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Liu X, Gong S, Ning Y, Li Y, Zhou H, He L, Lin L, Jin S, Shen Z, Zhu B, Li F, Li J, Tan X, Jiao X, Shi Y, Ding X. Urinary N-Acetyl-Beta-D-Glucosaminidase levels predict immunoglobulin a nephropathy remission status. BMC Nephrol 2023; 24:208. [PMID: 37452282 PMCID: PMC10347709 DOI: 10.1186/s12882-023-03262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Tubulointerstitial lesions play a pivotal role in the progression of IgA nephropathy (IgAN). Elevated N-acetyl-beta-D-glucosaminidase (NAG) in urine is released from damaged proximal tubular epithelial cells (PTEC) and may serve as a biomarker of renal progression in diseases with tubulointerstitial involvement. METHODS We evaluated the predictive value of urinary NAG (uNAG) for disease progression in 213 biopsy-proven primary IgAN patients from January 2018 to December 2019 at Zhongshan Hospital, Fudan University. We compared the results with those of serum cystatin C (sCysC). RESULTS Increased uNAG and sCysC levels were associated with worse clinical and histological manifestations. Only uNAG level was independently associated with remission status after adjustment. Patients with high uNAG levels (> 22.32 U/g Cr) had a 4.32-fold greater risk of disease progression. The combination of baseline uNAG and clinical data may achieve satisfactory risk prediction in IgAN patients with relatively preserved renal function (eGFR ≥ 60 ml/min/1.73 m2, area under the curve [AUC] 0.760). CONCLUSION Our results suggest that uNAG is a promising biomarker for predicting IgAN remission status.
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Affiliation(s)
- Xiao Liu
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Shaomin Gong
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yichun Ning
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Huili Zhou
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Luna He
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Lin Lin
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Shi Jin
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Ziyan Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Bowen Zhu
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Fang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jie Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Xiao Tan
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Xiaoyan Jiao
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yiqin Shi
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, No.180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
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Jones G, Zeng L, Kim J. Mechanism-Based Pharmacokinetic Modeling of Absorption and Disposition of a Deferoxamine-Based Nanochelator in Rats. Mol Pharm 2023; 20:481-490. [PMID: 36378830 DOI: 10.1021/acs.molpharmaceut.2c00737] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deferoxamine (DFO) is an effective FDA-approved iron chelator. However, its use is considerably limited by off-target toxicities and an extremely cumbersome dose regimen with daily infusions. The recent development of a deferoxamine-based nanochelator (DFO-NP) with selective renal excretion has shown promise in ameliorating animal models of iron overload with a substantially improved safety profile. To further the preclinical development of this promising nanochelator and to inform on the feasibility of clinical development, it is necessary to fully characterize the dose and administration-route-dependent pharmacokinetics and to develop predictive pharmacokinetic (PK) models describing absorption and disposition. Herein, we have evaluated the absorption, distribution, and elimination of DFO-NPs after intravenous and subcutaneous (SC) injection at therapeutically relevant doses in Sprague Dawley rats. We also characterized compartment-based model structures and identified model-based parameters to quantitatively describe the PK of DFO-NPs. Our modeling efforts confirmed that disposition could be described using a three-compartment mamillary model with elimination and saturable reabsorption both occurring from the third compartment. We also determined that absorption was nonlinear and best described by parallel saturable and first-order processes. Finally, we characterized a novel pathway for saturable SC absorption of an ultrasmall organic nanoparticle directly into the systemic circulation, which offers a novel strategy for improving drug exposure for nanotherapeutics.
