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Zhang JH, Liu J, Ruan DD, Chen Q, Yang J, Wu M, Yu HP, Liao LS, Zheng XL, Luo JW, Zhang L. Analyzing three pedigrees in X-linked Alport syndrome with the presentation of nephrotic syndrome. Front Genet 2024; 15:1419154. [PMID: 39184349 PMCID: PMC11341381 DOI: 10.3389/fgene.2024.1419154] [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: 04/17/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
Background Alport syndrome (AS) is a common cause of end-stage renal disease (ESRD) with various clinical symptoms and incomplete manifestation. Patients with AS and other renal disorders are often misdiagnosed. This study reported three X-linked dominant Alport syndrome (XLAS) pedigrees with nephrotic syndrome (NS) as the predominant phenotype and analyzed COL4A5 gene alterations. Methods Three Han Chinese XLAS pedigrees were recruited, and clinical phenotypes were obtained. The pre-certified individuals' peripheral blood DNA was taken, and whole-genome next-generation sequencing (NGS) was performed for candidate genes and mutation screening, followed by NGS or Sanger sequencing of suspected mutant types in participating family members. Results Both probands A and B were diagnosed with NS through biochemical tests, and X-linked Alport syndrome-associated renal injury was diagnosed by renal biopsy. The biopsy revealed focal foamy cells in the renal interstitium, tearing and delamination changes in the glomerular basement membrane, and negative α3 and α5 chains of type IV collagen. Proband C, who was earlier diagnosed with NS, has now advanced to ESRD, along with his mother and proband A's mother. Genetic sequencing of all three pedigrees identified three mutations, namely, c.5020C>T, c.4435_4445del, and c.1584_1587+6del in the X-linked dominant gene COL4A5 (NM_000495.5). These mutations lead to the production of shortened proteins, potentially impacting the function of COL4A5 and causing pathogenic effects. Conclusion The novel c.4435_4445del and c.1584_1587+6del mutations not only enrich the spectrum of mutations in the COL4A5 gene but also indicate that carriers of both mutation sites and those with mutation c.5020C>T may present NS as their primary clinical manifestation.
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Affiliation(s)
- Jian-Hui Zhang
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Digestive Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Jie Liu
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Digestive Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Dan-Dan Ruan
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Qian Chen
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Jie Yang
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Digestive Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Min Wu
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Hong-Ping Yu
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Li-Sheng Liao
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Hematology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Ling Zheng
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Digestive Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Jie-Wei Luo
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Li Zhang
- Department of Nephrology and Traditional Chinese Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
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Bedoyan S, Kurzinski KL, Seynnaeve B, Fuhrman DY. New Onset of Nephrotic Syndrome in a 17-year-old. Pediatr Rev 2024; 45:461-464. [PMID: 39085184 DOI: 10.1542/pir.2022-005863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 08/02/2024]
Affiliation(s)
- Sarah Bedoyan
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Katherine L Kurzinski
- Division of Pediatric Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Brittani Seynnaeve
- Department of Pediatric Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Dana Y Fuhrman
- Division of Pediatric Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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Zhan J, Rao Y, Liu J, Miao H, Xia Z. Ulcerative colitis and nephrotic syndrome: a two-sample Mendelian randomization study. Intern Emerg Med 2024; 19:1353-1358. [PMID: 38717727 DOI: 10.1007/s11739-024-03623-6] [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: 03/12/2024] [Accepted: 04/23/2024] [Indexed: 08/31/2024]
Abstract
To investigate the potential causal relationship between ulcerative colitis and nephrotic syndrome. We obtained the whole-genome association study data of ulcerative colitis in the European population from the GWAS database. Relevant single nucleotide polymorphisms (SNPs) were selected for analysis. We employed the inverse variance-weighted meta-analysis of multiplicative random effects models to obtain SNP-specific Wald ratio estimates, which assume horizontal pleiotropy. In addition, we performed sensitivity analyses using MR-Egger, weighted median, and IVW. Our findings suggest a strong association between ulcerative colitis and nephrotic syndrome (P < 0.05). After conducting sensitivity analyses, we found no evidence of horizontal pleiotropy or heterogeneity (P > 0.05). This study provides evidence for an association between ulcerative colitis and nephrotic syndrome, which may help us better understand the conditions of ulcerative colitis and nephropathy.
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Affiliation(s)
- Jinfeng Zhan
- Health Management Medicine Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yujie Rao
- Health Management Medicine Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiahao Liu
- The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Haizhou Miao
- The Fourth Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zhongbin Xia
- Health Management Medicine Department, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Krishna GM, Dabas A, Mantan M, Kumar M A, Goswami B. Adrenocortical suppression in children with nephrotic syndrome treated with corticosteroids. Pediatr Nephrol 2024; 39:1817-1824. [PMID: 38253887 DOI: 10.1007/s00467-024-06294-9] [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: 08/10/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Children with nephrotic syndrome are exposed to alternate day steroids for prolonged periods and this poses the need for evaluation of adrenocortical suppression using the adrenocorticotropic hormone (ACTH) stimulation test. METHODS This cross-sectional study enrolled children (2-18 years) both with steroid sensitive nephrotic syndrome (SSNS) (n = 27) and steroid resistant (SRNS) (n = 25); those on daily prednisolone or having serious bacterial infections or hospitalized were excluded. The primary objective was to determine prevalence of adrenocortical suppression in those on low dose alternate day steroids for more than 8 weeks or having received > 2 mg/kg/d for > 2 weeks in the past 1 year and currently in remission. A baseline morning fasting sample of serum cortisol was taken and 25 IU of ACTH (Acton Prolongatum*) injected intramuscularly and repeat serum cortisol sample taken after 1 h. All patients with 1 h post ACTH cortisol < 18.0 µgm/dl were diagnosed with adrenal insufficiency. Receiver operating characteristic curve was drawn to predict the prednisolone dose for adrenal insufficiency. RESULTS Fifty-two (33 males) children were enrolled (mean age 9.4 years); proportion of adrenal insufficiency was 50% and 64% using baseline and post stimulation cutoffs. The total cumulative annual dose of prednisolone 0.22 mg/kg/day predicted adrenocortical suppression with AUC 0.76 (95% CI 0.63-0.89), with sensitivity of 63.9% and specificity of 81.3%. CONCLUSIONS A significant proportion of children with nephrotic syndrome were detected with adrenal insufficiency on ACTH stimulation test. A cumulative steroid intake of > 0.22 mg/kg/day on an alternate day basis emerged as a risk factor for predicting adrenocortical suppression.
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Affiliation(s)
- Ganesh M Krishna
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Mukta Mantan
- Division of Pediatric Nephrology, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Akshay Kumar M
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Alenazi SA. Incidence and Pathological Patterns of Nephrotic Syndrome among Infants and Children: A Systematic Review. Cureus 2024; 16:e58331. [PMID: 38752042 PMCID: PMC11095912 DOI: 10.7759/cureus.58331] [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] [Accepted: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
Nephrotic syndrome (NS) is known to be a prevalent chronic illness in young patients. Periorbital swelling in children with this condition is a recurring symptom, either with or without generalized edema. The current study aimed to examine the incidence and pattern of nephrotic syndrome in infants and children by thoroughly examining the recently available literature. A thorough search of PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, to find pertinent material. The Rayyan software (Qatar Computing Research Institute, Ar-Rayyan, Qatar) was utilized during the whole process. Data from a total of 1418 patients from nine trials were considered in this study. Numerous factors influenced the incidence, mean age, sex dominance, and histological patterns in various sample groups. The current findings conclude that variations in socioeconomic, regional, and genetic factors influence the development and pattern of these diseases. The prevalence of pediatric renal disorders differs throughout countries. Season of occurrence, response to corticosteroid treatment, and histopathologic findings appear to differ amongst the diagnosed cases.
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Affiliation(s)
- Shehab A Alenazi
- Department of Pediatrics, Faculty of Medicine, Northern Border University, Arar, SAU
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Zhu Y, Chen J, Zhang Y, Wang X, Wang J. Immunosuppressive agents for frequently relapsing/steroid-dependent nephrotic syndrome in children: a systematic review and network meta-analysis. Front Immunol 2024; 15:1310032. [PMID: 38464533 PMCID: PMC10920238 DOI: 10.3389/fimmu.2024.1310032] [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: 10/09/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Aim This study aimed to systematically compare the efficacy of various immunosuppressive agents in treating pediatric frequently relapsing or steroid-dependent nephrotic syndrome (FRSDNS). Methods We conducted systematic searches of PubMed, Embase, the Cochrane Library, and the Web of Science up to May 23, 2023. Outcome measures included relapses within 1 year, mean cumulative exposure to corticosteroids, patients with treatment failure at 1 year, relapse-free survival during 1 year, and adverse events. The quality of the included studies was evaluated using the modified Jadad scale, the Methodological Index for Non-Randomized Studies (MINORS), and the modified Newcastle-Ottawa Scale (NOS). Results Rituximab was found to be the most likely (92.44%) to be associated with the fewest relapses within 1 year and was also most likely (99.99%) to result in the lowest mean cumulative exposure to corticosteroids. Rituximab had the highest likelihood (45.98%) of being associated with the smallest number of patients experiencing treatment failure at 1 year. CsA was most likely (57.93%) to achieve the highest relapse-free survival during 1 year, followed by tacrolimus (26.47%) and rituximab (30.48%). Rituximab showed no association with serious side effects and had comparable adverse effects to ofatumumab and tacrolimus. Conclusion Rituximab may be the most favorable immunosuppressive agent for treating pediatric FRSDNS. Nephrologists should consider this drug, along with their clinical experience, patient characteristics, and cost considerations, when choosing a treatment approach.
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Affiliation(s)
- Yu Zhu
- Department of Traditional Chinese Medicine, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Junyi Chen
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Yao Zhang
- Department of Traditional Chinese Medicine, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Xiaoai Wang
- Department of Traditional Chinese Medicine, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Jingjing Wang
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
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Jia W, Dou W, Zeng H, Wang Q, Shi P, Liu J, Liu Z, Zhang J, Zhang J. Diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome complicated by infection: a single center retrospective study. Pediatr Res 2024; 95:722-728. [PMID: 37773440 DOI: 10.1038/s41390-023-02830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE The purpose was to look into the diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome co-infection. METHODS One hundred and forty-nine children with nephrotic syndrome who met the inclusion and exclusion criteria were included in this study. The children were divided into three groups: bacterial infection group, non-bacterial infection group, and non-infection group. The diagnostic value was analyzed and compared using the ROC curve. RESULTS There was no statistically significant difference in the Leukocyte counts among three groups. The mean results of serum CRP, PCT and IL-6 were significantly higher in the bacterial infection group compared to those in the non-infection group (p < 0.05). AUC of CRP, PCT, IL-6 in bacterial infection were 0.791, 0.859, 0.783. The following combinations CRP + PCT + IL-6, IL-6 + PCT, CRP + PCT significantly increased the efficiency of bacterial infection diagnosis, the AUCs were 0.881, 0.884, and 0.884, respectively. AUC of PCT in non-bacterial infection was 0.663. The combinations of these three clinical indicators performed no better than PCT in ROC analysis. CONCLUSION Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve the diagnostic value. IMPACT This study evaluated the diagnostic value of the serum concentrations of CRP, PCT and IL-6 and assessed whether the value of their combined application is better than when used alone for diagnosing primary nephrotic syndrome complicated by infection. The elevation in leukocyte count cannot be used to diagnose children with nephrotic syndromes on long-term glucocorticoid treatment who have bacterial infections. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve diagnostic value, sensitivity, and specificity.
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Affiliation(s)
- Wanyu Jia
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Wenjie Dou
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Huiqin Zeng
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Qin Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Peipei Shi
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jing Liu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhen Liu
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jin Zhang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jianjiang Zhang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China.
