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Fogazzi GB, Garigali G, Abinti M, Lieti G, Verdesca S. An updated approach to the evaluation of the urinary sediment. Pediatr Nephrol 2024:10.1007/s00467-024-06545-9. [PMID: 39377940 DOI: 10.1007/s00467-024-06545-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 08/23/2024] [Accepted: 09/16/2024] [Indexed: 10/09/2024]
Abstract
Examination of the urinary sediment (U-sed) is an important non-invasive, rapid, and inexpensive tool for the diagnosis and surveillance over time of renal diseases. In this Educational Review, we describe first how to collect, prepare, and examine urine samples in order to obtain reliable results. Then, we describe the U-sed findings in isolated microscopic hematuria, glomerular diseases, acute interstitial nephritis, acute kidney injury, reactivation of the BK virus in kidney transplant recipients, and crystalluric genetic diseases.
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Affiliation(s)
- Giovanni B Fogazzi
- Clinical and Research Laboratory On Urinary Sediment, SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giuseppe Garigali
- Clinical and Research Laboratory On Urinary Sediment, SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Abinti
- SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Lieti
- USC Di Nefrologia E Dialisi, Ospedale Di Garbagnate Milanese, Garbagnate Milanese, Italy
| | - Simona Verdesca
- SC Di Nefrologia, Dialisi e Trapianto Di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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2
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Gaspar V, Fonseca NM, Lino S. Sulfadiazine-induced crystalluria and non-oliguric renal failure in HIV-1 inaugural infection with presumed cerebral toxoplasmosis. J Bras Nefrol 2024; 46:e20230151. [PMID: 38739000 PMCID: PMC11287978 DOI: 10.1590/2175-8239-jbn-2023-0151en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/22/2024] [Indexed: 05/14/2024] Open
Affiliation(s)
- Vasco Gaspar
- Centro Hospital Universitário Lisboa Central, Departamento de
Medicina Interna, Lisboa, Portugal
- Universidade NOVA de Lisboa, Faculdade de Medicina NOVA, Lisboa,
Portugal
| | - Nuno Moreira Fonseca
- Universidade NOVA de Lisboa, Faculdade de Medicina NOVA, Lisboa,
Portugal
- Centro Hospitalar Universitário Lisboa Central, Hospital Curry
Cabral, Departamento de Nefrologia, Lisboa, Portugal
| | - Sara Lino
- Universidade NOVA de Lisboa, Faculdade de Medicina NOVA, Lisboa,
Portugal
- Centro Hospitalar Universitário Lisboa Central, Hospital Curry
Cabral, Departamento de Infecciologia, Lisboa, Portugal
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3
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Gurevich E, Landau D. Tubulointerstitial nephritis in children and adolescents. Pediatr Nephrol 2024:10.1007/s00467-024-06526-y. [PMID: 39320551 DOI: 10.1007/s00467-024-06526-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/26/2024]
Abstract
The tubulointerstitial compartment comprises most of the kidney parenchyma. Inflammation in this compartment (tubulointerstitial nephritis-TIN) can be acute and resolves if the offending factor is withdrawn or may enter a chronic process leading to irreversible kidney damage. Etiologic factors differ, including different exposures, infections, and autoimmune and genetic tendency, and the initial damage can be acute, recurrent, or permanent, determining whether the acute inflammatory process will lead to complete healing or to a chronic course of inflammation leading to fibrosis. Clinical and laboratory findings of TIN are often nonspecific, which may lead to delayed diagnosis and a poorer clinical outcome. We provide a general review of TIN, with special mention of the molecular pathophysiological mechanisms of the associated kidney damage.
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Affiliation(s)
- Evgenia Gurevich
- Pediatrics Department, Barzilai University Medical Center, Ashqelon, Israel.
- Ben Gurion University of Negev, Faculty of Health Sciences, Beer Sheva, Israel.
| | - Daniel Landau
- Department of Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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Furbish A, Allinder M, Austin G, Tynan B, Byrd E, Gomez IP, Peterson Y. First analytical confirmation of drug-induced crystal nephropathy in felines caused by GS-441524, the active metabolite of Remdesivir. J Pharm Biomed Anal 2024; 247:116248. [PMID: 38823223 PMCID: PMC11229044 DOI: 10.1016/j.jpba.2024.116248] [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: 01/29/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
GS-441524 is an adenosine nucleoside antiviral demonstrating significant efficacy in the treatment of feline infectious peritonitis (FIP), an otherwise fatal illness, resulting from infection with feline coronavirus. However, following the emergence of COVID-19, veterinary development was halted, and Gilead pursued clinical development of a GS-441524 pro-drug, resulting in the approval of Remdesivir under an FDA emergency use authorization. Despite lack of regulatory approval, GS-441524 is available without a prescription through various unlicensed online distributors and is commonly purchased by pet owners for the treatment of FIP. Herein, we report data obtained from the analytical characterization of two feline renal calculi, demonstrating the propensity for GS-441524 to cause renal toxicity through drug-induced crystal nephropathy in vivo. As definitive diagnosis of drug-induced crystal nephropathy requires confirmation of the lithogenic material to accurately attribute a mechanism of toxicity, renal stone composition and crystalline matrix were characterized using ultra-performance liquid chromatography photodiode array detection (UPLC-PDA), ultra-performance liquid chromatography mass spectrometry (LCMS), nuclear magnetic resonance (NMR) spectroscopy, X-ray powder diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR). This work serves to provide the first analytical confirmation of GS-441524-induced crystal nephropathy in an effort to support toxicologic identification of adverse renal effects caused by administration of GS-441524 or any pro-drug thereof.
