1
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Sun H, Li Q, Jin Z, Lu Y, Ju Y. Simultaneous determination of multiple urine biomarkers for kidney injury using SPE combined with LC-MS/MS. Clin Chim Acta 2024; 555:117790. [PMID: 38246210 DOI: 10.1016/j.cca.2024.117790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Urinary biomarkers such as low molecular weight proteins and small molecular weight metabolites are crucial in the diagnosis of kidney injury. The objective of this study was to develop and preliminarily validate a sensitive and specific method using solid-phase extraction (SPE) in conjunction with liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the simultaneous measurement of these biomarkers in human urine. METHOD This study presents the development of a solid-phase extraction method integrated with LC-MS/MS analyzing biomarkers including creatinine, urea, β2-microglobulin, α1-microglobulin, and cystatin C in human urine. An enhanced solid-phase cartridge technique was employed for peptide purification and dilution of small molecule metabolites during sample preparation. RESULTS The developed LC-MS/MS method achieved satisfactory separation of the five analytes within 15 min. Accuracy levels ranged from -8.6% to 13.6%. Both intra-assay and inter-assay imprecision rates were maintained below 7.9% for all analytes. CONCLUSIONS The established LC-MS/MS method effectively quantifies creatinine, urea, β2-microglobulin, α1-microglobulin and cystatin C concurrently. This offers a viable alternative for the detection of kidney injury biomarkers in human urine, demonstrating potential for clinical application in kidney injury diagnosis.
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Affiliation(s)
- Hewei Sun
- Shanghai Center for Clinical Laboratory, Shanghai, PR China
| | - Qing Li
- Shanghai Center for Clinical Laboratory, Shanghai, PR China
| | - Zhonggan Jin
- Shanghai Center for Clinical Laboratory, Shanghai, PR China
| | - Yide Lu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, PR China
| | - Yi Ju
- Shanghai Center for Clinical Laboratory, Shanghai, PR China.
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2
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Bagińska J, Kirejczyk JK, Korzeniecka-Kozerska A. Evaluation of Urinary L-FABP as a Tubular Damage Marker in Pediatric Neurogenic Bladder-A Pilot Study. J Clin Med 2024; 13:736. [PMID: 38337429 PMCID: PMC10856261 DOI: 10.3390/jcm13030736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
The article aims to find potential biomarker for the detection of tubular damage in pediatric neurogenic bladder (NB) by investigating urinary levels of liver-type fatty acid-binding protein (uL-FABP). This prospective analysis was conducted on two groups: 42 children with NB and 18 healthy children. The uL-FABP concentrations were measured using ELISA methods. The medical charts of the children were examined to determine age, sex, anthropometric measurements, activity assessment using Hoffer's scale, and renal function parameters. The results revealed that the uL-FABP/creatinine ratio was higher in the study group compared with the reference group, but the difference was not statistically significant (p = 0.52, p > 0.05). However, the uL-FABP/creatinine ratio exhibited a wider range in NB patients compared to the reference group. NB children with proteinuria and the history of high-grade vesicoureteral reflux (VUR) tended to have the highest uL-FABP concentrations. In conclusion, uL-FABP may be considered a potential tubular damage biomarker in children with NB. Proteinuria and the history of VUR may be the factors influencing the uL-FABP.
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Affiliation(s)
- Joanna Bagińska
- Department of Pediatrics and Nephrology, Medical University of Białystok, 17 Waszyngtona Str., 15-274 Białystok, Poland;
| | | | - Agata Korzeniecka-Kozerska
- Department of Pediatrics and Nephrology, Medical University of Białystok, 17 Waszyngtona Str., 15-274 Białystok, Poland;
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3
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Marcellino A, Lubrano R. Type of proteinuria might be essential for RAAS-I treatment in children with CAKUT. Expert Rev Clin Pharmacol 2024; 17:111. [PMID: 38086609 DOI: 10.1080/17512433.2023.2295004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Alessia Marcellino
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Riccardo Lubrano
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
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4
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Younis D, Mosbah A, Zakaria MM, Awadalla A, El-Kannishy G, Shemies RS. Urinary congophilia in pregnancy: a marker of kidney injury rather than preeclampsia. J Hypertens 2023; 41:1760-1767. [PMID: 37602468 DOI: 10.1097/hjh.0000000000003531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND The differentiation between preeclampsia and similarly presenting kidney disease in pregnancy is a diagnostic challenge. Although some laboratory tests have been utilized, globally validated tools are yet needed, particularly in resource-limited settings. Congophilic proteins are abundantly detected in the urine of pregnant women who develop preeclampsia that is thought to be a marker of disease process. The present study aimed to assess the diagnostic and predictive utility of urinary congophilia in pregnant women with hypertensive disorders of pregnancy as well as kidney diseases. METHODS This cohort study included 157 pregnant women, classified as healthy controls ( n = 38), preeclampsia/eclampsia ( n = 45), gestational hypertension ( n = 9), chronic hypertension ( n = 8), chronic kidney disease (CKD) ( n = 27), and pregnancy-related acute kidney injury (PR-AKI) ( n = 30). Urinary congophilia was assessed by Congo Red Dot Blot assay. RESULTS Congo red retention (CRR) values were significantly higher in women with preeclampsia/eclampsia ( P ≤ 0.001), chronic hypertension ( P = 0.029), gestational hypertension ( P = 0.017), CKD ( P ≤ 0.001), PR-AKI secondary to preeclampsia ( P ≤ 0.001), and PR-AKI secondary to other causes ( P = 0.001), compared with healthy controls. Women with preeclampsia, CKD, and PR-AKI (non-preeclampsia related) exhibited the highest levels of CRR. CRR positively correlated to proteinuria ( P = 0.006) and serum creatinine ( P = 0.027). CRR did not significantly vary between women who presented antepartum and those presented postpartum after removal of the placenta ( P = 0.707). CRR at a cut-off point of at least 1.272 had 91% specificity and 61.1% sensitivity in predicting renal recovery in PR-AKI patients. CRR had a poor specificity in discriminating preeclampsia from the other clinical presentations. CONCLUSION Urinary congophilia could not discriminate preeclampsia from similarly presenting kidney diseases in pregnancy. Further studies are needed to improve differentiation of these conditions.