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Li D, Xie X, Yin N, Wu X, Yi B, Zhang H, Zhang W. tRNA-Derived Small RNAs: A Novel Regulatory Small Noncoding RNA in Renal Diseases. KIDNEY DISEASES (BASEL, SWITZERLAND) 2024; 10:1-11. [PMID: 38322624 PMCID: PMC10843216 DOI: 10.1159/000533811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/23/2023] [Indexed: 02/08/2024]
Abstract
Background tRNA-derived small RNAs (tsRNAs) are an emerging class of small noncoding RNAs derived from tRNA cleavage. Summary With the development of high-throughput sequencing, various biological roles of tsRNAs have been gradually revealed, including regulation of mRNA stability, transcription, translation, direct interaction with proteins and as epigenetic factors, etc. Recent studies have shown that tsRNAs are also closely related to renal disease. In clinical acute kidney injury (AKI) patients and preclinical AKI models, the production and differential expression of tsRNAs in renal tissue and plasma were observed. Decreased expression of tsRNAs was also found in urine exosomes from chronic kidney disease patients. Dysregulation of tsRNAs also appears in models of nephrotic syndrome and patients with lupus nephritis. And specific tsRNAs were found in high glucose model in vitro and in serum of diabetic nephropathy patients. In addition, tsRNAs were also differentially expressed in patients with kidney cancer and transplantation. Key Messages In the present review, we have summarized up-to-date works and reviewed the relationship and possible mechanisms between tsRNAs and kidney diseases.
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Affiliation(s)
- Dan Li
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China
- The Critical Kidney Disease Research Center of Central South University, Changsha, China
| | - Xian Xie
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China
- The Critical Kidney Disease Research Center of Central South University, Changsha, China
| | - Ni Yin
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China
- The Critical Kidney Disease Research Center of Central South University, Changsha, China
| | - Xueqin Wu
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China
- The Critical Kidney Disease Research Center of Central South University, Changsha, China
| | - Bin Yi
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China
- The Critical Kidney Disease Research Center of Central South University, Changsha, China
| | - Hao Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China
- The Critical Kidney Disease Research Center of Central South University, Changsha, China
| | - Wei Zhang
- Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, China
- The Critical Kidney Disease Research Center of Central South University, Changsha, China
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Alssum LR. Repeated implants failure in young patient with idiopathic nephrotic syndrome: a case report with brief review of the literature. BMC Oral Health 2024; 24:25. [PMID: 38183071 PMCID: PMC10770943 DOI: 10.1186/s12903-023-03772-8] [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: 01/30/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Nephrotic syndrome is a chronic disorder characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Idiopathic minimal-change disease is the most common form encountered in children. Corticosteroids are the cornerstone for the treatment of idiopathic nephrotic syndrome (INS), with different regimens depending on the response to therapy and frequency of relapses. This case report presents complications after implant treatment in patient with INS. CASE PRESENTATION 20 years old female patient presented for implant consultation. Medical history includes INS since early childhood, and she is on different medications to control her condition, including long-term steroid use. Dental history revealed that implant treatment was unsuccessful after multiple attempts. She presented with an implant on the area of lower left first mandibular molar, that shows increased mobility and radiolucency on radiographic examination. A diagnosis of implant failure was made, the implant was removed, and the area was cleaned and sutured. The patient decided to replace her missing teeth with fixed partial denture and was referred for prosthodontist. The potential adverse effect of steroid use and the possible underlying mechanism that could affect bone metabolism and implants osseointegration are reviewed. CONCLUSION Clinical practice guidelines are needed for the management of dental implants in chronic steroid users.
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Affiliation(s)
- Lamees R Alssum
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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Lee S, Jung S, Jeon H, Jang H, Kim HJ, Lee TW, Bae E, Park DJ, Chang SH. Spontaneous Remission of Minimal Change Disease in a Colon Cancer Patient: A Case Report. Biomed Hub 2024; 9:62-66. [PMID: 38638677 PMCID: PMC11026070 DOI: 10.1159/000538279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Minimal change disease (MCD) is most often primary but may occur secondary to other systemic diseases such as malignancy. In secondary MCD, spontaneous remission of nephrotic syndrome after the treatment of related diseases without steroid therapy is rare. Case Presentation A 78-year-old man visited the outpatient clinic with foamy urine and generalized edema that had persisted for 2 months. The patient had nephrotic syndrome. Before a kidney biopsy, he underwent several tests to determine the secondary cause of the nephrotic syndrome. The serum CEA was slightly elevated, and colon cancer was detected in the sigmoid colon. MCD was diagnosed from a kidney biopsy. He immediately underwent surgery for colon cancer. Complete remission of the MCD was achieved within 2 weeks after surgery. Conclusion Here, we report a rare case of a patient with secondary MCD who successfully achieved spontaneous remission after colon cancer surgery.
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Affiliation(s)
- Seunghye Lee
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sehyun Jung
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyejin Jeon
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hani Jang
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyun-Jung Kim
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Tae Won Lee
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Institute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Eunjin Bae
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Institute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Dong Jun Park
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Institute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Se-Ho Chang
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Medical Sciences, Gyeongsang National University, Jinju, Republic of Korea
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Cavdar S, Acar AG, Camyar A, Hür E, Sozmen EY, Sen S, Ozısık M, Akcay YD, Duman E, Gönen S, Akcicek F, Duman S. Effect of octreotide on oxidative stress in the erythrocyte and kidney tissue in adriamycin-induced experimental nephrotic syndrome model. J Bras Nefrol 2024; 46:18-28. [PMID: 37527531 PMCID: PMC10962405 DOI: 10.1590/2175-8239-jbn-2022-0180en] [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: 12/02/2022] [Accepted: 05/26/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Nephrotic syndrome (NS) is one of the reasons of end-stage kidney disease, and elucidating the pathogenesis and offer new treatment options is important. Oxidative stress might trigger pathogenesis systemically or isolated in the kidneys. Octreotide (OCT) has beneficial antioxidant effects. We aimed to investigate the source of oxidative stress and the effect of OCT on experimental NS model. METHODS Twenty-four non-uremic Wistar albino rats were divided into 3 groups. Control group, 2 mL saline intramuscular (im); NS group, adriamycin 5 mg/kg intravenous (iv); NS treatment group, adriamycin 5 mg/kg (iv) and OCT 200 mcg/kg (im) were administered at baseline (Day 0). At the end of 21 days, creatinine and protein levels were measured in 24-hour urine samples. Erythrocyte and renal catalase (CAT) and thiobarbituric acid reactive substance (TBARS) were measured. Renal histology was also evaluated. RESULTS There was no significant difference among the 3 groups in terms of CAT and TBARS in erythrocytes. Renal CAT level was lowest in NS group, and significantly lower than the control group. In treatment group, CAT level significantly increased compared with NS group. In terms of renal histology, tubular and interstitial evaluations were similar in all groups. Glomerular score was significantly higher in NS group compared with control group and it was significantly decreased in treatment group compared to NS group. CONCLUSIONS Oxidative stress in NS might be due to the decrease in antioxidant protection mechanism in kidney. Octreotide improves antioxidant levels and histology in renal tissue and might be a treatment option.
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Affiliation(s)
- Sibel Cavdar
- Ege University, Medical Faculty Hospital, Department of Internal
Medicine, Izmir, Turkey
| | - Alev Garip Acar
- Izmir Atatürk Training and Research Hospital, Department of Internal
Medicine, Izmir, Turkey
| | - Asuman Camyar
- Izmir Çiğli Training and Research Hospital, Department of Internal
Medicine, Izmir, Turkey
| | - Ender Hür
- Uşak University Medical Faculty Hospital, Department of Internal
Medicine, Usak, Turkey
| | - Eser Yıldırım Sozmen
- Ege University Medical Faculty Hospital, Department of Medical
Biochemistry, Izmir, Turkey
| | - Sait Sen
- Ege University Medical Faculty Hospital, Department of Pathology,
Izmir, Turkey
| | - Melih Ozısık
- Izmir Tepecik Training and Research Hospital, Department of Internal
Medicine, Izmir, Turkey
| | - Yasemin Delen Akcay
- Ege University Medical Faculty Hospital, Department of Medical
Biochemistry, Izmir, Turkey
| | - Elif Duman
- Suat Seren Chest Diseases and Surgery Training and Research
Hospital, Izmir, Turkey
| | - Sena Gönen
- Ege University Medical Faculty Hospital, Department of Microbiology,
Izmir, Turkey
| | - Fehmi Akcicek
- Ege University, Medical Faculty Hospital, Department of Internal
Medicine, Izmir, Turkey
| | - Soner Duman
- Ege University, Medical Faculty Hospital, Department of Internal
Medicine, Izmir, Turkey
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12
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Balestra E, Barbi E, Ceconi V, Di Maso V, Conversano E, Pennesi M. Pioglitazone, a PPAR-y agonist, as one of the new therapeutic candidates for C3 glomerulopathy. Pediatr Nephrol 2024; 39:309-314. [PMID: 37493956 PMCID: PMC10673980 DOI: 10.1007/s00467-023-06088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND C3-glomerulopathy (C3G) is a rare pediatric kidney disease characterised by dysregulation of the alternative complement pathway, with glomerular deposition of C3. C3G may often present as a steroid-resistant nephrotic syndrome (SRNS), and there is no established effective therapy: the usual treatment involves corticosteroids and immunosuppressive drugs. Pioglitazone, a PPAR-γ agonist with a protective action on podocytes, was reported in a few cases as helpful in reducing proteinuria when combined with steroids. CASE-DIAGNOSIS/TREATMENT We report the case of a 13-year-old girl with silent past medical history who presented with SRNS. A kidney biopsy showed findings indicative of C3G. A low sodium diet and angiotensin-converting enzyme inhibitor were started; immunosuppressive treatment with mycophenolate mofetil (MMF) was administered due to the cortico-resistance. Because of poor response to the immunosuppressant, a trial with eculizumab was attempted without significant response and persistence of proteinuria in the nephrotic range. A further therapeutic trial was performed with tacrolimus with no disease remission. Due to a severe deterioration in her condition, the girl was hospitalized and treated with high-dose steroid bolus. A daily dose of oral prednisone and MMF were re-started without benefit with persistent levels of nephrotic range proteinuria. The administration of pioglitazone consistently lowered proteinuria levels for the first time since the onset of the disease, with a maintenance of the effect and normalization (< 0.15 g/24 h) at the 10-month follow-up. CONCLUSIONS In this patient affected by C3G, pioglitazone proved effective in reducing proteinuria levels.
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Affiliation(s)
- Elia Balestra
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Egidio Barbi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Viola Ceconi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Vittorio Di Maso
- Department of Nephrology, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Ester Conversano
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Pennesi
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
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13
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Chen R, Yang M, Peng C, Yin D, Zhang Y, Xu F. Pharmacodynamics Research on Danggui-Shaoyao-San through Body Fluid Indexes of Spleen Deficiency-water Dampness Rats using Bio-impedance Technology. Curr Pharm Biotechnol 2024; 25:1602-1616. [PMID: 37921128 DOI: 10.2174/0113892010243018231025065109] [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: 01/29/2023] [Revised: 08/23/2023] [Accepted: 09/19/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Spleen deficiency-water dampness symptom is closely related to body fluid-mediated organism metabolism and circulation. However, previous clinical evaluation of spleen deficiency-water dampness model was based only on body weight, D-xylose excretion rate, serum gastrin content, etc. Therefore, we established a large sample of normal rats and model rats experiment to verify the scientific nature of bio-impedance measuring body fluid indexes for evaluation of the modeling state. Pharmacodynamics research on Danggui-Shaoyao- San (DSS) was conducted through body fluid index changes of rats using bio-impedance technology. METHODS A spleen deficiency-water dampness symptom rat model was established through an inappropriate diet combined with excess fatigue. Experimental rats were divided into a normal control group, a model control group, a positive drug control group (hydrochlorothiazide), a blood-activating group, a water-disinhibiting group, and a DSS group. Total Body Water/Body Weight (TBW%), extracellular fluid/total body water content (ECF%), intracellular fluid/total body water content (ICF%), extracellular fluid/intracellular fluid (ECF/ICF), fat mass/body weight (FM%), fat-free mass/body weight (FFM%), and fat mass/fat-free mass (FM/FFM) of 150 rats were detected by a Bio-Imp Vet Body analyzer. RESULTS The TBW% of the model control group increased significantly, and the FM/FFM was significantly reduced compared with the normal group (P < 0.05) (P < 0.01), showing symptoms of spleen deficiency and diarrhea; the TBW% of the blood-activating group, and the waterdisinhibiting group decreased significantly, and the FM/FFM increased significantly (P < 0.05) (P < 0.01). The TBW% and FM/FFM in the water-disinhibiting group had returned to nearnormal values compared with the model control group. The blood-activating and waterdisinhibiting split prescriptions in DSS are both effective in treating spleen deficiency-water dampness rats. Comparatively, the fluid-regulating effect of split prescriptions in DSS was even stronger than that of DSS as shown in the present study. CONCLUSIONS These findings suggest that using bio-impedance technology to measure body fluid indexes can pave a road for further exploring the molecular mechanism of the reason why the blood-activating and disinhibit-water split prescriptions in DSS are both effective in treating spleen deficiency-water dampness rats.