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Affiliation(s)
- Gregory Jones
- Department of Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts 02115, United States
| | - Lingxue Zeng
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Massachusetts 01854, United States
| | - Jonghan Kim
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Massachusetts 01854, United States
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Salihu S, Tosheska K, Aluloska N, Gucev Z, Cekovska S, Tasic V. The Spectrum of Kidney Diseases in Children Associated with Low Molecular Weight Proteinuria. Open Access Maced J Med Sci 2018; 6:814-819. [PMID: 29875851 PMCID: PMC5985860 DOI: 10.3889/oamjms.2018.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Proteinuria, in addition to haematuria, is the most important laboratory parameter in patients with nephro-urological diseases. Low molecular weight proteinuria (LMWP) is of particular importance because some diseases genetic and tubulointerstitial are diagnosed based on its presence. AIM The purpose of this study is to describe the clinical features, the course and outcome of pediatric patients with a renal disease associated with LMWP. MATERIAL AND METHODS This retrospective observational study included 250 pediatric patients with various kidney diseases in which the type of proteinuria was defined by 4-20% gradient gel sodium dodecyl sulphate polyacrylamide gel (SDS-PAG) electrophoresis. RESULTS Isolated LMWP was detected in 12% of patients, while mixed glomerulotubular proteinuria was detected in 18% of patients. It was detected in all patients with the Dent-1/2 disease, Lowe's syndrome and secondary Fanconi syndrome. Transient LMWP was also detected in a series of 12 patients with distal renal tubular acidosis. In patients with nephrotic syndrome, it was associated with corticoresistence and unfavourable clinical course. CONCLUSION This study contributes to the understanding of the clinical spectrum of various kidney diseases associated with LMWP, their natural course, and the effect of therapy.
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Affiliation(s)
- Shpetim Salihu
- Department of Neonatology, University Clinical Center, Prishtina, Kosovo
| | - Katerina Tosheska
- Institute of Medical and Experimental Biochemistry, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Natasa Aluloska
- University Children's Hospital, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Zoran Gucev
- University Children's Hospital, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Svetlana Cekovska
- Institute of Medical and Experimental Biochemistry, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Velibor Tasic
- University Children's Hospital, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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High (≥6.5) Spontaneous and Persistent Urinary pH Is Protective of Renal Function at Baseline and during Disease Course in Idiopathic Membranous Nephropathy. Int J Nephrol 2015; 2015:730234. [PMID: 26294975 PMCID: PMC4534628 DOI: 10.1155/2015/730234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/30/2015] [Accepted: 07/14/2015] [Indexed: 12/04/2022] Open
Abstract
Metabolic acidosis correction in advanced renal failure slows renal function decline attributed to tubulointerstitial damage (TID) reduction. No study evaluated if spontaneous baseline high urinary pH (UpH) is renoprotective in patients with normal renal function and without metabolic acidosis. The study tested this hypothesis in idiopathic membranous nephropathy (IMN). Eighty-five patients (follow-up 81 ± 54 months) measured UpH, serum creatinine, eGFR, protein/creatinine ratio, fractional excretion of albumin, IgG, α1-microglobulin, and urinary N-acetyl-β-D-glucosaminidase (β-NAG)/creatinine ratio. Twenty-eight patients (33%) had UpH ≥ 6.5 and 57 (67%) pH < 6.5; high versus low UpH patients had significantly lower values of the tubulointerstitial damage (TID) markers FE α1m and β-NAG and significantly better baseline renal function. These differences persisted over time in a subset of 38 patients with 5 measurements along 53 ± 26 months. In 29 patients with nephrotic syndrome (NS) treated with supportive therapy (follow-up: 80 ± 52 months) renal function was stable in 10 high and significantly worse in 19 low UpH patients. Steroids + cyclophosphamide treatment in 35 NS patients masks the renoprotection of high UpH. Conclusions. In IMN high and persistent UpH is associated with reduction of the proteinuric markers of tubulointerstitial damage and baseline better renal function in all patients and in NS patients treated only with supportive therapy during disease course. The factors associated with high pH-dependent renoprotection were lower values of TID markers, eGFR ≥ 60 mL/min, BP < 140/90 mmHg, and age < 55 years.
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