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Affiliation(s)
| | | | - Mahmoud M Zakaria
- Clinical Pathology Department, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt
| | - Amira Awadalla
- Clinical Pathology Department, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt
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5
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Darmayanti S, Lesmana R, Meiliana A, Abdulah R. V-ATPase subunit C 1 and IKBIP as tandem prospective biomarkers for diabetic nephropathy. Diabetes Res Clin Pract 2023; 203:110887. [PMID: 37604283 DOI: 10.1016/j.diabres.2023.110887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/17/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
AIMS The appearance of low-molecular-weight (LMW) protein in the urine indicates any disruption in the structural integrity of the glomerular capillary wall; therefore, the presence of LMW protein may be a potential predictive marker for DN. METHODS The urine proteomic profiling of T2DM patients (n = 94) and control group (n = 32) was compared by liquid chromatography-tandem mass spectrometry, and the untargeted LMW protein was identified by Progenesis Q1 For Proteomics v4.2. RESULTS A total of 73 LMW proteins were identified and quantified, of which, 32 proteins were found to be altered significantly (p < 0.05). Further analysis with heat maps identified two potential proteins with the highest folding alterations in urine. V-ATPase subunit C 1 abundance was significantly inversely correlated with microalbumin and significantly decreased in urine, whereas increased IKBIP was positively correlated with microalbumin. The level of those proteins was significantly different among the control, T2DM, and DN groups, implying an association with the progression of DN. CONCLUSIONS The present findings of our study indicate that the decreasing V-ATPase subunit C 1 together with increasing IKBIP in urine, were found to be closely associated with DN complications and signifying their value as biomarkers for predicting the risk of DN at initial diagnosis.
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Affiliation(s)
- Siska Darmayanti
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia; Prodia Clinical Laboratory, Jakarta, Indonesia
| | - Ronny Lesmana
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, Indonesia; Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia.
| | - Anna Meiliana
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia; Prodia Clinical Laboratory, Jakarta, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia; Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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6
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Bellia GRM, Bilott RA, Sun N, Thompson D, Vasiliou V. Use of clinical chemistry health outcomes and PFAS chain length to predict 28-day rodent oral toxicity. Toxicol Mech Methods 2023; 33:378-387. [PMID: 36446747 PMCID: PMC10625160 DOI: 10.1080/15376516.2022.2150591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
Abstract
Current literature suggests PFAS carbon chain length may be a predictive variable of toxicity. If so, statistical modeling may be used to help predict toxicity, thus improving the efficiency of PFAS regulation development. Data were analyzed using one-way ANOVAs, Tukey's HSD post hoc tests, and simple linear regressions. A dataset was predicted using modeling from this data. Analysis indicated that 11 of 15 health outcomes showed significant differences in mean values. Two of 15 health outcomes were analyzed using simple linear regressions, with statistically significant results. After predictive modeling generated a theoretical dataset, unpaired t-tests comparing the results of an actual dataset indicated no significant differences among the mean values of the two health outcomes. Therefore, predictive statistical modeling may be used to predict health outcomes for PFAS exposure.
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Affiliation(s)
- Giselle R M Bellia
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Robert A Bilott
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Ning Sun
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - David Thompson
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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7
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Pereira PR, Pereira J, Braga PC, Pereira SS, Nora M, Guimarães M, Monteiro MP, Rodrigues A. Renal Dysfunction Phenotypes in Patients Undergoing Obesity Surgery. Biomolecules 2023; 13:biom13050790. [PMID: 37238660 DOI: 10.3390/biom13050790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Obesity surgery candidates are at an increased risk of kidney injury, but pre-operative evaluation usually neglects kidney function assessment. This study aimed to identify renal dysfunction in candidates for bariatric surgery. To reduce the sources of bias, subjects with diabetes, prediabetes under metformin treatment, neoplastic or inflammatory diseases were excluded. Patients' (n = 192) average body mass index was 41.7 ± 5.4 kg/m2. Among these, 51% (n = 94) had creatinine clearance over 140 mL/min, 22.4% (n = 43) had proteinuria over 150 mg/day and 14.6% (n = 28) albuminuria over 30 mg/day. A creatinine clearance higher than 140 mL/min was associated with higher levels of proteinuria and albuminuria. Univariate analysis identified sex, glycated hemoglobin, uric acid, HDL and VLDL cholesterol as being associated with albuminuria, but not with proteinuria. On multivariate analysis, glycated hemoglobin and creatinine clearance as continuous variables were significantly associated with albuminuria. In summary, in our patient population prediabetes, lipid abnormalities and hyperuricemia were associated with albuminuria, but not with proteinuria, suggesting different disease mechanisms might be implicated. Data suggest that in obesity-associated kidney disease, tubulointerstitial injury precedes glomerulopathy. A significant proportion of obesity surgery candidates present clinically relevant albuminuria and proteinuria along with renal hyperfiltration, suggesting that routine pre-operative assessment of these parameters should be considered.