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Affiliation(s)
- Ran Chen
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China
- Key Laboratory of Chinese Medicine Formula of Anhui Province, Hefei, 230012, PR China
| | - Mo Yang
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China
- Key Laboratory of Chinese Medicine Formula of Anhui Province, Hefei, 230012, PR China
| | - Can Peng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application
| | - Dengke Yin
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China
- Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application
| | - Yunjing Zhang
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China
- Key Laboratory of Chinese Medicine Formula of Anhui Province, Hefei, 230012, PR China
| | - Fan Xu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, PR China
- Key Laboratory of Chinese Medicine Formula of Anhui Province, Hefei, 230012, PR China
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Ji B, Liu J, Ma Y, Yin Y, Xu H, Shen Q, Yu J. Minnelide Markedly Reduces Proteinuria in Mice with Adriamycin Nephropathy by Protecting Against Podocyte Injury. Appl Biochem Biotechnol 2023; 195:7379-7396. [PMID: 37000351 PMCID: PMC10754751 DOI: 10.1007/s12010-023-04333-z] [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] [Accepted: 01/10/2023] [Indexed: 04/01/2023]
Abstract
Minimal change disease (MCD) is the most common cause of idiopathic nephrotic syndrome in children. The current major therapy is hormones for most steroid-sensitive patients. However, many patients have recurrent relapses of the disease and require long-term immunosuppression, leading to significant morbidity due to the side effects of the drugs. Therefore, better drugs need to be urgently explored to treat nephrotic syndrome while avoiding the side effects of drugs. Minnelide, a water-soluble prodrug of triptolide, has been proved to be effective in treating cancers in many clinical trials. This study aimed to investigate the therapeutic effect of minnelide in mice with adriamycin (ADR) nephropathy, its underlying protection mechanisms, and its reproductive toxicity. Minnelide was administered intraperitoneally to 6-8-week female mice with adriamycin nephropathy for 2 weeks, and the urine, blood, and kidney tissues were taken to analyze the therapeutic effect. In addition, we evaluated reproductive toxicity by measuring the levels of gonadal hormones and observing the histological changes in ovaries and testes. Primary mouse podocytes were exposed to puromycin (PAN) to damage the cytoskeleton and induce apoptosis, and then, triptolide was used to evaluate the therapeutic effect and underlying protection mechanisms in vitro. It was observed that minnelide dramatically alleviated proteinuria and apoptosis in mice with adriamycin nephropathy. In vitro, triptolide ameliorated puromycin-induced cytoskeletal rearrangement and apoptosis via reactive oxygen species-mediated mitochondrial pathway. In addition, minnelide caused no reproductive toxicity to male and female mice. The results suggested that minnelide might be a promising drug for nephrotic syndrome.
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Affiliation(s)
- Baowei Ji
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Junchao Liu
- Department of Traditional Chinese Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Yanli Ma
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Ye Yin
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.
| | - Qian Shen
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Jian Yu
- Department of Traditional Chinese Medicine, Children's Hospital of Fudan University, Shanghai, China
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15
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Li J, Wang X, Jiang S, Li W. Serum PLA2R antibody as a predictive biomarker for venous thromboembolism risk in primary membranous nephropathy. Med Clin (Barc) 2023; 161:417-421. [PMID: 37532619 DOI: 10.1016/j.medcli.2023.06.007] [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: 03/21/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Patients with nephrotic syndrome are at high risk of venous thromboembolism (VTE), especially for primary membranous nephropathy (PMN). The phospholipase A2 receptor (PLA2R) is a marker of primary membranous nephropathy activity. This study investigated the predictive value of PLA2R antibodies in PMN for VTE. METHODS In this retrospective study, we included 97 PMN patients and evaluated the predictive value of serum PLA2R antibodies for VTE risk. Lower extremity venous ultrasound, renal vein ultrasound, or spiral computed tomography pulmonary arteriography were used to assess VTE events. Serum anti-PLA2R antibodies were detected by enzyme-linked immunosorbent assay (ELISA). The risk of VTE was stratified according to serum albumin levels. RESULTS Twenty PMN patients (21%) had thromboembolic events. Eight (15%) of patients with serum albumin >25g/l developed VTE, 6 of whom were positive for serum PLA2R antibodies. Positive serum PLA2R antibodies were significantly associated with VTE events in patients with serum albumin >25g/l (p=0.01). Age, sex, blood creatinine, serum albumin, and 24-h urine protein levels were not statistically different between the two groups. Kaplan-Meier analysis using the log-rank test revealed anti-PLA2R positive membranous nephropathy patients had more probability of VTE events than anti-PLA2R negative patients. Univariate Cox proportional hazards analysis revealed that lnPLA2R-Ab is an unfavorable predictor for VTE events in patients with serum albumin >25g/l (hazard ratio (HR) 2.1, p=0.01). CONCLUSIONS The PLA2R antibody was a risk predictor for thromboembolic events in patients with primary membranous nephropathy with serum albumin >25g/l.
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Affiliation(s)
- Jiayi Li
- Department of Nephrology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Xu Wang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Shimin Jiang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Wenge Li
- Department of Nephrology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.
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16
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Wan Y, Wang S, Chen K, Liu L, Wang X, Zhang B, Hu L, Liu S, Zhao T, Qi H. High-sulfated derivative of polysaccharide from Ulva pertusa improves Adriamycin-induced nephrotic syndrome by suppressing oxidative stress. Food Funct 2023; 14:9167-9180. [PMID: 37721012 DOI: 10.1039/d3fo01290e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Nephrotic syndrome (NS) is characterized by proteinuria, hyperlipidemia, and hypoalbuminemia. Ulva pertusa, a green seaweed, is a nutritional supplement. In this study, the high-sulfated derivative of Ulva pertusa polysaccharide (HU) was prepared by combining U pertusa polysaccharide with chlorosulfonic acid. The NS rat model was established by tail vein single injection of Adriamycin (6.0 mg kg-1). Normal rats were used as the control group. NS rat models were treated with HU or U (173 mg kg-1 day-1). After treatment for 6 weeks, we assessed urine protein, renal function, and blood lipids, and observed morphology and histologic injury of the kidney and glomerular microstructure. Furthermore, we detected antioxidant enzyme activity and expression level of the Keap1/Nrf2 signaling pathway to explore the potential mechanism of HU. Results showed that HU not only alleviated hyperlipidemia and hypoalbuminemia, but also reduced urine protein by inhibiting podocyte detachment, thickening of the glomerular basement membrane, and expression of kidney fibrosis markers (collagens I and IV). In addition, HU enhanced antioxidant enzyme activity (GSH-Px, CAT, SOD) in both serum and the kidney, which may be due to upregulating the expression of Nrf2 and downregulating the expression of Keap1. In conclusion, HU appears to be effective in attenuating NS in rats through suppressing oxidative stress by regulating the Keap1/Nrf2 signaling pathway.
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Affiliation(s)
- Yuzhou Wan
- College of Pharmacy, Weifang Medical University, No. 7166 Baotong Road, Weifang 261053, PR China.
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, PR China.
| | - Shaopeng Wang
- College of Pharmacy, Weifang Medical University, No. 7166 Baotong Road, Weifang 261053, PR China.
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, PR China.
| | - Kexu Chen
- College of Pharmacy, Weifang Medical University, No. 7166 Baotong Road, Weifang 261053, PR China.
| | - Lin Liu
- College of Pharmacy, Weifang Medical University, No. 7166 Baotong Road, Weifang 261053, PR China.
| | - Xiaoqian Wang
- Department of Pharmacy, Dezhou People's Hospital, No. 1166 Dongfanghong West Road, Dezhou 253000, PR China.
| | - Bo Zhang
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, PR China.
| | - Lin Hu
- National Energy R&D Center for Biorefinery, Beijing University of Chemical Technology, Beijing 100029, PR China.
| | - Shunmei Liu
- College of Pharmacy, Weifang Medical University, No. 7166 Baotong Road, Weifang 261053, PR China.
| | - Tingting Zhao
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, PR China.
| | - Huimin Qi
- College of Pharmacy, Weifang Medical University, No. 7166 Baotong Road, Weifang 261053, PR China.
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Ferjani M, Zaimi Y, Trad N, Hammi Y, Ayari M, Ayadi S, Sayari T, Gargah T. Mesenteric Arterial Thrombosis Revealing Relapse of Nephrotic Syndrome in Young Women. Int Med Case Rep J 2023; 16:633-639. [PMID: 37794997 PMCID: PMC10546993 DOI: 10.2147/imcrj.s401983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Nephrotic syndrome (NS) is associated with a hypercoagulable state and may be complicated by thrombotic events. Venous thrombosis is well-acknowledged, while arterial thrombosis is rather unusual. Case Presentation We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours. Conclusion Mesenteric arterial thrombosis, which is a rare but life-threatening NS complication, should always be considered, especially in the case of acute non-specific digestive symptoms.
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Affiliation(s)
- Maryem Ferjani
- Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Yosra Zaimi
- Department of Gastroenterology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Nouha Trad
- Department of Gastroenterology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Yousra Hammi
- Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Myriam Ayari
- Department of Gastroenterology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Shema Ayadi
- Department of Gastroenterology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Taha Sayari
- Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia
| | - Tahar Gargah
- Department of Pediatrics, Charles Nicolle Hospital, Tunis, Tunisia
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Long H, Wu Z. Immunoregulatory effects of Huaier (Trametes robiniophila Murr) and relevant clinical applications. Front Immunol 2023; 14:1147098. [PMID: 37449208 PMCID: PMC10337589 DOI: 10.3389/fimmu.2023.1147098] [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: 01/18/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Huaier (Trametes robiniophila Murr) is a medicinal fungus of traditional Chinese medicine with more than 1000 years of history of clinical application. Its remarkable anticancer activities has led to its application in treating diverse malignancies. In recent years, the immunomodulatory effects of Huaier have been uncovered and proved to be beneficial in a plethora of immune-related diseases including cancer, nephropathy, asthma, etc. In this review, we comprehensively summarized the active components of Huaier, its regulatory activities on multifaceted aspects of the immune system, its application in various clinical settings as well as toxicologic evidence. Based on currently available literature, Huaier possesses broad-spectrum regulatory activities on various components of the innate and adaptive immune system, including macrophages, dendritic cells, natural killer cells, T and B lymphocytes, etc. Versatile immunologic reactions are under the regulation of Huaier from expression of damage-associated molecular patterns, immune cell activation and maturation to cell proliferation, differentiation, antibody production, expression of cytokines and chemokines and terminal intracellular signal transduction. Moreover, some modulatory activities of Huaier might be context-dependent, typically promoting the restoration toward normal physiological status. With excellent efficacy and minimal side effects, we foresee more extensive application of Huaier for treating immune-related disorders.
