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Han Q, Xu H, Li L, Lei S, Yang M. Demographic distribution analysis of different glomerular diseases in Southwest China from 2008 to 2022. Int Urol Nephrol 2024; 56:2011-2020. [PMID: 38172368 DOI: 10.1007/s11255-023-03902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Environmental and lifestyle factors play an etiological role in the pathogenesis of different glomerular diseases. Thus, exploring the epidemic characteristics of renal disease in different nationalities and regions is important. MATERIALS AND METHODS Patients who underwent renal biopsy from October 2008 to October 2022 were included. The proportion and change tendency of glomerular diseases and the differences between the sexes and different ages and races were analyzed. RESULTS There were 15,146 cases of glomerular diseases (98.5%), involving 7538 males (49.8%) and 7608 females (50.2%). The mean age was 37.0 years (range 0-80 years). The proportion of membranous nephropathy (MN) and diabetic nephropathy (DN) showed an increased trend. The most common primary glomerulonephritis (PGN) was IgA nephropathy (IgAN, 44.6%), followed by minimal-change disease (MCD, 24.3%) and MN (15.4%). Lupus nephritis (LN, 30%) accounted for the largest proportion of SGNs, followed by Henoch-Schonlein purpura nephritis (HSPN, 20.9%) and DN (19.8%). Compared with adults aged 18-60 years old, MCD and HSPN were more common in children and MN and DN in elderly individuals, statistically significant differences. Additionally, the sex and age distribution of PGN and SGN between the Tibetan and Han populations differed significantly, whereby LN was higher in the Han population and HSPN in the Tibetan population. CONCLUSION The distribution of glomerular diseases showed age, sex and race differences. This research will be beneficial for providing epidemiological evidence for clinical diagnosis, disease prevention and public health decision-making.
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Affiliation(s)
- Qianqian Han
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
| | - Huan Xu
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
| | - Lin Li
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Song Lei
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Mei Yang
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
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Zaidi O, Du F, Tang Z, Bhattacharjee S, Pareja K. Review on epidemiology, disease burden, and treatment patterns of IgA nephropathy in select APAC countries. BMC Nephrol 2024; 25:136. [PMID: 38627670 PMCID: PMC11021013 DOI: 10.1186/s12882-024-03555-5] [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: 04/21/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Immunoglobulin type A (IgA) nephropathy is the most common primary glomerulonephritis (GN) worldwide with higher rates in East and Pacific Asia compared to North America and Europe. Despite high reported prevalence of IgAN in these countries, the overall disease prevalence across Asia is not available. Treatment patterns of IgAN patients across Asian countries have also not been summarized. The aim of this study was to review and summarize evidence on IgA nephropathy prevalence, treatment patterns, and humanistic and economic burden in mainland China, Taiwan, South Korea, Japan, and Australia. METHODS A targeted literature review was conducted in PubMed and local databases in China (including Taiwan), South Korea, Japan, and Australia between January 2010-December 2021. Website literature searches were conducted using Google Scholar and Baidu. RESULTS Sixty-nine publications and 3 clinical guidelines were included. Incidence ranged from 0 to 10.7 per 100 000 people per year in Australia, Japan, and Taiwan, and ranged from 6.3 to 24.70% among patients who underwent renal biopsy in mainland China. Prevalence and diagnosis rates ranged from 0 to 72.1% in mainland China, South Korea, Taiwan, Japan, and Australia. Mortality rates in mainland China, South Korea, and Japan varied widely. The top 3 commonly used therapies were angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (0.9-99.6%), corticosteroids (3.5-100%), and immunosuppressants (1.6-85.5%) in Japan, mainland China, and South Korea. Patient quality of life was measured by different tools, and annual hospitalization costs ranged from $1 284.73 to $2 252.12 (2015-2018) in China. CONCLUSIONS The prevalence of IgA nephropathy among the general population in select countries/regions is not commonly available, despite evidence from studies and clinical guidelines. In addition, it is observed across geographic regions that heterogeneity exists in prevalence rates, and large variations exist in treatment patterns. There is need to fill in these gaps to understand the contributing factors behind the differences through population-based, multi-center, and real-world studies.
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Affiliation(s)
| | - Fen Du
- OPEN Health, Shanghai, China
| | | | | | - Kristin Pareja
- Otsuka Pharmaceutical Development & Commercialization, Inc., NJ, Princeton, USA.
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Leow EH, Chong SL, Yap CJY, Chao SM, Ganesan I, Wang F, Ng YH. IgA nephropathy in children: before and after the start of COVID-19. Pediatr Nephrol 2024; 39:1161-1167. [PMID: 37947900 DOI: 10.1007/s00467-023-06196-2] [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: 07/29/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND We describe the clinical course of children with IgA nephropathy (IgAN), diagnosed before and after the emergence of COVID-19. We hypothesized that COVID-19 vaccination and/or infection resulted in more children with IgAN to present clinically. METHODS We conducted a retrospective cohort study of children with IgAN diagnosed on kidney biopsy from 2014-2020 (Period 1) and 2021-2022 (Period 2). Baseline characteristics, clinical presentation, investigations and treatments were compared between patients diagnosed in Period 1 and Period 2, as well as between patients with and without chronic changes on kidney biopsy. Continuous variables were compared using the Wilcoxon rank sum test. Categorical variables were compared using χ2 or Fisher exact tests. RESULTS Nineteen children with IgAN were diagnosed by kidney biopsy, with 10 during Period 1 and 9 patients during Period 2 (an average of 1-2 patients/year and 4-5 patients/year in Periods 1 and 2, respectively). The most common indication for kidney biopsy is proteinuria with urine protein/creatinine ratio 1.4 (interquartile range [IQR] 1.2-9.0) vs. 0.8 (IQR 0.6-1.5) g/g (p = 0.064) at time of kidney biopsy for patients in Period 1 and 2, respectively. Clinical course was similar in both periods. No patient required acute or chronic kidney replacement therapy. CONCLUSIONS The rate of diagnosing children with IgAN was higher since the emergence of COVID-19, suggesting that COVID-19 may trigger an immune response responsible for IgAN, similar to other mucosal infections.
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Affiliation(s)
- Esther Huimin Leow
- Paediatric Medicine, Nephrology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Siew Le Chong
- Paediatric Medicine, Nephrology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Celeste Jia Ying Yap
- Paediatric Medicine, Nephrology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Sing Ming Chao
- Paediatric Medicine, Nephrology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Indra Ganesan
- Paediatric Medicine, Nephrology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Fan Wang
- Nursing Clinical Services, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yong Hong Ng
- Paediatric Medicine, Nephrology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Goto K, Imaizumi T, Hamada R, Ishikura K, Kosugi T, Narita I, Sugiyama H, Shimizu A, Yokoyama H, Sato H, Mauryama S. Renal pathology in adult and paediatric population of Japan: review of the Japan renal biopsy registry database from 2007 to 2017. J Nephrol 2023; 36:2257-2267. [PMID: 37597092 PMCID: PMC10638177 DOI: 10.1007/s40620-023-01687-9] [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: 12/21/2022] [Accepted: 05/17/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND The Japan Renal Biopsy Registry (J-RBR), a nationwide, web-based, registry system, started in 2007. This study aimed to summarise the epidemiology of biopsy-diagnosed kidney disease in Japan over 10 years. METHODS We analysed the J-RBR database, from 2007 to 2017. Patients' clinical data collected at the time of biopsy and histopathological diagnoses were used for epidemiological and clinicopathologic analyses. RESULTS The predominant renal biopsy diagnoses were immunoglobulin A nephropathy (39.2%), lupus nephritis (6.5%) and minimal change disease (6.0%) in younger adults (19-64 years), and membranous nephropathy (17.4%), antineutrophil cytoplasmic antibody-associated vasculitis or anti-glomerular basement membrane glomerulonephritis (13.0%), and immunoglobulin A nephropathy (12.5%) in older adults (≥ 65 years). The percentages of patients diagnosed with membranoproliferative glomerulonephritis and immunoglobulin A nephropathy decreased, whereas those with immunoglobulin A vasculitis and diabetic nephropathy increased over the decade. In paediatric patients (< 19 years), immunoglobulin A nephropathy (36.1%), minimal change disease (17.6%), and immunoglobulin A vasculitis (8.6%) were the predominant diagnoses. The percentage of patients diagnosed with immunoglobulin A vasculitis increased over the decade. Based on the sex distribution, minimal change disease and membranous nephropathy were predominant in men aged < 20 and > 40 years, respectively, whereas immunoglobulin A vasculitis and antineutrophil cytoplasmic antibody-associated vasculitis or anti-glomerular basement membrane glomerulonephritis were predominant in women in their 20s and 30s and aged < 50 years, respectively. Immunoglobulin A nephropathy was predominant in men at most ages and in women in their 20s to 40s. CONCLUSIONS This study describes the distribution and changes in kidney biopsy diagnoses over 10 years in Japan and paves the way for future research on kidney diseases in adults and children.
