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Mastrangelo A, Serafinelli J, Giani M, Montini G. Clinical and Pathophysiological Insights Into Immunological Mediated Glomerular Diseases in Childhood. Front Pediatr 2020; 8:205. [PMID: 32478016 PMCID: PMC7235338 DOI: 10.3389/fped.2020.00205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
The kidney is often the target of immune system dysregulation in the context of primary or systemic disease. In particular, the glomerulus represents the anatomical entity most frequently involved, generally as the expression of inflammatory cell invasion or circulant or in situ immune-complex deposition. Glomerulonephritis is the most common clinical and pathological manifestation of this involvement. There are no universally accepted classifications for glomerulonephritis. However, recent advances in our understanding of the pathophysiological mechanisms suggest the assessment of immunological features, biomarkers, and genetic analysis. At the same time, more accurate and targeted therapies have been developed. Data on pediatric glomerulonephritis are scarce and often derived from adult studies. In this review, we update the current understanding of the etiologic events and genetic factors involved in the pathogenesis of pediatric immunologically mediated primitive forms of glomerulonephritis, together with the clinical spectrum and prognosis. Possible new therapeutic targets are also briefly discussed.
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Affiliation(s)
- Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Jessica Serafinelli
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marisa Giani
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Ashida A, Shoji T, Honda S, Iio R, Iga C, Hayashi T, Satomura K, Tsubakihara Y. Benefits of incorporating urinary protein/creatinine ratio measurement in a school urine screening system: The experience of restructuring the school urinary screening system in Osaka Prefecture, Japan. Nephrology (Carlton) 2019; 24:1142-1147. [PMID: 30635964 DOI: 10.1111/nep.13558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2019] [Indexed: 11/25/2022]
Abstract
AIM School urine screening has been established in several countries of Asia, including Japan, Korea and Taiwan. In Osaka prefectural schools, the urine screening system had some problematic issues including an unclear referral procedure for students with abnormal urinary findings. Therefore, the school urine screening system was reviewed and restructured in 2004. The aim of this study was to assess the improvement in school urine screening through evaluation of the restructured Osaka prefectural school urinary screening system. METHODS The Osaka prefectural school urinary screening system was reviewed, mainly considering two points. One was the incorporation of standard urinary protein/creatinine ratio measurement instead of the traditional urine dipstick and urine sediment tests; the second point was that all students requiring further examination were referred to regional nephrologists. RESULTS After restructuring, the number of students who were referred to a medical institute for detailed examinations decreased to 10%, although the number of students newly diagnosed with kidney disease and the types of diagnosis did not change. The positive predictive value of screening increased to about 8 times the value before the system restructuring. The reductions enabled students who required further examination to be referred to regional nephrologists and has contributed to a decreased cost for these examinations. CONCLUSION Incorporating urinary protein/creatinine ratio measurement into the school urinary screening system, and updating the guiding principles, including referral to nephrology specialists, has enabled the school urinary screening system in Osaka Prefecture to become more efficient and have better cost performance.