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Affiliation(s)
- Pedro R Pereira
- Department of Nephrology, Centro Hospitalar de Trás-os-Montes e Alto Douro (CHTMAD), 5000-508 Vila Real, Portugal
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- ITR-Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - João Pereira
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- ITR-Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Patrícia C Braga
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- ITR-Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Sofia S Pereira
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- ITR-Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Mário Nora
- Department of General Surgery, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho, 4050-220 Santa Maria da Feira, Portugal
| | - Marta Guimarães
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- ITR-Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600 Porto, Portugal
- Department of General Surgery, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho, 4050-220 Santa Maria da Feira, Portugal
| | - Mariana P Monteiro
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- ITR-Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - Anabela Rodrigues
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- ITR-Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600 Porto, Portugal
- Department of Nephrology, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
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8
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Casado-Barragán F, Lazcano-Páez G, Larenas PE, Aguirre-Delgadillo M, Olivares-Aravena F, Witto-Oyarce D, Núñez-Allimant C, Silva K, Nguyen QM, Cárdenas P, Kassan M, Gonzalez AA. Increased Renal Medullary NOX-4 in Female but Not Male Mice during the Early Phase of Type 1 Diabetes: Potential Role of ROS in Upregulation of TGF-β1 and Fibronectin in Collecting Duct Cells. Antioxidants (Basel) 2023; 12:antiox12030729. [PMID: 36978977 PMCID: PMC10045926 DOI: 10.3390/antiox12030729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic diabetes mellitus (DM) can lead to kidney damage associated with increased reactive oxygen species (ROS), proteinuria, and tubular damage. Altered protein expression levels of transforming growth factor-beta 1 (TGF-β1), fibronectin, and renal NADPH oxidase (NOX-4) are associated with the profibrotic phenotype in renal tubular cells. NOX-4 is one of the primary sources of ROS in the diabetic kidney and responsible for the induction of profibrotic factors in collecting duct (CD) cells. The renal medulla is predominantly composed of CDs; in DM, these CD cells are exposed to high glucose (HG) load. Currently there is no published literature describing the expression of these markers in the renal medulla in male and female mice during the early phase of DM, or the role of NOX-4-induced ROS. Our aim was to evaluate changes in transcripts and protein abundances of TGF-β1, fibronectin, and NOX-4 along with ROS levels in renal medullary tissues from male and female mice during a short period of streptozotocin (STZ)-induced type 1 DM and the effect of HG in cultured CD cells. CF-1 mice were injected with or without a single dose of STZ (200 mg/kg) and euthanized at day 6. STZ females showed higher expression of fibronectin and TGF-β1 when compared to control mice of either gender. Interestingly, STZ female mice showed a >30-fold increase on mRNA levels and a 3-fold increase in protein levels of kidney medullary NOX-4. Both male and female STZ mice showed increased intrarenal ROS. In primary cultures of inner medullary CD cells exposed to HG over 48 h, the expression of TGF-β1, fibronectin, and NOX-4 were augmented. M-1 CD cells exposed to HG showed increased ROS, fibronectin, and TGF-β1; this effect was prevented by NOX-4 inhibition. Our data suggest that at as early as 6 days of STZ-induced DM, the expression of profibrotic markers TGF-β1 and fibronectin increases in renal medullary CD cells. Antioxidants mechanisms in male and female in renal medullary tissues seems to be differentially regulated by the actions of NOX-4.
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Affiliation(s)
- Felipe Casado-Barragán
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Geraldine Lazcano-Páez
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Paulina E. Larenas
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | | | | | - Daniela Witto-Oyarce
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Camila Núñez-Allimant
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Katherin Silva
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Quynh My Nguyen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Pilar Cárdenas
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
| | - Modar Kassan
- College of Dental Medicine, Lincoln Memorial University, Knoxville, TN 37917, USA
| | - Alexis A. Gonzalez
- Institute of Chemisry, Pontificia Universidad Católica de Valparaíso, Valparaíso 2950, Chile
- Correspondence:
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Cadmium-Induced Proteinuria: Mechanistic Insights from Dose-Effect Analyses. Int J Mol Sci 2023; 24:ijms24031893. [PMID: 36768208 PMCID: PMC9915107 DOI: 10.3390/ijms24031893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Cadmium (Cd) is a toxic metal that accumulates in kidneys, especially in the proximal tubular epithelial cells, where virtually all proteins in the glomerular ultrafiltrate are reabsorbed. Here, we analyzed archived data on the estimated glomerular filtration rate (eGFR) and excretion rates of Cd (ECd), total protein (EProt), albumin (Ealb), β2-microglobulin (Eβ2M), and α1-microglobulin (Eα1M), which were recorded for residents of a Cd contamination area and a low-exposure control area of Thailand. Excretion of Cd and all proteins were normalized to creatinine clearance (Ccr) as ECd/Ccr and EProt/Ccr to correct for differences among subjects in the number of surviving nephrons. Low eGFR was defined as eGFR ≤ 60 mL/min/1.73 m2, while proteinuria was indicted by EPro/Ccr ≥ 20 mg/L of filtrate. EProt/Ccr varied directly with ECd/Ccr (β = 0.263, p < 0.001) and age (β = 0.252, p < 0.001). In contrast, eGFR values were inversely associated with ECd/Ccr (β = -0.266, p < 0.001) and age (β = -0.558, p < 0.001). At ECd/Ccr > 8.28 ng/L of filtrate, the prevalence odds ratios for proteinuria and low eGFR were increased 4.6- and 5.1-fold, respectively (p < 0.001 for both parameters). Thus, the eGFR and tubular protein retrieval were both simultaneously diminished by Cd exposure. Of interest, ECd/Ccr was more closely correlated with EProt/Ccr (r = 0.507), Eβ2M (r = 0.430), and Eα1M/Ccr (r = 0.364) than with EAlb/Ccr (r = 0.152). These data suggest that Cd may differentially reduce the ability of tubular epithelial cells to reclaim proteins, resulting in preferential reabsorption of albumin.
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10
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den Bakker E, Bökenkamp A, Haffner D. Assessment of Kidney Function in Children. Pediatr Clin North Am 2022; 69:1017-1035. [PMID: 36880920 DOI: 10.1016/j.pcl.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A good understanding of kidney function tests is essential for patient care. Urinalysis is the commonest used test for screening purposes in ambulatory settings. Glomerular function is assessed further by urine protein excretion and estimated glomerular filtration rate and tubular function by various tests such as urine anion gap and excretion of sodium, calcium, and phosphate. In addition, kidney biopsy and/or genetic analyses may be required to further characterize the underlying kidney disease. In this article, we discuss maturation and the assessment of kidney function in children.