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Affiliation(s)
- Kazunori Goto
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Riku Hamada
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tomoki Kosugi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Sugiyama
- Department of Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Medical Care Work, Kawasaki College of Allied Health Professions, Okayama, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Shoichi Mauryama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
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Xiong L, Liu L, Tao Y, Guo H. Clinical significance of IgM and C3 deposition in children with primary immunoglobulin A nephropathy. J Nephrol 2023; 36:2213-2222. [PMID: 37542609 DOI: 10.1007/s40620-023-01724-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Mesangial IgM and C3 deposition is commonly observed in patients with primary immunoglobulin A nephropathy (IgAN), but its characteristics and prognosis have rarely been reported. The aim of this study was to investigate the relationship between combined mesangial IgM and C3 deposition and disease progression in children with IgAN. METHODS One hundred sixteen children diagnosed with IgAN between 2016 and 2020 were selected. Renal biopsies were scored by Oxford classification including the presence of mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis and crescents. The primary renal outcome was an event of either ≥ 50% reduction of eGFR from the baseline value or the onset of end-stage renal disease within the follow-up period. Cox regression analysis was performed to examine the effect of the combined mesangial IgM and C3 deposition on renal outcomes. RESULTS Forty-seven (40.52%) patients presented combined mesangial IgM and C3 deposition. Compared with children without combined IgM and C3 deposition, children with combined IgM and C3 deposition presented higher mesangial hypercellularity, endocapillary hypercellularity and cresentic lesions in kidney biopsies, and higher prevalence of renal dysfunction (19.15% versus 2.90%; P = 0.007). Renal outcome was also significantly worse as revealed by Kaplan-Meier curves (P = 0.0034). Multivariable Cox analysis identified tubular atrophy/interstitial fibrosis lesions [hazard ratio (HR) 14.843, 95% CI, 3.497-62.997, P < 0.001] and intensity of IgM deposition (HR 2.838, 95% CI, 1.321-6.094, P = 0.007) as independent risk factors for poor renal function. CONCLUSIONS Combined mesangial IgM and C3 deposition was associated with unfavorable histopathological features. Mesangial IgM deposition was an independent risk factor for poor renal outcomes in children with primary IgAN.
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Affiliation(s)
- Limei Xiong
- Division of Nephrology, Department of Pediatrics, West China Second University Hospital, Sichuan University, NO. 20, Section 3, Renmin Nan Lu, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
| | - Lili Liu
- Division of Nephrology, Department of Pediatrics, West China Second University Hospital, Sichuan University, NO. 20, Section 3, Renmin Nan Lu, Chengdu, 610041, China
| | - Yuhong Tao
- Division of Nephrology, Department of Pediatrics, West China Second University Hospital, Sichuan University, NO. 20, Section 3, Renmin Nan Lu, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
| | - Hui Guo
- Division of Nephrology, Department of Pediatrics, West China Second University Hospital, Sichuan University, NO. 20, Section 3, Renmin Nan Lu, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
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Prasad N, Khurana M, Behera M, Yaccha M, Bhadauria D, Agarwal V, Kushwaha R, Patel M, Kaul A, Barratt J, Jain M. Clinicopathologic Manifestations of Immunoglobulin A Nephropathy in a Northern Indian Cohort: A Mute Assassin with Delayed Diagnosis. Indian J Nephrol 2023; 33:12-21. [PMID: 37197052 PMCID: PMC10185009 DOI: 10.4103/ijn.ijn_351_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide, but there is a marked geographic difference in its prevalence and prognosis. IgAN is known to have an aggressive course in Asians. However, its exact prevalence and clinicopathologic spectrum in North India are not well documented. Materials and Methods The study included all patients aged above 12 years with primary IgAN on kidney biopsy from January 2007 to December 2018. Clinical and pathological parameters were noted. Two histopathologists independently reviewed all kidney biopsies, and MEST-C score was assigned as per the Oxford classification. Results IgAN was diagnosed in 681 (11.85%) out of 5751 native kidney biopsies. The mean age was 32 ± 12.3 years, and the male to female ratio was 2.5:1. At presentation, 69.8% had hypertension, 68% had an estimated glomerular filtration rate (eGFR) of less than 60 ml/min, 63.2% had microscopic hematuria, and 4.6% had gross hematuria. The mean proteinuria was 3.61 ± 2.26 g/day, with 46.8% showing nephrotic range proteinuria and 15.2% showing nephrotic syndrome manifestation. Histopathologically, 34.4% of patients had diffuse global glomerulosclerosis. Oxford MEST-C scoring revealed M1 in 67%, E1 in 23.9%, S1 in 46.9%, T1/T2 in 33%, and crescents in 19.6% of biopsies. The mean serum creatinine was significantly higher in cases with E1, T1/2, and C1/2 scores (P < 0.05). Hematuria and proteinuria were significantly higher (P < 0.05) with E1 and C1/2 scores. Coexisting C3 was associated with higher serum creatinine at presentation (P < 0.05). Conclusion IgAN patients with late presentation and advanced disease became less amenable to immunomodulation in our cohort. The implementation of point-of-care screening strategies, early diagnosis, and retarding disease progression should be prioritized in the Indian strategy.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mudit Khurana
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manas Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Monika Yaccha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vinita Agarwal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ravi Kushwaha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manas Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jonathan Barratt
- The Mayer Professor of Renal Medicine, Department of Cardiovascular Sciences, Honorary Consultant Nephrologist, John Walls Renal Unit, Leicester General Hospital, UK
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Matsumoto Y, Aryal RP, Heimburg-Molinaro J, Park SS, Wever WJ, Lehoux S, Stavenhagen K, van Wijk JAE, Van Die I, Chapman AB, Chaikof EL, Cummings RD. Identification and characterization of circulating immune complexes in IgA nephropathy. SCIENCE ADVANCES 2022; 8:eabm8783. [PMID: 36306365 PMCID: PMC9616497 DOI: 10.1126/sciadv.abm8783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 09/12/2022] [Indexed: 05/14/2023]
Abstract
The underlying pathology of immunoglobulin A (IgA) nephropathy (IgAN), the most common glomerulonephritis worldwide, is driven by the deposition of immune complexes containing galactose-deficient IgA1 [Tn(+)IgA1] in the glomerular mesangium. Here, we report that novel anti-Tn circulating immune complexes (anti-Tn CICs) contain predominantly IgM, representing large macromolecular complexes of ~1.2 megadaltons to several megadalton sizes together with Tn(+)IgA1 and some IgG. These complexes are significantly elevated in sera of patients with IgAN, which contains higher levels of complement C3, compared to healthy individuals. Anti-Tn CICs are bioactive and induce specific proliferation of human renal mesangial cells. We found that these anti-Tn CICs can be dissociated with small glycomimetic compounds, which mimic the Tn antigen of Tn(+)IgA1, releasing IgA1 from anti-Tn CICs. This glycomimetic compound can also significantly inhibit the proliferative activity of anti-Tn CICs of patients with IgAN. These findings could enhance both the diagnosis of IgAN and its treatment, as specific drug treatments are now unavailable.
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Affiliation(s)
- Yasuyuki Matsumoto
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rajindra P. Aryal
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jamie Heimburg-Molinaro
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simon S. Park
- Department of Surgery, Center for Drug Discovery and Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Wyss Institute of Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Walter J. Wever
- Department of Surgery, Center for Drug Discovery and Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Wyss Institute of Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Sylvain Lehoux
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kathrin Stavenhagen
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joanna A. E. van Wijk
- Department of Pediatric Nephrology, Amsterdam University Medical Centre, location VUmc, Amsterdam, Netherlands
| | - Irma Van Die
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Arlene B. Chapman
- Department of Medicine, Section of Nephrology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Elliot L. Chaikof
- Department of Surgery, Center for Drug Discovery and Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Wyss Institute of Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Richard D. Cummings
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Li Y, Yang Y, Zhuo L, Wu D, Li W, Liu X, Cui Y. Epidemiology of biopsy‐proven glomerular diseases in Chinese children: A scoping review. Chronic Dis Transl Med 2022; 8:271-280. [DOI: 10.1002/cdt3.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yetong Li
- Department of Nephrology, Beijing Children's Hospital, National Center for Children's Health Capital Medical University Beijing China
- Department of Nephrology, China‐Japan Friendship Hospital Capital Medical University Beijing China
| | - Yue Yang
- Department of Nephrology, China‐Japan Friendship Hospital Capital Medical University Beijing China
| | - Li Zhuo
- Department of Nephrology, China‐Japan Friendship Hospital Capital Medical University Beijing China
| | - Dan Wu
- Department of Nephrology, Beijing Children's Hospital, National Center for Children's Health Capital Medical University Beijing China
| | - Wenge Li
- Department of Nephrology, China‐Japan Friendship Hospital Capital Medical University Beijing China
| | - Xiaorong Liu
- Department of Nephrology, Beijing Children's Hospital, National Center for Children's Health Capital Medical University Beijing China
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Identification of High-Risk Groups in Urinalysis: Lessons from the Longitudinal Analysis of Annual Check-Ups. Healthcare (Basel) 2022; 10:healthcare10091704. [PMID: 36141316 PMCID: PMC9498401 DOI: 10.3390/healthcare10091704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background: For effective screening in urinalysis, information on high-risk groups is needed; however, there is a lack of evidence in young adults in particular. The aim of this study was to provide information on urinalysis in young adults and to identify high-risk groups of urinalyses using multi-year data obtained from annual large-scale check-ups. Method: We used annual health check-up data collected from 2011 to 2016 at Kyoto University in Japan. Eligible participants were those aged 18–39 years who underwent annual health check-ups for four consecutive years between 2011 and 2016. We conducted descriptive analyses and calculated the risk ratios (RRs) for urinary abnormalities in the fourth year of urinalysis. Results: In total, 13,640 participants (10,877 men, 79.7%) met the eligibility criteria. The mean prevalence rates of proteinuria, haematuria and glucosuria were 1.61% (men: 1.63%; women: 1.53%), 1.48% (men: 0.53%; women: 5.22%) and 0.46% (men: 0.52%; women: 0.25%), respectively. Participants with urinary abnormalities at least once in the initial 3 years had a higher risk of urinary abnormalities in the fourth year than participants with no abnormal findings in the initial 3 years; the risk ratios (RRs) of proteinuria, haematuria and glucosuria were 3.5 (95% confidence interval (CI) = 3.2–3.7), 12.2 (95% CI = 11.7–12.7) and 42.6 (95% CI = 37.7–48.1), respectively. The RRs of all urinary abnormalities in the fourth year increased as the frequency of urinary abnormalities over the preceding 3 years increased. In haematuria, differences of the RR were observed between men and women. Conclusion: We clarified the prevalence of urinary abnormalities in young adults and high-risk groups of urinary abnormalities. Our findings support the need for multi-year annual urinalysis.
