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Paul EN, Satish S, Kelur KK, Shetty MS. Glomerular parietal epithelial expression of CD44 in minimal change nephrotic syndrome and primary focal segmental glomerulosclerosis: A clinico-pathological study. INDIAN J PATHOL MICR 2023; 66:526-532. [PMID: 37530333 DOI: 10.4103/ijpm.ijpm_593_21] [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: 08/03/2023] Open
Abstract
Introduction Minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) are the two common causes of nephrotic syndrome (NS) in both children and adults with overlapping clinical features, but with distinct prognostic and therapeutic implications. The distinction between these relies entirely on histopathology, which can sometimes be difficult. CD44 is expressed by activated parietal epithelial cells, plays a role in matrix deposition and thus in the pathogenesis of FSGS. Aims To assess the expression of CD44 in MCNS and FSGS and to evaluate its association with the known clinical and histopathological prognostic factors. Materials and Methods Thirty cases each of MCNS and FSGS were studied. The clinical, laboratory, histopathological, and CD 44 immunohistochemical data were recorded. The findings were analyzed and correlated. A P value of < 0.05 was considered statistically significant. Results Statistical association was noted between CD44 positivity and serum creatinine (p = 0.031), estimated glomerular filtration rate (p = 0.040), segmental sclerosis (p < 0.001), tubular atrophy (p = 0.027), interstitial fibrosis (p = 0.027), and histological diagnosis (p < 0.001). The sensitivity, specificity, positive predictive, and negative predictive values were 90%, 76.67%, 79.41% and 88.46%, respectively. Conclusions CD44 immunostain can effectively distinguish MCNS from FSGS. The congruent results of CD44 positivity with known prognostic factors support the possibility of using the CD44 marker as a predictive tool in selecting high-risk patients and offering appropriate therapeutic measures.
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Affiliation(s)
- E Nithin Paul
- Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Suchitha Satish
- Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Kiran Krishnamurthy Kelur
- Department of Nephrology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Manjunath Sanjeev Shetty
- Department of Nephrology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Spectrum of NPHS1 and NPHS2 variants in egyptian children with focal segmental glomerular sclerosis: identification of six novel variants and founder effect. Mol Genet Genomics 2022; 297:689-698. [DOI: 10.1007/s00438-022-01877-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/20/2022] [Indexed: 01/10/2023]
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Pokrajac D, Kamber AH, Karasalihovic Z. Children with Steroid-Resistant Nephrotic Syndrome: A Single -Center Experience. Mater Sociomed 2018; 30:84-88. [PMID: 30061794 PMCID: PMC6029918 DOI: 10.5455/msm.2018.30.84-88] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Nephrotic syndrome (NS) is one of the most frequent glomerular diseases among children. While most of the children with primary NS respond to steroid treatment, 10 to 20% of the patients are steroid-resistant, and the best therapy for such cases has never been defined. Objective The present study aimed to evaluate steroid-resistant nephrotic syndrome (SRNS) patients. Materials and methods Our research included 50 children (56% female and 44% male) with NS. NS was defined as the presence of edema, massive proteinuria, hypoalbuminemia and hyperlipidemia. Patients with NS were treated according to international protocol. SRNS was diagnosed in patients with idiopathic NS based on lack of complete remission despite treatment with steroids. Renal biopsy was performed in 22 patients with SRNS at the Pediatric Clinic II of the University Clinical Center in Sarajevo (UCCS). Histopathologic analyzes of renal biopsy were performed at the Department of Pathology, University Clinical Center in Tuzla (UCCT). Patients with SRNS, after kidney biopsy were treated with nonsteroidal immunosuppressant's. Results Eight (36.4%) of the 22 patients who had undergone renal biopsies had minimal change disease (MCNS) and seven (31.8%) had focal segmental glomerulosclerosis (FSGS). The immunosuppressive drugs used in SRNS were Cyclosporine (CsA), Cyclophosphamide (CYC), Mycophenolat mofetil (MMF) and Rituximab (RTX). Three patients (13.6%) did not respond to any treatment and had developed end - stage renal disease (ESRD). Conclusion With current treatments, some children will ultimately achieve a sustained remission with one of the second line or third line of the proposed drugs. Patients with refractory NS will go to progression towards ESRD. The rapid development of molecular genetics will give a new contribution to the pathogenesis and treatment of this disease.