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Affiliation(s)
- Emil den Bakker
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, Meibergdreef 9, Amsterdam NL-1105 AZ, the Netherlands
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Meibergdreef 9, Amsterdam NL-1105 AZ, the Netherlands
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
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11
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Ndour EHM, Mnika K, Tall FG, Seck M, Ly ID, Nembaware V, Mazandu GK, Sagna Bassène HAT, Dione R, Ndongo AA, Diop JPD, Barry NOK, Djité M, Ndiaye Diallo R, Guèye PM, Diop S, Diagne I, Cissé A, Wonkam A, Lopez Sall P. Biomarkers of sickle cell nephropathy in Senegal. PLoS One 2022; 17:e0273745. [PMID: 36409722 PMCID: PMC9678278 DOI: 10.1371/journal.pone.0273745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
Sickle cell anemia (SCA) is caused by a single point variation in the β-globin gene (HBB): c.20A> T (p.Glu7Val), in homozygous state. SCA is characterized by sickling of red blood cells in small blood vessels which leads to a range of multiorgan complications, including kidney dysfunction. This case-control study aims at identifying sickle cell nephropathy biomarkers in a group of patients living with SCA from Senegal. A total of 163 patients living with SCA and 177 ethnic matched controls were investigated. Biological phenotyping included evaluation of glycemia, glucosuria, albuminuria, proteinuria, tubular proteinuria, serum creatinine, urine creatinine, urine specific gravity and glomerular filtration rate. Descriptive statistics of biomarkers were performed using the χ2 -test, with the significance level set at p<0.05. Patients living with SCA had a median age of 20 years (range 4 to 57) with a female sex frequency of 53.21%. The median age of the control participants was 29 years (range: 4-77) with a female sex frequency of 66.09%. The following proportions of abnormal biological indices were observed in SCA patients versus (vs.) controls, as follows: hyposthenuria: 35.3%vs.5.2% (p<0.001); glomerular hyperfiltration: 47.66%vs.19.75% (p<0.001), renal insufficiency: 5.47%vs.3.82% (p = 0.182); microalbuminuria: 42.38%vs.5.78% (p<0.001); proteinuria: 39.33%vs.4.62% (p<0.001); tubular proteinuria: 40.97%vs.4.73% (p<0.001) and microglucosuria: 22.5%vs.5.1% (p<0.001). This study shows a relatively high proportion of SCA nephropathy among patients living with SCA in Senegal. Microglucosuria, proteinuria, tubular proteinuria, microalbuminuria, hyposthenuria and glomerular hyperfiltration are the most prevalent biomarkers of nephropathy in this group of Senegalese patients with SCA.
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Affiliation(s)
- El Hadji Malick Ndour
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
- * E-mail:
| | - Khuthala Mnika
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Human Genetics, National Health Laboratory Service, and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatou Guèye Tall
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | - Moussa Seck
- National Center of Blood Transfusion, Dakar, Senegal
| | - Indou Dème Ly
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | - Victoria Nembaware
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston Kuzamunu Mazandu
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Rokhaya Dione
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | | | - Jean Pascal Demba Diop
- Department of Human Genetics, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Nènè Oumou Kesso Barry
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Moustapha Djité
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Rokhaya Ndiaye Diallo
- Department of Human Genetics, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Papa Madièye Guèye
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Saliou Diop
- National Center of Blood Transfusion, Dakar, Senegal
| | - Ibrahima Diagne
- Department of Pediatrics, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Aynina Cissé
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Philomène Lopez Sall
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
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12
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Cao Y, Shao L, Xin M, Zhang Y, Xu Y, Song Y, Lu H, Wang Y, Xia Y, Zhang M, Guo Y, Wang L, Qiao Z. Urine protein in patients with type I hypersensitivity is indicative of reversible renal tube injury. Life Sci 2022; 305:120735. [DOI: 10.1016/j.lfs.2022.120735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/07/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
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AlSinan SR, Alsaigh SA, Al-Dawood KM, AbdelWahab MM. Proteinuria and its associated factors in patients attending family medicine clinics in Dammam, Saudi Arabia. J Family Community Med 2022; 29:223-229. [PMID: 36389034 PMCID: PMC9664458 DOI: 10.4103/jfcm.jfcm_133_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Urinalysis is a simple, valuable, and low-cost tool for the detection of proteinuria, a significant risk factor for renal and cardiovascular diseases. The purpose of this study was to determine the rate of proteinuria and its associated risk factors in patients attending Family Medicine Clinics in Dammam, Saudi Arabia, as no study of that nature had previously been conducted. MATERIALS AND METHODS In this register-based cross-sectional study, data including urinary protein and other urinalysis components ordered between January 2018 and January 2020 were collected from electronic medical records. In addition, data regarding nationality, gender, age, blood pressure, body mass index, serum human chorionic gonadotropin, fasting glucose, hemoglobin A1c (HbA1c), 25-hydroxy Vitamin D level, blood urea nitrogen (BUN), uric acid, creatinine, estimated glomerular filtration rate (eGFR), and lipid profile was also obtained. Proteinuria was classified as negative if no or trace protein was present, and positive if protein was ≥1+, and was considered overt proteinuria. RESULTS In total, results of 2942 urinalysis tests were included. The mean age of the patients was 42.4 ± 14.5 years; majority of the patients were females (62.3%) and were Saudis (68.8%). The rate of proteinuria was 4.2%. Saudi nationality, female gender, age ≥ 40 years, high systolic blood pressure, high diastolic blood pressure, fasting glucose ≥126, HbA1c ≥6.5%, BUN >20 mg/dl, creatinine >1.3 mg/dl, low eGFR <60, and high low-density lipoproteins cholesterol were significantly associated with proteinuria based on bivariate analysis. Using a logistic regression model, a statistically significant association was observed between proteinuria and advancing age, the presence of urinary casts, elevated serum creatinine level, and Saudi nationality. CONCLUSION The only variables that were independently associated with proteinuria using the logistic regression were the presence of casts in the urine, Saudi nationality, high creatinine level, and older age. These variables should be borne in mind by treating physicians.
