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Song J, Chen Y, Chen Y, Qiu M, Xiang W, Ke B, Fang X. DKK3 promotes renal fibrosis by increasing MFF-mediated mitochondrial dysfunction in Wnt/β-catenin pathway-dependent manner. Ren Fail 2024; 46:2343817. [PMID: 38682264 PMCID: PMC11060011 DOI: 10.1080/0886022x.2024.2343817] [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: 06/14/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) lacks effective treatments and renal fibrosis (RF) is one of CKD's outcomes. Dickkopf 3 (DKK3) has been identified as an agonist in CKD. However, the underlying mechanisms of DKK3 in CKD are not fully understood. METHODS H2O2-treated HK-2 cells and ureteric obstruction (UUO) mice were used as RF models. Biomarkers, Masson staining, PAS staining, and TUNEL were used to assess kidney function and apoptosis. Oxidative stress and mitochondria function were also evaluated. CCK-8 and flow cytometry were utilized to assess cell viability and apoptosis. Western blotting, IHC, and qRT-PCR were performed to detect molecular expression levels. Immunofluorescence was applied to determine the subcellular localization. Dual luciferase assay, MeRIP, RIP, and ChIP were used to validate the m6A level and the molecule interaction. RESULTS DKK3 was upregulated in UUO mouse kidney tissue and H2O2-treated HK-2 cells. Knockdown of DKK3 inhibited oxidative stress, maintained mitochondrial homeostasis, and alleviated kidney damage and RF in UUO mice. Furthermore, DKK3 silencing suppressed HK-2 cell apoptosis, oxidative stress, and mitochondria fission. Mechanistically, DKK3 upregulation was related to the high m6A level regulated by METTL3. DKK3 activated TCF4/β-catenin and enhanced MFF transcriptional expression by binding to its promoter. Overexpression of MFF reversed in the inhibitory effect of DKK3 knockdown on cell damage. CONCLUSION Upregulation of DKK3 caused by m6A modification activated the Wnt/β-catenin pathway to increase MFF transcriptional expression, leading to mitochondrial dysfunction and oxidative stress, thereby promoting RF progression.
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Affiliation(s)
- Jianling Song
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, P.R. China
| | - Yanxia Chen
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, P.R. China
| | - Yan Chen
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, P.R. China
| | - Minzi Qiu
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, P.R. China
| | - Wenliu Xiang
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, P.R. China
| | - Ben Ke
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, P.R. China
| | - Xiangdong Fang
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, P.R. China
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Mekahli D, Müller RU, Marlais M, Wlodkowski T, Haeberle S, de Argumedo ML, Bergmann C, Breysem L, Fladrowski C, Henske EP, Janssens P, Jouret F, Kingswood JC, Lattouf JB, Lilien M, Maleux G, Rozenberg M, Siemer S, Devuyst O, Schaefer F, Kwiatkowski DJ, Rouvière O, Bissler J. Clinical practice recommendations for kidney involvement in tuberous sclerosis complex: a consensus statement by the ERKNet Working Group for Autosomal Dominant Structural Kidney Disorders and the ERA Genes & Kidney Working Group. Nat Rev Nephrol 2024; 20:402-420. [PMID: 38443710 DOI: 10.1038/s41581-024-00818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the presence of proliferative lesions throughout the body. Management of TSC is challenging because patients have a multifaceted systemic illness with prominent neurological and developmental impact as well as potentially severe kidney, heart and lung phenotypes; however, every organ system can be involved. Adequate care for patients with TSC requires a coordinated effort involving a multidisciplinary team of clinicians and support staff. This clinical practice recommendation was developed by nephrologists, urologists, paediatric radiologists, interventional radiologists, geneticists, pathologists, and patient and family group representatives, with a focus on TSC-associated kidney manifestations. Careful monitoring of kidney function and assessment of kidney structural lesions by imaging enable early interventions that can preserve kidney function through targeted approaches. Here, we summarize the current evidence and present recommendations for the multidisciplinary management of kidney involvement in TSC.
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Affiliation(s)
- Djalila Mekahli
- PKD Research Group, Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
- Department of Paediatric Nephrology, University Hospitals Leuven, Leuven, Belgium.
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tanja Wlodkowski
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Stefanie Haeberle
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Marta López de Argumedo
- Basque Office for Health Technology Assessment, (OSTEBA), Basque Government, Vitoria-Gasteiz, Spain
| | - Carsten Bergmann
- Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | - Luc Breysem
- Department of Radiology, University Hospital of Leuven, Leuven, Belgium
| | - Carla Fladrowski
- Associazione Sclerosi Tuberosa ASP, Rome, Italy
- European Tuberous Sclerosis Complex Association (ETSC), Oestrich-Winkel, Germany
| | - Elizabeth P Henske
- Center for LAM Research and Clinical Care, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Janssens
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - François Jouret
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium
- Interdisciplinary Group of Applied Genoproteomics, Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - John Christopher Kingswood
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Centre, St Georges University of London, London, UK
| | - Jean-Baptiste Lattouf
- Department of Surgery-Urology, CHUM-Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marc Lilien
- Department of Paediatric Nephrology, Wilhelmina Children´s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Micaela Rozenberg
- European Tuberous Sclerosis Complex Association (ETSC), Oestrich-Winkel, Germany
- Associação de Esclerose Tuberosa em Portugal, Lisbon, Portugal
| | - Stefan Siemer
- Department of Urology and Paediatric Urology, Saarland University, Homburg, Germany
| | - Olivier Devuyst
- Department of Physiology, Mechanisms of Inherited Kidney Disorders, University of Zurich, Zurich, Switzerland
- Institute for Rare Diseases, Saint-Luc Academic Hospital, UC Louvain, Brussels, Belgium
| | - Franz Schaefer
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - David J Kwiatkowski
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Rouvière
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France, Faculté de médecine Lyon Est, Lyon, France
| | - John Bissler
- Department of Paediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA.
