased (from 17% to 75%) and postnatally changed its pattern, while nestin positive glomerular cells decreased from 98% to 40%. CNF glomeruli displayed increased number of immature ciliated podocytes (6%) and parietal epithelial cells (9%). CONCLUSION Changes in cytoplasmic alpha-tubulin expression and reduced nephrin expression (20%) indicating association of incomplete podocyte maturation with failure of GFB function and appearance of prenatal proteinuria in CNF patients.
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7
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Callaway DA, McGill-Vargas LL, Quinn A, Jordan JL, Winter LA, Anzueto D, Dick EJ, Blanco CL. Prematurity disrupts glomeruli development, whereas prematurity and hyperglycemia lead to altered nephron maturation and increased oxidative stress in newborn baboons. Pediatr Res 2018; 83:702-711. [PMID: 29166383 PMCID: PMC5902650 DOI: 10.1038/pr.2017.290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/02/2017] [Indexed: 12/17/2022]
Abstract
BackgroundPremature birth occurs when nephrogenesis is incomplete and has been linked to increased renal pathologies in the adult. Metabolic factors complicating preterm birth may have additional consequences for kidney development. Here, we evaluated the effects of prematurity and hyperglycemia on nephrogenesis in premature baboons when compared with those in term animals.MethodsBaboons were delivered prematurely (67% gestation; n=9) or at term (n=7) and survived for 2-4 weeks. Preterm animals were classified by glucose control during the first 5 days of life: normoglycemic (PtN; serum glucose 50-100 mg/dl, n=6) and hyperglycemic (PtH; serum glucose 150-250 mg/dl, n=3). Kidneys were assessed histologically for glomeruli relative area, maturity, size, and overall morphology. Kidney lysates were evaluated for oxidative damage with 4-hydroxynonenal (4-HNE) antibody.ResultsHistological examination revealed decreased glomeruli relative area (P<0.05), fewer glomerular generations (P<0.01), and increased renal corpuscle area (P<0.001) in preterm compared with those in term animals. Numbers of apoptotic glomeruli were similar between groups. PtH kidneys exhibited reduced nephrogenic zone width (P<0.0001), increased numbers of mature glomeruli (P<0.05), and increased 4-HNE staining compared with those in PtN kidneys.ConclusionPrematurity interrupts normal kidney development, independent of glomerular cell apoptosis. When prematurity is complicated by hyperglycemia; kidney development shifts toward accelerated maturation and increased oxidative stress.
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Affiliation(s)
- Danielle A. Callaway
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Lisa L. McGill-Vargas
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900,University Health System, Neonatology, San Antonio, Texas, 78229
| | - Amy Quinn
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900,University Health System, Neonatology, San Antonio, Texas, 78229
| | - Jasmine L. Jordan
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Lauryn A. Winter
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Diana Anzueto
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Edward J. Dick
- Texas Biomedical Research Institute PO Box 760549 San Antonio, TX 78245-0549
| | - Cynthia L. Blanco
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900,University Health System, Neonatology, San Antonio, Texas, 78229,Corresponding author: Cynthia L. Blanco, University of Texas Health Science Center San Antonio, Department of Pediatrics, Division of Neonatology, 7703 Floyd Curl Drive, MC-7812, San Antonio, TX, 78229, Phone: 210-567-5225, fax: 210-567-5169,
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En Bloc Cadaver Kidney Transplantation From a 9-Month-Old Donor to an Adult Recipient: Maturation of Glomerular Size and Podocyte in the Recipient. Transplant Direct 2017; 3:e130. [PMID: 28361114 PMCID: PMC5367747 DOI: 10.1097/txd.0000000000000648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Favorable outcomes of en bloc pediatric donor kidney transplantation to adult recipients are attributed primarily to grafting of twice the nephron mass of a single kidney. METHODS The kidneys of a 9-month-old male infant were transplanted en bloc in a 56-year-old man. Biopsies were performed 1 hour postreperfusion, 6 months and 3.5 years posttransplant. RESULTS Warm and cold ischemia times were 21 and 426 minutes, respectively. The recipient was released from hemodialysis 10 days posttransplant and discharged 91 days posttransplant when serum creatinine was 0.9 mg/dL. At 4 years and 9 months posttransplant, serum creatinine was 1.0 mg/dL, and estimated glomerular filtration