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Affiliation(s)
- Salma R. AlSinan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sukaynah A. Alsaigh
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Kasim M. Al-Dawood
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Moataza M. AbdelWahab
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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14
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Kooijmans ECM, van der Pal HJH, Pluijm SMF, van der Heiden-van der Loo M, Kremer LCM, Bresters D, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Loonen JJ, Louwerens M, Neggers SJC, Ronckers C, Tissing WJE, de Vries ACH, Kaspers GJL, Bökenkamp A, Veening MA. Long-Term Tubular Dysfunction in Childhood Cancer Survivors; DCCSS-LATER 2 Renal Study. Cancers (Basel) 2022; 14:cancers14112754. [PMID: 35681735 PMCID: PMC9179377 DOI: 10.3390/cancers14112754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
The aim of this nationwide cross-sectional cohort study was to determine the prevalence of and risk factors for tubular dysfunction in childhood cancer survivors (CCS). In the DCCSS-LATER 2 Renal study, 1024 CCS (≥5 years after diagnosis), aged ≥ 18 years at study, treated between 1963 and 2001 with potentially nephrotoxic therapy (i.e., nephrectomy, abdominal radiotherapy, total body irradiation, cisplatin, carboplatin, ifosfamide, high-dose cyclophosphamide, or hematopoietic stem cell transplantation) participated, and 500 age- and sex-matched participants from Lifelines acted as controls. Tubular electrolyte loss was defined as low serum levels (magnesium < 0.7 mmol/L, phosphate < 0.7 mmol/L and potassium < 3.6 mmol/L) with increased renal excretion or supplementation. A α1-microglobulin:creatinine ratio > 1.7 mg/mmol was considered as low-molecular weight proteinuria (LMWP). Multivariable risk analyses were performed. After median 25.5 years follow-up, overall prevalence of electrolyte losses in CCS (magnesium 5.6%, potassium 4.5%, phosphate 5.5%) was not higher compared to controls. LMWP was more prevalent (CCS 20.1% versus controls 0.4%). LMWP and magnesium loss were associated with glomerular dysfunction. Ifosfamide was associated with potassium loss, phosphate loss (with cumulative dose > 42 g/m2) and LMWP. Cisplatin was associated with magnesium loss and a cumulative dose > 500 mg/m2 with potassium and phosphate loss. Carboplatin cumulative dose > 2800 mg/m2 was associated with potassium loss. In conclusion, long-term tubular dysfunction is infrequent. Yet, ifosfamide, cisplatin and carboplatin are risk factors.
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Affiliation(s)
- Esmee C. M. Kooijmans
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.v.D.-d.B.); (G.J.L.K.); (M.A.V.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
- Correspondence:
| | - Helena J. H. van der Pal
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
| | - Saskia M. F. Pluijm
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
| | - Margriet van der Heiden-van der Loo
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
- Dutch Childhood Oncology Group, 3584 CS Utrecht, The Netherlands
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
- Deparmtnet of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
- Willem Alexander Children’s Hospital, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.v.D.-d.B.); (G.J.L.K.); (M.A.V.)
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
- Department of Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Jacqueline J. Loonen
- Department of Hematology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Sebastian J. C. Neggers
- Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, 8713 GZ Groningen, The Netherlands
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
- Department of Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.v.D.-d.B.); (G.J.L.K.); (M.A.V.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Margreet A. Veening
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.v.D.-d.B.); (G.J.L.K.); (M.A.V.)
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.v.d.P.); (S.M.F.P.); (M.v.d.H.-v.d.L.); (L.C.M.K.); (D.B.); (M.M.v.d.H.-E.); (C.R.); (W.J.E.T.); (A.C.H.d.V.)
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15
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Petzuch B, Benardeau A, Hofmeister L, Meyer J, Hartmann E, Pavkovic M, Mathar I, Sandner P, Ellinger-Ziegelbauer H. Urinary miRNA profiles in chronic kidney injury - Benefits of extracellular vesicle enrichment and miRNAs as potential biomarkers for renal fibrosis, glomerular injury and endothelial dysfunction. Toxicol Sci 2022; 187:35-50. [PMID: 35244176 DOI: 10.1093/toxsci/kfac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Micro-RNAs (miRNAs) are regulators of gene expression and play an important role in physiological homeostasis and disease. In biofluids miRNAs can be found in protein complexes or in extracellular vesicles (EVs). Altered urinary miRNAs are reported as potential biomarkers for chronic kidney disease (CKD). In this context we compared established urinary protein biomarkers for kidney injury with urinary miRNA profiles in obese ZSF1 and hypertensive renin transgenic rats. Additionally, the benefit of urinary EV enrichment was investigated in vivo and the potential association of urinary miRNAs with renal fibrosis in vitro. Kidney damage in both rat models was confirmed by histopathology, proteinuria, and increased levels of urinary protein biomarkers. In total 290 miRNAs were elevated in obese ZSF1 rats compared to lean controls, while 38 miRNAs were altered in obese ZSF1 rats during 14 to 26 weeks of age. These 38 miRNAs correlated better with disease progression than established urinary protein biomarkers. MiRNAs increased in obese ZSF1 rats were associated with renal inflammation, fibrosis, and glomerular injury. Eight miRNAs were also changed in urinary EVs of renin transgenic rats, including one which might play a role in endothelial dysfunction. EV enrichment increased the number and detection level of several miRNAs implicated in renal fibrosis in vitro and in vivo. Our results show the benefit of EV enrichment for miRNA detection and the potential of total urine and urinary EV-associated miRNAs as biomarkers of altered kidney physiology, renal fibrosis and glomerular injury, and disease progression in hypertension and obesity induced CKD.