- Children's Foundation Research Institute (CFRI), Le Bonheur Children's Hospital, Memphis, TN, USA.
- Paediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Zhu C, He X, Blumenfeld JD, Hu Z, Dev H, Sattar U, Bazojoo V, Sharbatdaran A, Aspal M, Romano D, Teichman K, Ng He HY, Wang Y, Soto Figueroa A, Weiss E, Prince AG, Chevalier JM, Shimonov D, Moghadam MC, Sabuncu M, Prince MR. A Primer for Utilizing Deep Learning and Abdominal MRI Imaging Features to Monitor Autosomal Dominant Polycystic Kidney Disease Progression. Biomedicines 2024; 12:1133. [PMID: 38791095 PMCID: PMC11118119 DOI: 10.3390/biomedicines12051133] [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: 04/11/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Abdominal imaging of autosomal dominant polycystic kidney disease (ADPKD) has historically focused on detecting complications such as cyst rupture, cyst infection, obstructing renal calculi, and pyelonephritis; discriminating complex cysts from renal cell carcinoma; and identifying sources of abdominal pain. Many imaging features of ADPKD are incompletely evaluated or not deemed to be clinically significant, and because of this, treatment options are limited. However, total kidney volume (TKV) measurement has become important for assessing the risk of disease progression (i.e., Mayo Imaging Classification) and predicting tolvaptan treatment's efficacy. Deep learning for segmenting the kidneys has improved these measurements' speed, accuracy, and reproducibility. Deep learning models can also segment other organs and tissues, extracting additional biomarkers to characterize the extent to which extrarenal manifestations complicate ADPKD. In this concept paper, we demonstrate how deep learning may be applied to measure the TKV and how it can be extended to measure additional features of this disease.
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Affiliation(s)
- Chenglin Zhu
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Xinzi He
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
- Cornell Tech, Cornell University, Ithaca, NY 10044, USA
| | - Jon D. Blumenfeld
- The Rogosin Institute, New York, NY 10021, USA; (J.D.B.); (J.M.C.); (D.S.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Zhongxiu Hu
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Hreedi Dev
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Usama Sattar
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Vahid Bazojoo
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Arman Sharbatdaran
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Mohit Aspal
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Dominick Romano
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Kurt Teichman
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Hui Yi Ng He
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Yin Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Andrea Soto Figueroa
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Erin Weiss
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Anna G. Prince
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - James M. Chevalier
- The Rogosin Institute, New York, NY 10021, USA; (J.D.B.); (J.M.C.); (D.S.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Daniil Shimonov
- The Rogosin Institute, New York, NY 10021, USA; (J.D.B.); (J.M.C.); (D.S.)
- Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Mina C. Moghadam
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
| | - Mert Sabuncu
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
- Cornell Tech, Cornell University, Ithaca, NY 10044, USA
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA; (C.Z.); (X.H.); (Z.H.); (H.D.); (U.S.); (V.B.); (A.S.); (M.A.); (D.R.); (K.T.); (H.Y.N.H.); (Y.W.); (A.S.F.); (E.W.); (A.G.P.); (M.C.M.)
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
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Fan Q, Hadla M, Peterson Z, Nelson G, Ye H, Wang X, Mardirossian JM, Harris PC, Alper SL, Prakash YS, Beyder A, Torres VE, Chebib FT. Activation of Piezo1 Inhibits Kidney Cystogenesis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.11.593717. [PMID: 38766249 PMCID: PMC11101129 DOI: 10.1101/2024.05.11.593717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The disruption of calcium signaling associated with polycystin deficiency has been proposed as the primary event underlying the increased abnormally patterned epithelial cell growth characteristic of Polycystic Kidney Disease. Calcium can be regulated through mechanotransduction, and the mechanosensitive cation channel Piezo1 has been implicated in sensing of intrarenal pressure and in urinary osmoregulation. However, a possible role for PIEZO1 in kidney cystogenesis remains undefined. We hypothesized that cystogenesis in ADPKD reflects altered mechanotransduction, suggesting activation of mechanosensitive cation channels as a therapeutic strategy for ADPKD. Here, we show that Yoda-1 activation of PIEZO1 increases intracellular Ca 2+ and reduces forskolin-induced cAMP levels in mIMCD3 cells. Yoda-1 reduced forskolin-induced IMCD cyst surface area in vitro and in mouse metanephros ex vivo in a dose-dependent manner. Knockout of polycystin-2 dampened the efficacy of PIEZO1 activation in reducing both cAMP levels and cyst surface area in IMCD3 cells. However, collecting duct-specific Piezo1 knockout neither induced cystogenesis in wild-type mice nor affected cystogenesis in the Pkd1 RC/RC model of ADPKD. Our study suggests that polycystin-2 and PIEZO1 play a role in mechanotransduction during cystogenesis in vitro , and ex vivo , but that in vivo cyst expansion may require inactivation or repression of additional suppressors of cystogenesis and/or growth. Our study provides a preliminary proof of concept for PIEZO1 activation as a possible component of combination chemotherapy to retard or halt cystogenesis and/or cyst growth.