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Affiliation(s)
- Danka Pokrajac
- Pediatric Clinic II, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Zinaida Karasalihovic
- Department of Pathology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Alsaidi S, Wagner D, Grisaru S, Midgley J, Hamiwka L, Wade A, Nettel-Aguirre A, Samuel S. Glomerular Filtration Rate Trends During Follow-up in Children With Steroid-Sensitive Nephrotic Syndrome. Can J Kidney Health Dis 2017; 4:2054358117709496. [PMID: 28607687 PMCID: PMC5453627 DOI: 10.1177/2054358117709496] [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: 07/24/2016] [Accepted: 03/19/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Overall prognosis of children with steroid-sensitive nephrotic syndrome (SSNS) is regarded as generally favorable. However, only a few recent studies have evaluated changes in kidney function and blood pressure over time in children with SSNS. OBJECTIVES We describe clinical features of SSNS patients and characterize changes in calculated estimated glomerular filtration rate (eGFR) and use of antihypertensive medications during follow-up. DESIGN This is a retrospective cohort study. SETTING This study was conducted in a Canadian pediatric nephrology center. PATIENTS This study included patients aged 1 to 18 years with SSNS. MEASUREMENTS eGFR was calculated from recorded serum creatinine and height measurements using the modified Schwartz equation. METHODS eGFR was calculated at yearly intervals, and the trend of eGFR was assessed using linear mixed effects model. Patients were also evaluated for use of antihypertensive medications during follow-up. RESULTS Seventy-eight patients-median age, 3.2 years (interquartile range [IQR], 2.65) and median follow-up of 4.37 (IQR, 5.6)-were evaluated. Sixty-three (80.8%) had at least 1 relapse. Twenty-two (28.2%) and 20 (25.6%) were steroid dependent and frequently relapsing, respectively. Forty-three patients (55.1%) received at least 1 steroid-sparing agent, and of these, 18 (41.8%) received a calcineurin inhibitor. One patient had eGFR ≤90 mL/min/1.73 m2 during observation. eGFR remained unchanged over the follow-up period in this cohort of patients. Four patients (5.1%) were on antihypertensive medications at the end of follow-up. LIMITATIONS Patients who had frequent relapses had more measurements available for serum creatinine and height, creating a sampling bias. The number of eGFR measurements was overall small, making it difficult to ascertain eGFR trend. CONCLUSION eGFR remained unchanged over time in this cohort, and a small proportion of patients required antihypertensive therapy at the end of follow-up. Our study highlights the needs for carefully constructed long-term observational studies of children with nephrotic syndrome.
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Affiliation(s)
- Sulaiman Alsaidi
- Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Daniel Wagner
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Silviu Grisaru
- Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Julian Midgley
- Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Andrew Wade
- Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Samuel
- Division of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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R229Q Polymorphism of NPHS2 Gene in Group of Iraqi Children with Steroid-Resistant Nephrotic Syndrome. Int J Nephrol 2017; 2017:1407506. [PMID: 28529802 PMCID: PMC5424166 DOI: 10.1155/2017/1407506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background. The polymorphism R229Q is one of the most commonly reported podocin sequence variations among steroid-resistant nephrotic syndromes (SRNS). Aim of the Study. We investigated the frequency and risk of this polymorphism among a group of Iraqi children with SRNS and steroid-sensitive nephrotic syndrome (SSNS). Patients and Methods. A prospective case control study which was conducted in Al-Imamein Al-Kadhimein Medical City, spanning the period from the 1st of April 2015 to 30th of November 2015. Study sample consisted of 54 children having NS, divided into 2 groups: patients group consisted of 27 children with SRNS, and control group involved 27 children with SSNS. Both were screened by real time polymerase chain reaction for R229Q in exon 5 of NPHS2 gene. Results. Molecular study showed R229Q polymorphism in 96.3% of SRNS and 100% of SSNS. There were no phenotypic or histologic characteristics of patients bearing homozygous R229Q polymorphism and the patients with heterozygous R229Q polymorphism. Conclusion. Polymorphism R229Q of NPHS2 gene is prevalent in Iraqi children with SRNS and SSNS. Further study needs to be done, for other exons and polymorphism of NPHS2 gene in those patients.