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Affiliation(s)
- Amelia Furbish
- Dept. of Drug Discovery and Biomedical Sciences, College of Pharmacy, Medical University of South Carolina, 70 President St, Charleston, SC 29425, USA
| | - Marissa Allinder
- Charleston Veterinary Referral Center, 3484 Shelby Ray Court, Charleston, SC, USA
| | - Glenn Austin
- Louis C. Herring and Company, 1111 S. Orange Ave., Orlando, FL, USA
| | - Beth Tynan
- Charleston Veterinary Referral Center, 3484 Shelby Ray Court, Charleston, SC, USA
| | - Emilee Byrd
- Dept. of Drug Discovery and Biomedical Sciences, College of Pharmacy, Medical University of South Carolina, 70 President St, Charleston, SC 29425, USA
| | - Ivette Pina Gomez
- Dept. of Drug Discovery and Biomedical Sciences, College of Pharmacy, Medical University of South Carolina, 70 President St, Charleston, SC 29425, USA
| | - Yuri Peterson
- Dept. of Drug Discovery and Biomedical Sciences, College of Pharmacy, Medical University of South Carolina, 70 President St, Charleston, SC 29425, USA.
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5
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Lathiya MK, Errabelli P, Roy S, Mareedu N. Severe acute kidney injury due to oxalate crystal induced severe interstitial nephritis: A case report. World J Nephrol 2024; 13:93976. [PMID: 38983760 PMCID: PMC11229832 DOI: 10.5527/wjn.v13.i2.93976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/04/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) due to interstitial nephritis is a known condition primarily attributed to various medications. While medication-induced interstitial nephritis is common, occurrences due to non-pharmacological factors are rare. This report presents a case of severe AKI triggered by intratubular oxalate crystal deposition, leading to interstitial nephritis. The aim is to outline the case and its management, emphasizing the significance of recognizing uncommon causes of interstitial nephritis. CASE SUMMARY A 71-year-old female presented with stroke-like symptoms, including weakness, speech difficulties, and cognitive impairment. Chronic hypertension had been managed with hydrochlorothiazide (HCTZ) for over two decades. Upon admission, severe hypokalemia and AKI were noted, prompting discontinuation of HCTZ and initiation of prednisolone for acute interstitial nephritis. Further investigations, including kidney biopsy, confirmed severe acute interstitial nephritis with oxalate crystal deposits as the underlying cause. Despite treatment, initial renal function showed minimal improvement. However, with prednisolone therapy and supportive measures, her condition gradually improved, highlighting the importance of comprehensive management. CONCLUSION This case underscores the importance of a thorough diagnostic approach in identifying and addressing uncommon causes of interstitial nephritis. The occurrence of interstitial nephritis due to oxalate crystal deposition, especially without typical risk factors, emphasizes the need for vigilance in clinical practice.
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Affiliation(s)
- Maulik K Lathiya
- Department of Emergency Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, United States
| | - Praveen Errabelli
- Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54703, United States
| | - Sasmit Roy
- Department of Nephrology, Centra Lynchburg General Hospital, Lynchburg, VA 24551, United States
| | - Neeharik Mareedu
- Department of Nephrology, UPMC Western Maryland, Cumberland, MD 21502, United States
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6
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Su Y, Li S, Li X, Zhou JY, Chauhan VP, Li M, Su YH, Liu CM, Ren YF, Yin W, Rimer JD, Cai T. Tartronic Acid as a Potential Inhibitor of Pathological Calcium Oxalate Crystallization. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400642. [PMID: 38647258 DOI: 10.1002/advs.202400642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/28/2024] [Indexed: 04/25/2024]
Abstract
Kidney stones are a pervasive disease with notoriously high recurrence rates that require more effective treatment strategies. Herein, tartronic acid is introduced as an efficient inhibitor of calcium oxalate monohydrate (COM) crystallization, which is the most prevalent constituent of human kidney stones. A combination of in situ experimental techniques and simulations are employed to compare the inhibitory effects of tartronic acid with those of its molecular analogs. Tartronic acid exhibits an affinity for binding to rapidly growing apical surfaces of COM crystals, thus setting it apart from other inhibitors such as citric acid, the current preventative treatment for kidney stones. Bulk crystallization and in situ atomic force microscopy (AFM) measurements confirm the mechanism by which tartronic acid interacts with COM crystal surfaces and inhibits growth. These findings are consistent with in vivo studies that reveal the efficacy of tartronic acid is similar to that of citric acid in mouse models of hyperoxaluria regarding their inhibitory effect on stone formation and alleviating stone-related physical harm. In summary, these findings highlight the potential of tartronic acid as a promising alternative to citric acid for the management of calcium oxalate nephropathies, offering a new option for clinical intervention in cases of kidney stones.