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Graziani L, Minotti C, Carriero ML, Bengala M, Lai S, Terracciano A, Novelli A, Novelli G. A Novel COL4A5 Pathogenic Variant Joins the Dots in a Family with a Synchronous Diagnosis of Alport Syndrome and Polycystic Kidney Disease. Genes (Basel) 2024; 15:597. [PMID: 38790225 PMCID: PMC11121527 DOI: 10.3390/genes15050597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Alport Syndrome (AS) is the most common genetic glomerular disease, and it is caused by COL4A3, COL4A4, and COL4A5 pathogenic variants. The classic phenotypic spectrum associated with AS ranges from isolated hematuria to chronic kidney disease (CKD) with extrarenal abnormalities. Atypical presentation of the disorder is possible, and it can mislead the diagnosis. Polycystic kidney disease (PKD), which is most frequently associated with Autosomal Dominant PKD (ADPKD) due to PKD1 and PKD2 heterozygous variants, is emerging as a possible clinical manifestation in COL4A3-A5 patients. We describe a COL4A5 novel familial frameshift variant (NM_000495.5: c.1095dup p.(Leu366ValfsTer45)), which was associated with AS and PKD in the hemizygous proband, as well as with PKD, IgA glomerulonephritis and focal segmental glomerulosclerosis (FSGS) in the heterozygous mother. Establishing the diagnosis of AS can sometimes be difficult, especially in the context of misleading family history and atypical phenotypic features. This case study supports the emerging genotypic and phenotypic heterogeneity in COL4A3-A5-associated disorders, as well as the recently described association between PKD and collagen type IV (Col4) defects. We highlight the importance of the accurate phenotyping of all family members and the relevance of next-generation sequencing in the differential diagnosis of hereditary kidney disease.
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Affiliation(s)
- Ludovico Graziani
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.M.); (M.L.C.); (G.N.)
| | - Chiara Minotti
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.M.); (M.L.C.); (G.N.)
| | - Miriam Lucia Carriero
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.M.); (M.L.C.); (G.N.)
| | - Mario Bengala
- Medical Genetics Unit, Tor Vergata University Hospital, 00133 Rome, Italy;
| | - Silvia Lai
- Division of Nephrology, Department of Translational and Precision Medicine, “Sapienza” University, 00133 Rome, Italy;
| | - Alessandra Terracciano
- Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.T.); (A.N.)
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.T.); (A.N.)
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.M.); (M.L.C.); (G.N.)
- Medical Genetics Unit, Tor Vergata University Hospital, 00133 Rome, Italy;
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6
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Simmons KE, Ullman LS, Dahl NK. Kidney Stones Account for Increased Imaging Studies in Autosomal Dominant Polycystic Kidney Disease. KIDNEY360 2024; 5:707-714. [PMID: 38526140 PMCID: PMC11146651 DOI: 10.34067/kid.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Key Points Kidney stones are common in patients with autosomal dominant polycystic kidney disease compared with matched controls with CKD. The increase in imaging seen in patients with autosomal dominant polycystic kidney disease correlates with the kidney stone burden in these patients. Background Patients with autosomal dominant polycystic kidney disease (ADPKD) may have more imaging studies than patients with other forms of CKD. We characterized the imaging burden of patients with ADPKD relative to a CKD population to determine which factors lead to increased imaging in patients with ADPKD. Methods We retrospectively reviewed patients seen at Yale Nephrology between January 2012 and January 2021. We collected demographic, clinical, and imaging data through automated query and manual chart review. Eight hundred seven patients with ADPKD were matched to 4035 CKD controls on the basis of criteria of sex, race, ethnicity, CKD stage, hypertension, and diabetes, but not age. The number of abdominal imaging studies were compared between ADPKD and CKD groups, and the effect of kidney stone diagnosis was further evaluated. Chi-square and t tests were used to evaluate demographic variables, and Kruskal Wallis and negative binomial regression models were used to evaluate differences between abdominal imaging studies. Results Patients with ADPKD had a greater number of total abdominal imaging studies (P < 0.0001), ultrasounds (P < 0.0001), and magnetic resonance imagings (P = 0.02) compared with controls. In patients with preserved renal function (eGFR >60 ml/min per m2), these differences persisted. Kidney stones were significantly more common among patients with ADPKD (P < 0.0001). In multivariable assessment of imaging study counts using a negative binomial model controlling for kidney stones, ADPKD was no longer a significant predictor. In patients with ADPKD, pyelonephritis; cyst complications; lower eGFR; diabetes; coronary artery disease; kidney stones; lower body mass index; and being male, Black, and younger increased the likelihood of having more imaging studies. Conclusions The higher prevalence of abdominal imaging studies in patients with ADPKD correlated with the increased incidence of kidney stones observed in this population.