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Single Nucleotide Polymorphisms in Pediatric Idiopathic Nephrotic Syndrome. Int J Nephrol 2016; 2016:1417456. [PMID: 27247801 PMCID: PMC4876225 DOI: 10.1155/2016/1417456] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/05/2016] [Indexed: 11/24/2022] Open
Abstract
Polymorphic variants in several molecules involved in the glomerular function and drug metabolism have been implicated in the pathophysiology of pediatric idiopathic nephrotic syndrome (INS), but the results remain inconsistent. We analyzed the association of eleven allelic variants in eight genes (angiopoietin-like 4 (ANGPTL4), glypican 5 (GPC5), interleukin-13 (IL-13), macrophage migration inhibitory factor (MIF), neural nitric oxide synthetase (nNOS), multidrug resistance-1 (MDR1), glucocorticoid-induced transcript-1 (GLCCI1), and nuclear receptor subfamily-3 (NR3C1)) in 100 INS patients followed up till adulthood. We genotyped variants using PCR and direct sequencing and evaluated estimated haplotypes of MDR1 variants. The analysis revealed few differences in SNP genotype frequencies between patients and controls, or in clinical parameters among the patients. Genotype distribution of MDR1 SNPs rs1236, rs2677, and rs3435 showed significant (p < 0.05) association with different medication regimes (glucocorticoids only versus glucocorticoids plus additional immunosuppressives). Some marginal association was detected between ANGPTL4, GPC5, GLCCI1, and NR3C1 variants and different medication regimes, number of relapses, and age of onset. Conclusion. While MDR1 variant genotype distribution associated with different medication regimes, the other analyzed gene variants showed only little or marginal clinical relevance in INS.
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Lu L, Sun XM, Yin Y, Huang YF, Wang M, Wan H, Wei LB, Xiao W. The amino acid mutations of the podocin in proteinuria: a meta-analysis. Ren Fail 2015. [PMID: 26211502 DOI: 10.3109/0886022x.2015.1067129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
While many previous studies have reported an association between the single-nucleotide polymorphisms (SNPs) of the podocin and proteinuria occurred, a conclusive relationship has not been defined in every oligoallelic state of amino acid (AA) mutations in podocin. In this study, we performed a meta-analysis of the published data to investigate the impact of the oligoallelic AA mutations of the podocin on proteinuria; a total 16 AA mutations were investigated for oligoallelic pathogenicity. Despite significant heterogeneity within some of the comparisons, the results revealed significantly higher risks of proteinuria in early-onset (onset age <16) individuals for five mutations (P118L, R138Q, R168H, V180M, and V260E), and in all onset ages individuals for five mutations (R138Q, G140X, R229Q, V260E, and V290M) compared to non-variant individuals. We also tested the steroid response in individuals with R229Q and E237Q. No statistically significant differences in the two mutations carrier rate were observed between steroid resistance patients and controls. No AA mutation was selected for meta-analysis on the recurrence of proteinuria after renal transplantation as lack of control data. In conclusion, our meta-analysis tested the pathogenicity of the oligoallelic AA mutations in podocin and suggested the potential causative mutations, and the alleles showing an association with protein susceptibility. The sensitivity and specificity of each causative mutation are pending further testing.
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Affiliation(s)
- Lu Lu
- a School of Traditional Chinese Medicine, Southern Medical University , Guangzhou , China
| | - Xiao-ming Sun
- a School of Traditional Chinese Medicine, Southern Medical University , Guangzhou , China
| | - Yi Yin
- a School of Traditional Chinese Medicine, Southern Medical University , Guangzhou , China .,b Department of Nephrology , Southern Medical University TCM-Integrated Hospital , Guangzhou , China .,c Department of Traditional Chinese Medicine , ZhuJiang Hospital, Southern Medical University , Guangzhou , China , and
| | - Yan-feng Huang
- a School of Traditional Chinese Medicine, Southern Medical University , Guangzhou , China .,b Department of Nephrology , Southern Medical University TCM-Integrated Hospital , Guangzhou , China
| | - Ming Wang
- c Department of Traditional Chinese Medicine , ZhuJiang Hospital, Southern Medical University , Guangzhou , China , and
| | - Heng Wan
- d Department of Endocrinology , The Third Affiliated Hospital, Southern Medical University , Guangzhou , China
| | - Lian-Bo Wei
- a School of Traditional Chinese Medicine, Southern Medical University , Guangzhou , China .,b Department of Nephrology , Southern Medical University TCM-Integrated Hospital , Guangzhou , China .,c Department of Traditional Chinese Medicine , ZhuJiang Hospital, Southern Medical University , Guangzhou , China , and
| | - Wei Xiao
- a School of Traditional Chinese Medicine, Southern Medical University , Guangzhou , China
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Metz DK, Kausman JY. Childhood nephrotic syndrome in the 21st century: What's new? J Paediatr Child Health 2015; 51:497-504. [PMID: 25266706 DOI: 10.1111/jpc.12734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Abstract
Childhood nephrotic syndrome is a condition managed by general paediatricians and paediatric nephrologists. Whether treating a first presentation or a relapse, the clinician requires expertise in order to minimise the risk of serious complications and optimise long-term care. Indeed, many children suffer a difficult relapsing course in their disease, warranting consideration of second-line therapies. The last two decades have witnessed a growing knowledge of the condition and increased complexity of diagnostic and therapeutic options, which poses a challenge for the general paediatrician, given the condition's relative rarity in daily practice. This review aims to familiarise the reader with some of the most important recent developments and particularly to provide an insight into what management options are available and when it may be appropriate to seek advice from a nephrologist.