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Affiliation(s)
- Akira Ashida
- Department of Pediatrics, Osaka Medical College, Osaka, Japan.,Osaka Prefectural School Urine Examination Board, Osaka, Japan
| | - Tatsuya Shoji
- Osaka Prefectural School Urine Examination Board, Osaka, Japan.,Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Shiho Honda
- Osaka Prefectural School Urine Examination Board, Osaka, Japan.,Osaka Prefectural Board of Education, Osaka, Japan
| | - Rei Iio
- Osaka Prefectural School Urine Examination Board, Osaka, Japan.,Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Chihiro Iga
- Osaka Prefectural School Urine Examination Board, Osaka, Japan.,Iga Clinic, Osaka, Japan
| | - Terumasa Hayashi
- Osaka Prefectural School Urine Examination Board, Osaka, Japan.,Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Kenichi Satomura
- Osaka Prefectural School Urine Examination Board, Osaka, Japan.,Department of Internal Medicine, Meisei-Daini Hospital, Osaka, Japan
| | - Yoshiharu Tsubakihara
- Osaka Prefectural School Urine Examination Board, Osaka, Japan.,Master Course of Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
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Miyazaki K, Enya T, Miyazawa T, Okada M, Takemura T, Sugimoto K. A case of membranoproliferative glomerulonephritis in whom clinical remission could be achieved by tonsillectomy. ACTA ACUST UNITED AC 2019. [DOI: 10.3165/jjpn.cr.2018.0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kohei Miyazaki
- Department of Pediatrics, Kindai University Faculty of Medicine
| | - Takuji Enya
- Department of Pediatrics, Kindai University Faculty of Medicine
| | - Tomoki Miyazawa
- Department of Pediatrics, Kindai University Faculty of Medicine
| | - Mitsuru Okada
- Department of Pediatrics, Kindai University Faculty of Medicine
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Okuda Y, Ishikura K, Hamada R, Harada R, Sakai T, Hamasaki Y, Hataya H, Fukuzawa R, Ogata K, Honda M. Membranoproliferative glomerulonephritis and C3 glomerulonephritis: Frequency, clinical features, and outcome in children. Nephrology (Carlton) 2015; 20:286-92. [DOI: 10.1111/nep.12382] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Yusuke Okuda
- Department of Nephrology; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
| | - Kenji Ishikura
- Department of Nephrology; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
- Clinical Research Support Center; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
| | - Riku Hamada
- Department of Nephrology; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
| | - Ryoko Harada
- Department of Nephrology; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
| | - Tomoyuki Sakai
- Department of Pediatrics; Shiga University of Medical Science; Shiga Japan
| | - Yuko Hamasaki
- Department of Pediatric Nephrology; Toho University Faculty of Medicine; Tokyo Japan
| | - Hiroshi Hataya
- Department of Nephrology; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
| | - Ryuji Fukuzawa
- Department of Pathology and Laboratory Medicine; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
| | - Kentaro Ogata
- Division of Pathology; Tachikawa Hospital; Federation of National Public Service Personnel Mutual Aid Associations; Tokyo Japan
| | - Masataka Honda
- Department of Nephrology; Tokyo Metropolitan Children's Medical Center; Tokyo Japan
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Zhai Y, Xu H, Shen Q, Cao Q, Zhu G, Wei M, Sun L, Liu H, Rao J, Fang X, Chen J, Guo W. Renal histological features of school-age children with asymptomatic haematuria and/or proteinuria: a multicenter study. Nephrology (Carlton) 2015; 19:426-31. [PMID: 24720478 DOI: 10.1111/nep.12260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 11/27/2022]
Abstract
AIM The risk of asymptomatic haematuria and/or proteinuria development into chronic progressive glomerulonephritis (CPG) is unclear. The indications for renal biopsy and follow-up on these asymptomatic children remain controversial. METHODS A multicenter, retrospective study was performed to investigate the renal histological features of school-age children with asymptomatic urine abnormalities. RESULTS A total of 112 asymptomatic children's renal biopsy data were studied. Most of the children (71%) received a renal biopsy because of isolated microscopic haematuria (IH), and these children were predominantly (60%) proven to have only mild lesions in the glomeruli. Approximately 30% of the children were biopsied because of asymptomatic proteinuria with or without microscopic haematuria (HP or isolated asymptomatic proteinuria (IP)), and these children were mostly (44-83%) indicated to have CPG, such as IgA nephropathy, focal segmental glomerulosclerosis, and Alport syndrome. The junior high school students had a greater percentage of HP than the primary school children. IgA nephropathy was the most common diagnosis in children who received renal biopsy because of HP. CONCLUSIONS Our findings indicate that IP and especially HP may have a high risk of development into CPG. IH, however, has a relatively low risk of severe histological lesions. Thus, IH per se might not be suggested as an indication for early renal biopsy. Long-term follow-up is necessary for these asymptomatic children.