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Affiliation(s)
| | | | - Neera K. Dahl
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Yen PW, Chen YA, Wang W, Mao FS, Chao CT, Chiang CK, Lin SH, Tarng DC, Chiu YW, Wu MJ, Chen YC, Kao JTW, Wu MS, Lin CL, Huang JW, Hung KY. The screening, diagnosis, and management of patients with autosomal dominant polycystic kidney disease: A national consensus statement from Taiwan. Nephrology (Carlton) 2024; 29:245-258. [PMID: 38462235 DOI: 10.1111/nep.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of end-stage kidney disease (ESKD) worldwide. Guidelines for the diagnosis and management of ADPKD in Taiwan remains unavailable. In this consensus statement, we summarize updated information on clinical features of international and domestic patients with ADPKD, followed by suggestions for optimal diagnosis and care in Taiwan. Specifically, counselling for at-risk minors and reproductive issues can be important, including ethical dilemmas surrounding prenatal diagnosis and pre-implantation genetic diagnosis. Studies reveal that ADPKD typically remains asymptomatic until the fourth decade of life, with symptoms resulting from cystic expansion with visceral compression, or rupture. The diagnosis can be made based on a detailed family history, followed by imaging studies (ultrasound, computed tomography, or magnetic resonance imaging). Genetic testing is reserved for atypical cases mostly. Common tools for prognosis prediction include total kidney volume, Mayo classification and PROPKD/genetic score. Screening and management of complications such as hypertension, proteinuria, urological infections, intracranial aneurysms, are also crucial for improving outcome. We suggest that the optimal management strategies of patients with ADPKD include general medical care, dietary recommendations and ADPKD-specific treatments. Key points include rigorous blood pressure control, dietary sodium restriction and Tolvaptan use, whereas the evidence for somatostatin analogues and mammalian target of rapamycin (mTOR) inhibitors remains limited. In summary, we outline an individualized care plan emphasizing careful monitoring of disease progression and highlight the need for shared decision-making among these patients.
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Affiliation(s)
- Pao-Wen Yen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yung-An Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wei Wang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Fang-Sheng Mao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Chih-Kang Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Juliana Tze-Wah Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Fu-Jen Catholic University Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Liang Lin
- Division of Nephrology, Department of Internal Medicine, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi County, Taiwan
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
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Hoover E, Holliday V, Merullo N, Oberdhan D, Perrone RD, Rusconi C, Park M, Phadnis MA, Thewarapperuma N, Dahl NK. Pain and Health-Related Quality of Life in Autosomal Dominant Polycystic Kidney Disease: Results from a National Patient-Powered Registry. Kidney Med 2024; 6:100813. [PMID: 38689835 PMCID: PMC11059322 DOI: 10.1016/j.xkme.2024.100813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Rationale & Objective Autosomal dominant polycystic kidney disease (ADPKD) affects health-related quality of life (HRQoL) including pain, discomfort, fatigue, emotional distress, and impaired mobility. Stakeholders prioritized kidney cyst-related pain as an important core outcome domain in clinical trials, leading to the development of disease-specific assessment tools. Study Design The ADPKD Registry is hosted online with multiple disease-specific patient-reported outcomes modules to characterize the patient experience in the United States. Setting & Participants The ADPKD Registry allows consented participants access to a Core Questionnaire that includes demographics, comorbid conditions, current symptoms, and kidney function. Participants complete subsequent modules on a 3-month schedule, including 2 validated HRQoL tools, the ADPKD-Pain and Discomfort Scale (ADPKD-PDS), the ADPKD Impact Scale (ADPKD-IS) and a Healthcare Access and Utilization module. Exposures Patient-reported latest estimated glomerular filtration rate or creatinine used to calculate stage of chronic kidney disease. Outcomes Health-related quality of life, measured using validated ADPKD-specific tools; access to polycystic kidney disease-specific health care. Analytical Approach For the 2 HRQoL tools, scores were calculated for physical, emotional, and fatigue domains; pain severity; and pain interference (based on the licensed user manuals). Associations to health care access were also assessed. Results By July 2022, 1,086 individuals with ADPKD completed at least 1 of the HRQoL modules, and 319 completed 4 over a year. Participants were an average age of 53. In total, 71% were women, and 91% were White, with all chronic kidney disease (CKD) stages represented. In total, 2.5% reported being treated with dialysis, and 23% had a kidney transplant. CKD stage 4/5 participants reported the most dull kidney pain, whereas sharp kidney pain was evenly distributed across early CKD stages. Dull kidney pain had an impact on sleep regardless of CKD stage. There was a strong positive correlation between the ADPKD-PDS and ADPKD-IS. Patients with a neutral or positive HRQoL were less likely to have been denied access to imaging or other care. Limitations Currently, all the information collected is patient reported without health record validation of clinical variables. Conclusions Use of the HRQoL tools in the ADPKD Registry provided a broad cross-sectional assessment in the United States and provided granular information on the burden of pain across the CKD spectrum in ADPKD. The ADPKD Registry allowed assessment of ADPKD impact in a community that experiences decline in health and kidney function over decades.