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Affiliation(s)
- Yuan Su
- Department of Pharmaceutics, China Pharmaceutical University, Nanjing, 211198, China
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing, 211198, China
| | - Si Li
- Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA
| | - Xin Li
- The State Key Lab of Pharmaceutical Biotechnology, College of Life Science, Nanjing University, Nanjing, 210036, China
| | - Jing-Ying Zhou
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing, 211198, China
| | - Vraj P Chauhan
- Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA
| | - Meng Li
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing, 211198, China
| | - Ya-Hui Su
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing, 211198, China
| | - Chun-Mei Liu
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing, 211198, China
| | - Yi-Fei Ren
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing, 211198, China
| | - Wu Yin
- The State Key Lab of Pharmaceutical Biotechnology, College of Life Science, Nanjing University, Nanjing, 210036, China
| | - Jeffrey D Rimer
- Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA
| | - Ting Cai
- Department of Pharmaceutics, China Pharmaceutical University, Nanjing, 211198, China
- Department of Pharmaceutical Engineering, China Pharmaceutical University, Nanjing, 211198, China
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7
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Xu R, Gao Q, Zhang Y, Lin Y, Li Y, Su L, Zhou S, Cao Y, Gao P, Li P, Luo F, Chen R, Zhang X, Nie S, Xu X. Associations between Different Antivirals and Hospital-Acquired Acute Kidney Injury in Adults with Herpes Zoster. Clin J Am Soc Nephrol 2024; 19:694-703. [PMID: 38527975 PMCID: PMC11168829 DOI: 10.2215/cjn.0000000000000452] [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: 08/12/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
Key Points Among intravenous antivirals, acyclovir was associated with the highest risk of hospital-acquired AKI, followed by penciclovir/ganciclovir and foscarnet. The risk of hospital-acquired AKI was dose dependent for intravenous nucleoside analogs. Background To examine the association of use of different antivirals with hospital-acquired AKI among Chinese adults with herpes zoster. Methods This study selected 3273 adult patients who received antiviral therapy for herpes zoster during hospitalization from the China Renal Data System. We identified and staged AKI using patient-level serum creatinine data according to the Kidney Disease Improving Global Outcomes criteria. We compared the relative risks of hospital-acquired AKI among patients treated with different antivirals using Cox proportional hazards models. Results Among 3273 patients, 1480 (45%), 681 (21%), 489 (15%), and 623 (19%) were treated with acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet, respectively. During the follow-up period, a total of 111 cases of hospital-acquired AKI occurred, predominantly classified as AKI stage 1. The cumulative incidences of hospital-acquired AKI were 5%, 3%, 3%, and 1% in the patients receiving acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet, respectively. Compared with acyclovir/valacyclovir, penciclovir/famciclovir/ganciclovir and foscarnet were associated with a lower risk of hospital-acquired AKI, with an adjusted hazard ratio of 0.59 (95% confidence interval [CI], 0.37 to 0.94) and 0.27 (95% CI, 0.11 to 0.63), respectively. Compared with intravenous acyclovir, intravenous penciclovir/ganciclovir and foscarnet were associated with a lower risk of hospital-acquired AKI with an adjusted hazard ratio of 0.53 (95% CI, 0.29 to 0.98) and 0.31 (95% CI, 0.12 to 0.76), respectively. The associations were consistent across various subgroups and sensitivity analyses. Conclusions Among antiviral therapies for herpes zoster, we found different risks of hospital-acquired AKI among the patients receiving different antivirals, in particular, those administered intravenously. Among intravenous antivirals, acyclovir was associated with the highest risk of hospital-acquired AKI, followed by penciclovir/ganciclovir and foscarnet. Confirmation studies with large samples from other populations are warranted.
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Affiliation(s)
- Ruqi Xu
- Division of Nephrology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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8
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Zhang H, Zhang C, Su H. Concurrent Crystalline Light-Chain Proximal Tubulopathy and Membranous Nephropathy: A Case Report and Literature Review. Kidney Med 2024; 6:100816. [PMID: 38720788 PMCID: PMC11077163 DOI: 10.1016/j.xkme.2024.100816] [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] [Indexed: 05/12/2024] Open
Abstract
Light-chain proximal tubulopathy (LCPT) is typically characterized by the intracytoplasmic deposition of light chains within the proximal tubular epithelial cells, which is usually classified into crystalline and noncrystalline subgroups. Membranous nephropathy (MN) is a common glomerular disease characterized by diffused subepithelial electron-dense deposits along the capillary loop accompanied by the effacement and microvillus transformation of the foot process. Here, we report a biopsy-confirmed case of a concurrence of LCPT with crystals (κ light chains restricted) and antigen-undetermined MN in a male patient. The patient presented with low-molecular-weight proteinuria, increased serum creatinine levels, and incomplete Fanconi syndrome. To our knowledge, this is the first report of a concurrence of LCPT and independent MN of unknown target antigens, which may enrich our recognition of monoclonal gammopathy of renal significance with synchronous MN.
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Affiliation(s)
- Huizi Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Chunyun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
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Hou Y, Huang C, Huang Z, Huang J, Zhu B. STUB1 exacerbates calcium oxalate-induced kidney injury by modulating reactive oxygen species-mediated cellular autophagy via regulating CFTR ubiquitination. Urolithiasis 2024; 52:55. [PMID: 38564006 DOI: 10.1007/s00240-024-01547-6] [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: 11/23/2023] [Accepted: 02/12/2024] [Indexed: 04/04/2024]
Abstract
The formation of calcium oxalate (CaOx) crystals in the kidneys leads to renal epithelial damage and the progression of crystalline nephropathy. This study investigated the role of STIP1 homology and U-box protein 1 (STUB1), an E3 ubiquitin ligase, and cystic fibrosis transmembrane conductance regulator (CFTR), a chloride channel, in CaOx-related renal damage and autophagy regulation. HK-2 cells were treated with various doses of CaOx monohydrate (COM) to simulate kidney injury in vitro. Cell viability, reactive oxygen species (ROS) production, and apoptosis were assessed. The regulation of CFTR ubiquitination by STUB1 was confirmed by immunoprecipitation. An in vivo model was established by injecting mice with glyoxylate. COM treatment dose-dependently decreased cell viability, increased TNF-α and ROS production, and induced apoptotic cell death in HK-2 cells. COM-treated cells also showed decreased CFTR protein expression. CFTR overexpression improved cell viability and reduced ROS production in COM-stimulated HK-2 cells. Bioinformatics analysis predicted CFTR's ubiquitination binding site for STUB1. Further analysis confirmed the role of STUB1 as a ubiquitin ligase in CFTR degradation. Knockdown of STUB1 upregulated CFTR expression, while STUB1 overexpression had the opposite effect. Knockdown of CFTR reversed the impact of STUB1 deficiency on autophagy. The in vivo experiments showed that CFTR overexpression attenuated kidney tissue damage and CaOx deposition in mice. STUB1-mediated CFTR ubiquitination plays a crucial role in mitigating calcium oxalate-related renal damage by regulating autophagy. Targeting the STUB1/CFTR axis may hold therapeutic potential for treating kidney injury associated with calcium oxalate deposition.