rate was 58.0 mL/min per 1.73 m2. The grafts increased in size until they reached adult size by 3 months posttransplant. The glomerular area and volume, respectively, increased from 5.9 × 103 μm2 and 0.34 × 106 μm3 at 1 hour postreperfusion to 14.9 × 103 μm2 and 1.27 × 106 μm3 at 3.5 years posttransplant, both of which were less than half of adult size. At 1 hour postreperfusion, podocytes were structurally immature. At 6 months posttransplant, podocyte immaturity was still evident. At 3.5 years posttransplant, podocytes were mature. CONCLUSIONS These findings suggest that podocytes and glomerular size of pediatric donor kidneys can continue to mature in adult recipients at rates appropriate for donor age when transplanted en bloc. The maturational levels of podocytes and glomeruli may also be a factor involved in favorable outcomes of en bloc pediatric donor kidney transplantation.
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Francipane MG, Lagasse E. The lymph node as a new site for kidney organogenesis. Stem Cells Transl Med 2015; 4:295-307. [PMID: 25646529 PMCID: PMC4339853 DOI: 10.5966/sctm.2014-0208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022] Open
Abstract
The shortage of organs for kidney transplantation has created the need to develop new strategies to restore renal structure and function. Given our recent finding that the lymph node (LN) can serve as an in vivo factory to generate or sustain complex structures like liver, pancreas, and thymus, we investigated whether it could also support kidney organogenesis from mouse renal embryonic tissue (metanephroi). Here we provide the first evidence that metanephroi acquired a mature phenotype upon injection into LN, and host cells likely contributed to this process. Urine-like fluid-containing cysts were observed in several grafts 12 weeks post-transplantation, indicating metanephroi transplants' ability to excrete products filtered from the blood. Importantly, the kidney graft adapted to a loss of host renal mass, speeding its development. Thus, the LN might provide a unique tool for studying the mechanisms of renal maturation, cell proliferation, and fluid secretion during cyst development. Moreover, we provide evidence that inside the LN, short-term cultured embryonic kidney cells stimulated with the Wnt agonist R-Spondin 2 gave rise to a monomorphic neuron-like cell population expressing the neuronal 200-kDa neurofilament heavy marker. This finding indicates that the LN might be used to validate the differentiation potential of candidate stem cells in regenerative nephrology.
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Affiliation(s)
- Maria Giovanna Francipane
- Department of Pathology, McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Ri.MED Foundation, Palermo, Italy
| | - Eric Lagasse
- Department of Pathology, McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Ri.MED Foundation, Palermo, Italy
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10
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From ureteric bud to the first glomeruli: genes, mediators, kidney alterations. Int Urol Nephrol 2014; 47:109-16. [PMID: 25201458 DOI: 10.1007/s11255-014-0784-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/04/2014] [Indexed: 12/23/2022]
Abstract
The development of the mammalian kidney is a complex and in part unknown process which requires interactions between pluripotential/stem cells, undifferentiated mesenchymal cells, epithelial and mesenchymal components, eventually leading to the coordinate development of multiple different specialized epithelial, endothelial and stromal cell types within the kidney architectural complexity. We will describe the embryology and molecular nephrogenetic mechanisms, a fascinating traffic of cells and tissues which takes place in five stages: (1) ureteric bud (UB) development; (2) cap mesenchyme formation; (3) mesenchymal-epithelial transition (MET); (4) glomerulogenesis and tubulogenesis; (5) interstitial cell development. In particular, we will analyze the multiple cell types involved in these dramatic events as characters moving between different worlds, from the mesenchymal to the epithelial world and back, and will start to define the multiple factors that propel these cells during their travels throughout the developing kidney. Moreover, according with the hypothesis of renal perinatal programing, we will present the results reached in the fields of immunohistochemistry and molecular biology, by means of which we can explain how a loss or excess of molecular factors governing nephrogenesis may cause the onset of pathologies of different gravity, in some cases leading to a chronic kidney disease at different times from birth.