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Affiliation(s)
| | | | - Nicole Merullo
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA
| | - Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD
| | - Ronald D. Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA
| | | | - Meyeon Park
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Milind A. Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | | | - Neera K. Dahl
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN
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Raj A, Tollens F, Caroli A, Nörenberg D, Zöllner FG. Automated prognosis of renal function decline in ADPKD patients using deep learning. Z Med Phys 2024; 34:330-342. [PMID: 37612178 PMCID: PMC11156781 DOI: 10.1016/j.zemedi.2023.08.001] [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: 04/11/2023] [Revised: 06/20/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
An accurate prognosis of renal function decline in Autosomal Dominant Polycystic Kidney Disease (ADPKD) is crucial for early intervention. Current biomarkers used are height-adjusted total kidney volume (HtTKV), estimated glomerular filtration rate (eGFR), and patient age. However, manually measuring kidney volume is time-consuming and subject to observer variability. Additionally, incorporating automatically generated features from kidney MRI images, along with conventional biomarkers, can enhance prognostic improvement. To address these issues, we developed two deep-learning algorithms. Firstly, an automated kidney volume segmentation model accurately calculates HtTKV. Secondly, we utilize segmented kidney volumes, predicted HtTKV, age, and baseline eGFR to predict chronic kidney disease (CKD) stages >=3A, >=3B, and a 30% decline in eGFR after 8 years from the baseline visit. Our approach combines a convolutional neural network (CNN) and a multi-layer perceptron (MLP). Our study included 135 subjects and the AUC scores obtained were 0.96, 0.96, and 0.95 for CKD stages >=3A, >=3B, and a 30% decline in eGFR, respectively. Furthermore, our algorithm achieved a Pearson correlation coefficient of 0.81 between predicted and measured eGFR decline. We extended our approach to predict distinct CKD stages after eight years with an AUC of 0.97. The proposed approach has the potential to enhance monitoring and facilitate prognosis in ADPKD patients, even in the early disease stages.
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Affiliation(s)
- Anish Raj
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden Württemberg, Germany; Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden Württemberg, Germany.
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden Württemberg, Germany
| | - Anna Caroli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG 24020, Italy
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden Württemberg, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden Württemberg, Germany; Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Baden Württemberg, Germany
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10
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Chebib FT, Tawk RG. All Patients with ADPKD Should Undergo Screening for Intracranial Aneurysms: CON. KIDNEY360 2024; 5:495-498. [PMID: 37990377 PMCID: PMC11093549 DOI: 10.34067/kid.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Fouad T. Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida
- Mayo Clinic Florida PKD Center of Excellence, Jacksonville, Florida
| | - Rabih G. Tawk
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida
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11
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Lee WC, Cheng BC, Lee CT, Liao SC. Update on the Application of Ultrasonography in Understanding Autosomal Dominant Polycystic Kidney Disease. J Med Ultrasound 2024; 32:110-115. [PMID: 38882609 PMCID: PMC11175384 DOI: 10.4103/jmu.jmu_77_23] [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: 07/03/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 06/18/2024] Open
Abstract
With an estimated prevalence of 1 in 1000 individuals globally, autosomal dominant polycystic kidney disease (ADPKD) stands as the most prevalent inherited renal disorder. Ultrasonography (US) is the most widely used imaging modality in the diagnosis and monitoring of ADPKD. This review discusses the role of US in the evaluation of ADPKD, including its diagnostic accuracy, limitations, and recent advances. An overview of the pathophysiology and clinical manifestations of ADPKD has also been provided. Furthermore, the potential of US as a noninvasive tool for the assessment of disease progression and treatment response is examined. Overall, US remains an essential tool for the management of ADPKD, and ongoing research efforts are aimed at improving its diagnostic and prognostic capabilities.
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Affiliation(s)
- Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, Taiwan
| | - Shang-Chih Liao
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, Taiwan
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12
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Djajapranata KM, Tjempakasari A. Autosomal dominant polycystic kidney disease (ADPKD) with multiple complications: Management challenges. NARRA J 2024; 4:e584. [PMID: 38798842 PMCID: PMC11125292 DOI: 10.52225/narra.v4i1.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary polycystic kidney disease characterized by renal enlargement, resulting in renal failure. In Indonesia, the exact prevalence of ADPKD is unknown due to limited reports on the disease. The aim of this study was to report a case of a patient with ADPKD with multiple complications. A 54-year-old male presented to the emergency room of Dr. Soetomo Academic General Hospital, Surabaya, Indonesia, with a chief complaint of dark-red-colored urine for one week. There was a progressive abdominal enlargement over the past five years, which had become more tense and rigid for the past one month. The patient had a history of fatigue and hypertension with routine follow-up. Physical examination on admission showed normal vital signs, and the abdominal assessment revealed a palpable hard mass approximately 4 cm in size in the right upper abdomen. Laboratory test indicated anemia, leukocytosis, lymphopenia, proteinuria, hematuria, leukocyturia, and elevated serum creatinine and urea levels. Abdominal imaging using ultrasonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) revealed bilateral kidney and liver enlargement containing multiple cysts, suggesting polycystic kidney and liver disease. There was a ruptured cyst in the middle of the left kidney pole with minimal ascites found in the CT scan. The MRI exhibited the presence of multiple cysts in both kidneys, partially filled with blood. The patient was diagnosed with ADPKD, gross hematuria, acute or chronic kidney disease (CKD), urinary tract infection (UTI), normochromic-normocytic anemia, and metabolic acidosis. Dietary control with high-calorie, high-protein, and low-salt diet; fluid balance; and other symptomatic medications were initiated. It is critical to be aware of risk factors associated with the rapid progression of ADPKD in order to be able to provide a favorable impact on the disease prevention and management.