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Affiliation(s)
- B Petzuch
- Bayer AG, Pharmaceuticals, Investigational Toxicology, 42096 Wuppertal, Germany.,Boehringer Ingelheim Pharma GmbH & Co. KG, Investigative Toxicology, Department of Non-Clinical Drug Safety, 88400 Biberach (Riß), Germany
| | - A Benardeau
- Novo Nordisk A/S,Cardio-Renal Biology, Måløv, Denmark
| | - L Hofmeister
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany
| | - J Meyer
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany
| | - E Hartmann
- Bayer AG, Pharmaceuticals, Toxicology, Pathology and Clinical Pathology, 42096 Wuppertal, Germany
| | - M Pavkovic
- Bayer AG, Pharmaceuticals, Investigational Toxicology, 42096 Wuppertal, Germany
| | - I Mathar
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany
| | - P Sandner
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany.,Hannover Medical School, Institute of Pharmacology, 30625 Hannover, Germany
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16
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Effects of Environmental Exposure to Cadmium and Lead on the Risks of Diabetes and Kidney Dysfunction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042259. [PMID: 35206446 PMCID: PMC8871722 DOI: 10.3390/ijerph19042259] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023]
Abstract
Environmental exposure to cadmium (Cd) or lead (Pb) is independently associated with increased risks of type 2 diabetes, and chronic kidney disease. The aim of this study was to examine the effects of concurrent exposure to these toxic metals on the risks of diabetes and kidney functional impairment. The Cd and Pb exposure levels among study subjects were low to moderate, evident from the means for blood concentrations of Cd and Pb ([Cd]b and [Pb]b) of 0.59 µg/L and 4.67 µg/dL, respectively. Of 176 study subjects (mean age 60), 71 (40.3%) had abnormally high fasting plasma glucose levels. Based on their [Cd]b and [Pb]b, 53, 71, and 52 subjects were assigned to Cd and Pb exposure profiles 1, 2, and 3, respectively. The diagnosis of diabetes was increased by 4.2-fold in those with an exposure profile 3 (p = 0.002), and by 2.9-fold in those with the estimated glomerular filtration (eGFR) ≤ 60 mL/min/1.73 m2 (p = 0.029). The prevalence odds ratio (POR) for albuminuria was increased by 5-fold in those with plasma glucose levels above kidney threshold of 180 mg/dL (p = 0.014), and by 3.1-fold in those with low eGFR) (p = 0.050). Collectively, these findings suggest that the Cd and Pb exposure profiles equally impact kidney function and diabetes risk.
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17
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Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol 2022; 226:S819-S834. [PMID: 32882208 DOI: 10.1016/j.ajog.2020.08.108] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
Qualitative and quantitative measurement of urine protein excretion is one of the most common tests performed during pregnancy. For more than 100 years, proteinuria was necessary for the diagnosis of preeclampsia, but recent guidelines recommend that proteinuria is sufficient but not necessary for the diagnosis. Still, in clinical practice, most patients with gestational hypertension will be diagnosed as having preeclampsia based on the presence of proteinuria. Although the reference standard for measuring urinary protein excretion is a 24-hour urine collection, spot urine protein-to-creatinine ratio is a reasonable "rule-out" test for proteinuria. Urine dipstick screening for proteinuria does not provide any clinical benefit and should not be used to diagnose proteinuria. The classic cutoff cited to define proteinuria during pregnancy is a value of >300 mg/24 hours or a urine protein-to-creatinine ratio of at least 0.3. Using this cutoff, the rate of isolated proteinuria in pregnancy may reach 8%, whereas preeclampsia occurs among 3% to 8% of pregnancies. Although this threshold is widely accepted, its origin is not based on evidence on adverse pregnancy outcomes but rather on expert opinion and results of small studies. After reviewing the available data, the most important factor that influences maternal and neonatal outcome is the severity of blood pressures and presence of end organ damage, rather than the excess protein excretion. Because the management of gestational hypertension and preeclampsia without severe features is almost identical in frequency of surveillance and timing of delivery, the separation into 2 disorders is unnecessary. If the management of women with gestational hypertension with a positive assessment of proteinuria will not change, we believe that urine assessment for proteinuria is unnecessary in women who develop new-onset blood pressure at or after 20 weeks' gestation. Furthermore, we do not recommend repeated measurement of proteinuria for women with preeclampsia, the amount of proteinuria does not seem to be related to poor maternal and neonatal outcomes, and monitoring proteinuria may lead to unindicated preterm deliveries and related neonatal complications. Our current diagnosis of preeclampsia in women with chronic kidney disease may be based on a change in protein excretion, a baseline protein excretion evaluation is critical in certain conditions such as chronic hypertension, diabetes, and autoimmune or other renal disorders. The current definition of superimposed preeclampsia possesses a diagnostic dilemma, and it is unclear whether a change in the baseline proteinuria reflects another systemic disease such as preeclampsia or whether women with chronic disease such as chronic hypertension or diabetes will experience a different "normal" pattern of protein excretion during pregnancy. Finally, limited data are available regarding angiogenic and other biomarkers in women with chronic kidney disease as a potential aid in distinguishing the worsening of baseline chronic kidney disease and chronic hypertension from superimposed preeclampsia.
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Gong E, Perin L, Da Sacco S, Sedrakyan S. Emerging Technologies to Study the Glomerular Filtration Barrier. Front Med (Lausanne) 2021; 8:772883. [PMID: 34901088 PMCID: PMC8655839 DOI: 10.3389/fmed.2021.772883] [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: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022] Open
Abstract
Kidney disease is characterized by loss of glomerular function with clinical manifestation of proteinuria. Identifying the cellular and molecular changes that lead to loss of protein in the urine is challenging due to the complexity of the filtration barrier, constituted by podocytes, glomerular endothelial cells, and glomerular basement membrane. In this review, we will discuss how technologies like single cell RNA sequencing and bioinformatics-based spatial transcriptomics, as well as in vitro systems like kidney organoids and the glomerulus-on-a-chip, have contributed to our understanding of glomerular pathophysiology. Knowledge gained from these studies will contribute toward the development of personalized therapeutic approaches for patients affected by proteinuric diseases.
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Affiliation(s)
- Emma Gong
- Division of Urology, GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Children's Hospital Los Angeles, Saban Research Institute, Los Angeles, CA, United States
| | - Laura Perin
- Division of Urology, GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Children's Hospital Los Angeles, Saban Research Institute, Los Angeles, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Stefano Da Sacco
- Division of Urology, GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Children's Hospital Los Angeles, Saban Research Institute, Los Angeles, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sargis Sedrakyan
- Division of Urology, GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Children's Hospital Los Angeles, Saban Research Institute, Los Angeles, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Liu W, Huang G, Rui H, Geng J, Hu H, Huang Y, Huo G, Liu B, Xu A. Course monitoring of membranous nephropathy: Both autoantibodies and podocytes require multidimensional attention. Autoimmun Rev 2021; 21:102976. [PMID: 34757091 DOI: 10.1016/j.autrev.2021.102976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 01/15/2023]
Abstract
A variety of podocyte antigens have been identified in human membranous nephropathy (MN), which is divided into various antigen-dominated subtypes, confirming the concept that MN is the common pattern of glomerular injury in multiple autoimmune responses. The detection of autoantibodies has been widely used, which promoted the clinical practice of MN toward personalized precision medicine. However, given the potential risks of immunosuppressive therapy, more autoantibodies and biomarkers need to be identified to predict the prognosis and therapeutic response of MN more accurately. In this review, we attempted to summarize the autoantigens/autoantibodies and autoimmune mechanisms that can predict disease states based on the current understanding of MN pathogenesis, especially the podocyte injury manifestations. In conclusion, both the autoimmune response and podocyte injury require multidimensional attention in the disease course of MN.