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Saha MK, Massicotte-Azarniouch D, Reynolds ML, Mottl AK, Falk RJ, Jennette JC, Derebail VK. Glomerular Hematuria and the Utility of Urine Microscopy: A Review. Am J Kidney Dis 2022; 80:383-392. [PMID: 35777984 DOI: 10.1053/j.ajkd.2022.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/16/2022] [Indexed: 01/27/2023]
Abstract
Evaluation of hematuria and microscopic examination of urine sediment are commonly used tools by nephrologists in their assessment of glomerular diseases. Certain morphological aspects of urine red blood cells (RBCs) seen by microscopy may help in identifying the source of hematuria as glomerular or not. Recognized signs of glomerular injury are RBC casts or dysmorphic RBCs, in particular acanthocytes (ring-shaped RBCs with protruding blebs). Despite being a highly operator-dependent test, urine sediment examination revealing these signs of glomerular hematuria has demonstrated specificities and positive predictive values ranging between 90%-100% for diagnosing glomerular disease, although sensitivity can be quite variable. Hematuria is a commonly used tool for diagnosing patients with proliferative glomerulonephritis such as IgA nephropathy, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and lupus nephritis, sometimes even as a surrogate for kidney involvement. Studies examining the role for hematuria in monitoring and predicting adverse outcomes in these diseases have shown inconsistent results, possibly due to inconsistent definitions that often fail to consider specific markers of glomerular hematuria such as dysmorphic RBCs, acanthocytes, or RBC casts. A consensus definition of what constitutes glomerular hematuria would help standardize use in future studies and likely improve the diagnostic and prognostic value of hematuria as a marker of glomerulonephritis.
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Affiliation(s)
- Manish K Saha
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
| | - David Massicotte-Azarniouch
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Monica L Reynolds
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Amy K Mottl
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Ronald J Falk
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Vimal K Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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11
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Gül CB, Küçük M, Öztürk S, Demir E, Eren N, Şumnu A, Seyahi N, Güllülü M, Dede F, Derici Ü, Koç Y, Şahin G, Oymak O, Sahin GM, Tatar E, Dursun B, Dheir H, Apaydın S, Süleymanlar G, Ulu S, Altınören O, Kutlay S, Meşe M, Şahin İ, Üstündağ S, Türkmen K, Yılmaz ME, Kazancıoğlu RT, Uzun Ö, Candan F, Aydın Z, Oygar D, Aktaş N, Erdem Y, Paydaş S, Taymez D, Can B, Kıykım A, Koç L, Sezer S, Duranay M, Bardak S, Altıntepe L, Kaya B, Azak A, Ecder SA, Çavdar C, Selçuk NY. Trends of primary glomerular disease in Turkey: TSN-GOLD registry report. Int Urol Nephrol 2022; 54:2285-2294. [PMID: 35107695 DOI: 10.1007/s11255-022-03123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although several renal biopsy registry reports have been published worldwide, there are no data on primary glomerular disease trends in Turkey. METHODS Three thousand eight-hundred fifty-eight native kidney biopsy records were assessed in the Turkish Society of Nephrology Primary Glomerulopathy Working Group (TSN-GOLD) Registry. Secondary disease and transplant biopsies were not recorded in the registry. These records were divided into four periods, before 2009, 2009 to 2013, 2013-2017, and 2017-current. RESULTS A total of 3858 patients (43.6% female, 6.8% elderly) were examined. Nephrotic syndrome was the most common biopsy indication in all periods (58.6%, 53%, 44.1%, 51.6%, respectively). In the whole cohort, IgA nephropathy (IgAN) (25.7%) was the most common PGN with male predominance (62.7%), and IgAN frequency steadily increased through the periods (× 2 = 198, p < 0.001). MGN was the most common nephropathy in the elderly (> 65 years), and there was no trend in this age group. An increasing trend was seen in the frequency of overweight patients (× 2 = 37, p < 0.0001). Although the biopsy rate performed with interventional radiology gradually increased, the mean glomeruli count in the samples did not change over the periods. CONCLUSIONS In Turkey, IgAN is the most common primary glomerulonephritis, and the frequency of this is increasing.
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Affiliation(s)
- Cuma Bülent Gül
- Department of Nephrology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Mehmet Küçük
- Nephrology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Savaş Öztürk
- Nephrology, Haseki Training and Resarch Hospital, Istanbul, Turkey
| | - Erol Demir
- Nephrology, Istanbul University Medical School, Istanbul, Turkey
| | - Necmi Eren
- Nephrology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Abdullah Şumnu
- Faculty of Medicine, Nephrology, Medipol University Hospital, Istanbul, Turkey
| | - Nurhan Seyahi
- Nephrology, Cerrahpasa University Medical School, Istanbul, Turkey
| | - Mustafa Güllülü
- Nephrology, Uludag University Medical Faculty Hospital, Bursa, Turkey
| | - Fatih Dede
- Nephrology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ülver Derici
- Nephrology, Gazi University Medical Faculty, Ankara, Turkey
| | - Yener Koç
- Nephrology, Sisli Hamidiye Training and Research Hospital, Istanbul, Turkey
| | - Garip Şahin
- Nephrology, Osmangazi University, Odunpazarı, Eskisehir, Turkey
| | - Oktay Oymak
- Nephrology, Erciyes University, Kayseri, Turkey
| | - Gülizar Manga Sahin
- Nephrology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Erhan Tatar
- Nephrology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Belda Dursun
- Nephrology, Pamukkale University, Denizli, Turkey
| | - Hamad Dheir
- Nephrology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Süheyla Apaydın
- Istanbul Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Sena Ulu
- Nephrology, Afyon Kocatepe University Medical School, Afyonkarahisar, Turkey
| | - Orçun Altınören
- Nephrology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Sim Kutlay
- Faculty of Medicine, Nephrology, Ankara University, Ankara, Turkey
| | - Meral Meşe
- Nephrology, Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - İdris Şahin
- Nephrology, Inonu University Medical School, Malatya, Turkey
| | - Sedat Üstündağ
- Nephrology, Trakya University Medical School, Edirne, Turkey
| | - Kültigin Türkmen
- Nephrology, Necmettin Erbakan University Meram Medical School, Konya, Turkey
| | | | | | - Özcan Uzun
- Nephrology, Dokuz Eylul University Medical School, Izmir, Turkey
| | - Ferhan Candan
- Nephrology, Cumhuriyet University Medical School, Sivas, Turkey
| | - Zeki Aydın
- Nephrology, Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Deren Oygar
- Nephrology, Lefkosa Burhan Nalbantoglu Hospital, Lefkosa, Turkish Republic of Northern Cyprus
| | - Nimet Aktaş
- Department of Nephrology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Yunus Erdem
- Nephrology, Hacettepe University Medical School, Ankara, Turkey
| | - Saime Paydaş
- Nephrology, Cukurova University Medical School, Adana, Turkey
| | - Dilek Taymez
- Nephrology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Başak Can
- Nephrology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kıykım
- Nephrology, Mersin University Medical School, Mersin, Turkey
| | - Leyla Koç
- Nephrology, Taksim Training and Research Hospital, Istanbul, Turkey
| | - Siren Sezer
- Nephrology, Baskent University Medical School, Ankara, Turkey
| | - Murat Duranay
- Nephrology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Simge Bardak
- Nephrology, Batman State Hospital, Batman, Turkey
| | | | - Burcu Kaya
- Nephrology, Marmara University Medical School, Istanbul, Turkey
| | - Alper Azak
- Nephrology, Balıkesir Training and Research Hospital, Balikesir, Turkey
| | - Sebahat Alışır Ecder
- Nephrology, Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Caner Çavdar
- Nephrology, Dokuz Eylul University Medical School, Izmir, Turkey
| | - Nedim Yılmaz Selçuk
- Nephrology, Necmettin Erbakan University Meram Medical School, Konya, Turkey
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12
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Chen T, Yang Q, Xu H, Gong Y, Guo X, Lin H, Yang J, Zhuang J, Lan J, Chu M, Wang D. Urine Screening and 9 Years' Medical Record System Follow-Up Among School Students in Wenzhou, China. Front Pediatr 2022; 10:862029. [PMID: 35547544 PMCID: PMC9081790 DOI: 10.3389/fped.2022.862029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
School urinary screening programming can be useful for the early detection of renal and urinary disorders. However, urine screening is not included in the school health check-up in our region. Therefore, from February 2012 to March 2021, 12,497 school students were screened for urinalysis, and a long-term follow-up took place via an electronic medical record system. Among these screened students, 719 (5.75%) positive individuals received a repeat urinalysis 2 weeks later. During the 9-year medical record system follow-up period, 5 children had renal biopsies and 2 children had a diagnosis of IgA nephropathy (IgAN), while the remaining 3 children were diagnosed with thin basement membrane disease (TBM), primary nephrotic syndrome (PNS), and were suspected of C3 glomerulopathy, respectively. By this, calling for the school urine screening program as a physical examination item for primary and secondary school-aged students will contribute to enabling early detection of urine abnormalities and allow for early treatment.
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Affiliation(s)
- Tingting Chen
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing Yang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Yinv Gong
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoling Guo
- Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Children Genitourinary Diseases of Wenzhou, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongzhou Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianhuan Yang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jieqiu Zhuang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junwei Lan
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Maoping Chu
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dexuan Wang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Children Genitourinary Diseases of Wenzhou, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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13
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La Scola C, Ammenti A, Bertulli C, Bodria M, Brugnara M, Camilla R, Capone V, Casadio L, Chimenz R, Conte ML, Conversano E, Corrado C, Guarino S, Luongo I, Marsciani M, Marzuillo P, Meneghesso D, Pennesi M, Pugliese F, Pusceddu S, Ravaioli E, Taroni F, Vergine G, Peruzzi L, Montini G. Management of the congenital solitary kidney: consensus recommendations of the Italian Society of Pediatric Nephrology. Pediatr Nephrol 2022; 37:2185-2207. [PMID: 35713730 PMCID: PMC9307550 DOI: 10.1007/s00467-022-05528-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022]
Abstract
In recent years, several studies have been published on the prognosis of children with congenital solitary kidney (CSK), with controversial results, and a worldwide consensus on management and follow-up is lacking. In this consensus statement, the Italian Society of Pediatric Nephrology summarizes the current knowledge on CSK and presents recommendations for its management, including diagnostic approach, nutritional and lifestyle habits, and follow-up. We recommend that any antenatal suspicion/diagnosis of CSK be confirmed by neonatal ultrasound (US), avoiding the routine use of further imaging if no other anomalies of kidney/urinary tract are detected. A CSK without additional abnormalities is expected to undergo compensatory enlargement, which should be assessed by US. We recommend that urinalysis, but not blood tests or genetic analysis, be routinely performed at diagnosis in infants and children showing compensatory enlargement of the CSK. Extrarenal malformations should be searched for, particularly genital tract malformations in females. An excessive protein and salt intake should be avoided, while sport participation should not be restricted. We recommend a lifelong follow-up, which should be tailored on risk stratification, as follows: low risk: CSK with compensatory enlargement, medium risk: CSK without compensatory enlargement and/or additional CAKUT, and high risk: decreased GFR and/or proteinuria, and/or hypertension. We recommend that in children at low-risk periodic US, urinalysis and BP measurement be performed; in those at medium risk, we recommend that serum creatinine also be measured; in high-risk children, the schedule has to be tailored according to kidney function and clinical data.