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10
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Behbahan AG, Poorshiri B, Mortazavi F, Khaniani MS, Derakhshan SM. NPHS1 gene mutations in children with Nephrotic Syndrome in northwest Iran. Pak J Biol Sci 2014; 16:882-6. [PMID: 24498843 DOI: 10.3923/pjbs.2013.882.886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Idiopathic Nephrotic Syndrome (NS) is the prevalent glomerular disease in childhood. It is treated with steroid and according to its response is defined as steroid sensitive NS (SSNS) and steroid resistance NS (SRNS). Mutation in NPHS 1 gene is reported in children with SRNS and few cases of SSNS. The aim of current study is to evaluate NPHS1 gene mutations in idiopathic NS (SSNS and SSRS) in Northwest Iran. In this cross-sectional analytic study 20 children from Azeri population in Iran with idiopathic NS including 10 cases with SRNS (5 male and 5 female) and 10 cases with SSNS (7 male and 3 female) were evaluated for NPHS1 gene mutations. DNA was extracted from peripheral blood and NPHSI gene analysis was performed by PCR and direct sequencing method with the use of standard primers. Mutations in NPHS1 gene occurred in 6 cases of SSNS including 3 heterozygous and 3 homozygous mutations and in 8 cases of SRNS including 5 homozygous, one compound heterozygous and 2 heterozygous mutations. Overall 6 different mutations were detected in NPHS1 gene: one deletion, one insertion, 3 missense and one nonsense mutations. Mutations in exon 4 and 27 were only seen in SRNS patients. Mutations in NPHS1 gene could occur in both SRNS and SSNS patients; however, considering higher incidence of heterozygous mutations in SSNS, the existence of milder phenotype in these cases would be the reason for steroid response.
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Affiliation(s)
- A G Behbahan
- Department of Pediatrics, Pediatrics Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - B Poorshiri
- Department of Pediatrics, Pediatrics Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - F Mortazavi
- Department of Pediatrics, Pediatrics Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M S Khaniani
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - S M Derakhshan
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Bouchireb K, Boyer O, Gribouval O, Nevo F, Huynh-Cong E, Morinière V, Campait R, Ars E, Brackman D, Dantal J, Eckart P, Gigante M, Lipska BS, Liutkus A, Megarbane A, Mohsin N, Ozaltin F, Saleem MA, Schaefer F, Soulami K, Torra R, Garcelon N, Mollet G, Dahan K, Antignac C. NPHS2Mutations in Steroid-Resistant Nephrotic Syndrome: A Mutation Update and the Associated Phenotypic Spectrum. Hum Mutat 2013; 35:178-86. [DOI: 10.1002/humu.22485] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Karim Bouchireb
- Assistance Publique-Hôpitaux de Paris, Service de Néphrologie Pédiatrique; Centre de Référence des Maladies Rénales Héréditaires (MARHEA), Hôpital Necker-Enfants Malades; Paris France
- Inserm U983; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
| | - Olivia Boyer
- Assistance Publique-Hôpitaux de Paris, Service de Néphrologie Pédiatrique; Centre de Référence des Maladies Rénales Héréditaires (MARHEA), Hôpital Necker-Enfants Malades; Paris France
- Inserm U983; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
| | - Olivier Gribouval
- Inserm U983; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
| | - Fabien Nevo
- Inserm U983; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
| | - Evelyne Huynh-Cong
- Inserm U983; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
| | - Vincent Morinière
- Assistance Publique-Hôpitaux de Paris; Département de Génétique, Hôpital Necker-Enfants Malades; Paris France
| | - Raphaëlle Campait
- Assistance Publique-Hôpitaux de Paris; Département de Génétique, Hôpital Necker-Enfants Malades; Paris France
| | - Elisabet Ars
- Molecular Biology Laboratory; Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III; Barcelona Spain
| | - Damien Brackman
- Department of Pediatrics; Haukeland University Hospital; Bergen Norway