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Affiliation(s)
- Yi Hou
- Department of Urology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Mid Road Furong District, Changsha, 410011, Hunan, People's Republic of China
| | - Changkun Huang
- Department of Urology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Mid Road Furong District, Changsha, 410011, Hunan, People's Republic of China
| | - Zhichao Huang
- Department of Urology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Mid Road Furong District, Changsha, 410011, Hunan, People's Republic of China
| | - Jun Huang
- Department of Urology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Mid Road Furong District, Changsha, 410011, Hunan, People's Republic of China
| | - Bin Zhu
- Department of Urology, The Second Xiangya Hospital of Central South University, No. 139, Renmin Mid Road Furong District, Changsha, 410011, Hunan, People's Republic of China.
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10
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Parodi E, Rossi M, Bottiglieri A, Ladetto M, Merlotti G, Cantaluppi V, Quaglia M. Pharmacotherapy considerations in patients who develop acute kidney injury during anti-cancer therapy. Expert Opin Pharmacother 2024; 25:595-610. [PMID: 38646905 DOI: 10.1080/14656566.2024.2346268] [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: 02/18/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) frequently develops in patients receiving cancer therapy and requires a wide differential diagnosis due to possible role of unique cancer and drug-related factors, in addition to common pre- and post-renal causes. Rapid development of new molecular targeted anti-cancer drugs and immunotherapies has opened unprecedented possibilities of treatment at the price of an increased spectrum of renal side effects. AREAS COVERED The present review aims at providing a state-of-the-art picture of AKI in cancer patient (PubMed and Embase libraries were searched from inception to January 2024), with a focus on differential diagnosis and management of diverse clinical settings. Reports of parenchymal AKI due to glomerular, microvascular, tubular and interstitial damage have been constantly increasing. Complex electrolyte and acid-base disorders can coexist. The role of renal biopsy and possible therapeutic approaches are also discussed. EXPERT OPINION Onconephrology has become an important subspecialty of clinical nephrology, requiring constantly updated skills and a high degree of interdisciplinary integration to tackle diagnostic challenges and even therapeutic and ethical dilemmas. Integrated onconephrological guidelines and availability of biomarkers may provide new tools for management of this unique type of patients in the near future.
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Affiliation(s)
- Emanuele Parodi
- Nephrology and Dialysis Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Maura Rossi
- Oncology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Achille Bottiglieri
- Oncology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
| | - Marco Ladetto
- Hematology Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
| | - Guido Merlotti
- Department of Primary Care, "Azienda Socio Sanitaria Territoriale (ASST) of Pavia", Pavia, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
- Nephrology and Renal Transplant Unit, "Maggiore della Carita" University Hospital, Novara, Italy
| | - Marco Quaglia
- Nephrology and Dialysis Unit, "SS Antonio e Biagio e Cesare Arrigo" University Hospital, Alessandria, Italy
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy
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11
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Settembre C, Perera RM. Lysosomes as coordinators of cellular catabolism, metabolic signalling and organ physiology. Nat Rev Mol Cell Biol 2024; 25:223-245. [PMID: 38001393 DOI: 10.1038/s41580-023-00676-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/26/2023]
Abstract
Every cell must satisfy basic requirements for nutrient sensing, utilization and recycling through macromolecular breakdown to coordinate programmes for growth, repair and stress adaptation. The lysosome orchestrates these key functions through the synchronised interplay between hydrolytic enzymes, nutrient transporters and signalling factors, which together enable metabolic coordination with other organelles and regulation of specific gene expression programmes. In this Review, we discuss recent findings on lysosome-dependent signalling pathways, focusing on how the lysosome senses nutrient availability through its physical and functional association with mechanistic target of rapamycin complex 1 (mTORC1) and how, in response, the microphthalmia/transcription factor E (MiT/TFE) transcription factors exert feedback regulation on lysosome biogenesis. We also highlight the emerging interactions of lysosomes with other organelles, which contribute to cellular homeostasis. Lastly, we discuss how lysosome dysfunction contributes to diverse disease pathologies and how inherited mutations that compromise lysosomal hydrolysis, transport or signalling components lead to multi-organ disorders with severe metabolic and neurological impact. A deeper comprehension of lysosomal composition and function, at both the cellular and organismal level, may uncover fundamental insights into human physiology and disease.
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Affiliation(s)
- Carmine Settembre
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy.
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
| | - Rushika M Perera
- Department of Anatomy, University of California at San Francisco, San Francisco, CA, USA.
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA.