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Affiliation(s)
- Claudio La Scola
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Anita Ammenti
- Pediatric Multi-Specialistic Unit, Poliambulatorio Medi-Saluser, Parma, Italy
| | - Cristina Bertulli
- grid.6292.f0000 0004 1757 1758Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138 Bologna, Italy
| | - Monica Bodria
- grid.419504.d0000 0004 1760 0109Division of Nephrology, Dialysis, Transplantation, and Laboratory On Pathophysiology of Uremia, Istituto G. Gaslini, Genova, Italy
| | | | - Roberta Camilla
- grid.432329.d0000 0004 1789 4477Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Valentina Capone
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | - Luca Casadio
- Unità Operativa Complessa Di Pediatria E Neonatologia, Ospedale Di Ravenna, AUSL Romagna, Ravenna, Italy
| | - Roberto Chimenz
- Unità Operativa Di Nefrologia Pediatrica Con Dialisi, Azienda Ospedaliero-Universitaria G. Martino, Messina, Italy
| | - Maria L. Conte
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Ester Conversano
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Ciro Corrado
- Pediatric Nephrology, “G. Di Cristina” Hospital, Palermo, Italy
| | - Stefano Guarino
- grid.9841.40000 0001 2200 8888Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania “Luigi Vanvitelli, Napoli, Italy
| | - Ilaria Luongo
- Unità Operativa Complessa Di Nefrologia E Dialisi, AORN Santobono – Pausilipon, Napoli, Italy
| | - Martino Marsciani
- grid.414682.d0000 0004 1758 8744Unità Operativa Di Pediatria E Terapia Intensiva Neonatale-Pediatrica, Ospedale M Bufalini, Cesena, Italy
| | - Pierluigi Marzuillo
- grid.9841.40000 0001 2200 8888Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania “Luigi Vanvitelli, Napoli, Italy
| | - Davide Meneghesso
- grid.5608.b0000 0004 1757 3470Unità Operativa Complessa Di Nefrologia Pediatrica - Dialisi E Trapianto, Dipartimento Di Salute Della Donna E del Bambino, Azienda Ospedaliero-Universitaria Di Padova, Padova, Italy
| | - Marco Pennesi
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Fabrizio Pugliese
- grid.7010.60000 0001 1017 3210Pediatric Nephrology Unit, Department of Pediatrics, Marche Polytechnic University, Ancona, Italy
| | | | - Elisa Ravaioli
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | - Gianluca Vergine
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Licia Peruzzi
- grid.432329.d0000 0004 1789 4477Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy ,grid.4708.b0000 0004 1757 2822Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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14
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Zhang Z, Zhang Y, Zhang H. IgA Nephropathy: A Chinese Perspective. GLOMERULAR DISEASES 2021; 2:30-41. [PMID: 36751266 PMCID: PMC9677733 DOI: 10.1159/000520039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022]
Abstract
Background IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide and remains a leading cause of chronic kidney disease and end-stage renal disease. The disease prevalence, clinical and pathological phenotypes, the underlying pathogenic molecular mechanisms, and the response to treatments are highly heterogeneous in different ethnic populations, which raise the concern that IgAN may differ across different parts of the world. Summary From a Chinese perspective, we stated the disease burden of IgAN, summarized genome-wide association studies and research into pathological molecules, and compared them with findings based on other populations. The emerging biomarkers, indigenous clinical trials, and major challenges for Chinese researchers and nephrologists in studying IgAN are also discussed. Key Messages In this review, we described a higher risk of major susceptible loci in mucosal immunity, IgA production, and complement activation pathways in Chinese patients with IgAN. With our understanding of the pathogenesis of IgAN, novel biomarkers are emerging. Although there are challenges for conducting high-quality clinical trials in China, it is still feasible to conduct innovative and well-designed studies of IgAN. In the future, international collaborations on research infrastructure would be helpful to advance clinical and basic research in China.
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Affiliation(s)
- Zhao Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China,Institute of Nephrology, Peking University, Beijing, China,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
| | - Yuemiao Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China,Institute of Nephrology, Peking University, Beijing, China,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
| | - Hong Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China,Institute of Nephrology, Peking University, Beijing, China,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China,*Hong Zhang,
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15
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Naka S, Wato K, Misaki T, Ito S, Matsuoka D, Nagasawa Y, Nomura R, Matsumoto-Nakano M, Nakano K. Streptococcus mutans induces IgA nephropathy-like glomerulonephritis in rats with severe dental caries. Sci Rep 2021; 11:5784. [PMID: 33707585 PMCID: PMC7952735 DOI: 10.1038/s41598-021-85196-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
The mechanisms underlying immunoglobulin A nephropathy (IgAN), the most common chronic form of primary glomerulonephritis, remain poorly understood. Streptococcus mutans, a Gram-positive facultatively anaerobic oral bacterium, is a common cause of dental caries. In previous studies, S. mutans isolates that express Cnm protein on their cell surface were frequently detected in IgAN patients. In the present study, inoculation of Cnm-positive S. mutans in the oral cavities of 2-week-old specific-pathogen free Sprague-Dawley rats fed a high-sucrose diet for 32 weeks produced severe dental caries in all rats. Immunohistochemical analyses of the kidneys using IgA- and complement C3-specific antibodies revealed positive staining in the mesangial region. Scanning electron microscopy revealed a wide distribution of electron dense deposits in the mesangial region and periodic acid-Schiff staining demonstrated prominent proliferation of mesangial cells and mesangial matrix. These results suggest that IgAN-like glomerulonephritis was induced in rats with severe dental caries by Cnm-positive S. mutans.
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Affiliation(s)
- Shuhei Naka
- Department of Pediatric Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kaoruko Wato
- Department of Pediatric Dentistry, Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Taro Misaki
- Division of Nephrology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
- Department of Nursing, Faculty of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka, Japan
| | - Seigo Ito
- Department of Nephrology and Endocrinology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Daiki Matsuoka
- Department of Pediatric Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuyuki Nagasawa
- Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryota Nomura
- Department of Pediatric Dentistry, Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Michiyo Matsumoto-Nakano
- Department of Pediatric Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiko Nakano
- Department of Pediatric Dentistry, Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.
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16
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Zhong X, Ding J, Wang Z, Gao Y, Wu Y, Shen Y, Song H, Zhao Z, Chen X, Zhang P, Xu G, Yao C, Zhang H, Zhong F, Tang Y, Wang H, Wang W, Li W, Zhang W, Zhu S, Shang M. Risk Factors Associated With Abnormal Urinalysis in Children. Front Pediatr 2021; 9:649068. [PMID: 33869116 PMCID: PMC8044805 DOI: 10.3389/fped.2021.649068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Targeted urinalysis has been suggested to improve screening efficiency in adults. However, there is no well-defined target population in children yet, with limited information on the risk factors for urinalysis abnormalities. Methods: Children from infants to 17 years old were randomly selected. Dipstick urinalysis was initially performed. Among those who were abnormal, a repeat dipstick or dipstick with microscopic urinalysis was performed for confirmation. Results: In total, 70,822 children were included, with 37,866 boys and 32,956 girls. Prevalence of abnormal urinalysis was 4.3%. Age was significantly associated with abnormal urinalysis, with the highest prevalence among 12-14-year-olds. Girls were 2.0 times more likely to exhibit abnormalities. Compared with children whose guardians had a college degree or higher, those whose guardians had a high school degree or lower had a higher likelihood of abnormalities. Geographic location was also associated with abnormal results. Conclusion: Girls, children aged 12-14 years old, and children whose guardians had a low educational level and children in certain geographic locations were significantly associated with abnormal urinalysis. Identification of children at high risk would contribute to targeted urinalysis screening.