| | - Jacques Dantal
- Service de Néphrologie et Immunologie Clinique; ITERT, CHU Hôtel Dieu; Nantes France
| | | | - Maddalena Gigante
- Department of Medical and Surgical Sciences; University of Foggia; Foggia Italy
| | - Beata S. Lipska
- Department of Biology and Genetics; Medical University of Gdansk; Gdansk 80-211 Poland
| | - Aurélia Liutkus
- Service de Néphrologie et Rhumatologie Pédiatriques; Centre de référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant; Bron France
| | - André Megarbane
- Unité de Génétique Médicale, Faculté de Médecine; Université Saint Joseph; Beirut Lebanon
| | - Nabil Mohsin
- Department of Nephrology; Royal Hospital; Muscat Oman
| | - Fatih Ozaltin
- Nephrogenetics Laboratory, Department of Pediatric Nephrology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Moin A. Saleem
- Department of Paediatric Nephrology; Bristol Royal Hospital for Children, Academic Renal Unit, School of Clinical Sciences, University of Bristol; Bristol UK
| | - Franz Schaefer
- PodoNet Consortium; Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine; Heidelberg Germany
| | - Kenza Soulami
- CHU Ibn Rochd; Service de Néphrologie Dialyse Transplantation; Casablanca Morocco
| | - Roser Torra
- Nephrology Department; Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III; Barcelona Spain
| | - Nicolas Garcelon
- Assistance Publique-Hôpitaux de Paris; Département de Génétique, Hôpital Necker-Enfants Malades; Paris France
- Inserm U872; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
| | - Géraldine Mollet
- Inserm U983; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
| | - Karin Dahan
- Centre de Génétique Humaine; Université Catholique de Louvain; Bruxelles Belgique
| | - Corinne Antignac
- Assistance Publique-Hôpitaux de Paris; Département de Génétique, Hôpital Necker-Enfants Malades; Paris France
- Inserm U983; Institut Imagine, Hôpital Necker-Enfants Malades; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
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Chehade H, Parvex P, Poncet A, Werner D, Mosig D, Cachat F, Girardin E. Urinary low-molecular-weight protein excretion in pediatric idiopathic nephrotic syndrome. Pediatr Nephrol 2013; 28:2299-306. [PMID: 23949592 DOI: 10.1007/s00467-013-2569-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 05/28/2013] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are the most common causes of idiopathic nephrotic syndrome (INS). We have evaluated the reliability of urinary neutrophil-gelatinase-associated lipocalin (uNGAL), urinary alpha1-microglobulin (uα1M) and urinary N-acetyl-beta-D-glucosaminidase (uβNAG) as markers for differentiating MCD from FSGS. We have also evaluated whether these proteins are associated to INS relapses or to glomerular filtration rate (GFR). METHODS The patient cohort comprised 35 children with MCD and nine with FSGS; 19 healthy age-matched children were included in the study as controls. Of the 35 patients, 28 were in remission (21 MCD, 7 FSGS) and 16 were in relapse (14 MCD, 2 FSGS). The prognostic accuracies of these proteins were assessed by receiver operating characteristic (ROC) curve analyses. RESULTS The level of uNGAL, indexed or not to urinary creatinine (uCreat), was significantly different between children with INS and healthy children (p = 0.02), between healthy children and those with FSGS (p = 0.007) and between children with MCD and those with FSGS (p = 0.01). It was not significantly correlated to proteinuria or GFR levels. The ROC curve analysis showed that a cut-off value of 17 ng/mg for the uNGAL/uCreat ratio could be used to distinguish MCD from FSGS with a sensitivity of 0.77 and specificity of 0.78. uβNAG was not significantly different in patients with MCD and those with FSGS (p = 0.86). Only uα1M, indexed or not to uCreat, was significantly (p < 0.001) higher for patients in relapse compared to those in remission. CONCLUSIONS Our results indicate that in our patient cohort uNGAL was a reliable biomarker for differentiating MCD from FSGS independently of proteinuria or GFR levels.