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Affiliation(s)
- Hongrong Long
- Department of cardiac function, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhongcai Wu
- Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wen F, Liu J, Dai R, Hong S, Ji B, Liu J, Zhang J, Han X, Lv Q, Liu J, Shen Q, Xu H. Angiopoietin-like protein 3: a novel potential biomarker for nephrotic syndrome in children. Front Pediatr 2023; 11:1113484. [PMID: 37266537 PMCID: PMC10229790 DOI: 10.3389/fped.2023.1113484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
Background Angiopoietin-like 3 (ANGPTL3) is a secretory glycoprotein. It has been demonstrated that ANGPTL3 level was upregulated in minimal change nephrotic syndrome (MCNS) kidney tissues. Subsequently, our group found that ANGPTL3 level was closely correlated with nephropathy in vivo and in vitro. Hence, whether ANGPTL3 level could be correlated with the proteinuria level, and assessment of disease severity of nephrotic syndrome (NS) remained to be investigated. This study aimed to analyzed the correlation between the levels of ANGPTL3 in serum and urine of patients with nephrotic syndrome and proteinuria, and assessed the severity of the patients' disease. In future clinical translation, the level of ANGPTL3 in serum, urine will be used as a biomarker to better predict the development of nephrotic syndrome. Methods A total of 200 NS patients and 80 healthy controls (age, 1-18 years) were admitted to our institution between 2021 and 2022. The etiology of NS included primary nephrotic syndrome (PNS, n = 144) and NS with other causes (n = 56). A total of 280 serum samples and 244 urinary samples were collected to determine ANGPTL3 level using enzyme-linked immunosorbent assay (ELISA). Results Serum ANGPTL3 and urinary ANGPTL3/Cre were remarkably elevated in NS patients compared with those in healthy controls. Furthermore, serum ANGPTL3 and urinary ANGPTL3/Cre were significantly correlated with proteinuria level. Additionally, multivariate linear regression analysis demonstrated that serum ALB was independently correlated with serum ANGPTL3 and PRO/CR was independently correlated with urinary ANGPTL3/Cre in NS patients. Conclusion Serum ANGPTL3 and urinary ANGPTL3/Cre showed a promising performance in the diagnosis of NS, and served as novel potential noninvasive biomarkers to assess disease severity of NS. Further exploration of the role of ANGPTL3 level may shed a new light on the treatment of NS.
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Affiliation(s)
- Fujie Wen
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Junchao Liu
- Department of Traditional Chinese Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Rufeng Dai
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Sha Hong
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Baowei Ji
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Jiaojiao Liu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Jun Zhang
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Xinli Han
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Qianying Lv
- Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Jialu Liu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Qian Shen
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
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Leventoğlu E, Kavgacı A, İncedere F, Tokgöz S, Büyükkaragöz B. Arterial Stiffness and Cardiac Functions in Children with Idiopathic Nephrotic Syndrome. Indian J Pediatr 2023; 90:413. [PMID: 36757653 DOI: 10.1007/s12098-023-04500-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Emre Leventoğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Akif Kavgacı
- Department of Pediatric Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fatma İncedere
- Department of Pediatric Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Semiha Tokgöz
- Department of Pediatric Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Hunley TE, Hidalgo G, Ng KH, Shirai Y, Miura K, Beng HM, Wu Q, Hattori M, Smoyer WE. Pioglitazone enhances proteinuria reduction in complicated pediatric nephrotic syndrome. Pediatr Nephrol 2023; 38:1127-1138. [PMID: 35969278 DOI: 10.1007/s00467-022-05637-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nephrotic syndrome (NS) is a common pediatric kidney disease, yet current treatments for complicated NS are only partially effective and have significant toxicity. There is no Food and Drug Administration (FDA)- or European Medicines Agency (EMA)-approved safe and effective treatment for NS. Thiazolidinediones (TZDs) have been shown to reduce proteinuria in both diabetic and non-diabetic kidney disease and in preclinical studies to directly protect podocytes from injury and reduce proteinuria. Here, we report on the potential utility of the addition of the TZD pioglitazone (PIO) to enhance proteinuria reduction in 8 children and young adults with steroid dependent NS and steroid resistant NS. METHODS Clinical data were analyzed in comparable time periods before and after the addition of PIO to their medical regimens. Eight NS patients with minimal change NS (n = 2), focal segmental glomerulosclerosis (FSGS) (n = 4), or collapsing FSGS (n = 2) were evaluated. RESULTS Prior to PIO initiation, all children and young adults had already received multiple immunosuppressive medications (mean = 3.75). Five of eight patients (63%; "Responders") had notable proteinuria reduction within 1 month of PIO initiation (62% reduction; P = 0.04) and normalization within 6 months (97% reduction; P = 0.04). PIO-related benefits among the responders included notable increases in serum albumin (2.5 to 3.7 g/dl; P = 0.08), dramatic reductions in hospitalizations for IV albumin infusions and diuresis (11 to 0; P < 0.01), and considerable reduction in total immunosuppression (43% reduction; P > 0.1). Importantly, no patients experienced any adverse events attributable to PIO during a total of 136 patient-months of treatment. CONCLUSIONS While confirmatory safety and efficacy studies are needed, these findings suggest pioglitazone (a non-immunosuppressive drug) may be useful to enhance proteinuria reduction in some children and young adults with complicated NS. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Tracy E Hunley
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Guillermo Hidalgo
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- K. Hovnanian Children's Hospital, HMH School of Medicine, Neptune, NJ, USA
| | - Kar Hui Ng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Yoko Shirai
- Tokyo Women's Medical University, Tokyo, Japan
| | | | - Hostensia M Beng
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Qiang Wu
- East Carolina University, Greenville, NC, USA
| | | | - William E Smoyer
- Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Lin L, Li L, Cao Y, Peng X, Wu Y, Yu P, Dong L. The expression of respiratory tract virus in pediatric glomerular disease: a retrospective study of 45 renal biopsy in China. BMC Nephrol 2023; 24:36. [PMID: 36792980 PMCID: PMC9931563 DOI: 10.1186/s12882-023-03083-8] [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: 03/23/2022] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND More attention has been put on the relationship between pediatric glomerular disease and respiratory tract virus infection. Children with glomerular illness, however, are uncommonly found to have biopsy-proven pathological evidence of viral infection. The purpose of this study is to determine whether and what kind of respiratory viruses are found in renal biopsy from glomerular disorders. METHODS We used a multiplex PCR to identify a wide range of respiratory tract viruses in the renal biopsy samples (n = 45) from children with glomerular disorders and a specific PCR to verify their expression. RESULTS These case series included 45 of 47 renal biopsy specimens, with 37.8% of male and 62.2% of female patients. Indications for a kidney biopsy were present in all of the individuals. In 80% of the samples, respiratory syncytial virus was discovered. Following that, the RSV subtypes in several pediatric renal disorders were found. There were 16 RSVA positives, 5 RSVB positives, and 15 RSVA/B positives, accounting for 44.4%, 13.9%, and 41.7%, respectively. Nephrotic syndrome samples made up 62.5% of RSVA positive specimens. The RSVA/B-positive was detected in all pathological histological types. CONCLUSIONS Patients with glomerular disease exhibit respiratory tract viral expression in the renal tissues, especially respiratory syncytial virus. This research offers new information on the detection of respiratory tract viruses in renal tissue, which may facilitate the identification and treatment of pediatric glomerular diseases.
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Affiliation(s)
- Li Lin
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Lu Li
- grid.13291.380000 0001 0807 1581National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 17, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Yao Cao
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Xin Peng
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Yi Wu
- grid.461863.e0000 0004 1757 9397Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041 Sichuan Province China
| | - Ping Yu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 17, Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China.
| | - LiQun Dong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China.
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Lv J, Xue G, Zhang Y, Wang X, Dai E. Icariin synergizes therapeutic effect of dexamethasone on adriamycin-induced nephrotic syndrome. Eur J Med Res 2023; 28:52. [PMID: 36707848 PMCID: PMC9881371 DOI: 10.1186/s40001-022-00973-9] [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: 04/08/2021] [Accepted: 12/28/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Glomerular damage is a common clinical indicator of nephrotic syndrome. High-dose hormone treatment often leads to hormone resistance in patients. How to avoid resistance and improve the efficiency of hormone therapy draws much attention to clinicians. METHODS Adriamycin (ADR) was used to induce nephropathy model in SD rats. The rats were treated with dexamethasone (DEX), icariin (ICA), and DEX + ICA combination therapy. The changes in urinary protein (UP), urea nitrogen (BUN), and serum creatinine (SCR) contents in rats were detected by enzyme-linked immunosorbent assay (ELISA), and the degree of pathological injury and the expression level of podocin were detected by HE staining and immunohistochemistry, to test the success of the model and the therapeutic effects of three different ways. The effect of treatments on podocytes autophagy was evaluated via transfection of mRFP-GFP-LC3 tandem adenovirus in vitro. RESULTS The contents of UP, SCR, and BUN were significantly increased, the glomerulus was seriously damaged, and the expression of Nephrosis2 (NPHS2) was significantly decreased in the ADR-induced nephrotic syndrome rat model compared to that of the control group. DEX, ICA, and the DEX + ICA combined treatment significantly alleviated these above changes induced by ADR. The combined treatment of DEX + ICA exhibited better outcome than single treatment. The combined treatment also restored the podocyte autophagy, increased the expression of microtubule-associated protein light-chain 3II (LC3II), and reduced the expression of p62 in vitro. The combined treatment protects podocytes by mediating the PI3K/AKT/mTOR (rapamycin complex) signaling pathway. CONCLUSION ICA enhances the therapeutic effect of DEX on the nephrotic syndrome.
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Affiliation(s)
- Juan Lv
- grid.418117.a0000 0004 1797 6990Department of Integrated Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000 Gansu China ,grid.469592.50000 0004 9339 6752Department of Neurology, Gansu Provincial Hospital of TCM, Lanzhou, Gansu China
| | - Guozhong Xue
- grid.418117.a0000 0004 1797 6990Department of Nephrology, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu China
| | - Yunxia Zhang
- grid.469592.50000 0004 9339 6752Department of Neurology, Gansu Provincial Hospital of TCM, Lanzhou, Gansu China
| | - Xinbin Wang
- grid.418117.a0000 0004 1797 6990Department of Integrated Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000 Gansu China
| | - Enlai Dai
- grid.418117.a0000 0004 1797 6990Department of Integrated Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000 Gansu China
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24
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Deng Y, Ou YY, Mo CJ, Huang L, Qin X, Li S. Peripheral blood lymphocyte subsets in children with nephrotic syndrome: a retrospective analysis. BMC Nephrol 2023; 24:7. [PMID: 36627573 PMCID: PMC9830737 DOI: 10.1186/s12882-022-03015-y] [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: 08/07/2022] [Accepted: 11/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) in children is widely believed to be associated with severe changes in the immune system. Based on lymphocyte subset analysis, we examined the pathogenesis of immune deficiencies in children with NS with varying steroid sensitivity. METHODS Our study utilized flow cytometry to retrospectively analyze the ratios of lymphocyte subsets in 204 children with nephrotic syndrome and 19 healthy children. RESULTS Compared with healthy children, the ratio of CD4 + /CD8 + in onset and remission was decreased in SRNS group (p < 0.05), and CD19 + B lymphocytes were increased in onset (p < 0.05). Compared with onset, the proportion of CD19 + B lymphocytes decreased in SRNS, while the proportion of CD19 + B lymphocytes increased in SDNS, p < (0.01). The ratio of CD8 + T/CD19 + B in onset in SDNS group was significantly higher than that in SSNS and SRNS groups (p < 0.01) and healthy control group (p < 0.05). Compared with onset, the ratio of CD8 + T/CD19 + B in SDNS group decreased significantly (p < 0.01), while the ratio of CD8 + T/CD19 + B in SRNS group increased significantly (p < 0.01). The proportion of CD56 + CD16 + NK cells was significantly reduced in children with INS (p < 0.01). CONCLUSION CD8 + T lymphocytes may be involved in the mechanism of lymphocyte subsets disorder during onset of SDNS, while CD19 + B lymphocytes may be involved in the mechanism of lymphocyte subsets disorder during relapse of SDNS. The CD8 + T/CD19 + B ratio may predict the degree of frequent recurrence. There is a certain degree of lymphoid subsets disorder in children with NS.