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Affiliation(s)
- Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zheng Wang
- Department of Pediatrics, Sichuan University West China Second University Hospital, Chengdu, China
| | - Yan Gao
- Department of Pediatric Nephrology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yubin Wu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Shen
- Department of Pediatric Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Zhengyan Zhao
- Department of Child Healthcare, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinxin Chen
- Department of Infant Healthcare Section, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Puhong Zhang
- Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Guobin Xu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Chen Yao
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Hui Zhang
- Department of Pediatrics, Sichuan University West China Second University Hospital, Chengdu, China
| | - Fu Zhong
- Department of Pediatric Nephrology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ying Tang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hui Wang
- Department of Pediatric Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Wenhao Li
- Department of Child Healthcare, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wanxia Zhang
- Department of Infant Healthcare Section, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Meixia Shang
- Department of Biostatistics, Peking University First Hospital, Beijing, China
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17
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Barbour SJ, Coppo R, Er L, Russo ML, Liu ZH, Ding J, Katafuchi R, Yoshikawa N, Xu H, Kagami S, Yuzawa Y, Emma F, Cambier A, Peruzzi L, Wyatt RJ, Cattran DC. Updating the International IgA Nephropathy Prediction Tool for use in children. Kidney Int 2020; 99:1439-1450. [PMID: 33220356 DOI: 10.1016/j.kint.2020.10.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/21/2022]
Abstract
Although IgA nephropathy (IgAN) is a common cause of glomerulonephritis in children, the absence of a method to predict disease progression limits personalized risk-based treatment decisions. The adult International IgAN Prediction Tool comprises two validated Cox survival models that predict a 50% decline in estimated glomerular filtration rate (eGFR) or end stage kidney disease (ESKD) using clinical risk factors and Oxford MEST histology scores. Here, we updated the Prediction Tool for use in children using a multiethnic international cohort of 1,060 children with IgAN followed into adulthood. The updated pediatric Prediction Tool had better model fit than the original adult tool with lower Akaike Information Criterion, higher R2D and similar C-statistics. However, calibration showed very poor agreement between predicted and observed risks likely due to the observed disease trajectory in children. Therefore, the Tool was updated using a secondary outcome of a 30% reduction in eGFR or ESKD, resulting in better R2D (30.3%/22.2%) and similar C-statistics (0.74/0.68) compared to the adult tool but with good calibration. The trajectory of eGFR over time in children differed from adults being highly non-linear with an increase until 18 years old followed by a linear decline similar to that of adults. A higher predicted risk was associated with a smaller increase in eGFR followed by a more rapid decline, suggesting that children at risk of a 30% decrease in eGFR will eventually experience a larger 50% decrease in eGFR when followed into adulthood. As such, these two outcomes are analogous between pediatric and adult Prediction Tools. Thus, our pediatric Prediction Tool can accurately predict the risk of a 30% decline in eGFR or ESKD in children with IgAN.
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Affiliation(s)
- Sean J Barbour
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; BC Renal, Vancouver, British Columbia, Canada.
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Lee Er
- BC Renal, Vancouver, British Columbia, Canada
| | - Maria Luisa Russo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Zhi-Hong Liu
- Nanjing University School of Medicine, Nanjing, China
| | - Jie Ding
- Peking University First Hospital, Beijing, China
| | - Ritsuko Katafuchi
- National Hospital Organization Fukuoka Higashi Medical Center, Fukuoka, Japan
| | | | - Hong Xu
- Children's Hospital of Fudan University, Shanghai, China
| | | | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Tokyo, Japan
| | - Francesco Emma
- Nephrology Unit, Department of Pediatric Subspecialties, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | | | - Licia Peruzzi
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy; Regina Margherita Hospital, Turin, Italy
| | - Robert J Wyatt
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Daniel C Cattran
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada.
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Suh JS, Jang KM, Hyun H, Cho MH, Lee JH, Park YS, Oh JH, Kim JH, Yoo KH, Chung WY, Kim SH, Kim K, Lee DY, Lee JW, Cho MH, Park H, Koo JW, Han KH, Yang EM, Lee KH, Shin JI, Cho H, Kim KS, Ha IS, Park YH, Kang HG. Remission of Proteinuria May Protect against Progression to Chronic Kidney Disease in Pediatric-Onset IgA Nephropathy. J Clin Med 2020; 9:jcm9072058. [PMID: 32629965 PMCID: PMC7408672 DOI: 10.3390/jcm9072058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 01/25/2023] Open
Abstract
Immunoglobulin A nephropathy (IgAN) is one of the most common primary glomerulopathies diagnosed in children and adolescents. This study aimed to evaluate the clinical features in and outcomes of pediatric IgAN over the last 30 years. Patients who were diagnosed before age of 18 at 20 centers in Korea were evaluated retrospectively. Of the 1154 patients (768 males, 386 females) with a median follow-up of 5 years, 5.6% (n = 65) progressed to stage 3–5 chronic kidney disease (CKD). The 10- and 20-year CKD-free survival rates were 91.2% and 75.6%, respectively. Outcomes did not differ when comparing those in Korea who were diagnosed prior to versus after the year 2000. On multivariate analysis, combined asymptomatic hematuria and proteinuria as presenting symptoms and decreased renal function at the time of biopsy were associated with progression to CKD, while remission of proteinuria was negatively associated with this outcome. Patients who presented with gross hematuria or nephrotic syndrome tended toward positive outcomes, especially if they ultimately achieved remission. While remission of proteinuria might imply that the disease is inherently less aggressive, it also can be achieved by management. Therefore, more aggressive management might be required for pediatric-onset IgAN.
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Affiliation(s)
- Jin-Soon Suh
- Departments of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon 14647, Korea;
| | - Kyung Mi Jang
- Yeungnam University Hospital, Daegu 42415, Korea; (K.M.J.); (Y.H.P.)
| | - Hyesun Hyun
- St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea;
| | - Myung Hyun Cho
- Hallym University Sacred Heart Hospital, Anyang 14068, Korea;
| | - Joo Hoon Lee
- Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.H.L.); (Y.S.P.)
| | - Young Seo Park
- Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.H.L.); (Y.S.P.)
| | - Jae Hyuk Oh
- Ajou University Hospital, School of Medicine, Suwon 16499, Korea;
| | - Ji Hong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.K.); (K.H.L.); (J.I.S.)
| | - Kee Hwan Yoo
- Korea University Guro Hospital, Seoul 08308, Korea;
| | - Woo Yeong Chung
- Busan Paik Hospital, College of Medicine, Inje University, Busan 47392, Korea;
| | - Seong Heon Kim
- Pusan National University Children’s Hospital, Yangsan 50612, Korea;
| | - Keehyuck Kim
- National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea;
| | - Dae Yeol Lee
- Jeonbuk National University Hospital, Jeonju 54907, Korea;
| | - Jung Won Lee
- Ewha Womans University Seoul Hospital, Seoul 07804, Korea;
| | - Min Hyun Cho
- School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Hyewon Park
- Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Ja Wook Koo
- Inje University Sanggye Paik Hospital, Seoul 01757, Korea;
| | - Kyoung Hee Han
- Jeju National University School of Medicine, Jeju 63243, Korea;
| | - Eun Mi Yang
- Chonnam National University Hospital and Medical School, Hwasun 58128, Korea;
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.K.); (K.H.L.); (J.I.S.)
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.K.); (K.H.L.); (J.I.S.)
| | - Heeyeon Cho
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | | | - Il-Soo Ha
- Seoul National University College of Medicine and Seoul National University Children’s Hospital, Seoul 03080, Korea;
| | - Yong Hoon Park
- Yeungnam University Hospital, Daegu 42415, Korea; (K.M.J.); (Y.H.P.)
| | - Hee Gyung Kang
- Seoul National University College of Medicine and Seoul National University Children’s Hospital, Seoul 03080, Korea;
- Correspondence:
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IgA nephropathy in children and in adults: two separate entities or the same disease? J Nephrol 2020; 33:1219-1229. [PMID: 32314305 DOI: 10.1007/s40620-020-00725-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
IgA nephropathy (IgAN) is observed in subjects of any age, however perspective and management of this disease are different between adult and pediatrician Nephrologists. Most children with IgAN present with gross hematuria rapidly vanishing or persistent mild microscopic hematuria, which rarely progresses to end stage renal disease (ESRD) over the pediatric observation. The perspective of IgAN in adults is of a slowly progressive glomerular disease with 30-40% probabilities to reach ESRD. However, mild cases of IgAN in children might be missed with manifestation of irreversible damage only decades after the true onset, as 50% of subjects with IgAN enter renal replacement treatment before the age of 50 years. In both adults and children the assessment of risk profile is crucial to avoid overtreatment in benign cases or institute a prompt and valid therapy in potentially progressive cases. In case of common risk factors, new therapeutic opportunities tested in adults might be applied to children with the expectation of similar results. If IgAN is the same disease in spite of different clinical profiles in children and adults, an early intervention may be the correct way to prevent progression decades later. On the contrary, if we are dealing with different clinical entities, the treatment in pediatric and in adult settings must be kept apart. This review addresses to report similarities and differences of IgAN across the life periods in order to reason on the application of newly offered treatments over the entire spectrum of this disease or in focused age indications.
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20
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Sakai T, Nomura Y, Sawai T, Hamada R, Gotoh Y, Yamamoto K, Ichioka S, Masuda T, Maruo Y, Honda M. Uptake of further investigations following universal urinary screening among elementary and junior high school students in Shiga Prefecture, Japan: A retrospective cohort study. Nephrology (Carlton) 2020; 25:599-606. [PMID: 32147900 DOI: 10.1111/nep.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/28/2019] [Accepted: 02/26/2020] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to investigate the current progression status from screening phase to further investigation phase in the Japanese school urine mass screening (SUS) project. METHODS This retrospective cohort study on the SUS project across the Shiga Prefecture during 2012 to 2017 analysed data from school life instruction sheets, which are principal documents in the SUS project, regarding urinalysis, attendance at follow-up and diagnoses. RESULTS Between the years 2012 to 2017, a median of 107 out of 83 749 elementary school students (aged 6-11 years) and 215 out of 42 870 junior high students (aged 12-14 years) had urine abnormalities identified for the first time in the SUS project. Among those with urine abnormalities, a mean of 4.2% of elementary school and 1.8% of junior high school students, respectively, were diagnosed with suspected glomerulonephritis for the first time. Overall, 5.9% (95% confidence interval [CI] 4.1, 7.7) and 23.6% (95% CI 21.3, 25.9) of proteinuria-positive elementary and junior high school students, respectively, did not undergo further investigations. The probability of a student undergoing further investigations was not affected by the local availability of medical care benefits. CONCLUSION In the current SUS project, screening frequently does not lead to further investigation, especially among junior high school students. To maintain the integrity of the SUS project and to prevent the progression of renal disease in young students, efforts including elucidation of barriers to further investigations should be made to reduce the proportions of students not undergoing further investigations for abnormal urinalysis findings.