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Affiliation(s)
- Yihui Zhai
- Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China
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Cho BS, Park SS, Kim SD, Won KY, Lim SJ. Clinical and histologic response to methylprednisolone pulse therapy in glomerulonephritis. Fetal Pediatr Pathol 2010; 29:271-90. [PMID: 20594152 DOI: 10.3109/15513811003786335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We retrospectively analyzed the data of the first and second renal biopsies to investigate the adverse effects as well as the clinical and histologic responses of methylprednisolone pulse therapy in patients with chronic glomerulonephritis. At the time of the second renal biopsy, the activity index had decreased significantly and the chronicity index was well preserved. The activity index and interstitial fibrosis were improved in the complete and partial remission groups, but not in the nonresponse group. These findings indicate that methylprednisolone pulse therapy is effective in patients with chronic glomerulonephritis and has an acceptably low risk of side effects.
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Affiliation(s)
- Byoung-Soo Cho
- Department of Pediatrics, Kyung Hee University, Seoul, Korea.
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Transition of children with membranoproliferative glomerulonephritis to adolescence and adulthood. Clin Exp Nephrol 2008; 12:28-32. [PMID: 18175061 DOI: 10.1007/s10157-007-0014-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Accepted: 09/27/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many chronic renal diseases in children, including membranoproliferative glomerulonephritis (MPGN), often continue into adulthood, and these patients require continuing management. Despite the importance of the topic, there has been limited discussion about the problems of transition in children with continuing renal disease. We report our experience in patients with MPGN, as they matured from childhood to adolescence and adulthood, so-called "carry-over" cases. METHODS The clinical course of diffuse MPGN in 27 children was retrospectively reviewed. Patients were over 18 years old at the end of follow-up. RESULTS The mean follow-up period was 12.6 years; 20 children (74%) were identified by school urinary screening. The clinical course was favorable, and none of the patients progressed to end-stage renal failure during follow-up. However, eight patients (30%) continued to demonstrate proteinuria; two patients were nephrotic. Four patients were non-compliant and discontinued medication by themselves. Three patients were still on low dose of alternate-day (ALD) prednisolone. Twenty patients finished the treatment and were followed for an average of 4.6 years. Only one demonstrated trace amounts of proteinuria 1 year after discontinuing ALD prednisolone. CONCLUSIONS MPGN often continues during maturation from childhood to adulthood, and patients are usually referred to adult nephrologists. Good communication between pediatric and adult nephrologists is important. In addition, more in depth explanation and reeducation about their disease and its management are helpful when these patients reach adolescence. These measures will improve their care and help to assure compliance with their medication regimen.
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Zhai YH, Xu H, Zhu GH, Wei MJ, Hua BC, Shen Q, Rao J, Ge J. Efficacy of urine screening at school: experience in Shanghai, China. Pediatr Nephrol 2007; 22:2073-9. [PMID: 17943322 DOI: 10.1007/s00467-007-0629-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 08/06/2007] [Accepted: 08/08/2007] [Indexed: 11/24/2022]
Abstract
To explore the prevalence of hematuria or proteinuria in school children in Shanghai and to evaluate the screening methods, we conducted urine screening in more than 40,000 school children between 2003 and 2005. Children were tested with dipsticks read manually (method A) or dipsticks read by machines (method B) combined with a sulfosalicylic acid test or microscopy. Some children were tested once, and others who had abnormal results in the first screening were tested again 2 weeks later. The prevalence of urine abnormalities in the first screening was more than 5.00% and of the second screening about 1.00%. Either method B or testing two urine samples for each child had higher specificity. As to the direct cost, that of screening twice with method A was lower than just screening once with method B. So using method A to screen twice for each child was not only convenient and economical, but also could reduce the false positive rate effectively. More than 10 months of follow-up diagnosed two cases of IgA nephropathy. Asymptomatic chronic renal diseases in school children could be detected through school urine screening. For Shanghai, China, screening twice using method A might be the best choice.
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Affiliation(s)
- Yi-Hui Zhai
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, People's Republic of China.
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Chung SH, Park SS, Kim SD, Cho BS. The impact of early detection through school urinary screening tests of membranoproliferative glomerulonephritis type I. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.11.1104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sung-Hoon Chung
- Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
| | - Sung-Sin Park
- Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
| | - Sung-Do Kim
- Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
| | - Byoung-Soo Cho
- Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
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