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11
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Tomita M, Asada M, Asada N, Nakamura J, Oguchi A, Higashi AY, Endo S, Robertson E, Kimura T, Kita T, Economides AN, Kreidberg J, Yanagita M. Bmp7 maintains undifferentiated kidney progenitor population and determines nephron numbers at birth. PLoS One 2013; 8:e73554. [PMID: 23991197 PMCID: PMC3753328 DOI: 10.1371/journal.pone.0073554] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 07/29/2013] [Indexed: 01/13/2023] Open
Abstract
The number of nephrons, the functional units of the kidney, varies among individuals. A low nephron number at birth is associated with a risk of hypertension and the progression of renal insufficiency. The molecular mechanisms determining nephron number during embryogenesis have not yet been clarified. Germline knockout of bone morphogenetic protein 7 (Bmp7) results in massive apoptosis of the kidney progenitor cells and defects in early stages of nephrogenesis. This phenotype has precluded analysis of Bmp7 function in the later stage of nephrogenesis. In this study, utilization of conditional null allele of Bmp7 in combination with systemic inducible Cre deleter mice enabled us to analyze Bmp7 function at desired time points during kidney development, and to discover the novel function of Bmp7 to inhibit the precocious differentiation of the progenitor cells to nephron. Systemic knockout of Bmp7 in vivo after the initiation of kidney development results in the precocious differentiation of the kidney progenitor cells to nephron, in addition to the prominent apoptosis of progenitor cells. We also confirmed that in vitro knockout of Bmp7 in kidney explant culture results in the accelerated differentiation of progenitor population. Finally we utilized colony-forming assays and demonstrated that Bmp7 inhibits epithelialization and differentiation of the kidney progenitor cells. These results indicate that the function of Bmp7 to inhibit the precocious differentiation of the progenitor cells together with its anti-apoptotic effect on progenitor cells coordinately maintains renal progenitor pool in undifferentiated status, and determines the nephron number at birth.
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Affiliation(s)
- Mayumi Tomita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
| | - Misako Asada
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
| | - Nariaki Asada
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
| | - Jin Nakamura
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
| | - Akiko Oguchi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
| | - Atsuko Y. Higashi
- Department of Pharmacology, Kansai Medical University, Moriguchi-city, Osaka, Japan
| | - Shuichiro Endo
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
| | - Elizabeth Robertson
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
| | - Toru Kita
- Kobe City Medical Center General Hospital, Kobe-city, Hyogo, Japan
| | - Aris N. Economides
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, United States of America
| | - Jordan Kreidberg
- Children’s Hospital Boston, Harvard Medical School, Boston, Massachusettes, United States of America
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
- * E-mail:
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Cyclosporin A may cause injury to undifferentiated glomeruli persisting in patients with Alport syndrome. Clin Exp Nephrol 2013; 18:492-8. [PMID: 23828692 DOI: 10.1007/s10157-013-0836-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/AIMS Alport syndrome (AS) is a renal disorder caused by a genetic abnormality of type IV collagen α3 and α4, or α5 genes and shows a poor prognosis. Since the defect of type IV collagen synthesis disturbs the maturation process of the glomerular capillary loop, residual immature glomeruli persist after birth. The therapeutic efficacy of cyclosporin A (CyA) for AS patients seems to be controversial. We recently noted that renal specimens obtained from a child with AS who was treated with CyA and then developed CyA nephropathy included an increased number of undifferentiated embryonic-type glomeruli. METHODS We analyzed renal histologic and immunohistologic findings in children with AS who did (n = 3) or did not (n = 2) develop CyA-induced nephropathy despite appropriately low serum CyA concentrations (<100 ng/mL) being maintained over a period of 2 years. To discriminate embryonic-type from mature glomeruli, staining for type IV collagen α1, laminin β1, and laminin β2 accompanied by light microscopic observation were employed. Staining patterns were used to semiquantitatively assess glomerular immaturity (glomerular immaturity index, or GII). RESULTS In initial biopsy specimens, residual embryonic-type glomeruli were observed in each patient. Patients with early-onset CyA nephropathy had a high GII (median value 2.91 vs 1.23 ± 0.62 normal kidney tissues). In the follow-up biopsy after CyA treatment, surviving embryonic-type, collapsing embryonic-type, and sclerotic glomeruli that had failed to differentiate were observed. Taken together, the number of these glomeruli essentially equaled the total number of embryonic-type glomeruli in specimens obtained before CyA treatment. CONCLUSIONS Our findings indicate a need for caution in CyA therapy for patients with AS, even for a relatively short course of administration, because some patients may have an unexpected number of embryonic-type glomeruli that predispose to CyA nephropathy.