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Affiliation(s)
- Kenneth M. Djajapranata
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Artaria Tjempakasari
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Nephrology and Hypertension, Department of Internal Medicine, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
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13
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Conze PH, Andrade-Miranda G, Le Meur Y, Cornec-Le Gall E, Rousseau F. Dual-task kidney MR segmentation with transformers in autosomal-dominant polycystic kidney disease. Comput Med Imaging Graph 2024; 113:102349. [PMID: 38330635 DOI: 10.1016/j.compmedimag.2024.102349] [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: 06/23/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Autosomal-dominant polycystic kidney disease is a prevalent genetic disorder characterized by the development of renal cysts, leading to kidney enlargement and renal failure. Accurate measurement of total kidney volume through polycystic kidney segmentation is crucial to assess disease severity, predict progression and evaluate treatment effects. Traditional manual segmentation suffers from intra- and inter-expert variability, prompting the exploration of automated approaches. In recent years, convolutional neural networks have been employed for polycystic kidney segmentation from magnetic resonance images. However, the use of Transformer-based models, which have shown remarkable performance in a wide range of computer vision and medical image analysis tasks, remains unexplored in this area. With their self-attention mechanism, Transformers excel in capturing global context information, which is crucial for accurate organ delineations. In this paper, we evaluate and compare various convolutional-based, Transformers-based, and hybrid convolutional/Transformers-based networks for polycystic kidney segmentation. Additionally, we propose a dual-task learning scheme, where a common feature extractor is followed by per-kidney decoders, towards better generalizability and efficiency. We extensively evaluate various architectures and learning schemes on a heterogeneous magnetic resonance imaging dataset collected from 112 patients with polycystic kidney disease. Our results highlight the effectiveness of Transformer-based models for polycystic kidney segmentation and the relevancy of exploiting dual-task learning to improve segmentation accuracy and mitigate data scarcity issues. A promising ability in accurately delineating polycystic kidneys is especially shown in the presence of heterogeneous cyst distributions and adjacent cyst-containing organs. This work contribute to the advancement of reliable delineation methods in nephrology, paving the way for a broad spectrum of clinical applications.
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Affiliation(s)
- Pierre-Henri Conze
- IMT Atlantique, LaTIM UMR 1101, Technopôle Brest-Iroise, 29238 Brest, France; LaTIM UMR 1101, Inserm, IBRBS, 22 rue Camille Desmoulins, 29200 Brest, France.
| | | | - Yannick Le Meur
- Department of Nephrology, University Hospital of Brest, bd Tanguy Prigent, 29200 Brest, France; LBAI UMR 1227, Inserm, 9 rue Félix le Dantec, 29200 Brest, France
| | - Emilie Cornec-Le Gall
- Department of Nephrology, University Hospital of Brest, bd Tanguy Prigent, 29200 Brest, France; UMR 1078, Inserm, IBRBS, 22 rue Camille Desmoulins, 29238 Brest, France
| | - François Rousseau
- IMT Atlantique, LaTIM UMR 1101, Technopôle Brest-Iroise, 29238 Brest, France; LaTIM UMR 1101, Inserm, IBRBS, 22 rue Camille Desmoulins, 29200 Brest, France
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14
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Eswarappa MS, Park M. All Patients with ADPKD Should Undergo Screening for Intracranial Aneurysms: PRO. KIDNEY360 2024; 5:492-494. [PMID: 37990366 PMCID: PMC11093534 DOI: 10.34067/kid.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Meghana S Eswarappa
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, California
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15
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Ji T, Lv Y, Liu M, Han Y, Yuan B, Gu J. Causal relationships between mitochondrial proteins and different pathological types of lung cancer: a bidirectional mendelian randomization study. Front Genet 2024; 15:1335223. [PMID: 38596213 PMCID: PMC11002161 DOI: 10.3389/fgene.2024.1335223] [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: 11/08/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
An increasing number of studies point to an association between mitochondrial proteins (MPs) and lung cancer (LC). However, the causal relationship between MPs and LC remains unclear. Consequently, our study employed a bidirectional Mendelian randomization (MR) analysis to explore the causal association between MPs and different pathological types of LC. A two-sample MR study was performed using the genome-wide association study (GWAS) data publicly available. We applied the primary inverse variance weighted (IVW) method along with additional MR methods to validate the causality between MPs and different pathological types of LC. To ensure the robustness of our findings, sensitivity analyses were employed. Moreover, we performed a bi-directional MR analysis to determine the direction of the causal association. We identified a total of seven MPs had significant causal relationships on overall LC, lung squamous cell carcinoma (LUSC), and small cell lung carcinoma (SCLC). We found two MPs had significant associations with overall LC, four MPs had significant associations with LUSC, and four MPs had significant associations with SCLC. Additionally, an MP was found to have a nominal relationship with LUSC. Moreover, no causality was found between MPs and lung adenocarcinoma (LUAD). Bidirectional MR showed no reverse effect between identified MPs and different pathological types of LC. In general, our findings of this MR study suggest causal associations of specific MPs with overall LC, LUSC, and SCLC. However, no such causality was found in LUAD.