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12
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Huang L, Chen W, Tan Z, Huang Y, Gu X, Liu L, Zhang H, Shi Y, Ding J, Zheng C, Guo Z, Yu B. Mrc1 + macrophage-derived IGF1 mitigates crystal nephropathy by promoting renal tubule cell proliferation via the AKT/Rb signaling pathway. Theranostics 2024; 14:1764-1780. [PMID: 38389846 PMCID: PMC10879870 DOI: 10.7150/thno.89174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/11/2024] [Indexed: 02/24/2024] Open
Abstract
Rationale: The present understanding of the cellular characteristics and communications in crystal nephropathy is limited. Here, molecular and cellular studies combined with single-cell RNA sequencing (scRNA-seq) were performed to investigate the changes in cell components and their interactions in glyoxylate-induced crystallized kidneys to provide promising treatments for crystal nephropathy. Methods: The transcriptomes of single cells from mouse kidneys treated with glyoxylate for 0, 1, 4, or 7 days were analyzed via 10× Genomics, and the single cells were clustered and characterized by the Seurat pipeline. The potential cellular interactions between specific cell types were explored by CellChat. Molecular and cellular findings related to macrophage-to-epithelium crosstalk were validated in sodium oxalate (NaOx)-induced renal tubular epithelial cell injury in vitro and in glyoxylate-induced crystal nephropathy in vivo. Results: Our established scRNA atlas of glyoxylate-induced crystalline nephropathy contained 15 cell populations with more than 40000 single cells, including relatively stable tubular cells of different segments, proliferating and injured proximal tubular cells, T cells, B cells, and myeloid and mesenchymal cells. In this study, we found that Mrc1+ macrophages, as a subtype of myeloid cells, increased in both the number and percentage within the myeloid population as crystal-induced injury progresses, and distinctly express IGF1, which induces the activation of a signal pathway to dominate a significant information flow towards injured and proliferating tubule cells. IGF1 promoted the repair of damaged tubular epithelial cells induced by NaOx in vitro, as well as the repair of damaged tubular epithelial cells and the recovery of disease outcomes in glyoxylate-induced nephrolithic mice in vivo. Conclusion: After constructing a cellular atlas of glyoxylate-induced crystal nephropathy, we found that IGF1 derived from Mrc1+ macrophages attenuated crystal nephropathy through promoting renal tubule cell proliferation via the AKT/Rb signaling pathway. These findings could lead to the identification of potential therapeutic targets for the treatment of crystal nephropathy.
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Affiliation(s)
- Linxi Huang
- Department of Cell Biology, Naval Medical University (Second Military Medical University), Shanghai, China
- Department of Nephrology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
- Department of Nephrology, PLA Navy No.905 Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Wei Chen
- Department of Nephrology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Zhuojing Tan
- Department of Nephrology, Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226006, Jiangsu, China
| | - Yunxiao Huang
- Department of Cell Biology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xinji Gu
- Department of Cell Biology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Lantian Liu
- Department of Cell Biology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Hongxia Zhang
- Department of Cell Biology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Yihan Shi
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiarong Ding
- Department of Nephrology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Chengjian Zheng
- Faculty of Pharmacy, Naval Medical University, Shanghai, China
| | - Zhiyong Guo
- Department of Nephrology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Bing Yu
- Department of Cell Biology, Naval Medical University (Second Military Medical University), Shanghai, China
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13
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Karimzadeh I, Barreto EF, Kellum JA, Awdishu L, Murray PT, Ostermann M, Bihorac A, Mehta RL, Goldstein SL, Kashani KB, Kane-Gill SL. Moving toward a contemporary classification of drug-induced kidney disease. Crit Care 2023; 27:435. [PMID: 37946280 PMCID: PMC10633929 DOI: 10.1186/s13054-023-04720-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
Drug-induced kidney disease (DIKD) accounts for about one-fourth of all cases of acute kidney injury (AKI) in hospitalized patients, especially in critically ill setting. There is no standard definition or classification system of DIKD. To address this, a phenotype definition of DIKD using expert consensus was introduced in 2015. Recently, a novel framework for DIKD classification was proposed that incorporated functional change and tissue damage biomarkers. Medications were stratified into four categories, including "dysfunction without damage," "damage without dysfunction," "both dysfunction and damage," and "neither dysfunction nor damage" using this novel framework along with predominant mechanism(s) of nephrotoxicity for drugs and drug classes. Here, we briefly describe mechanisms and provide examples of drugs/drug classes related to the categories in the proposed framework. In addition, the possible movement of a patient's kidney disease between certain categories in specific conditions is considered. Finally, opportunities and barriers to adoption of this framework for DIKD classification in real clinical practice are discussed. This new classification system allows congruencies for DIKD with the proposed categorization of AKI, offering clarity as well as consistency for clinicians and researchers.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Linda Awdishu
- Division of Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA, USA
| | | | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's and St Thomas' Hospital, London, UK
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandra L Kane-Gill
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Pharmacy, UPMC, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, Department of Biomedical Informatics, School of Medicine and the Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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14
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Campbell RE, Chen CH, Edelstein CL. Overview of Antibiotic-Induced Nephrotoxicity. Kidney Int Rep 2023; 8:2211-2225. [PMID: 38025228 PMCID: PMC10658282 DOI: 10.1016/j.ekir.2023.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
Drug-induced nephrotoxicity accounts for up to 60% of cases of acute kidney injury (AKI) in hospitalized patients and is associated with increased morbidity and mortality in both adults and children. Antibiotics are one of the most common causes of drug-induced nephrotoxicity. Mechanisms of antibiotic-induced nephrotoxicity include glomerular injury, tubular injury or dysfunction, distal tubular obstruction from casts, and acute interstitial nephritis (AIN) mediated by a type IV (delayed-type) hypersensitivity response. Clinical manifestations of antibiotic-induced nephrotoxicity include acute tubular necrosis (ATN), AIN, and Fanconi syndrome. Given the potential nephrotoxic effects of antibiotics on critically ill patients, the use of novel biomarkers can provide information to optimize dosing and duration of treatment and can help prevent nephrotoxicity when traditional markers, such as creatinine, are unreliable. Use of novel kidney specific biomarkers, such as cystatin C and urinary kidney injury molecule-1 (KIM-1), may result in earlier detection of AKI, dose adjustment, or discontinuation of antibiotic and development of nonnephrotoxic antibiotics.