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Affiliation(s)
- Yan Deng
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Ying-ying Ou
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Cui-Ju Mo
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Li Huang
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Xue Qin
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Shan Li
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
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Metabolomic Analysis of Stephania tetrandra- Astragalus membranaceus Herbal Pair-Improving Nephrotic Syndrome Identifies Activation of IL-13/STAT6 Signaling Pathway. Pharmaceuticals (Basel) 2023; 16:ph16010088. [PMID: 36678585 PMCID: PMC9863900 DOI: 10.3390/ph16010088] [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: 12/07/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The Stephania tetrandra−Astragalus membranaceus herbal pair (FH) is a classic herbal pair widely used in the treatment of nephrotic syndrome (NS). The effects of Stephania tetrandra (FJ) and Astragalus membranaceus (HQ) on NS have been reported, but the mechanism of their combination on the improvement of NS are still unclear. The NS model was established by injecting adriamycin into the tail vein. FH intervention reduced the levels of serum triglyceride, total cholesterol, interleukin-6 (IL-6), blood urea nitrogen (BUN), urinary protein, and the gene expression levels of aquaporin 2 (AQP2) and arginine vasopressin (AVP) in NS rats. In addition, FH improved kidney injury in NS rats by inhibiting the expression of interleukin 13 (IL-13), phospho-signal transducers, and activators of transcription 6 (p-STAT6), Bax, cleaved-caspase3, while promoting the expression of Bcl-2. By comprehensive comparison of multiple indexes, the effects of FH on lipid metabolism, glomerular filtration rate, and inflammation were superior to that of FJ and HQ. Metabonomic studies showed that, compared with FJ and HQ, FH intervention significantly regulated tricarboxylic acid (TCA) cycle, cysteine and methionine metabolism, and alanine, aspartic acid and glutamic acid metabolism. Pearson correlation analysis showed that succinic acid and L-aspartic acid were negatively correlated with urinary protein, cystatin C (Cys C) and BUN (p < 0.05). In summary, FH could reduce renal injury and improve NS through inhibiting the IL-13/STAT6 signal pathway, regulating endogenous metabolic pathways, such as TCA cycle, and inhibiting the expression of AQP2 and AVP genes. This study provides a comprehensive strategy to reveal the mechanism of FH on the treatment of NS, and also provides a reasonable way to clarify the compatibility of traditional Chinese medicine.
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26
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Shi J, Li W, Tao R, Zhou D, Guo Y, Fu H, Sun A, Zhang J, Mao J. Association of Catalase Gene Polymorphisms with Idiopathic Nephrotic Syndrome in a Chinese Pediatric Population. Lab Med 2023; 54:35-40. [PMID: 35964233 DOI: 10.1093/labmed/lmac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Our aim was to investigate the association between gene polymorphisms in catalase (CAT), a well-known oxidative stress regulator, and susceptibility to idiopathic nephrotic syndrome (INS) or responses to steroid therapy in a Chinese pediatric population. METHODS We analyzed 3 CAT single-nucleotide polymorphisms (SNVs; rs7943316, rs769217, and rs12270780) using multi-polymerase chain reaction combined with next-generation sequencing in 183 INS patients and 100 healthy controls. RESULTS For the allele and genotype frequencies of the CAT SNVs, no significant differences were observed between INS patients and controls. Patients with C allele of CAT rs769217 had a higher risk of developing steroid-dependent nephrotic syndrome than the steroid-sensitive nephrotic syndrome patients (P = 0.018; odds ratio = 1.76). CONCLUSION Our data suggests that genetic variations in CAT were unlikely to confer susceptibility to INS in Chinese children, whereas the C allele of the CAT rs769217 polymorphism showed a strong association with steroid-dependent responses in Chinese INS children.
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Affiliation(s)
- Jianrong Shi
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Wei Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Ran Tao
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Dongming Zhou
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Yajun Guo
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Haidong Fu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Anna Sun
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Junfeng Zhang
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Jianhua Mao
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
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Liu L, Zheng W, Wang P, Wu Y, Zhu G, Yang R, Gu L, Huang W, Kang Y. Case Report: Successful treatment of severe pneumocystis carinii pneumonia in a case series of primary nephrotic syndrome after receiving anti-CD20 monoclonal antibody therapy. Front Pediatr 2023; 10:1067634. [PMID: 36683820 PMCID: PMC9845562 DOI: 10.3389/fped.2022.1067634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023] Open
Abstract
Rituximab is emerging as a new steroid sparing agent in children with difficult-to-treat nephrotic syndrome due to its ability of depleting CD20-positive B cells. Life-threatening adverse events such as pneumocystis carinii pneumonia may occur even though it seems to be well tolerated. Since rituximab is wildly used in immune-mediated diseases, it is important to manage its severe adverse events. To explore the importance of early diagnosis and treatment of pneumocystis carinii pneumonia in children with primary nephrotic syndrome (PNS) after receiving rituximab therapy, we retrospectively analyzed the clinical data of PNS patients younger than 18 years old with pneumocystis carinii pneumonia who were hospitalized in our center. Clinical features and laboratory test results were retrieved from the electronic medical records. Severe pneumocystis carinii pneumonia occurred in one child with steroid resistant nephrotic syndrome and two with steroid dependent nephrotic syndrome patients after rituximab treatment. These patients were diagnosed in time by metagenomic next-generation sequencing (mNGS) for pathogen detection. Fortunately, all three patients survived after antifungal treatment and achieved complete remission eventually. In conclusion, early diagnosis by using mNGS and timely antifungal treatment is the key to successful management of pneumocystis carinii pneumonia in children with difficult-to-treat PNS.
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Affiliation(s)
- Lili Liu
- Department of Nephrology and Rheumatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weihua Zheng
- Department of Nephrology and Rheumatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Wang
- Department of Nephrology and Rheumatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wu
- Department of Nephrology and Rheumatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanghua Zhu
- Department of Nephrology and Rheumatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Yang
- Department of Pediatrics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Gu
- Department of Pediatrics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenyan Huang
- Department of Nephrology and Rheumatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yulin Kang
- Department of Nephrology and Rheumatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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28
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Liu C, Liu L, Huang Y, Shi R, Wu Y, Hakimah Binti Ismail I. Contribution of IL-33/ILC2-mediated Th2 cytokines during the progression of minimal change disease. Int Immunopharmacol 2023; 114:109493. [PMID: 36527879 DOI: 10.1016/j.intimp.2022.109493] [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: 09/21/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Minimal change disease (MCD) is a common type of nephrotic syndrome with high recurrence rate. This study aims to explore the impacts of interleukin (IL)-33 in MCD and to discuss its potential mechanism. In adriamycin (ADM) and puromycin aminonucleoside (PAN)-induced MCD rat model, IL-33 was used for treatment. H&E staining was applied for detecting histological changes. Critical proteins were examined by western blot. Corresponding commercial kits tested oxidative stress- and inflammation-related factors. Cell apoptosis was measured by TUNEL assay. ADM-induced podocyte injury model was establish to mimic MCD in vitro. Cell proliferation and apoptosis were detected by CCK-8 and TUNEL assays. Finally, podocyte was stimulated by innate lymphoid type-2 cells-secreted Th2 cytokines (ILC2s: IL-13 and IL-5 respectively), with or without incubation with M1 macrophage medium to further explore the immune-regulation of ILC2s behind the inflammatory environment of MCD. It was found that PAN-induced kidney jury, inflammation, oxidative stress and apoptosis were severer than ADM, and IL-33 treatment significantly alleviated the above injuries in PAN and ADM-induced MCD rat model. Moreover, IL-33 reversed the reduced viability and increased oxidative stress and apoptosis in ADM-induced podocyte injury model. Further, the capacities of IL-13 alone in inducing M1/M2 macrophage polarization, apoptosis, inflammation, kidney injury and reducing cell viability are stronger than IL-5. However, IL-13 reversed reduced cell viability and stimulated apoptosis, inflammation, kidney injury mediated by co-incubation with M1-conditioned medium. Collectively, IL-33 might protect against immunologic injury in MCD via mediating ILC2s-secreted IL-13.
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Affiliation(s)
- Cui Liu
- Department of Pediatrics, Xi'an International Medical Center Hospital, Xi'an, Shaanxi 710100, China
| | - Li Liu
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yanping Huang
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Ruiming Shi
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yue Wu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Intan Hakimah Binti Ismail
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
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29
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Teplan V. Multimorbidity in nephrotic syndrome. VNITRNI LEKARSTVI 2023; 69:156-165. [PMID: 37468310 DOI: 10.36290/vnl.2023.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Nephrotic syndrome (NS) is characterized by high proteinuria (over 3,5g/24 hrs), hypalbuminaemia, general edemas and hypercoagulation. Beside of primary glomerulonephritides this is found in secundary glomerulopaties eg. diabetes, systemic inflammatory diseases, oncology, damage by drugs and poisoning, by alergy, serious infections and in children from hereditary reasons. The most frequent reason for NS in adults patiens is diabetes and diabetes with nephropathy represents almost 40% of dialysed patiens. From this point of view, there is great interest focusing on gliflozins (SGLT2 inhibitors) with positive nephroprotecive effect. It leads do increasing of glycosuria with concomitant natriuresis and osmotic diuresis. The effect is proportional to glomerulal filtration, but the effect on natriuresis stay in all stages of renal insufficiency.
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30
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Beaudoin L, Puyol I, Robledo NL, Balestracci A. A 16-month-old boy with nephrotic syndrome of apparent idiopathic origin: Answer. Pediatr Nephrol 2023; 38:107-111. [PMID: 35695961 DOI: 10.1007/s00467-022-05607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Laura Beaudoin
- Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Buenos Aires, Argentina.
| | - Iris Puyol
- Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Buenos Aires, Argentina
| | - Natalia Luján Robledo
- Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Buenos Aires, Argentina
| | - Alejandro Balestracci
- Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Buenos Aires, Argentina
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Wang J, Luo J, Du L, Shu X, Guo C, Li T. Nuclear paraspeckle assembly transcript 1 promotes the podocyte injury via targeting miR-23b-3p/B-cell lymphoma-2 interacting protein 3 like axis. Ren Fail 2022; 44:1961-1975. [DOI: 10.1080/0886022x.2022.2091998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jing Wang
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Junpeng Luo
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Guangzhou, China
| | - Li Du
- The Institute of Radiation Medicine, The Academy of Military Medical Science, Beijing, China
| | - Xin Shu
- Department of Dermatology, Third Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Chengyu Guo
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tanshi Li
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
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Forero-Delgadillo J, Ochoa V, Restrepo JM, Torres-Canchala L, Nieto-Aristizábal I, Ruiz-Ordoñez I, Sánchez A, Barrera MC, Jimenez CA, Tobón GJ. B-cell activating factor (BAFF) and its receptors' expression in pediatric nephrotic syndrome is associated with worse prognosis. PLoS One 2022; 17:e0277800. [PMID: 36399480 PMCID: PMC9674176 DOI: 10.1371/journal.pone.0277800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
AIM Immune pathogenesis of nephrotic syndrome (NS) is not completely understood. We aimed to evaluate the expression of B-cell activating factor (BAFF) and its receptors in renal samples from pediatric NS patients and its relationship with renal function survival. MATERIALS AND METHODS We conducted an ambispective study on 33 patients with pediatric NS. Immunohistochemistry for BAFF, TACI, BCMA and BR3 was performed. Markers were evaluated on podocytes and interstitial inflammatory infiltrates (III). We performed Kaplan-Meier curves to describe renal function survival according to markers' expression. RESULTS Thirty-three NS patients were included. Minimal change disease was seen in 21 (63.6%) patients, and focal segmental glomerulosclerosis in 12 (36.4%). BAFF was found in podocytes (18.2% of samples) and III (36.4% of samples), BAFF-R in one sample, TACI in 4 (podocytes and III), and BCMA in 5 samples of podocytes and 7 of III. BAFF on podocytes and III was associated with worst renal function at follow-up; those patients had 25% probability of having GFR >90 mL/min/1.73m2, versus 84.9% when absent (p = 0.0067). Patients with BAFF in III had 42.9% probability of having GFR>90 mL/min/1.73 m2, versus 94.1% when absent (p = 0.0063). CONCLUSION BAFF expression in renal biopsies could be a prognostic factor for renal function.