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Affiliation(s)
- Hassib Chehade
- Division of Pediatric Nephrology, Department of Pediatrics, Lausanne University Hospital, Rue Bugnon 46, 1011, Lausanne, Switzerland,
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Mantan M, Sethi GR. Presence of CAKUT: A predictor of difficult-to-control nephrotic syndrome. Int J Organ Transplant Med 2013. [DOI: 10.1016/j.hkjn.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Chehade H, Cachat F, Girardin E, Rotman S, Correia AJ, Fellmann F, Bonny O. Two new families with hereditary minimal change disease. BMC Nephrol 2013; 14:65. [PMID: 23517548 PMCID: PMC3616856 DOI: 10.1186/1471-2369-14-65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Steroid-sensitive idiopathic nephrotic syndrome (SSINS) is most often encountered in sporadic cases of minimal change disease (MCD). Only rare cases of familial forms of MCD have been reported and most of them only in one generation. The scarcity of data has precluded unraveling the underlying genetic defect and candidate gene approaches have been unsuccessful. Here we report two families with related SSINS cases and review the related literature. CASE PRESENTATION Two siblings and a cousin (first family), and a father and his son (second family), are reported with SSINS due to MCD. Patients have been followed up for more than 12 years and a renal biopsy was performed in three cases, demonstrating typical features of MCD. The course of the disease was remarkable because of several relapses treated with steroids. In three cases, mycophenolate mofetil or cyclosporine was added. CONCLUSION Familial SSINS due to MCD is extremely rare and no genetic defect has been identified so far. Reporting cases of hereditary MCD will allow further genetic studies which will ultimately help unravel the molecular basis of this disease.
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Affiliation(s)
- Hassib Chehade
- Division of Pediatric Nephrology of West Switzerland, Lausanne University Hospital, Lausanne, Switzerland
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Fujinaga S, Hirano D, Nishizaki N, Someya T, Ohtomo Y, Ohtsuka Y, Shimizu T, Kaneko K. Single daily high-dose mizoribine therapy for children with steroid-dependent nephrotic syndrome prior to cyclosporine administration. Pediatr Nephrol 2011; 26:479-83. [PMID: 21174219 DOI: 10.1007/s00467-010-1707-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/31/2010] [Accepted: 11/04/2010] [Indexed: 11/30/2022]
Abstract
Although cyclosporine (CsA) therapy is effective in the management of children with steroid-dependent nephrotic syndrome (SDNS), a recent study has revealed that the use of CsA itself was a significant predictor of NS relapse in adulthood. The efficacy of single daily high-dose mizoribine (MZR) therapy was assessed in 10 children with SDNS (mean age, 6.2 years) who had never been treated with CsA previously. MZR was started at 5 mg/kg, administered as a single daily dose after breakfast, and the dose was adjusted to achieve 2-h post-dose MZR levels (C2) of approximately 3 μg/ml. In 9 of the 10 patients, treatment with a single daily dose of MZR (mean dose, 8.4 mg/kg/day) over a period of 22 months (median) resulted in significant reduction of the mean prednisolone dose from 0.39 to 0.15 mg/kg/day and the median 12-month relapse rate from 3.0 to 0.4 episodes/12 months. Although cyclophosphamide was initiated in one patient because of treatment failure, none of the 10 patients required treatment with CsA during the observation period (median, 33 months). These data indicate that single daily high-dose MZR therapy is possibly useful in treating children with SDNS and that it may also eliminate the need for CsA in some patients.
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Affiliation(s)
- Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki-ward, Saitama-city, Saitama, 339 8551, Japan.