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Affiliation(s)
- Ruth E. Campbell
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Chang Huei Chen
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles L. Edelstein
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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15
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Brocheriou I, Jhaveri KD, Izzedine H. How I Treat: An Algorithmic Approach to Crystalline Nephropathies: An Algorithmic Approach to Crystalline Nephropathies. Clin J Am Soc Nephrol 2023; 18:1369-1371. [PMID: 37342972 PMCID: PMC10578620 DOI: 10.2215/cjn.0000000000000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Isabelle Brocheriou
- Department of Pathology, Pitie-Salpetriere Hospital, Paris, France; Sorbonne Université, INSERM UMR S1155, Pitié-Salpêtrière Hospital, APHP6, Paris, France
| | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Northwell Health, Hempstead, New York
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Paris, France
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16
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Mousseaux C, Tang E, Tristant M, Luque Y, Frochot V, Mesnard L, Bazin D, Rafat C, Buob D, Letavernier E. The Case | Acute kidney injury following infective endocarditis. Kidney Int 2023; 104:863-864. [PMID: 37739623 DOI: 10.1016/j.kint.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Cyril Mousseaux
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France.
| | - Ellie Tang
- INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Maxime Tristant
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Yosu Luque
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France
| | - Vincent Frochot
- Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurent Mesnard
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France
| | - Dominique Bazin
- Laboratoire de Chimie Physique, Centre National de la Recherche Scientifique, Université Paris Sud, Orsay, France
| | - Cédric Rafat
- Soins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - David Buob
- INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France; Service d'Anatomo-Pathologie, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emmanuel Letavernier
- INSERM UMR S 1155, Common and Rare Kidney Disease, Hôpital Tenon, Paris, France; Sorbonne Université, Faculté de Médecine, Paris, France; Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
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17
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Meriam H, Bettaieb A, Kaaroud H, Ben Hamida F, Gargeh T, Mrad R, Bouzid K, Abderrahim E. Primary Hyperoxaluria Type 1: Clinical, Paraclinical, and Evolutionary Aspects in Adults from One Nephrology Center. Int J Nephrol 2023; 2023:2874414. [PMID: 37521011 PMCID: PMC10372328 DOI: 10.1155/2023/2874414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Primary hyperoxaluria type 1 (PH1) is a rare and inherited condition of urolithiasis. The aim of our study was to analyze clinical, paraclinical, and evolutionary aspects of PH1 in adult patients in our Nephrology department. Methods We conducted a retrospective single-center study between 1990 and 2021. We collected patients followed for PH1 confirmed by genetic study and/or histopathological features of renal biopsy and morphoconstitutional analysis of the calculi. Results There were 25 patients with a gender ratio of 1.78. The median age at onset of symptoms was 18 years. A delay in diagnosis more than 10 years was noted in 13 cases. The genetic study found the I244T mutation in 17 cases and 33-34 InsC in 4 cases. A kidney biopsy was performed in 5 cases, on a native kidney in 4 cases and on a graft biopsy in one case. The analysis of calculi was done in 10 cases showing type Ic in 2 cases. After a median follow-up of 13 years (1 year-42 years), 14 patients progressed to end-stage chronic renal failure (ESRD). The univariate study demonstrated a remarkable association with progression to ESRD in our population (44% vs. 56%) RR = 13.32 (adjusted ORs (95% CI): 2.82-62.79) (p < 0.01). Conclusion Progression to ESRD was frequent in our series. Early diagnosis and adequate management can delay such an evolution.
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Affiliation(s)
- Hajji Meriam
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Asma Bettaieb
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
- Department of Nephrology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
| | - Hayet Kaaroud
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Taher Gargeh
- Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ridha Mrad
- Department of Genetics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Kahena Bouzid
- Department of Biochemistry, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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18
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Wimalawansa SJ, Dissanayake CB. Nanocrystal-induced chronic tubular-nephropathy in tropical countries: diagnosis, mitigation, and eradication. Eur J Med Res 2023; 28:221. [PMID: 37408060 DOI: 10.1186/s40001-023-01162-y] [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: 08/07/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
In tropical countries, a mysterious tubulo-interstitial chronic renal disease (CKD), unrelated to diabetes, hypertension, and immunological causes, manifested four decades ago. Approximately 25,000 primarily middle-aged male farmers succumb annually to this crystal-tubular nephropathy (CTN). Without any known causative factors, it was identified as CKD of unknown aetiology (CKDu). Because multiple factors contribute to causing it later, was changed to CKD of multi-factorial (CKDmfo). Despite no evidence, it was hypothesised to cause by agrochemicals or heavy metals in food or drinking contaminated water. However, current data suggest that the CKD-CTN is due to natural geogenic water contamination. Consumption of concentrated stagnant groundwater from deep-dug wells and tube wells containing hard water and fluoride, overdecades is necessary for its clinical manifestations. In all affected countries have prolonged annual dry seasons that led to the evopo-concentration of ions and minerals in groundwater, making hard water even more unpalatable, thus, peasants consume lesser amounts of water. They develop chronic dehydration from daily exposure to hot climatic conditions aggravated by regular alcohol intake. These conditions provide a highly conducive environment-a perfect storm for calcium phosphate (CaPO4) crystal formation in renal tissues. Our recent histological and preliminary electron microscopic data reveal deposition of CaPO4 crystals and nano-tubes in kidneys. While CaPO4 nano-minerals are unstable, the presence of fluoride ions stabilises and allows their growth. This new concept paves the path for highly cost-effective, straightforward local solutions to protect farm workers and eliminate the disease, without embarking on expensive medications, interventions, or building hospitals. Chronic dehydration-associated CKD-CTN is preventable by increased consumption of potable water. Increasing clean water consumption reduces CKD-CTN incidence, and associated morbidities and premature deaths. However, the damage becomes irreversible when the disease advances beyond CKD stage IIIB. The incidence of this deadly renal failure can be prevented by its education, lifestyle changes, and increased water consumption, not by treating the renal disease or expanding dialysis centres/hospitals, or transplantation services. Eradication of CKD-CTN cost significantly less than the current approach of treating affected persons and unnecessarily expanding health infrastructure. Since the manifestation of CKD-CTN is due to consuming naturally contaminated drinking water (with calcium containing hard water and fluoride), it is not difficult to remove these to prevent CKD-CTN: thus, international assistance is unwarranted for its eradication. The straightforward approaches described here will prevent CKD-CTN and save thousands of lives in affected farming communities.