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Affiliation(s)
- Tanao Ji
- Department of General Practice, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Yue Lv
- Department of Hematology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Meiqun Liu
- Department of Electrocardioeraphy, Qidong People’s Hospital, Qidong Liver Cancer Institute, Affiliated Qidong Hospital of Nantong University, Nantong, China
| | - Yujie Han
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong Key Laboratory of Respiratory, Nantong, China
| | - Baochang Yuan
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong Key Laboratory of Respiratory, Nantong, China
| | - Jun Gu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong Key Laboratory of Respiratory, Nantong, China
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Grlić S, Gregurović V, Martinić M, Davidović M, Kos I, Galić S, Fištrek Prlić M, Vuković Brinar I, Vrljičak K, Lamot L. Single-Center Experience of Pediatric Cystic Kidney Disease and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:392. [PMID: 38671609 PMCID: PMC11048964 DOI: 10.3390/children11040392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Pediatric cystic kidney disease (CyKD) includes conditions characterized by renal cysts. Despite extensive research in this field, there are no reliable genetics or other biomarkers to estimate the phenotypic consequences. Therefore, CyKD in children heavily relies on clinical and diagnostic testing to predict the long-term outcomes. AIM A retrospective study aimed to provide a concise overview of this condition and analyze real-life data from a single-center pediatric CyKD cohort followed during a 12-year period. METHODS AND MATERIALS Medical records were reviewed for extensive clinical, laboratory, and radiological data, treatment approaches, and long-term outcomes. RESULTS During the study period, 112 patients received a diagnosis of pediatric CyKD. Male patients were more involved than female (1:0.93). Fifty-six patients had a multicystic dysplastic kidney; twenty-one of them had an autosomal dominant disorder; fifteen had an isolated renal cyst; ten had been diagnosed with autosomal recessive polycystic kidney disease; three had the tuberous sclerosis complex; two patients each had Bardet-Biedl, Joubert syndrome, and nephronophthisis; and one had been diagnosed with the trisomy 13 condition. Genetic testing was performed in 17.9% of the patients, revealing disease-causing mutations in three-quarters (75.0%) of the tested patients. The most commonly presenting symptoms were abdominal distension (21.4%), abdominal pain (15.2%), and oligohydramnios (12.5%). Recurrent urinary tract infections (UTI) were documented in one-quarter of the patients, while 20.5% of them developed hypertension during the long-term follow-up. Antibiotic prophylaxis and antihypertensive treatment were the most employed therapeutic modalities. Seventeen patients progressed to chronic kidney disease (CKD), with thirteen of them eventually reaching end-stage renal disease (ESRD). The time from the initial detection of cysts on an ultrasound (US) to the onset of CKD across the entire cohort was 59.0 (7.0-31124.0) months, whereas the duration from the detection of cysts on an US to the onset of ESRD across the whole cohort was 127.0 (33.0-141.0) months. The median follow-up duration in the cohort was 3.0 (1.0-7.0) years. The patients who progressed to ESRD had clinical symptoms at the time of initial clinical presentation. CONCLUSION This study is the first large cohort of patients reported from Croatia. The most common CyKD was the multicystic dysplastic kidney disease. The most common clinical presentation was abdominal distention, abdominal pain, and oliguria. The most common long-term complications were recurrent UTIs, hypertension, CKD, and ESRD.
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Affiliation(s)
- Sara Grlić
- Department of Pediatrics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.G.); (I.V.B.); (L.L.)
| | - Viktorija Gregurović
- Department of Pediatrics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.G.); (I.V.B.); (L.L.)
| | - Mislav Martinić
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (M.M.); (M.D.); (I.K.); (S.G.); (K.V.)
| | - Maša Davidović
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (M.M.); (M.D.); (I.K.); (S.G.); (K.V.)
| | - Ivanka Kos
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (M.M.); (M.D.); (I.K.); (S.G.); (K.V.)
| | - Slobodan Galić
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (M.M.); (M.D.); (I.K.); (S.G.); (K.V.)
| | - Margareta Fištrek Prlić
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
| | - Ivana Vuković Brinar
- Department of Pediatrics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.G.); (I.V.B.); (L.L.)
- Department of Internal Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Kristina Vrljičak
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (M.M.); (M.D.); (I.K.); (S.G.); (K.V.)
| | - Lovro Lamot
- Department of Pediatrics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.G.); (I.V.B.); (L.L.)
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (M.M.); (M.D.); (I.K.); (S.G.); (K.V.)
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Copur S, Ozbek L, Guldan M, Topcu AU, Kanbay M. Native nephrectomy in polycystic kidney disease patients on transplant lists: how and when? J Nephrol 2024:10.1007/s40620-024-01899-7. [PMID: 38512371 DOI: 10.1007/s40620-024-01899-7] [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: 10/14/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD), the most common hereditary kidney disease, accounts for approximately 10% of the patients on kidney transplantation waitlists. High rates of complications including hemorrhage, infections, nephrolithiasis and kidney size-related compressive complaints have been reported among ADPKD patients. Therefore, the need for routine native nephrectomy and timing of such procedure in ADPKD patients being prepared for transplantation are debated. Even though pre-transplant nephrectomy has the potential to provide fewer infectious complications due to lack of immunosuppressive medication use, such procedure has been associated with longer hospital stay, loss of residual kidney function and need for dialysis. Although simultaneous nephrectomy and transplantation could potentially lead to longer perioperative duration, perioperative complications and need for blood transfusions, this was not confirmed in cohort studies. Therefore, some institutions routinely perform simultaneous unilateral nephrectomy and kidney transplantation. In this narrative review, our aim is to evaluate the current evidence regarding the need and timing of nephrectomy in ADPKD patients in relation to kidney transplantation.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Lasin Ozbek
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mustafa Guldan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmet Umur Topcu
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey.
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18
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Stanley IK, Palma AM, Viecelli AK, Johnson DW, Hawley CM, Staatz CE, Mallett AJ. A secondary analysis of concurrent use of metformin and tolvaptan in ADPKD tolvaptan trials. J Nephrol 2024:10.1007/s40620-024-01906-x. [PMID: 38512373 DOI: 10.1007/s40620-024-01906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/15/2024] [Indexed: 03/23/2024]
Affiliation(s)
- I Kitty Stanley
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
| | - Anton M Palma
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Andrea K Viecelli
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, Australia
| | - David W Johnson
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, Australia
| | | | - Andrew J Mallett
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, Australia.