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16
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How 'minimal' are the adult consequences of childhood MCNS? Nat Rev Nephrol 2010; 6:70-1. [DOI: 10.1038/nrneph.2009.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tonna SJ, Needham A, Polu K, Uscinski A, Appel GB, Falk RJ, Katz A, Al-Waheeb S, Kaplan BS, Jerums G, Savige J, Harmon J, Zhang K, Curhan GC, Pollak MR. NPHS2 variation in focal and segmental glomerulosclerosis. BMC Nephrol 2008; 9:13. [PMID: 18823551 PMCID: PMC2569023 DOI: 10.1186/1471-2369-9-13] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 09/29/2008] [Indexed: 11/10/2022] Open
Abstract
Background Focal and segmental glomerulosclerosis (FSGS) is the most common histologic pattern of renal injury seen in adults with idiopathic proteinuria. Homozygous or compound heterozygous mutations in the podocin gene NPHS2 are found in 10–30% of pediatric cases of steroid resistant nephrosis and/or FSGS. Methods We studied the spectrum of genetic variation in 371 individuals with predominantly late onset FSGS (mean age of onset 25 years) by analysis of DNA samples. Results We identified 15 non-synonymous alleles that changed the amino acid sequence in 63 of the subjects screened (17%). Eight of these (p.R138Q, p.V180M, p.R229Q, p.E237Q, p.A242V, p.A284V, p.L327F and the frameshift 855–856 delAA) are alleles previously reported to cause FSGS in either the homozygous or compound heterozygous states, while the remaining 7 (p.R10T, p.V127W, p.Q215X, p.T232I, p.L270F, p.L312V and the frameshift 397delA) are novel alleles that have not been demonstrated previously. Twelve individuals of the 371 (3.2%) screened had two likely disease-causing NPHS2 alleles, present in either a homozygous or compound heterozygous state. We genotyped the two most common of the non-synonymous NPHS2 alleles (p.A242V and p.R229Q) identified by resequencing in participants from the Nurses' Health Study and also genotyped p.R229Q in 3 diabetic cohorts. We found that the presence of either of these variants does not significantly alter the risk of albuminuria in the Nurses' Health participants, nor does p.R229Q associate with "diabetic nephropathy". Conclusion NPHS2 mutations are a rare cause of FSGS in adults. The most common non-synonymous NPHS2 variants, p.R229Q and p.A242V, do not appear to alter the risk of proteinuria in the general population nor does p.R229Q associate with measures of kidney dysfunction in diabetic individuals. Our results help clarify the frequency of FSGS-causing NPHS2 mutations in adults and broaden our understanding of the spectrum of NPHS2 mutations that lead to human disease.
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Affiliation(s)
- Stephen J Tonna
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Patrakka J, Tryggvason K. Nephrin--a unique structural and signaling protein of the kidney filter. Trends Mol Med 2007; 13:396-403. [PMID: 17766183 DOI: 10.1016/j.molmed.2007.06.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 06/12/2007] [Accepted: 06/13/2007] [Indexed: 12/23/2022]
Abstract
Since the discovery of nephrin, the first integral component of the slit diaphragm to be identified, the podocyte slit pore has become a major focus in research concerning the glomerular filtration barrier. Nephrin is a central component of the glomerular ultrafilter, with both structural and signaling functions. The extracellular domain of nephrin and other components of the slit diaphragm seem to form a porous molecular sieve. The intracellular domain of nephrin is associated with linker proteins, such as CD2-associated protein and Nck proteins that can connect nephrin to the actin cytoskeleton. Alterations in nephrin interactions with other proteins during development or injury can lead to complex signaling reactions aimed at establishing or restoring the filter function.
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Affiliation(s)
- Jaakko Patrakka
- Division of Matrix Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, 171 77 Stockholm, Sweden
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Gbadegesin R, Hinkes B, Vlangos C, Mucha B, Liu J, Hopcian J, Hildebrandt F. Mutational analysis of NPHS2 and WT1 in frequently relapsing and steroid-dependent nephrotic syndrome. Pediatr Nephrol 2007; 22:509-13. [PMID: 17216259 DOI: 10.1007/s00467-006-0377-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 09/25/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
Idiopathic nephrotic syndrome is a common pediatric kidney disease, 80% of all cases are steroid sensitive (SSNS). A significant proportion of children with SSNS will have a frequently relapsing or steroid-dependent course (FRNS/SDNS) that is associated with significant treatment-related morbidity. Mutations in NPHS2 account for more than 28% of all cases of steroid-resistant nephrotic syndrome (SRNS) and dominant mutations in WT1 for 5%; while mutations are absent from children with uncomplicated SSNS. Since FRNS/SDNS is phenotypically positioned within a spectrum between SSNS and SRNS, we hypothesized that heterozygous mutations of NPHS2 may be causing FRNS/SDNS. Mutational analysis of NPHS2 and WT1 was carried out in a single-center cohort of 20 children with FRNS/SDNS, ten children with uncomplicated SSNS (control), and 22 children with SRNS (control). Renal biopsy findings were available in 15/20 children with FRNS/SDNS and revealed IgM nephropathy, MCNS, and FSGS in six, five, and four children, respectively. Children with FRNS/SDNS were significantly younger at first presentation than those with SSNS and SRNS (median age: 3.0 years in FRNS/SDNS patients, 7.0 years in SSNS patients, and 5.0 in SRNS patients; p < 0.001). No NPHS2 or WT1 mutations were found in patients with FRNS/SDNS and uncomplicated SSNS. The hypothesis that FRNS/SDNS may be associated with heterozygous mutations in NPHS2 or WT1 was not confirmed.