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Affiliation(s)
- Sunil J Wimalawansa
- Cardiometabolic & Endocrine Institute, Department of Medicine, Endocrinology, Nutrition, (formerly UMDNJ/Rutgers University), New Brunswick, NJ, 08902, USA.
- , Moratuwa, Sri Lanka.
| | - Chandra B Dissanayake
- Department of Geology, University of Peradeniya, Peradeniya, Sri Lanka
- Institute of Fundamental Studies, Kandy, Sri Lanka
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19
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Donaldson Dasgupta A, Schretlen C, Atta MG, Arend LJ. Acute kidney injury following methotrexate treatment. J Nephrol 2023; 36:1447-1450. [PMID: 36800105 DOI: 10.1007/s40620-023-01567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/01/2023] [Indexed: 02/18/2023]
Affiliation(s)
| | - Claire Schretlen
- Department of Internal Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mohamed G Atta
- Department of Internal Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Lois J Arend
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA.
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20
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Li J, Li T, Li Z, Song Z, Gong X. Potential therapeutic effects of Chinese meteria medica in mitigating drug-induced acute kidney injury. Front Pharmacol 2023; 14:1153297. [PMID: 37077810 PMCID: PMC10106589 DOI: 10.3389/fphar.2023.1153297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
Drug-induced acute kidney injury (DI-AKI) is one of the leading causes of kidney injury, is associated with high mortality and morbidity, and limits the clinical use of certain therapeutic or diagnostic agents, such as antineoplastic drugs, antibiotics, immunosuppressants, non-steroidal anti-inflammatory drugs, and contrast media. In recent years, numerous studies have shown that many Chinese meteria medica, metabolites derived from botanical drugs, and Chinese medicinal formulas confer protective effects against DI-AKI by targeting a variety of cellular or molecular mechanisms, such as oxidative stress, inflammatory, cell necrosis, apoptosis, and autophagy. This review summarizes the research status of common DI-AKI with Chinese meteria medica interventions, including cisplatin, gentamicin, contrast agents, methotrexate, and acetaminophen. At the same time, this review introduces the metabolites with application prospects represented by ginseng saponins, tetramethylpyrazine, panax notoginseng saponins, and curcumin. Overall, this review provides a reference for the development of promising nephroprotectants.
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21
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Dobrek L. A Synopsis of Current Theories on Drug-Induced Nephrotoxicity. Life (Basel) 2023; 13:life13020325. [PMID: 36836682 PMCID: PMC9960203 DOI: 10.3390/life13020325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
The overriding goal of the treatment of patients is its effectiveness and safety. However, all medications currently being used also exert some adverse pharmaceutical reactions, which may be regarded as an unintended but inevitable cost of pharmacotherapy. The kidney, as the main organ that eliminates xenobiotics, is an organ especially predisposed and vulnerable to the toxic effects of drugs and their metabolites during their excretion from the body. Moreover, some drugs (e.g., aminoglycosides, cyclosporin A, cisplatin, amphotericin B, and others) have a "preferential" nephrotoxicity potential, and their use is associated with an increased risk of kidney damage. Drug nephrotoxicity is, therefore, both a significant problem and a complication of pharmacotherapy. It should be noted that, currently, there is no generally recognized definition of drug-induced nephrotoxicity and no clear criteria for its diagnosis. This review briefly describes the epidemiology and diagnosis of drug-induced nephrotoxicity and characterizes its pathomechanisms, including immunological and inflammatory disturbances, altered kidney blood flow, tubulointerstitial injury, increased lithogenesis-crystal nephropathy, rhabdomyolysis, and thrombotic microangiopathy. The study also lists the basic drugs with nephrotoxicity potential and provides a short overview of the preventive methods for reducing the risk of drug-related kidney damage developing.
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Affiliation(s)
- Lukasz Dobrek
- Department of Clinical Pharmacology, Wroclaw Medical University, Wroclaw, Poland
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22
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Zhang L, Liang Y, Liang G, Tian Z, Zhang Y, Liu Z, Ji X. The therapeutic prospects of N-acetylgalactosamine-siRNA conjugates. Front Pharmacol 2022; 13:1090237. [PMID: 36588695 PMCID: PMC9794871 DOI: 10.3389/fphar.2022.1090237] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
RNA interference has become increasingly used for genetic therapy following the rapid development of oligonucleotide drugs. Significant progress has been made in its delivery system and implementation in the treatment of target organs. After a brief introduction of RNA interference technology and siRNA, the efficiency and stability of GalNAc-siRNA conjugates are highlighted since several oligonucleotide drugs of GalNAc have been approved for clinical use in recent years. The structure and features of GalNAc-siRNA conjugates are studied and the clinical efficiency and limitations of oligonucleotide-based drugs are summarized and investigated. Furthermore, another delivery system, lipid nanoparticles, that confer many advantages, is concluded, includ-ing stability and mass production, compared with GalNAc-siRNA conjugates. Importantly, developing new approaches for the use of oligonucleotide drugs brings hope to genetic therapy.