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Nakamura T, Tsuruga K, Watanabe S, Ito E, Joh K, Tanaka H. Persistent Immature Glomeruli in a Girl with Refractory Nephrotic Syndrome. Nephrology (Carlton) 2012; 18:77-8. [DOI: 10.1111/j.1440-1797.2012.01617.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Martinerie L, Pussard E, Meduri G, Delezoide AL, Boileau P, Lombès M. Lack of renal 11 beta-hydroxysteroid dehydrogenase type 2 at birth, a targeted temporal window for neonatal glucocorticoid action in human and mice. PLoS One 2012; 7:e31949. [PMID: 22359645 PMCID: PMC3281096 DOI: 10.1371/journal.pone.0031949] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 01/18/2012] [Indexed: 11/20/2022] Open
Abstract
Background Glucocorticoid hormones play a major role in fetal organ maturation. Yet, excessive glucocorticoid exposure in utero can result in a variety of detrimental effects, such as growth retardation and increased susceptibility to the development of hypertension. To protect the fetus, maternal glucocorticoids are metabolized into inactive compounds by placental 11beta-hydroxysteroid dehydrogenase type2 (11βHSD2). This enzyme is also expressed in the kidney, where it prevents illicit occupation of the mineralocorticoid receptor by glucocorticoids. We investigated the role of renal 11βHSD2 in the control of neonatal glucocorticoid metabolism in the human and mouse. Methods Cortisol (F) and cortisone (E) concentrations were measured in maternal plasma, umbilical cord blood and human newborn urine using HPLC. 11βHSD2 activity was indirectly assessed by comparing the F/E ratio between maternal and neonatal plasma (placental activity) and between plasma and urine in newborns (renal activity). Direct measurement of renal 11βHSD2 activity was subsequently evaluated in mice at various developmental stages. Renal 11βHSD2 mRNA and protein expression were analyzed by quantitative RT-PCR and immunohistochemistry during the perinatal period in both species. Results We demonstrate that, at variance with placental 11βHSD2 activity, renal 11βHSD2 activity is weak in newborn human and mouse and correlates with low renal mRNA levels and absence of detectable 11βHSD2 protein. Conclusions We provide evidence for a weak or absent expression of neonatal renal 11βHSD2 that is conserved among species. This temporal and tissue-specific 11βHSD2 expression could represent a physiological window for glucocorticoid action yet may constitute an important predictive factor for adverse outcomes of glucocorticoid excess through fetal programming.