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Affiliation(s)
- Wenbin Liu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Guangrui Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Hongliang Rui
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jie Geng
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Haikun Hu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yujiao Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Guiyang Huo
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Baoli Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
| | - Anlong Xu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
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20
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The Case | Isolated microscopic hematuria: a diagnostic journey. Kidney Int 2021; 100:955-956. [PMID: 34556307 DOI: 10.1016/j.kint.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022]
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21
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Amount and selectivity of proteinuria may predict the treatment response in post-transplant recurrence of focal segmental glomerulosclerosis: a single-center retrospective study. Pediatr Nephrol 2021; 36:2433-2442. [PMID: 33538912 DOI: 10.1007/s00467-021-04951-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/20/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary focal segmental glomerulosclerosis (FSGS) frequently recurs after kidney transplantation and is associated with poor graft survival. To date, few studies have investigated predictive factors for treatment responses in recurrent FSGS. METHODS We retrospectively analyzed 16 patients who were < 16 years at the age of onset and had post-transplant recurrence of FSGS from 1993 to 2018. Patients who achieved complete remission or partial remission after initiating therapy for recurrent FSGS were defined as responders. We compared several clinical characteristics between responders and non-responders. Time to remission was also analyzed. RESULTS Ten patients were responders, and six patients were non-responders. Univariate analysis showed that responders had a significantly lower amount of maximum proteinuria at the time of recurrence (P = 0.015) and more highly selective proteinuria (P = 0.013) than non-responders. The time to remission from initiation of therapy was 2 months (interquartile range 0.2-4.4). In all responders, except for one patient, remission was achieved within 6 months. CONCLUSIONS Therapeutic responses may be predicted by examining the amount and selectivity of proteinuria at the time of recurrence. Further studies with larger numbers of patients are clearly required to validate these findings.
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Acute skin exposure to ultraviolet light triggers neutrophil-mediated kidney inflammation. Proc Natl Acad Sci U S A 2021; 118:2019097118. [PMID: 33397815 DOI: 10.1073/pnas.2019097118] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Photosensitivity to ultraviolet (UV) light affects up to ∼80% of lupus patients. Sunlight exposure can exacerbate local as well as systemic manifestations of lupus, including nephritis, by mechanisms that are poorly understood. Here, we report that acute skin exposure to UV light triggers a neutrophil-dependent injury response in the kidney characterized by upregulated expression of endothelial adhesion molecules as well as inflammatory and injury markers associated with transient proteinuria. We showed that UV light stimulates neutrophil migration not only to the skin but also to the kidney in an IL-17A-dependent manner. Using a photoactivatable lineage tracing approach, we observed that a subset of neutrophils found in the kidney had transited through UV light-exposed skin, suggesting reverse transmigration. Besides being required for the renal induction of genes encoding mediators of inflammation (vcam-1, s100A9, and Il-1b) and injury (lipocalin-2 and kim-1), neutrophils significantly contributed to the kidney type I interferon signature triggered by UV light. Together, these findings demonstrate that neutrophils mediate subclinical renal inflammation and injury following skin exposure to UV light. Of interest, patients with lupus have subpopulations of blood neutrophils and low-density granulocytes with similar phenotypes to reverse transmigrating neutrophils observed in the mice post-UV exposure, suggesting that these cells could have transmigrated from inflamed tissue, such as the skin.
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Figueroa SM, Araos P, Reyes J, Gravez B, Barrera-Chimal J, Amador CA. Oxidized Albumin as a Mediator of Kidney Disease. Antioxidants (Basel) 2021; 10:antiox10030404. [PMID: 33800425 PMCID: PMC8000637 DOI: 10.3390/antiox10030404] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022] Open
Abstract
Renal diseases are a global health concern, and nearly 24% of kidney disease patients are overweight or obese. Particularly, increased body mass index has been correlated with oxidative stress and urinary albumin excretion in kidney disease patients, also contributing to increased cardiovascular risk. Albumin is the main plasma protein and is able to partially cross the glomerular filtration barrier, being reabsorbed mainly by the proximal tubule through different mechanisms. However, it has been demonstrated that albumin suffers different posttranslational modifications, including oxidation, which appears to be tightly linked to kidney damage progression and is increased in obese patients. Plasma-oxidized albumin levels correlate with a decrease in estimated glomerular filtration rate and an increase in blood urea nitrogen in patients with chronic kidney disease. Moreover, oxidized albumin in kidney disease patients is independently correlated with higher plasma levels of transforming growth factor beta (TGF-β1), tumor necrosis factor (TNF-α), and interleukin (IL)-1β and IL-6. In addition, oxidized albumin exerts a direct effect on neutrophils by augmenting the levels of neutrophil gelatinase-associated lipocalin, a well-accepted biomarker for renal damage in patients and in different experimental settings. Moreover, it has been suggested that albumin oxidation occurs at early stages of chronic kidney disease, accelerating the patient requirements for dialytic treatment during disease progression. In this review, we summarize the evidence supporting the role of overweight- and obesity-induced oxidative stress as a critical factor for the progression of renal disease and cardiovascular morbimortality through albumin oxidation.