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Affiliation(s)
- Lei Zhang
- Henan International Joint Laboratory of Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, China
| | - Yayu Liang
- School of Stomatology, Henan University, Kaifeng, China
| | - Guohui Liang
- School of Clinical Medical Sciences, Henan University, Kaifeng, China
| | - Zhili Tian
- School of Clinical Medical Sciences, Henan University, Kaifeng, China
| | - Yue Zhang
- Department of Obstetrics and Gynecology, Zhengzhou, China
| | - Zhihui Liu
- Department of General Practice, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, China
| | - Xinying Ji
- Henan International Joint Laboratory of Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, China
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23
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Pearson A, Gafner S, Rider CV, Embry M, Ferguson SS, Mitchell CA. Plant vs. Kidney: Evaluating Nephrotoxicity of Botanicals with the Latest Toxicological Tools. CURRENT OPINION IN TOXICOLOGY 2022; 32:100371. [PMID: 36311298 PMCID: PMC9601601 DOI: 10.1016/j.cotox.2022.100371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Botanicals can cause nephrotoxicity via numerous mechanisms, including disrupting renal blood flow, damaging compartments along the nephron, and obstructing urinary flow. While uncommon, there are various reports of botanical-induced nephrotoxicity in the literature, such as from aristolochia (Aristolochia spp.) and rhubarb (Rheum spp.). However, at present, it is a challenge to assess the toxic potential of botanicals because their chemical composition is variable due to factors such as growing conditions and extraction techniques. Therefore, selecting a single representative sample for an in vivo study is difficult. Given the increasing use of botanicals as dietary supplements and herbal medicine, new approach methodologies (NAMs) are needed to evaluate the potential for renal toxicity to ensure public safety. Such approaches include in vitro models that use layers of physiological complexity to emulate the in vivo microenvironment, enhance the functional viability and differentiation of cell cultures, and improve sensitivity to nephrotoxic insults. Furthermore, computational tools such as physiologically based pharmacokinetic (PBPK) modeling can add confidence to these tools by simulating absorption, distribution, metabolism, and excretion. The development and implementation of NAMs for renal toxicity testing will allow specific mechanistic data to be generated, leading to a better understanding of the nephrotoxic potential of botanicals.
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Affiliation(s)
- Adam Pearson
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | | | - Cynthia V. Rider
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Michelle Embry
- Health and Environmental Sciences Institute, Washington, DC, USA
| | - Stephen S Ferguson
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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24
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Crystal-induced collapsing podocytopathy and light chain proximal tubulopathy in monoclonal gammopathy of renal significance. J Nephrol 2022; 35:2127-2130. [PMID: 35687268 DOI: 10.1007/s40620-022-01362-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
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25
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Abstract
PURPOSE OF REVIEW Progressive forms of chronic kidney disease (CKD) exhibit kidney inflammation and fibrosis that drive continued nephron loss; however, factors responsible for the development of these common pathologic features remain poorly defined. Recent investigations suggest pathways involved in maintaining urinary phosphate excretion in CKD may be contributing to kidney function decline. This review provides an update on recent evidence linking altered phosphate homeostasis to CKD progression. RECENT FINDINGS High dietary phosphate intake and increased serum concentrations of fibroblast growth factor 23 (FGF23) both increase urinary phosphate excretion and are associated with increased risk of kidney function decline. Recent investigations have discovered high concentrations of tubular phosphate promote phosphate-based nanocrystal formation that drives tubular injury, cyst formation, and fibrosis. SUMMARY Studies presented in this review highlight important scientific discoveries that have molded our current understanding of the contribution of altered phosphate homeostasis to CKD progression. The collective observations from these investigations implicate phosphaturia, and the resulting formation of phosphate-based crystals in tubular fluid, as unique risk factors for kidney function decline. Developing a better understanding of the relationship between tubular phosphate handling and kidney pathology could result in innovative strategies for improving kidney outcomes in patients with CKD.
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Affiliation(s)
- Kyle P Jansson
- The Jared Grantham Kidney Institute
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
| | - Alan S L Yu
- The Jared Grantham Kidney Institute
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
| | - Jason R Stubbs
- The Jared Grantham Kidney Institute
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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26
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Molecular Mechanisms and Biomarkers Associated with Chemotherapy-Induced AKI. Int J Mol Sci 2022; 23:ijms23052638. [PMID: 35269781 PMCID: PMC8910619 DOI: 10.3390/ijms23052638] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/10/2022] Open
Abstract
Acute kidney injury (AKI) is a life-threatening condition characterized by a rapid and transient decrease in kidney function. AKI is part of an array of conditions collectively defined as acute kidney diseases (AKD). In AKD, persistent kidney damage and dysfunction lead to chronic kidney disease (CKD) over time. A variety of insults can trigger AKI; however, chemotherapy-associated nephrotoxicity is increasingly recognized as a significant side effect of chemotherapy. New biomarkers are urgently needed to identify patients at high risk of developing chemotherapy-associated nephrotoxicity and subsequent AKI. However, a lack of understanding of cellular mechanisms that trigger chemotherapy-related nephrotoxicity has hindered the identification of effective biomarkers to date. In this review, we aim to (1) describe the known and potential mechanisms related to chemotherapy-induced AKI; (2) summarize the available biomarkers for early AKI detection, and (3) raise awareness of chemotherapy-induced AKI.
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