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Affiliation(s)
- Tomoyuki Sakai
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | | | - Toshihiro Sawai
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Riku Hamada
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yoshimitsu Gotoh
- Department of Pediatric Nephrology, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Kazuna Yamamoto
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Satoko Ichioka
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Toshiki Masuda
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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21
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Cambier A, Boyer O, Deschenes G, Gleeson J, Couderc A, Hogan J, Robert T. Steroid therapy in children with IgA nephropathy. Pediatr Nephrol 2020; 35:359-366. [PMID: 30778826 DOI: 10.1007/s00467-018-4189-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 01/14/2023]
Abstract
IgA nephropathy (IgAN) is one the most common primary glomerulonephritis in children and adolescents worldwide, with 20% of children developing end-stage kidney disease (ESKD) within 20 years of diagnosis. There is a need for treatment guidelines, especially for steroids in children with primary IgAN, since the STOP-IgA trial casts doubts on the use of steroids in adults with intermediate risk. Pediatricians are prone to prescribe steroids in addition to renin-angiotensin system blockade (RASB) when proteinuria is > 0.5 g/l, eGFR deteriorates < 70 ml/min/1.73 m2, or when a biopsy sample shows glomerular inflammation. Lack of randomized controlled trials (RCTs) in children with IgAN has led to an absence of consensus on the use of immunosuppressive agents in the treatment of progressive IgAN. This literature review evaluates the available evidence on steroid treatment in children with IgAN.
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Affiliation(s)
- Alexandra Cambier
- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France.
| | - Olivia Boyer
- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Georges Deschenes
- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - James Gleeson
- Université Paris Diderot, Faculté de Médecine, Site Xavier Bichat, INSERM U1149 & CNRS ERL8252, Centre de Recherche sur l'Inflammation, Paris, France
| | - Anne Couderc
- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - Julien Hogan
- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - Thomas Robert
- Department of Nephrology, Transplantation and Emergency, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France.
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22
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Identification of children with chronic kidney disease through school urinary screening using urinary protein/creatinine ratio measurement: an observational study. Clin Exp Nephrol 2020; 24:450-457. [PMID: 32006130 PMCID: PMC7174251 DOI: 10.1007/s10157-020-01852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022]
Abstract
Background School urinary screening has been performed in Japan. Methods Ikeda City and Toyono Town introduced, in 2012 and 2013, urinary protein/creatinine (Cr) ratio measurement into the urine-screening protocols designed for students aged between 4 and 15 years. For each student whose urinary protein/Cr ratio was ≥ 0.15 g/gCr (positive case), an appointment was made with a specialist at Ikeda City Hospital. The results of these screening urinalyses conducted through 2018 are summarized. Results 14,606 junior high and elementary school students aged between 6 and 15 years were included. On average, they underwent 4.16 screening tests. 77 positive cases were detected, and seven students were diagnosed with high-risk chronic kidney disease (CKD). Of these, four underwent renal biopsy, and two, one, and one were diagnosed with IgA nephropathy, MPGN, and FSGS, respectively. In three students, detection of CKD would have been difficult without urinary screening. Incident rates of high-risk CKD and IgA nephropathy are estimated as 11.5 and 3.3 cases/100,000 students/year. 78.0% of positive cases without high-risk CKD showed no urinary abnormality after one year. 2301 kindergarten students aged between 4 and 6 years received an average of 1.74 screening urinalyses; none was positive or high-risk CKD. The estimated cost of detecting one high-risk CKD student whose detection would have been difficult without this screening was 3,156,711 Japanese yen. Conclusion School urinary screening using the urinary protein/Cr ratio can efficiently refer to a specialist. It detects a few children with high-risk CKD early with spending high cost. Electronic supplementary material The online version of this article (10.1007/s10157-020-01852-5) contains supplementary material, which is available to authorized users.
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23
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Chen MC, Wang JH, Chen JS, Chang YC, Jan RH, Yang SH, Chu SY, Lai PC, Chu CH, Cheng CF, Chang YH. Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study. Front Pediatr 2020; 8:600907. [PMID: 33363066 PMCID: PMC7758220 DOI: 10.3389/fped.2020.600907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: Child hematuria/proteinuria is a risk factor for chronic kidney disease (CKD) in later life, and mass urinary screening could detect asymptomatic glomerulonephritis at an early stage. This study aimed to evaluate the longitudinal prevalence of hematuria/proteinuria and its association with socio-demographic factors among school children in Hualien, Taiwan. Methods: The study cohort consisted of first and fourth graders enrolled from 2008 to 2015 in Hualien. We combined the data from two consecutive health examinations to ensure the validity of the body mass index (BMI), urbanization, proteinuria, and hematuria grouping. Prevalence and health status differences between sex, age, BMI, and urbanization level were examined. Results: A total of 16,990 students within the same BMI and urbanization categories were included during the study interval. The prevalence of persistent hematuria was 1.0%. Fourth graders (odds ratio OR: 1.68, p = 0.002), girls (OR: 1.48, p = 0.014), and students from suburban/rural areas (OR: 1.99, and OR: 4.93, respectively; both p < 0.001) demonstrated higher hematuria risk. The prevalence of proteinuria was 0.2%. Fourth graders (OR: 4.44, p < 0.001) and students in suburban areas (OR: 0.27, p = 0.031) were associated with persistent proteinuria. After stratifying by age, the significant association remained. A higher risk of proteinuria was noted in underweight subjects (OR: 2.52, p = 0.023) among the fourth-grade students. Conclusion: The prevalence of hematuria/proteinuria in Hualien was higher than the average reported for Taiwan. Hematuria/proteinuria was significantly associated with sex, age, BMI, and urbanization. Our longitudinal results can provide information for future pediatric CKD prevention in Taiwan.
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Affiliation(s)
- Ming-Chun Chen
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jui-Shia Chen
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yung-Chieh Chang
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Rong-Hwa Jan
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shang-Hsien Yang
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shao-Yin Chu
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Pei-Chun Lai
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Evidence-Based Medicine Center, Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chia-Hsiang Chu
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Feng Cheng
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Pediatric, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Yu-Hsun Chang
- Department of Pediatric, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Pediatric, National Taiwan University Hospital, Hsinchu, Taiwan
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24
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Cheng XY, Zhu YF, Luo S, He Y, Wang XC. [An epidemiological investigation of chronic kidney disease in children with hearing disorder in Hunan province, China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:915-918. [PMID: 31506153 PMCID: PMC7390239 DOI: 10.7499/j.issn.1008-8830.2019.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the prevalence of chronic kidney disease (CKD) among the children with hearing disorder in Hunan province, China. METHODS In this cross-sectional study, the multi-stage cluster sampling method was used to select 1 500 children as subjects. Questionnaire surveys, physical examinations, and laboratory examinations were performed on the spot. RESULTS Among the 1 500 children, 1 459 with complete data were included in analysis. Among the 1 459 children, 43 had CKD, with a prevalence rate of 2.95%. The <7 years group had a significantly higher prevalence rate than the 7-14 years group [5.8% (35/604) vs 0.9% (8/855); P<0.05]. Among the 43 children with CKD, 31 (72%) had proteinuria, 27 (63%) had hematuria, and 11 (26%) had a decreased glomerular filtration rate. Among the 43 children with CKD, stage 1, 2, 3a, 3b, 4, and 5 CKD accounted for 30% (13 cases), 44% (19 cases), 12% (5 cases), 7% (3 cases), 7% (3 cases), and 0% (0 case) respectively. The prevalence rate of CKD increased with the severity of hearing disorder (P<0.01). CONCLUSIONS The prevalence rate of CKD is higher among the children with hearing disorder in Hunan province. Most children have early-stage CKD. CKD is commonly seen in preschool children. Severity of hearing disorder is associated with the prevalence of CKD.
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Affiliation(s)
- Xiang-Yang Cheng
- Department of Nephrology, Second Affiliated Hospital of Hunan Normal University/921 Hospital of the People's Liberation Army of China, Changsha 410003, China.
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25
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Abstract
IgA nephropathy (IgAN), or Berger's disease, is the most common primary glomerular disease worldwide, but varies largely in its geographic distribution. A systematic review of 1,619 publications from the five continental regions of the world was performed to assess the prevalence of IgAN in different worldwide regions and analyze factors responsible for geographic differences. All observational studies that described the prevalence and incidence data on glomerulonephritis were considered. IgAN is more frequent in Asian populations (45 cases per million population/y in Japan) than in Caucasians (31 cases per million population/y in France). These differences are owing to some relevant aspects: (1) systematic mass screening of urine in populations, as occurring in some Asian countries (Hong Kong, Japan, Korea, and Singapore), is not common in Western countries; (2) general practitioners and health care professionals in Western countries underestimate persistent microscopic hematuria and/or mild proteinuria in apparently healthy individuals causing late referral to a nephrologist; and (3) nephrologists adopt different indications for kidney biopsy in individuals with persistent urinary abnormalities. In addition, differences also are owing to the source of data, because the frequency of IgAN observed in a nephrology center with a high incidence of kidney biopsies is higher than in a regional renal biopsy registry that receives data from many centers. In conclusion, greater efforts should be made to diagnose IgAN earlier in individuals who manifest persistent microhematuria and/or mild proteinuria and to introduce less stringent indications for kidney biopsies. This preventive approach, followed by early therapy, may reduce the global burden of end-stage kidney disease caused by IgAN.