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Affiliation(s)
- Laetitia Martinerie
- INSERM, U693, Le Kremlin-Bicêtre, France
- Univ Paris-Sud 11, Faculté de Médecine Paris-Sud, UMR-S693, Le Kremlin-Bicêtre, France
- Service d'Endocrinologie et Maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Eric Pussard
- INSERM, U693, Le Kremlin-Bicêtre, France
- Univ Paris-Sud 11, Faculté de Médecine Paris-Sud, UMR-S693, Le Kremlin-Bicêtre, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Geri Meduri
- INSERM, U693, Le Kremlin-Bicêtre, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Anne-Lise Delezoide
- Service de Biologie du Développement, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Hôpital Robert Debré, Paris, France
- PremUp Foundation, Paris, France
| | - Pascal Boileau
- PremUp Foundation, Paris, France
- Service de Pédiatrie et Réanimation néonatale, Univ Paris-Sud 11, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart, France
| | - Marc Lombès
- INSERM, U693, Le Kremlin-Bicêtre, France
- Univ Paris-Sud 11, Faculté de Médecine Paris-Sud, UMR-S693, Le Kremlin-Bicêtre, France
- Service d'Endocrinologie et Maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
- PremUp Foundation, Paris, France
- * E-mail:
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15
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Sutherland MR, Gubhaju L, Moore L, Kent AL, Dahlstrom JE, Horne RSC, Hoy WE, Bertram JF, Black MJ. Accelerated maturation and abnormal morphology in the preterm neonatal kidney. J Am Soc Nephrol 2011; 22:1365-74. [PMID: 21636639 DOI: 10.1681/asn.2010121266] [Citation(s) in RCA: 228] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Nephrogenesis is ongoing at the time of birth for the majority of preterm infants, but whether postnatal renal development follows a similar trajectory to normal in utero growth is unknown. Here, we examined tissue collected at autopsy from 28 kidneys from preterm neonates, whose postnatal survival ranged from 2 to 68 days, including 6 that had restricted intrauterine growth. In addition, we examined kidneys from 32 still-born gestational controls. We assessed the width of the nephrogenic zone, number of glomerular generations, cross-sectional area of the renal corpuscle, and glomerular maturity and morphology. Renal maturation accelerated after preterm birth, with an increased number of glomerular generations and a decreased width of the nephrogenic zone in the kidneys of preterm neonates. Of particular concern, compared with gestational controls, preterm kidneys had a greater percentage of morphologically abnormal glomeruli and a significantly larger cross-sectional area of the renal corpuscle, suggestive of renal hyperfiltration. These observations suggest that the preterm kidney may have fewer functional nephrons, thereby increasing vulnerability to impaired renal function in both the early postnatal period and later in life.
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Affiliation(s)
- Megan R Sutherland
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, 3800, Australia
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Martinerie L, Viengchareun S, Delezoïde AL, Jaubert F, Sinico M, Prevot S, Boileau P, Meduri G, Lombès M. Low renal mineralocorticoid receptor expression at birth contributes to partial aldosterone resistance in neonates. Endocrinology 2009; 150:4414-24. [PMID: 19477942 PMCID: PMC3201843 DOI: 10.1210/en.2008-1498] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The human neonatal period is characterized by renal immaturity with impaired capacity to regulate water and sodium homeostasis, resembling partial aldosterone resistance. Because aldosterone effects are mediated by the mineralocorticoid receptor (MR), we postulated that this hormonal unresponsiveness could be related to low MR expression in the distal nephron. We measured aldosterone and renin levels in umbilical cord blood of healthy newborns. We used quantitative real-time PCR and immunohistochemistry to analyze the expression of MR and key players of the mineralocorticoid signaling pathway during human and mouse renal development. High aldosterone and renin levels were found at birth. MR mRNA was detected in mouse kidney at d 16 postcoitum, peaking at d 18 postcoitum, but its expression was surprisingly very low at birth, rising progressively afterward. Similar biphasic temporal expression was observed during human renal embryogenesis, with a transient expression between 15 and 24 wk of gestation but an undetectable immunoreactive MR in late gestational and neonatal kidneys. This cyclic MR expression was tightly correlated with the evolution of the 11beta-hydroxysteroid dehydrogenase type 2 and the epithelial sodium channel alpha-subunit. In contrast, glucocorticoid and vasopressin receptors and aquaporin 2 followed a progressive and sustained evolution during renal maturation. Our study provides the first evidence for a low renal MR expression level at birth, despite high aldosterone levels, which could account for compromised postnatal sodium handling. Elucidation of regulatory mechanisms governing MR expression should lead to new strategies for the management of sodium waste in preterms and neonates.