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Affiliation(s)
| | - Vanessa Ochoa
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Jaime M Restrepo
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Servicio de Nefrología Pediátrica, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Ingrid Ruiz-Ordoñez
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Aura Sánchez
- Servicio de Patología, Fundación Valle del Lili, Cali, Colombia
| | - María Claudia Barrera
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
| | | | - Gabriel J Tobón
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Laboratorio de Inmunología, Fundación Valle del Lili, Cali, Colombia
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Guernsey D, Arun A, Agha R, Kupferman JC. Streptococcus pneumoniae meningitis in a child with idiopathic nephrotic syndrome: a case report. J Med Case Rep 2022; 16:403. [PMID: 36336675 PMCID: PMC9639306 DOI: 10.1186/s13256-022-03648-5] [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: 03/25/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Children with nephrotic syndrome are at increased risk of infections, including bacterial peritonitis, pneumonia, and cellulitis. However, bacterial meningitis, a potentially life-threatening complication, has not been highlighted as an infectious complication of nephrotic syndrome in recent reviews. We report a very subtle and unusual presentation of bacterial meningitis in a child with nephrotic syndrome, which without a high index of suspicion, would have been missed. CASE PRESENTATION A 9-year-old African-American male with a history of steroid-dependent nephrotic syndrome presented to the nephrology clinic for routine follow-up. His medications included mycophenolate mofetil and alternate-day steroids. His only complaint was neck pain and stiffness that the mother attributed to muscle tightness relieved by massage. There was no history of fever, vomiting, headache, photophobia, or altered mental status. On physical examination, he was afebrile (99 °F), but had mild periorbital swelling and edema on lower extremities. He appeared ill and exhibited neck rigidity, and demonstrated reflex knee flexion when the neck was bent. Laboratory evaluation revealed leukocytosis, elevated C-reactive protein, hypoalbuminemia, and proteinuria. Cerebrospinal fluid suggested bacterial meningitis. The patient was treated with ceftriaxone and vancomycin. Both cerebrospinal and blood cultures grew Streptococcus pneumoniae; vancomycin was discontinued. The child completed a 2-week course of ceftriaxone and was discharged home. CONCLUSIONS A high index of suspicion is necessary in children with nephrotic syndrome treated with corticosteroids, as symptoms may be masked, and thus, a life-threatening disease be missed. Bacterial meningitis should be highlighted as a serious infection complication in children with nephrotic syndrome.
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Affiliation(s)
- David Guernsey
- grid.416306.60000 0001 0679 2430Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY 11219 USA
| | - Aparna Arun
- grid.416306.60000 0001 0679 2430Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY 11219 USA
| | - Rabia Agha
- grid.416306.60000 0001 0679 2430Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY 11219 USA
| | - Juan C. Kupferman
- grid.416306.60000 0001 0679 2430Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY 11219 USA
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Mantan M, Kansal A, Swarnim S. Effectiveness of a Low Dose Prednisolone Regimen for Treatment of Relapses in Children with Steroid Sensitive Nephrotic Syndrome. Indian J Nephrol 2022; 32:588-594. [PMID: 36704589 PMCID: PMC9872916 DOI: 10.4103/ijn.ijn_463_21] [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: 11/05/2021] [Revised: 01/06/2022] [Accepted: 03/25/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction There may be a role of reducing the total steroid doses for the treatment of relapses of nephrotic syndrome in children with milder and more stable disease. The primary objective of this study was to compare the effectiveness of a low-dose prednisolone regimen with standard therapy for the treatment of relapses in steroid-sensitive nephrotic syndrome (SSNS) at the end of treatment, the secondary objectives being time to remission and sustained remission after 3 months. Methods This randomized controlled trial included a total of 40 children (20 in each group) with SSNS (presently infrequently relapsing course) and with a relapse. Both groups received prednisolone at a dose of 2 mg/kg/day until remission; subsequently, the patients in the study group received 1 mg/kg, and the control group participants received 1.5 mg/kg prednisolone on alternate days for 4 weeks. The patients were followed up till 3 months after stopping the therapy. Results The median (IQR) age of children enrolled was 7.5 (range: 5-9.65) years, and the age at onset of nephrotic syndrome was 4 (range: 2.3-5.5) years. The median time to achieve remission was 9 days (comparable in low dose vs. standard therapy group; P = 0.14). All patients were in remission at the end of therapy; 85% of patients were in the low-dose group and 90% in the standard therapy group after 1 month (P = 0.32). At the end of 3 months, 60% continued to be in remission in the low-dose group and 65% with standard therapy (P = 0.37). Hazard ratios for relapse at the end of 1, 2, and 3 months were 1.05, 1.08, and 1.13, respectively. Patients who were infrequently relapsing (79%) from the onset of nephrotic syndrome had higher remission rates at the end of 3 months (80% in the low-dose group vs. 76.9% in the standard therapy group). Hazard ratios for relapse in these patients at the end of 1, 2, and 3 months were 1.01, 1.03, and 1.08, respectively. Conclusions Lower doses of prednisolone can be used for the treatment of relapse of steroid sensitive nephrotic syndrome, with an infrequently relapsing course.
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Affiliation(s)
- Mukta Mantan
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, University of Delhi, New Delhi, India
| | - Aparajita Kansal
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, University of Delhi, New Delhi, India
| | - Swarnim Swarnim
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, University of Delhi, New Delhi, India
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Metabolomics Profiling of Nephrotic Syndrome towards Biomarker Discovery. Int J Mol Sci 2022; 23:ijms232012614. [PMID: 36293474 PMCID: PMC9603939 DOI: 10.3390/ijms232012614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Nephrotic syndrome (NS) is a kidney illness characterized by excessive proteinuria, hypoalbuminemia, edema, and hyperlipidemia, which may lead to kidney failure and necessitate renal transplantation. End-stage renal disease, cardiovascular issues, and mortality are much more common in those with NS. Therefore, the present study aimed to identify potential new biomarkers associated with the pathogenesis and diagnosis of NS. The liquid chromatography–mass spectrometry (LC–MS) metabolomics approach was applied to profile the metabolome of human serum of patients with NS. A total of 176 metabolites were significantly altered in NS compared to the control. Arginine, proline, and tryptophan metabolism; arginine, phenylalanine, tyrosine, and tryptophan biosynthesis were the most common metabolic pathways dysregulated in NS. Furthermore, alanyl-lysine and isoleucyl-threonine had the highest discrimination between NS and healthy groups. The candidate biomarkers may lead to understanding the possible metabolic alterations associated with NS and serve as potential diagnostic biomarkers.
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Storrar J, Gill-Taylor T, Chinnadurai R, Chrysochou C, Poulikakos D, Rainone F, Ritchie J, Lamerton E, Kalra PA, Sinha S. A low rate of end-stage kidney disease in membranous nephropathy: A single centre study over 2 decades. PLoS One 2022; 17:e0276053. [PMID: 36228014 PMCID: PMC9560622 DOI: 10.1371/journal.pone.0276053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Membranous nephropathy is the commonest cause of nephrotic syndrome in non-diabetic Caucasian adults over the age of 40 years. Primary membranous nephropathy is limited to the kidneys. Clinical management aims to induce remission, either spontaneously with supportive care, or with immunosuppression. Here, we describe the natural history of this condition in a large tertiary centre in the UK. METHODS 178 patients with primary membranous nephropathy were identified over 2 decades. We collected data on demographics, baseline laboratory values, treatment received and outcomes including progression to renal replacement therapy and death. Analysis was performed on the whole cohort and specific subgroups. Univariate and multivariate Cox regression was also performed. RESULTS Median age was 58.3 years with 63.5% male. Median baseline creatinine was 90μmol/L and urine protein-creatinine ratio 664g/mol. Remission (partial or complete) was achieved in 134 (75.3%), either spontaneous in 60 (33.7%) or after treatment with immunosuppression in 74 (41.6%), and of these 57 (42.5%) relapsed. Progression to renal replacement therapy was seen in 10.1% (much lower than classically reported) with mortality in 29.8%. Amongst the whole cohort, those who went into remission had improved outcomes compared to those who did not go into remission (less progression to renal replacement therapy [4.5% vs 28%] and death [20.1% vs 67%]. Those classified as high-risk (based on parameters including eGFR, proteinuria, serum albumin, PLA2R antibody level, rate of renal function decline) also had worse outcomes than those at low-risk (mortality seen in 52.6% vs 10.8%, p<0.001). The median follow-up period was 59.5 months. CONCLUSION We provide a comprehensive epidemiologic analysis of primary membranous nephropathy at a large tertiary UK centre. Only 10.1% progressed to renal replacement therapy. For novelty, the KDIGO risk classification was linked to outcomes, highlighting the utility of this classification system for identifying patients most likely to progress.
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Affiliation(s)
- Joshua Storrar
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
- University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Tarra Gill-Taylor
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Rajkumar Chinnadurai
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Constantina Chrysochou
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Dimitrios Poulikakos
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Francesco Rainone
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - James Ritchie
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Elizabeth Lamerton
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Philip A. Kalra
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Smeeta Sinha
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
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Lin L, Hu K. Annexin A2 and Kidney Diseases. Front Cell Dev Biol 2022; 10:974381. [PMID: 36120574 PMCID: PMC9478026 DOI: 10.3389/fcell.2022.974381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Annexin A2 is a Ca2+- and phospholipid-binding protein which is widely expressed in various types of cells and tissues. As a multifunctional molecule, annexin A2 is found to be involved in diverse cell functions and processes, such as cell exocytosis, endocytosis, migration and proliferation. As a receptor of plasminogen and tissue plasminogen activator, annexin A2 promotes plasmin generation and regulates the homeostasis of blood coagulation, fibrinolysis and matrix degradation. As an antigen expressed on cell membranes, annexin A2 initiates local inflammation and damage through binding to auto-antibodies. Annexin A2 also mediates multiple signaling pathways induced by various growth factors and oxidative stress. Aberrant expression of annexin A2 has been found in numerous kidney diseases. Annexin A2 has been shown to act as a co-receptor of integrin CD11b mediating NF-kB-dependent kidney inflammation, which is further amplified through annexin A2/NF-kB-triggered macrophage M2 to M1 phenotypic change. It also modulates podocyte cytoskeleton rearrangement through Cdc42 and Rac1/2/3 Rho pathway causing proteinuria. Thus, annexin A2 is implicated in the pathogenesis and progression of various kidney diseases. In this review, we focus on the current understanding of the role of annexin A2 in kidney diseases.
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Affiliation(s)
- Ling Lin
- *Correspondence: Ling Lin, ; Kebin Hu,
| | - Kebin Hu
- *Correspondence: Ling Lin, ; Kebin Hu,
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Doiron S, Paquette M, Baass A, Bollée G, Cardinal H, Bernard S. Association between circulating PCSK9 and proteinuria in nephrotic syndrome: A cross-sectional study. Clin Biochem 2022; 109-110:51-56. [DOI: 10.1016/j.clinbiochem.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
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Experimental Study on the Mechanism of Cinnamaldehyde Ameliorate Proteinuria Induced by Adriamycin. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9600450. [PMID: 35993052 PMCID: PMC9385347 DOI: 10.1155/2022/9600450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Objective. Cinnamaldehyde (CA) is the main active component of Guizhi (Cinnamomi ramulus) to ameliorate adriamycin- (ADR-) induced proteinuria in rats. However, the underlying mechanism of CA against proteinuria remains unclear. The aim of this study was to investigate the action mechanisms of CA to treat proteinuria. Methods. 13 rats were randomly selected from 78 SD rats as control group, and the other rats were injected with ADR (3 mg/kg/time) twice through tail vein on day 1 and day 8 for modeling. After modeling, the rats were randomly divided into 5 groups as follows: ADR group, ADR+CA low-dose group, ADR+CA middle-dose group, ADR+CA high-dose group and Benazepril group with 13 rats in each group. The urine of SD rats was collected for 24 h, urine protein, creatinine and urea nitrogen were detected, renal index was calculated, and HE staining and western blot were performed. Results. The 24 h urine volume and urine protein, renal function, and renal histopathology got worse significantly in the ADR group. To western blot, CA downregulated the protein expression of ACE and Ang-2 and upregulated the protein expression of ACE2 in RAS signaling pathway. Conclusion. The underlying action mechanism of CA to treat NS might mainly be achieved by regulating RAS signaling pathway.