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Affiliation(s)
- Francesco Paolo Schena
- Department of Nephrology, University of Bari, Bari, Italy; Schena Foundation, Valenzano, Bari, Italy.
| | - Ionut Nistor
- Department of Nephrology, Grigore T. Popa University of Medicine and Pharmacology, Iasi, Romania
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26
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Coppo R. Pediatric IgA Nephropathy in Europe. KIDNEY DISEASES 2019; 5:182-188. [PMID: 31259180 DOI: 10.1159/000495751] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023]
Abstract
Background In Europe IgA nephropathy (IgAN) is detected in 20% of children with glomerular diseases diagnosed by renal biopsy. The outcome during childhood is generally good, but progression in the long-term follow-up may occur in about 20% of children after 20 years. Summary In Europe, urine screening programs are not active, and there is variability in the policy to perform renal biopsies in oligo-symptomatic children. Hence, a suitable observational approach to pediatric IgAN is offered by the VALIGA study which included 174 children aged < 18 years from 13 European countries followed over a median of 4.4 (2.5-7.5) years. Renal pathology lesions were centrally scored according to the Oxford Classification of IgAN (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T; crescents, C [MEST-C]). Children had renal biopsy mostly with normal estimated glomerular filtration rate (eGFR) and moderate proteinuria of a median of 0.84 g/day/1.73 m<sup>2</sup> (< 0.30 g/day/1.73 m<sup>2</sup> in 30% of the cases). Children showed M1 in 21.8%, E1 in 13.8%, S1 in 42.5%, T1-2 in 6.3%, and C1 in 14.9%. The survival at the combined endpoint of 50% eGFR decrease or end-stage renal disease at 15 years was 94%. The slow progression rate and the limited number of cases progressing to the combined endpoint (6.4%) did not allow the detection of a predictive value of the MEST-C score. Moreover, the predictive value of clinical and pathological features was likely blunted by the use of corticosteroid/immunosuppressive treatment (CS/IS) in 50% of the cases. The survival tree analysis also proved that children < 16 years old with IgAN without mesangial hypercellularity (M0) and well preserved eGFR (> 90 mL/min/1.73 m<sup>2</sup>) had a high probability of proteinuria remission during follow-up. Moreover, in this subgroup of children, the benefits of CS/IS therapy reached statistical significance. In Europe, the use of CS/IS treatment in IgAN is still a debated issue, but most children tend to be treated more commonly than adults with CS/IS. A recent uncontrolled study reports a favorable outcome in European children with IgAN and very active acute forms of IgAN with improvement in eGFR and reduction in proteinuria. Key Messages In Europe, children with IgAN have a favorable prognosis in the short term, and this may be due also to the frequently adopted CS/IS therapy, particularly with acute and active pathological features. The risk of progression over decades of follow-up remains an unsolved problem which needs to be addressed by controlling subtle chronic pathogenetic factors which work in children as well as in adult cases of IgAN.
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Affiliation(s)
- Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
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Chen MC, Wang JH, Chu CH, Cheng CF. Differential prevalence of hematuria and proteinuria with socio-demographic factors among school children in Hualien, Taiwan. Pediatr Neonatol 2018; 59:360-367. [PMID: 29221788 DOI: 10.1016/j.pedneo.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 07/11/2017] [Accepted: 11/15/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pediatric hematuria/proteinuria is a risk factor for chronic kidney disease in later life, and school urinary screening can detect asymptomatic glomerulonephritis in the early stage. This study aimed to evaluate the prevalence of hematuria/proteinuria and its association with different socio-demographic factors among school children in 2013 in Hualien, Taiwan. METHODS A cross-sectional study was conducted among first, fourth, and seventh graders. Health examination results and urinalysis data were analyzed. Logistic regression models were used to the simultaneously analyze the association between the prevalence of hematuria/proteinuria and socio-demographic factors. RESULTS A total of 9544 students were included. The overall prevalence of hematuria and proteinuria was 4.1% and 5.7%, respectively. Students who were females, of a high grade level, of aboriginal ethnicity, and living in rural areas had higher hematuria risk (all P < 0.001) than other students. Underweight students had low odds ratio (0.53) of hematuria (P < 0.001). Seventh-grade students had higher odds ratio (3.63) of proteinuria than first grade students (P < 0.001). Students with both parents of aboriginal descent had lower odds ratio (0.81) of proteinuria than those with non-aboriginal parents (P = 0.044). Only higher grade level students had significantly higher risk of combined hematuria and light proteinuria (odds ratio: 10.67) and heavy proteinuria with/without hematuria (odds ratio: 3.22) than first graders. CONCLUSION Increased hematuria/proteinuria prevalence was noted in our county as compared to prior studies. Hematuria/proteinuria was significantly associated with gender, grade level, body mass index, ethnicity, and residence urbanization. Our data can be used for future longitudinal dataset collection to prevent pediatric renal disorders in Taiwan.
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Affiliation(s)
- Ming-Chun Chen
- Department of Pediatrics, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Tzu Chi General Hospital, Hualien, Taiwan
| | - Chia-Hsiang Chu
- Department of Pediatrics, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Feng Cheng
- Department of Pediatrics, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Medical Research, Tzu Chi General Hospital, Hualien, Taiwan; Department of Pediatrics, College of Medicine, Tzu-Chi University, Hualien, Taiwan.
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Nie S, He W, Huang T, Liu D, Wang G, Geng J, Chen N, Xu G, Zhang P, Luo Y, Nie J, Xu X, Hou FF. The Spectrum of Biopsy-Proven Glomerular Diseases among Children in China: A National, Cross-Sectional Survey. Clin J Am Soc Nephrol 2018; 13:1047-1054. [PMID: 29915132 PMCID: PMC6032591 DOI: 10.2215/cjn.11461017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES High-quality epidemiologic data on the spectrum of biopsy-proven glomerular diseases among children are limited. This study aimed to determine the profile of and temporal change in biopsy-proven pediatric glomerular diseases in China. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We previously conducted a nationwide kidney biopsy survey including 71,151 patients over an 11-year period from January 2004 to December 2014. A total of 7962 children younger than 18 years old from 115 hospitals across China with biopsy-proven glomerular diseases were included in this study. The demographic and clinical variables were extracted from referral records and pathology reports. The composition of pediatric glomerular diseases and clinicopathologic correlations in different sexes, age groups, and regions were assessed. The changing patterns of common glomerulopathies over the study period were examined. RESULTS Nephrotic syndrome (50%) was the most frequent indication for kidney biopsy in children. Minimal change disease was the most common primary glomerular disease (29%) followed by IgA nephropathy (17%). Henoch-Schonlein purpura nephritis (13%) and lupus nephritis (9%) were the most common secondary glomerular diseases. The proportion of minimal change disease was significant higher in boys (38%) than in girls (13%), whereas lupus nephritis was more prevalent in girls (20%) than in boys (3%). Purpura nephritis (23%) was the major pathologic pattern in younger children (0-12 years old), whereas minimal change disease (33%) was the most common glomerulopathy in adolescents (13-18 years old). The clinicopathologic correlations were slightly different between sexes and age groups. We observed increases in the proportions of minimal change disease, purpura nephritis, and membranous nephropathy over the study period that were contemporaneous with a fall in the proportion of FSGS. CONCLUSIONS The spectrum of glomerular diseases among children varied across sexes, age groups, and regions and changed substantially from 2004 to 2014 in China.
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Affiliation(s)
- Sheng Nie
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital and
| | - Wenjuan He
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital and
| | - Ting Huang
- Renal Division, Anhui Provincial Hospital, Hefei, China
| | - Diankun Liu
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital and
| | - Guobao Wang
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital and
| | - Jian Geng
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Nan Chen
- Renal Division, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Xu
- Renal Division, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Renal Division, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, China; and
| | - Yang Luo
- Renal Division, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jing Nie
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital and
| | - Xin Xu
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital and
| | - Fan Fan Hou
- The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Renal Division, Nanfang Hospital and
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Kim MS, Lee DY. Urinary Glucose Screening for Early Detection of Asymptomatic Type 2 Diabetes in Jeonbuk Province Korean Schoolchildren. J Korean Med Sci 2017; 32:985-991. [PMID: 28480657 PMCID: PMC5426236 DOI: 10.3346/jkms.2017.32.6.985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/10/2017] [Indexed: 11/23/2022] Open
Abstract
This study aimed to investigate the prevalence of glucosuria and the characteristics of diabetes in schoolchildren as detected by a school urine glucose screening program implemented from 2010 to 2013 in the Jeonbuk province area of Korea. A total of 110 children without known diabetes were analyzed. They were checked with an oral glucose tolerance test (OGTT) with other laboratory tests and their clinical data were collected. A total of 707,238 schoolchildren from a school population of 1,064,999 were screened for glucosuria. In total, over a 4-year period, 545 schoolchildren (0.077%) were positive for glucosuria on the second urine test. The prevalence of glucosuria was more common among middle and high schoolchildren than among elementary schoolchildren. Among 110 students who completed the OGTT to confirm diabetes, 40 were diagnosed with diabetes mellitus (DM); 39 children, type 2 diabetes mellitus (T2DM) and 1 child, slowly progressive insulin dependent diabetes mellitus (SPIDDM). The mean annual incidence of diabetes was 5.6 per 100,000 schoolchildren and adolescents. The subjects with diabetes diagnosed through the urine screening test showed minimal or no symptoms of diabetes. The students with diabetes were more likely to be woman and obese, and they have a higher body mass index, higher cholesterol, triglyceride, insulin, C-peptide, and fasting glucosuria values than the students with normal glucose tolerance. We identified 40 new cases of diabetes in the Korean schoolchildren with asymptomatic glucosuria on urine glucose screening. This finding shows that school urine glucose screening is a feasible and simple method for early detection of asymptomatic T2DM.
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Affiliation(s)
- Min Sun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Dae Yeol Lee
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Institute of Chonbuk National University Hospital, Jeonju, Korea.
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Güven S, Gökçe İ, Deniz NÇ, Altuntaş Ü, Yıldız N, Alpay H. Clinical and histopathological features of asymptomaticpersistent microscopic hematuria in children. Turk J Med Sci 2016; 46:1707-1711. [PMID: 28081313 DOI: 10.3906/sag-1511-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/25/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM We analyzed the clinical and pathological features and prognosis of 106 children with persistent asymptomatic microscopic hematuria (PAMH) with or without mild proteinuria. MATERIALS AND METHODS This was a retrospective study of 106 children who were referred to our clinics from 2000 to 2013 for evaluation of PAMH. RESULTS Among the 106 patients, 69 (65%) were female and 37 (35%) were male. The patients were divided into two groups: 101 patients with isolated microscopic hematuria (IMH) and 5 patients with asymptomatic microscopic hematuria and mild proteinuria (AMHP). Renal biopsy was performed in all 5 children with AHMP: 2 patients had hereditary nephropathy and 2 patients had focal segmental glomerulosclerosis (FSGS). One biopsy specimen revealed nonspecific findings. Renal biopsy was performed in 9 children with IMH: 4 patients had hereditary nephropathy and 5 patients had nonspecific findings. None of the patients received any specific treatment prior to renal biopsy. During the follow-up period, none of the patients developed impaired renal function. Among all the children, only one patient with AMHP developed hypertension and 2 patients with IMH developed proteinuria. CONCLUSION Long-term follow-up must be done carefully for isolated microscopic hematuria and renal biopsy should be performed in selected cases.