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Affiliation(s)
- Laetitia Martinerie
- Récepteurs stéroïdiens : physiopathologie endocrinienne et métabolique
INSERM : U693IFR93Université Paris Sud - Paris XIFaculté de médecine 63, Rue Gabriel Peri 94276 LE KREMLIN BICETRE,FR
| | - Say Viengchareun
- Récepteurs stéroïdiens : physiopathologie endocrinienne et métabolique
INSERM : U693IFR93Université Paris Sud - Paris XIFaculté de médecine 63, Rue Gabriel Peri 94276 LE KREMLIN BICETRE,FR
| | - Anne-Lise Delezoïde
- Service de Biologie du Développement
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Robert DebréUniversité Paris Diderot - Paris 775019 Paris,FR
| | - Francis Jaubert
- Service d'AnatomoPathologie
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Necker - Enfants MaladesUniversité Paris DescartesParis 75015,FR
| | - Martine Sinico
- Service d'AnatomoPathologie
CHIC CréteilCréteil 94010,FR
| | - Sophie Prevot
- Service d'AnatomoPathologie
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Antoine BéclèreUniversité Paris Sud - Paris XIClamart 92141,FR
| | - Pascal Boileau
- Service de Pédiatrie et Réanimations néonatales
Université Paris Sud - Paris XIAssistance publique - Hôpitaux de Paris (AP-HP)Hôpital Antoine Béclère92141 Clamart,FR
| | - Géri Meduri
- Récepteurs stéroïdiens : physiopathologie endocrinienne et métabolique
INSERM : U693IFR93Université Paris Sud - Paris XIFaculté de médecine 63, Rue Gabriel Peri 94276 LE KREMLIN BICETRE,FR
- Service de génétique moléculaire, pharmacogénétique et hormonologie
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital BicêtreUniversité Paris Sud - Paris XI78, rue du Général Leclerc 94275 Le Kremlin Bicêtre,FR
| | - Marc Lombès
- Récepteurs stéroïdiens : physiopathologie endocrinienne et métabolique
INSERM : U693IFR93Université Paris Sud - Paris XIFaculté de médecine 63, Rue Gabriel Peri 94276 LE KREMLIN BICETRE,FR
- Service d'Endocrinologie et Maladies de la reproduction
Assistance publique - Hôpitaux de Paris (AP-HP)Hôpital Bicêtre78 rue du général Leclerc, Le Kremlin Bicêtre 94275,FR
- Correspondence should be adressed to: Marc Lombès
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Obikane K, Nakashima T, Watarai Y, Morita K, Cho K, Tonoki H, Nagata M, Sasaki S. Renal failure due to tubulointerstitial nephropathy in an infant with cranioectodermal dysplasia. Pediatr Nephrol 2006; 21:574-6. [PMID: 16491415 DOI: 10.1007/s00467-006-0031-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 11/09/2005] [Accepted: 11/11/2005] [Indexed: 01/08/2023]
Abstract
Cranioectodermal dysplasia (CED) is a rare autosomal recessive disease with characteristic craniofacial, skeletal, and ectodermal-derived tissue abnormalities. In this disease, tubulointerstitial nephropathy (TIN) has been reported as one of the life-threatening combinations. Here we report a sporadic case of CED showing signs of renal failure during the perinatal period. Renal biopsy at the age of 6 months revealed TIN consisting of marked interstitial fibrosis with inflammatory cell infiltration accompanied by scattered tubular atrophy. Glomeruli were often sclerosed and others showed prominent immaturity; the findings are supportive of progressive deterioration of renal function in this infant. This case suggests that TIN in CED can occur during the fetal period and progress rapidly, leading to end-stage renal failure in infancy.
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Affiliation(s)
- Katsuyuki Obikane
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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