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Affiliation(s)
- Rasheed Gbadegesin
- Department of Pediatrics, Division of Nephrology, Ann Arbor, MI 48109, USA
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20
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Aaltonen P, Holthöfer H. Nephrin and related proteins in the pathogenesis of nephropathy. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.ddmec.2007.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mao J, Zhang Y, Du L, Dai Y, Gu W, Liu A, Shang S, Liang L. NPHS1 and NPHS2 gene mutations in Chinese children with sporadic nephrotic syndrome. Pediatr Res 2007; 61:117-22. [PMID: 17211152 DOI: 10.1203/01.pdr.0000250041.19306.3d] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent discoveries indicate that the molecules in glomerular podocytes and slit diaphragms may play an important role in the development of proteinuria and nephrotic syndrome. Mutational analyses of NPHS1 and NPHS2 were performed to verify this hypothesis in sporadic nephrotic syndrome (NS) patients. Clinical characteristics and DNA samples were collected from 38 Chinese children with sporadic steroid-sensitive NS, 22 with steroid-resistant NS and 30 controls. Direct sequencing was performed after PCR amplification of all 29 and 8 exons of the NPHS1 and NPHS2 genes, respectively. In NPHS1, 4 patients had heterozygous missense mutations leading to amino acid substitutions (R800C, Q453R). Furthermore, 3 known single nucleotide polymorphism (SNP) were found (T741T, V763V, S1105S). In NPHS2, 3 patients had novel heterozygous allelic variants leading to amino acid substitutions (S206I, E188D), while 1 patient was found to carry a novel nonsense mutation leading to a truncated protein product (Glu237STOP). Two known polymorphisms were also found (A318A, L346L). The results demonstrate that NPHS1 and NPHS2 mutations are also present in Chinese sporadic NS patients, suggesting that genetic changes of nephrin and podocin may play pathogenetic roles in some patients with sporadic steroid resistant NS.
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Affiliation(s)
- Jianhua Mao
- Department of Nephrology, Zhejiang University School of Medicine, Children's Hospital, Hangzhou 310006, Zhejiang Province, PR China
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Mao J, Zhang Y, Du L, Dai Y, Yang C, Liang L. Expression profile of nephrin, podocin, and CD2AP in Chinese children with MCNS and IgA nephropathy. Pediatr Nephrol 2006; 21:1666-75. [PMID: 16941146 DOI: 10.1007/s00467-006-0218-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 05/02/2006] [Accepted: 05/03/2006] [Indexed: 12/29/2022]
Abstract
There have been many exciting advances in our understanding of genetic causes of nephrotic syndrome since 1998 when nephrin was first found. The mRNA expressions of nephrin and CD2AP were studied by quantitative real-time polymerase chain reaction (PCR) in aspirated renal biopsy tissues from 9 subjects with minimal change nephrotic syndrome (MCNS), 6 with primary IgA nephropathy (IgAN), and 15 controls. Protein expression of nephrin, podocin, and CD2AP were analyzed by immunohistochemistry, indirect immunofluorescence, and laser confocal microscope. Compared with controls, the CD2AP mRNA level was significantly downregulated in renal samples from MCNS and IgAN patients (p=0.001 in MCNS, p=0.046 in IgAN), though no significant downregulation was found in the mRNA level of nephrin (p=0.346 in MCNS, p=0.311 in IgAN). The expression levels of protein CD2AP and nephrin were significantly reduced in MCNS and IgAN (MCNS: nephrin, p=0.034, CD2AP, p=0.005; IgAN: nephrin, p=0.021, CD2AP, p=0.025). The podocin staining did not differ significantly between controls and disease groups (p value 0.340 and 0.787, respectively). The results suggest that transcript and translation expression changes of nephrin and CD2AP may have pathogenetic roles in some patients with MCNS and IgAN in Chinese, though no correlation was found in podocin with proteinuria in this study.
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Affiliation(s)
- Jianhua Mao
- Department of Nephrology, The Children's Hospital of Zhejiang, University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
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