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Affiliation(s)
- Stefanny M. Figueroa
- Laboratory of Renal Physiopathology, Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago 8910060, Chile; (S.M.F.); (P.A.); (J.R.); (B.G.)
| | - Patricio Araos
- Laboratory of Renal Physiopathology, Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago 8910060, Chile; (S.M.F.); (P.A.); (J.R.); (B.G.)
| | - Javier Reyes
- Laboratory of Renal Physiopathology, Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago 8910060, Chile; (S.M.F.); (P.A.); (J.R.); (B.G.)
| | - Basile Gravez
- Laboratory of Renal Physiopathology, Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago 8910060, Chile; (S.M.F.); (P.A.); (J.R.); (B.G.)
| | - Jonatan Barrera-Chimal
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
- Laboratorio de Fisiología Cardiovascular y Trasplante Renal, Unidad de Investigación UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Cristián A. Amador
- Laboratory of Renal Physiopathology, Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago 8910060, Chile; (S.M.F.); (P.A.); (J.R.); (B.G.)
- Correspondence: ; Tel.: +56-22-303-6662
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Hodel NC, Hamad A, Reither K, Kasella IM, Abdulla S, Schoetzau A, Hatz CFR, Mayr M. Comparison of Two Different Semiquantitative Urinary Dipstick Tests with Albumin-to-Creatinine Ratio for Screening and Classification of Albuminuria According to KDIGO. A Diagnostic Test Study. Diagnostics (Basel) 2021; 11:diagnostics11010081. [PMID: 33419091 PMCID: PMC7825407 DOI: 10.3390/diagnostics11010081] [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: 11/05/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Semiquantitative dipstick tests are utilized for albuminuria screening. Methods: In a prospective cross-sectional survey, we analyzed the diagnostic test validity of the semiquantitative colorimetric indicator-dye-based Combur9-Test® and the albumin-specific immunochromatographic assay Micral-Test® for the detection of albuminuria, the distribution of the semiquantitative measurements within the albuminuria stages according to KDIGO, and the utility for albuminuria screening compared with an albumin-to-creatinine ratio (ACR) in a walk-in population. Results: In 970 subjects, albuminuria (≥30 mg/g) was detected in 12.7% (95% CI 85.6–96.3%) with the ACR. Sensitivity was 82.9% (95% CI 75.1–89.1%) and 91.9% (95% CI 88.7–96.9%) and specificity 71.5% (95% CI 68.4–74.6%) and 17.5% (95% CI 15.0–20.2%) for the Combur9-Test® and Micral-Test®, respectively. Correct classification to KDIGO albuminuria stages A2/A3 with the Combur9-Test® was 15.4%, 51.4%, and 87.9% at cut-offs of 30, 100, and ≥300 mg/dL, and with the Micral-Test® it was 1.8%, 10.5%, and 53.6% at cut-offs of 2, 5, and 10 mg/dL, respectively. Overall, disagreement to KDIGO albuminuria was seen in 27% and 73% with the Combur9-Test® and Micral-Test®, respectively. From the total population, 62.5% and 15.3% were correctly ruled out and 2.2% and 1% were missed as false-negatives by the Combur9-Test® and Micral-Test®, respectively. Conclusion: Compared to the Combur9-Test®, the utility of the Micral-Test® is limited, because the fraction of correctly ruled out patients is small and a large proportion with a positive Micral-Test® require a subsequent ACR conformation test.
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Affiliation(s)
- Nikolai C. Hodel
- Medical Outpatient Department, University Hospital Basel, 4031 Basel, Switzerland;
- Clinical Research Unit, Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland; (K.R.); (C.F.R.H.)
| | - Ali Hamad
- Chronic Disease Clinic, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania; (A.H.); (S.A.)
| | - Klaus Reither
- Clinical Research Unit, Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland; (K.R.); (C.F.R.H.)
- Chronic Disease Clinic, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania; (A.H.); (S.A.)
- Faculty of Science, University of Basel, 4001 Basel, Switzerland;
| | | | - Salim Abdulla
- Chronic Disease Clinic, Ifakara Health Institute, Bagamoyo P.O. Box 74, Tanzania; (A.H.); (S.A.)
| | | | - Christoph F. R. Hatz
- Clinical Research Unit, Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland; (K.R.); (C.F.R.H.)
- Faculty of Science, University of Basel, 4001 Basel, Switzerland;
- Infectiology/Hospital Hygiene Department, Cantonal Hospital, 9007 St. Gallen, Switzerland
| | - Michael Mayr
- Medical Outpatient Department, University Hospital Basel, 4031 Basel, Switzerland;
- Correspondence:
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Prasad A, Prasad M. Single Virus Targeting Multiple Organs: What We Know and Where We Are Heading? Front Med (Lausanne) 2020; 7:370. [PMID: 32850890 PMCID: PMC7419463 DOI: 10.3389/fmed.2020.00370] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 caused by SARS-CoV-2 has already infected more than 6. 3 million people worldwide as of 1st June 2020 and caused a global medical emergency. Healthcare professionals have been struggling to devise appropriate therapeutic strategies against the virus mainly due to the diverse range of symptoms and multiple-organ failure in infected patients. Several broad-spectrum antiviral drugs are being used for treatment; however, there is yet no specific drug or vaccine against the virus. Multiple-organ failure due to hyperactivity of the immune system resulting in cytokine storms is a major reason for death among the 5% critically ill patients. In this article, we have discussed the damage caused by COVID-19 on different organs of the human body.
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Regev LC, Bouts AH, Groothoff JW, van Wijk JA, van Wijk M, van der Valk P, Bökenkamp A. A riddle wrapped in an enigma: acute kidney injury in a girl with Crohn's disease: Answers. Pediatr Nephrol 2020; 35:1867-1870. [PMID: 32232639 PMCID: PMC7501117 DOI: 10.1007/s00467-020-04538-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Lilach C. Regev
- grid.413795.d0000 0001 2107 2845Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Antonia H.M. Bouts
- grid.7177.60000000084992262Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jaap W. Groothoff
- grid.7177.60000000084992262Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Joanna A.E. van Wijk
- grid.7177.60000000084992262Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michiel van Wijk
- grid.7177.60000000084992262Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Paul van der Valk
- grid.7177.60000000084992262Department of Pathology, location VU medical center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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