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Affiliation(s)
- Serçin Güven
- Department of Pediatric Nephrology, School of Medicine, Marmara University, İstanbul, Turkey
| | - İbrahim Gökçe
- Department of Pediatric Nephrology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Neslihan Çiçek Deniz
- Department of Pediatric Nephrology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Ülger Altuntaş
- Department of Pediatric Nephrology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Nurdan Yıldız
- Department of Pediatric Nephrology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Harika Alpay
- Department of Pediatric Nephrology, School of Medicine, Marmara University, İstanbul, Turkey
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Manoni F, Gessoni G, Fogazzi GB, Alessio MG, Caleffi A, Gambaro G, Epifani MG, Pieretti B, Perego A, Ottomano C, Saccani G, Valverde S, Secchiero S. Esame fisico, chimico e morfologico delle urine: proposta di linee guida per la fase analitica del Gruppo Intersocietario Analisi delle Urine (GIAU). ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13631-016-0127-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Xue N, Zhang X, Teng J, Fang Y, Ding X. A Cross-Sectional Study on the Use of Urinalysis for Screening Early-Stage Renal Insufficiency. Nephron Clin Pract 2016; 132:335-41. [PMID: 26959373 DOI: 10.1159/000444650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Proteinuria and hematuria detected by routine urinalysis can indicate impaired renal function. This study evaluated the effect of routine urinalysis in screening out patients with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 at an early stage and investigated its associated factors. METHODS Healthy adults who underwent physical examination between September 2008 and September 2013 were enrolled in the study (n = 43,516). Urine was analyzed for protein, and red and white blood cells. Ten milliliter blood samples were collected for serum creatinine, urea, albumin and other parameters for the estimation of eGFR and renal function. RESULTS Abnormal routine urinalysis was found in 7.1% and eGFR <60 ml/min/1.73 m2 was found in 0.9% of subjects. Age and gender were similar in the overall and abnormal urinalysis populations (43 vs. 43 years and 36.7 vs. 38.2% females, respectively), but the eGFR <60 ml/min/1.73 m2 group were older (64 years, p < 0.001) with increased females (46.4%, p = 0.002). Sensitivity for predicting eGFR <60 ml/min/1.73 m2 was 0.110 and specificity was 0.928. Univariate and multivariate analyses in 6,318 subjects with more detailed clinical data suggested significant associations of sex (OR 0.058, 95% CI 0.030-0.113), age (OR 1.045, 95% CI 1.027-1.064), and high density lipoprotein (HDL) (OR 0.158, 95% CI 0.043-0.587) with eGFR <60 ml/min/1.73 m2. CONCLUSION Routine urinalysis showed a poor performance in the screening for early-stage renal insufficiency. In future, other screening methods should be considered. Age, gender and HDL were associated with eGFR <60 ml/min/1.73 m2.
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Affiliation(s)
- Ning Xue
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
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Abstract
Globally, IgA nephropathy (IgAN) is the most common primary glomerulonephritis that can progress to renal failure. The exact pathogenesis of IgAN is not well defined, but current biochemical and genetic data implicate overproduction of aberrantly glycosylated IgA1. These aberrant immunoglobulins are characterized by galactose deficiency of some hinge-region O-linked glycans. However, aberrant glycosylation alone is insufficient to induce renal injury: the participation of glycan-specific IgA and IgG autoantibodies that recognize the undergalactosylated IgA1 molecule is required. Glomerular deposits of immune complexes containing undergalactosylated IgA1 activate mesangial cells, leading to the local overproduction of cytokines, chemokines and complement. Emerging data indicate that mesangial-derived mediators that are released following mesangial deposition of IgA1 lead to podocyte and tubulointerstitial injury via humoral crosstalk. Patients can present with a range of signs and symptoms, from asymptomatic microscopic haematuria to macroscopic haematuria. The clinical progression varies, with 30-40% of patients reaching end-stage renal disease 20-30 years after the first clinical presentation. Currently, no IgAN-specific therapies are available and patients are managed with the aim of controlling blood pressure and maintaining renal function. However, new therapeutic approaches are being developed, building upon our ever-improving understanding of disease pathogenesis.
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Li RR, Li H, Wen YB, Huang QY, Duan L, Li Y. Clinicopathological analysis of 155 patients with persistent isolated hematuria. ACTA ACUST UNITED AC 2014; 29:148-55. [PMID: 25264882 DOI: 10.1016/s1001-9294(14)60060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To reveal etiologies of persistent isolated hematuria (PIH) through ultrastructural pathological examination, to disclose clinicopathological correlation in cases with PIH, and to summarize appropriate management of patients with PIH. METHODS we retrospectively studied 155 PIH patients receiving renal biopsy between January, 2003 and December, 2008 in Peking Union Medical College Hospital. All the clinical data and follow-up result were analyzed. RESULTS All subjects included 38 children and 117 adults, with mean age of 11.38±3.25 years for children and 35.17±8.44 years for adults. Thin basement membrane nephropathy (TBMN) was the most common pathology (55.3% of children and 49.6% of adults), followed by IgA nephropathy (18.4% of children and 32.5% of adults, mainly grade 2-3) and mesangial proliferative glomerulonephritis (MsPGN) without IgA deposition (13.2% of children and 12.8% of adults). Besides, Alport syndrome (2.6% of children) and membrane nephropathy (2.6% of children and 0.9% of adults) were demonstrated as other causes of PIH. Elevated mean arteral pressure or protein excretion rate, as well as episodic macrohematuria, indicated higher risk for MsPGN rather than TBMN. On the other hand, severity of microhematuria was irrelevant to pathological types of PIH. Totally, 86 patients were followed up and 37 cases therein stayed on track for long term (mean duration 41.11?28.92 months, range 8-113 months). Most cases had benign clinical course except 3 cases with TBMN, 5 cases with IgA nephropathy, 1 case with MsPGN (without IgA deposition), and 1 case with Alport syndrome, who developed hypertension or proteinuria. All of them were administered timely intervention. CONCLUSIONS Close follow-up should be required as the primary management for PIH. Equally important is careful monitoring for early identification of undesirable predictors; while renal biopsy and other timely intervention are warranted if there is hypertension, significant proteinuria or renal impairment.
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Affiliation(s)
- Rong-rong Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Hang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yu-bin Wen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Qing-yuan Huang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Lin Duan
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yan Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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When should we consider renal biopsy in children with isolated microscopic hematuria? Clin Exp Nephrol 2014; 18:521-2. [DOI: 10.1007/s10157-013-0858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/21/2013] [Indexed: 10/25/2022]
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Kajiwara N, Hayashi K, Fukui T, Yamamoto S, Senzaki K, Murakami S, Kitamura T, Ueoka T, Inoue M, Hayashi S, Sakamoto K, Yoshimoto M, Asano S, Maki I. Restructuring the Ikeda City school urinary screening system: report of a screening survey. ASIA PACIFIC FAMILY MEDICINE 2013; 12:6. [PMID: 24330222 PMCID: PMC4028752 DOI: 10.1186/1447-056x-12-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Annual urinary screening is conducted at municipal kindergartens, elementary schools, and junior high schools in Ikeda City, Osaka, Japan (Ikeda City School System), and the results are reviewed by a general physician, but standards for when to recommend specialist referral have not been clear. METHODS In all children attending the Ikeda City School System in 2012, dipstick urinalysis of a first-morning urine specimen was recommended once or twice, and if a second urinalysis showed proteinuria (≥1+), the urinary protein/creatinine ratio was measured. If this showed ≥0.2 g/g of creatinine (g/gCr), it was recommended that the child be evaluated by a specialist at Ikeda City Hospital. RESULTS Urinary screening was performed in about 20% (388) of kindergarten, about 90% (5363) of elementary school, and about 86% (2523) of junior high school children living in Ikeda City. Urine samples were obtained from 387, 5349, and 2476 children, respectively. The urinary protein/creatinine ratio was ≥0.2 g/gCr in 13 children, including 1 elementary and 12 junior high children. In these 13 children, chronic nephritic syndrome (CNS) was suspected in 6 junior high school children, and of these, this was a new finding in 5, and renal biopsy was indicated in 3. In Ikeda City, the prevalence of CNS in elementary school children was <0.03%, the prevalence of CNS in junior high school children was 0.29%, and a renal biopsy was indicated in 0.14%. By eliminating the costs associated with assessment of the results by the Ikeda Medical Association, and by directly contracting with the testing company, the expenses paid by Ikeda City for the system itself decreased from 2,508,619 yen to 966,157 yen. CONCLUSIONS Incorporating the urinary protein/creatinine ratio into the school urinary screening system in the Ikeda City School System and clarifying standards for specialist referral has enabled restructuring of the system so that is efficient and its effectiveness can be assessed.
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Affiliation(s)
| | - Kazuyuki Hayashi
- Department of Nephrology, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Takayuki Fukui
- Department of Nephrology and Artificial Kidney, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Satoko Yamamoto
- Department of Nephrology, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Kensuke Senzaki
- Department of General Medicine, Ikeda City Hospital, Ikeda, Osaka, Japan
| | | | - Takuya Kitamura
- Department of General Medicine, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Takato Ueoka
- Department of General Medicine, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Mikito Inoue
- Inoue Clinic Medical Corporation, Ikeda, Osaka, Japan
| | | | | | | | - Seiko Asano
- Ikeda City Fushiodai Elementary School, Ikeda, Osaka, Japan
| | - Ichiro Maki
- Department of Pediatrics, Ikeda City Hospital, Ikeda, Osaka, Japan
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