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Zhao C, Tang J, Li X, Yan Z, Zhao L, Lang W, Yuan C, Zhou C. Beneficial effects of procyanidin B2 on adriamycin-induced nephrotic syndrome mice: the multi-action mechanism for ameliorating glomerular permselectivity injury. Food Funct 2022; 13:8436-8464. [PMID: 35861207 DOI: 10.1039/d1fo03616e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite considerable advances in prevention, diagnosis, and therapy, nephrotic syndrome (NS) remains a significant cause of high morbidity and mortality globally. As a result, there is an urgent need to identify novel effective preventative and therapeutic agents for NS. NS is implicated in glomerular permselectivity injury, which can be attributed to oxidative distress, inflammation, lipid nephrotoxicity, podocyte apoptosis, autophagy dysfunction, and slit diaphragm (SLD) dysfunction. In addition to its well-documented antioxidant potency, procyanidin B2 (PB2) may exhibit pleiotropic effects by targeting various canonical signaling events, such as NF-κB, PPARs, PI3K/Akt, mTOR, and the caspase family. As a result, PB2 may be a promising therapeutic target against NS. To test this hypothesis, we established an Adriamycin (ADR)-induced NS mouse model to evaluate the pleiotropic renoprotective effects of PB2 on NS. Here, we demonstrated that PB2 improves podocyte injury via inhibition of NOX4/ROS and Hsp90/NF-κB to exhibit antioxidant and anti-inflammatory potency, respectively. We also show that PB2 indirectly activates the PI3K/Akt axis by regulating SLD protein levels, resulting in normalized podocyte apoptosis and autophagy function. Further, loss of albumin (ALB) induces lipid nephrotoxicity, which we found to be alleviated by PB2 via activation of PPARα/β-mediated lipid homeostasis and the cholesterol efflux axis. Interestingly, our results also suggested that PB2 reduces electrolyte abnormalities and edema. In addition, PB2 may contribute protective effects against trace element dys-homeostasis, which, through alleviating serum ALB loss, leads to a protective effect on glomerular permselectivity injury. Taken together, our results reveal that the identified mechanisms of PB2 on NS are multifactorial and involve inhibition of oxidative distress and inflammatory responses, as well as improvements in podocyte apoptosis and autophagy dysfunction, amelioration of lipid nephrotoxicity, and modulation of electrolyte abnormalities and edema. Thus, we provide a theoretical basis for the clinical application of PB2 against NS.
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Affiliation(s)
- Chuanping Zhao
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, College of Pharmaceutical Sciences, Institute of Life Science and Green Development, Hebei University, 180 WuSi Road, Lianchi District, Baoding, 071002, China.
| | - Jiamei Tang
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, College of Pharmaceutical Sciences, Institute of Life Science and Green Development, Hebei University, 180 WuSi Road, Lianchi District, Baoding, 071002, China.
| | - Xiaoya Li
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, College of Pharmaceutical Sciences, Institute of Life Science and Green Development, Hebei University, 180 WuSi Road, Lianchi District, Baoding, 071002, China.
| | - Zihan Yan
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, College of Pharmaceutical Sciences, Institute of Life Science and Green Development, Hebei University, 180 WuSi Road, Lianchi District, Baoding, 071002, China.
| | - Liangliang Zhao
- Department of Monitoring and Analysis, Baoding Environmental Monitoring Center of Hebei Province, 224 Dongfeng Road, Lianchi District, Baoding, 071000, China
| | - Wenbo Lang
- Department of Monitoring and Analysis, Baoding Environmental Monitoring Center of Hebei Province, 224 Dongfeng Road, Lianchi District, Baoding, 071000, China
| | - Chunmao Yuan
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang 550014, China
| | - Chengyan Zhou
- Key Laboratory of Pharmaceutical Quality Control of Hebei Province, College of Pharmaceutical Sciences, Institute of Life Science and Green Development, Hebei University, 180 WuSi Road, Lianchi District, Baoding, 071002, China.
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Network Pharmacology and In Vivo Experimental Validation to Uncover the Renoprotective Mechanisms of Fangji Huangqi Decoction on Nephrotic Syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4223729. [PMID: 35722158 PMCID: PMC9200505 DOI: 10.1155/2022/4223729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022]
Abstract
Background Fangji Huangqi decoction (FHD) is a traditional Chinese medicine formula that has the potential efficacy for nephrotic syndrome (NS) treatment. This study aims to explore the effects and underlying mechanisms of FHD against NS via network pharmacology and in vivo experiments. Methods The bioactive compounds and targets of FHD were retrieved from the TCMSP database. NS-related targets were collected from GeneCards and DisGeNET databases. The compound-target and protein-protein interaction networks were constructed by Cytoscape 3.8 and BisoGenet, respectively. GO and KEGG analyses were performed by the DAVID online tool. The interactions between active compounds and hub genes were revealed by molecular docking. An NS rat model was established to validate the renoprotective effects and molecular mechanisms of FHD against NS in vivo. Results A total of 32 hub genes were predicted to play essential roles in FHD treating NS. Eight main bioactive compounds of FHD had the good affinity with 9 hub targets (CCL2, IL-10, PTGS2, TNF, MAPK1, IL-6, CXCL8, TP53, and VEGFA). The therapeutic effect of FHD on NS was closely involved in the regulation of inflammation and PI3K-Akt pathway. In vivo experiments confirmed the renoprotective effect of FHD on NS, evidenced by reducing the levels of proteinuria, serum creatinine, blood urea nitrogen, and inflammatory factors in NS rats. The PI3K activator 740Y-P weakened the effects of FHD against NS. Furthermore, FHD downregulated the levels of PTGS2, MAPK1, IL-6, and p-Akt in NS rats. Conclusions FHD alleviates kidney injury and inflammation in NS by targeting PTGS2, MAPK1, IL-6, and PI3K-Akt pathway.
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Tang L, Cai Z, Wang SX, Zhao WJ. Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure: A case report. World J Clin Cases 2022; 10:5861-5868. [PMID: 35979127 PMCID: PMC9258360 DOI: 10.12998/wjcc.v10.i17.5861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/21/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) have been described as two separate forms of nephrotic syndrome (NS), they are not completely independent. We report a case of a patient transitioning from MCD to FSGS, review the literature, and explore the relationship between the two diseases.
CASE SUMMARY A 42-year-old male welder, presenting with lower extremity edema and elevated serum creatinine, was diagnosed with NS and end-stage kidney disease (ESKD) based on laboratory test results. The patient had undergone a kidney biopsy for NS 20 years previously, which indicated MCD, and a second recent kidney biopsy suggested FSGS. The patient was an electric welder with excessive levels of cadmium and lead in his blood. Consequently, we suspect that his aggravated pathology and occurrence of ESKD were related to metal nephrotoxicity. The patient eventually received kidney replacement therapy and quit his job which involved long-term exposure to metals. During the 1-year follow-up period, the patient was negative for metal elements in the blood and urine and recovered partial kidney function.
CONCLUSION MCD and FSGS may be different stages of the same disease. The transition from MCD to FSGS in this case indicates disease progression, which may be related to excessive metal contaminants caused by the patient’s occupation.
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Affiliation(s)
- Long Tang
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Zhen Cai
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Su-Xia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China
| | - Wen-Jing Zhao
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
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Clinical Efficacy of Persian Medicine Diet Combined with Western Medicine-Based Diet on Proteinuria in Pediatric Nephrotic Syndrome: A Randomized Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2279209. [PMID: 35656469 PMCID: PMC9155912 DOI: 10.1155/2022/2279209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022]
Abstract
Introduction Nephrotic syndrome (NS) is a common chronic kidney disorder during childhood. The most important characteristic of this disease is proteinuria. The Persian medicine (PM) has important dietary recommendations for strengthening the kidney function and treatment of this disease. The aim of this study was to investigate the effect of a diet including PM recommendations and general principles of Western medicine. Materials and Methods Twenty children with nephrotic syndrome were randomly divided into intervention and control groups and monitored for one month. The control group received a diet based on the general principles of Western medicine. In the intervention group, in addition to the Western medicine diet, dietary recommendations of PM were also prescribed including the pomegranate (Cydonia oblonga mill.), quince (Cydonia oblonga mill.), and whole grains (wheat and barley). A 24-hour dietary questionnaire was applied and anthropometric and biochemical indices including spot urine protein (proteinuria), albumin (Alb), urea, creatinine (Cr), total cholesterol (TC), and triglyceride (TG) were measured before and after the study. Results The amount of protein intake reduced significantly in the diet of both groups but the differences between the two groups were not significant. Proteinuria reduced significantly in both the Western and PM groups; however, proteinuria was significantly lower in the Persian medicine group compared to the control group. TC and Cr levels reduced significantly in the intervention group, although the changes were not significant compared to the control group. Conclusion The results of this study showed that adding dietary recommendations of the Persian medicine to the general rules of the Western medicine diet reduced proteinuria and improved the combat against nephrotic syndrome.
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Henderson S, Ardill R, Reynolds B, Kavanagh D. Use of a B-cell depleting regimen for antifactor H autoantibody-mediated membranoproliferative glomerulonephritis in a paediatric patient. BMJ Case Rep 2022; 15:e246281. [PMID: 35444020 PMCID: PMC9021740 DOI: 10.1136/bcr-2021-246281] [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] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
A male child presented initially well with a mixed nephrotic-nephritic syndrome and was commenced on standard high-dose oral corticosteroids. Clinical deterioration occurred 3 weeks later with rapidly progressing renal dysfunction, seizures and diminished urinary output, requiring renal replacement therapy. Once stabilised, renal biopsy demonstrated mesangial and capillary C3, minimal IgG deposition, with mesangial electron dense deposits felt consistent with postinfectious glomerulonephritis or C3 glomerulopathy. Further investigations identified circulating autoantibody directed against factor H, as a plausible aetiology of the membranoproliferative glomerulonephritis (MPGN). Treatment with rituximab and mycophenolate mofetil was associated with a reduction in antibody titres and a concurrent reduction in proteinuria and normalisation of renal function.Subsequent monitoring of antibody titres prompted further administrations of rituximab, with reduction in titres demonstrated after repeat doses. Atypical presentations or complications of nephrotic syndrome or MPGN should prompt detailed investigations for the cause with consideration of antifactor H antibodies.
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Affiliation(s)
| | | | - Ben Reynolds
- Paediatric Renal Department, NHS Greater Glasgow and Clyde, Glasgow, UK
- Department of Child Life and Health, University of Glasgow, Glasgow, UK
| | - David Kavanagh
- Complement Therapeutics Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- National Renal Complement Therapeutics Centre, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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45
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Zou X, Nie L, Liao Y, Liu Z, Zheng W, Qu X, Xu X, Qin H, Wang H, Liu J, He G, Jing T. Effects of statin therapy and treatment duration on cardiovascular disease risk in patients with nephrotic syndrome: A nested case-control study. Pharmacotherapy 2022; 42:311-319. [PMID: 35184315 PMCID: PMC9314031 DOI: 10.1002/phar.2675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although statins are the cornerstone of lipid management, hardly any of the existing studies on statin treatment of dyslipidemia in nephrotic syndrome (NS) addressed patient-centered outcomes of cardiovascular events. OBJECTIVE To evaluate whether statin treatment impacts the outcomes of cardiovascular events in patients with NS. DESIGN A single-center, retrospective, nested case-control study analyzed data from the First Affiliated Hospital of Army Medical University. PATIENTS Patients diagnosed with NS from January 1, 1999, to November 30, 2014, were selected and followed up for 5 years. MEASUREMENTS AND MAIN RESULTS A total of 2706 patients with NS were enrolled in this study cohort. Among these, 115 patients diagnosed with cardiovascular disease (CVD) at the end of the observational period and 235 CVD-free controls enrolled by 1:2 matching with gender, age, and index time were included in the study. Propensity score matching was used to match (1:1) the baseline characteristics of the cases and controls. The chi-square test was performed based on whether the patient used a statin as an exposure factor, and binary logistic regression analysis of the association between cardiovascular events and statin therapy duration was conducted. Subgroup analyses for relevant variables were also performed. The chi-square test showed that statin therapy was significantly associated with a reduction in CVD risk in patients with NS (p = 0.002). Furthermore, the risk of cardiovascular events in patients with NS decreased as the length of statin treatment increased (OR = 0.82 [95% CI 0.73-0.89], p < 0.001). CONCLUSIONS For NS patients with dyslipidemia, statin therapy may be used to decrease CVD risk, and extended treatment was associated with more significant risk reduction.
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Affiliation(s)
- Xinliang Zou
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Li Nie
- Department of Internal Medicine, Central Hospital of Wandong, Wansheng, Chongqing, China
| | - Yi Liao
- Department of Thoracic Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhihui Liu
- Department of Burn Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wanxiang Zheng
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaolong Qu
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiang Xu
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haoran Qin
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jianping Liu
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Guoxiang He
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, Guiqian International General Hospital, Guiyang, China
| | - Tao Jing
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Maghrabi K, Aldhaheri R, Aljunaid N, Alzahrani AS, Alsayyad HM, Kalakattawi N, Safdar O. Postoperative Intracardiac Thrombus in a Child with Nephrotic Syndrome. Int Med Case Rep J 2022; 15:91-96. [PMID: 35300123 PMCID: PMC8922339 DOI: 10.2147/imcrj.s349740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Thromboembolic events are a known complication of nephrotic syndrome in children. Intracardiac thrombi are a rare location for thrombus formation but can lead to severe clinical consequences. Case Presentation We report an intracardiac left atrial thrombus in a child with new onset steroid-resistant nephrotic syndrome and recently repaired atrial septal defect and cor triatriatum. The thrombus was successfully treated with surgical excision. Conclusion Intracardiac thrombus is a rare but serious complication of nephrotic syndrome in children, especially in children with risk factors for potentially increased intracardiac thrombogenicity such as history of recent intervention.
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Affiliation(s)
- Khadijah Maghrabi
- Abdullah Bakhsh Children’s Heart Center, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Khadijah Maghrabi, Abdullah Bakhsh Children’s Heart Center, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Saudi Arabia, Tel +996 2 6401000 Ext. 20208, Email
| | - Ruba Aldhaheri
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nora Aljunaid
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amal Saeed Alzahrani
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hanan Mohammad Alsayyad
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nada Kalakattawi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Safdar
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Hilmanto D, Mawardi F, Lestari AS, Widiasta A. Disease-Associated Systemic Complications in Childhood Nephrotic Syndrome: A Systematic Review. Int J Nephrol Renovasc Dis 2022; 15:53-62. [PMID: 35241925 PMCID: PMC8887965 DOI: 10.2147/ijnrd.s351053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Nephrotic syndrome (NS) is one of the most common childhood kidney diseases. During the active phase, the disease pathogenesis affects various biological functions linked to loss of proteins negatively, which can result in systemic complications. Complications of childhood NS are divided into two categories: disease-associated complications and drug-associated complications. However, complications in pediatric patients with NS, especially disease-associated complications are still limited. Although reported in the literature, information is not comprehensive and needs to be updated. This study aimed to systematically assess systemic complications in children with NS, especially disease-associated complications, to better understand how they impact outcomes. METHODS We conducted a systematic search of several databases: BioMed Central Pediatrics, PubMed, Google Scholar, the National Library of Medicine, Cochrane Library, CINAHL/EBSCO, British Medical Journal, Science Direct, Scopus, and Elsevier's ClinicalKey. We followed the PRISMA guidelines to plan, conduct, and report this review. We used the Joanna Briggs Institute's critical appraisal tools for assuring the quality of the journal articles that were chosen. RESULTS Eleven articles concerning complications in childhood NS were analyzed. Systemic disease-associated complications in covered were cardiovascular complications, infections, thyroid-hormone complication, kidney complications, and oral health complications. CONCLUSION NS is marked by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia, which can result in systemic disease-associated complications. Cardiovascular complications, infections, thyroid-hormone complications, kidney complications, and oral health complications are the main systemic complications in childhood NS. It is essential that health-care providers prevent these complications for proper maintenance of patients' health.
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Affiliation(s)
- Dany Hilmanto
- Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Fitriana Mawardi
- Community and Family Medicine Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, Indonesia
| | - Ayuningtyas S Lestari
- Nursing Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, Indonesia
| | - Ahmedz Widiasta
- Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Feng D, Li XR, Wang ZY, Gu NN, Zhang SX, Li CF, Chen Y, Ma ZQ, Lin RC, Zhang HG, Zhao C. Integrated UPLC-MS and Network Pharmacology Approach to Explore the Active Components and the Potential Mechanism of Yiqi Huoxue Decoction for Treating Nephrotic Syndrome. Front Pharmacol 2022; 12:775745. [PMID: 35295738 PMCID: PMC8919777 DOI: 10.3389/fphar.2021.775745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/09/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Yiqi Huoxue Decoction (YQHXD) is a traditional Chinese medicine that promotes blood circulation, removes blood stasis, facilitates diuresis, and alleviates edema. It is composed of 10 herbal medicines and has extensive application in treating nephrotic syndrome (NS). However, the active components and the potential mechanism of YQHXD for treating NS remain unclear. Methods: We set up a sensitive and rapid method based on Ultra-High Performance Liquid Chromatograph-Mass (UPLC-MS) to identify the compounds in YQHXD and constituents absorbed into the blood. Disease genes were collected through GeneCards, DisGeNET, and OMIM database. Genes of compounds absorbed into blood were predicted by the TCMSP database. We constructed Disease-Drug-Ingredient-Gene (DDIG) network using Cytoscape, established a Protein-protein interaction (PPI) network using String, Gene biological process (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis was performed using DAVID. Cellular experiments were performed to validate the results of network pharmacology. Result: A total of 233 compounds in YQHXD and 50 constituents absorbed into the blood of rats were identified. The 36 core targets in the PPI network were clustered in the phosphatidylinositol 3 kinase-RAC serine/threonine-protein kinase (PI3K-AKT) and nuclear factor kappa-B (NF-κB) signaling pathways. Luteolin, Wogonin, Formononetin, and Calycosin were top-ranking components as potentially active compounds. Conclusion: The results of our studies show that YQHXD is able to enhance renal function, alleviate podocyte injury, and improve adriamycin nephrotic syndrome.
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Affiliation(s)
- Dan Feng
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xiang-Ri Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Zhao-Yi Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Nian-Nian Gu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Shuang-Xi Zhang
- First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Chao-Feng Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Chen
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-Qiang Ma
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Rui-Chao Lin
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Rui-Chao Lin, ; Hong-Gui Zhang, ; Chongjun Zhao,
| | - Hong-Gui Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Rui-Chao Lin, ; Hong-Gui Zhang, ; Chongjun Zhao,
| | - Chongjun Zhao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Rui-Chao Lin, ; Hong-Gui Zhang, ; Chongjun Zhao,
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49
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Banderali G, Salvatici E, Rovelli V, Jaeken J. PMM2-CDG and nephrotic syndrome: A case report. Clin Case Rep 2022; 10:e05347. [PMID: 35154715 PMCID: PMC8829655 DOI: 10.1002/ccr3.5347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/09/2022] Open
Abstract
Congenital disorders of glycosylation (CDG) are a group of rare metabolic diseases, characterized by a defect in the protein glycosylation process. Enzymes involved in this metabolic mechanism have ubiquitous distribution; thus, their alteration can cause systemic involvement and considerable phenotypic variability. Nephrotic syndrome (NS) is a clinical condition characterized by edema, hypoalbuminemia, hyperlipidemia, and proteinuria. We hereby report the case of a girl with central hypotonia, epilepsy, and severe psychomotor delay diagnosed with phosphomannomutase 2 deficiency (PMM2-CDG) after presenting with nephrotic syndrome at age 4 years.
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Affiliation(s)
- Giuseppe Banderali
- Clinical Department of PediatricsASST Santi Paolo CarloSan Paolo HospitalUniversity of MilanMilanItaly
| | - Elisabetta Salvatici
- Clinical Department of PediatricsASST Santi Paolo CarloSan Paolo HospitalUniversity of MilanMilanItaly
| | - Valentina Rovelli
- Clinical Department of PediatricsASST Santi Paolo CarloSan Paolo HospitalUniversity of MilanMilanItaly
| | - Jaak Jaeken
- Department of Regeneration and DevelopmentCenter for Metabolic DiseasesUniversity Hospital GasthuisbergLeuvenBelgium
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50
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Hou YP, Diao TT, Xu ZH, Mao XY, Wang C, Li B. Bioinformatic Analysis Combined With Experimental Validation Reveals Novel Hub Genes and Pathways Associated With Focal Segmental Glomerulosclerosis. Front Mol Biosci 2022; 8:691966. [PMID: 35059432 PMCID: PMC8763695 DOI: 10.3389/fmolb.2021.691966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Focal segmental glomerulosclerosis (FSGS) is a type of nephrotic syndrome leading to end-stage renal disease, and this study aimed to explore the hub genes and pathways associated with FSGS to identify potential diagnostic and therapeutic targets. Methods: We downloaded the microarray datasets GSE121233 and GSE129973 from the Gene Expression Omnibus (GEO) database. The datasets comprise 25 FSGS samples and 25 normal samples. The differential expression genes (DEGs) were identified using the R package “limma”. Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the database for Annotation, Visualization and Integrated Discovery (DAVID) to identify the pathways and functional annotation of the DEGs. The protein–protein interaction (PPI) was constructed based on the Search Tool for the Retrieval of Interacting Genes (STRING) database and visualized using Cytoscape software. The hub genes of the DEGs were then evaluated using the cytoHubba plugin of Cytoscape. The expression of the hub genes was validated by quantitative real-time polymerase chain reaction (qRT-PCR) using the FSGS rat model, and receiver operating characteristic (ROC) curve analysis was performed to validate the accuracy of these hub genes. Results: A total of 45 DEGs including 18 upregulated and 27 downregulated DEGs, were identified in the two GSE datasets (GSE121233 and GSE129973). Among them, five hub genes with a high degree of connectivity were selected. From the PPI network, of the top five hub genes, FN1 was upregulated, while ALB, EGF, TTR, and KNG1 were downregulated. The qRT-PCR analysis of FSGS rats confirmed that the expression of FN1 was upregulated and that of EGF and TTR was downregulated. The ROC analysis indicated that FN1, EGF, and TTR showed considerable diagnostic efficiency for FSGS. Conclusion: Three novel FSGS-specific genes were identified through bioinformatic analysis combined with experimental validation, which may promote our understanding of the molecular underpinning of FSGS and provide potential therapeutic targets for the clinical management.
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Affiliation(s)
- Yan-Pei Hou
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tian-Tian Diao
- Department of Pediatrics, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhi-Hui Xu
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin-Yue Mao
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Nephrology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Chang Wang
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Nephrology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Bing Li
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Nephrology, Second Affiliated Hospital of Hainan Medical University, Haikou, China
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