- Department of Renal Medicine, Townsville University Hospital, Townsville, Australia.
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
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Jeon SK, Joo I, Park J, Kim JM, Park SJ, Yoon SH. Fully-automated multi-organ segmentation tool applicable to both non-contrast and post-contrast abdominal CT: deep learning algorithm developed using dual-energy CT images. Sci Rep 2024; 14:4378. [PMID: 38388824 PMCID: PMC10883917 DOI: 10.1038/s41598-024-55137-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/20/2024] [Indexed: 02/24/2024] Open
Abstract
A novel 3D nnU-Net-based of algorithm was developed for fully-automated multi-organ segmentation in abdominal CT, applicable to both non-contrast and post-contrast images. The algorithm was trained using dual-energy CT (DECT)-obtained portal venous phase (PVP) and spatiotemporally-matched virtual non-contrast images, and tested using a single-energy (SE) CT dataset comprising PVP and true non-contrast (TNC) images. The algorithm showed robust accuracy in segmenting the liver, spleen, right kidney (RK), and left kidney (LK), with mean dice similarity coefficients (DSCs) exceeding 0.94 for each organ, regardless of contrast enhancement. However, pancreas segmentation demonstrated slightly lower performance with mean DSCs of around 0.8. In organ volume estimation, the algorithm demonstrated excellent agreement with ground-truth measurements for the liver, spleen, RK, and LK (intraclass correlation coefficients [ICCs] > 0.95); while the pancreas showed good agreements (ICC = 0.792 in SE-PVP, 0.840 in TNC). Accurate volume estimation within a 10% deviation from ground-truth was achieved in over 90% of cases involving the liver, spleen, RK, and LK. These findings indicate the efficacy of our 3D nnU-Net-based algorithm, developed using DECT images, which provides precise segmentation of the liver, spleen, and RK and LK in both non-contrast and post-contrast CT images, enabling reliable organ volumetry, albeit with relatively reduced performance for the pancreas.
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Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center Seoul National University Hospital, Seoul, Korea.
| | - Junghoan Park
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- MEDICALIP. Co. Ltd., Seoul, Korea
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20
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Schmidt EK, Krishnan C, Onuoha E, Gregory AV, Kline TL, Mrug M, Cardenas C, Kim H. Deep learning-based automated kidney and cyst segmentation of autosomal dominant polycystic kidney disease using single vs. multi-institutional data. Clin Imaging 2024; 106:110068. [PMID: 38101228 DOI: 10.1016/j.clinimag.2023.110068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE This study aimed to investigate if a deep learning model trained with a single institution's data has comparable accuracy to that trained with multi-institutional data for segmenting kidney and cyst regions in magnetic resonance (MR) images of patients affected by autosomal dominant polycystic kidney disease (ADPKD). METHODS We used TensorFlow with a Keras custom UNet on 2D slices of 756 MRI images of kidneys with ADPKD obtained from four institutions in the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) study. The ground truth was determined via a manual plus global thresholding method. Five models were trained with 80 % of all institutional data (n = 604) and each institutional data (n = 232, 172, 148, or 52), respectively, and validated with 10 % and tested on an unseen 10 % of the data. The model's performance was evaluated using the Dice Similarity Coefficient (DSC). RESULTS The DSCs by the model trained with all institutional data ranged from 0.92 to 0.95 for kidney image segmentation, only 1-2 % higher than those by the models trained with single institutional data (0.90-0.93).In cyst segmentation, however, the DSCs by the model trained with all institutional data ranged from 0.83 to 0.89, which were 2-20 % higher than those by the models trained with single institutional data (0.66-0.86). CONCLUSION The UNet performance, when trained with a single institutional dataset, exhibited similar accuracy to the model trained on a multi-institutional dataset. Segmentation accuracy increases with models trained on larger sample sizes, especially in more complex cyst segmentation.
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Affiliation(s)
- Emma K Schmidt
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Chetana Krishnan
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ezinwanne Onuoha
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Timothy L Kline
- Department of Radiology, Mayo Clinic, Rochester, MN 55902, USA
| | - Michal Mrug
- Department of Veterans Affairs Medical Center, Birmingham, AL 35233, USA; Department of Nephrology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Carlos Cardenas
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Harrison Kim
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL 35294, USA; Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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21
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GÜNDOĞDU E, CİHAN Ç, YAZICI C. Total kidney volume in autosomal dominant polycystic kidney disease: intraobserver and interobserver agreement of two methods with MRI. Turk J Med Sci 2024; 54:537-544. [PMID: 39049998 PMCID: PMC11265870 DOI: 10.55730/1300-0144.5820] [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: 04/10/2023] [Revised: 06/12/2024] [Accepted: 01/05/2024] [Indexed: 07/27/2024] Open
Abstract
Background/aim Total kidney volume (TKV) is a parameter used in both treatment decision and follow-up in autosomal dominant polycystic kidney disease (ADPKD) patients. The objective of this study was to evaluate intra- and interobserver agreement of the ellipsoid formula (EF) and manual boundary tracing method (MBTM) used in TKV measurement of ADPKD patients across different levels of experience radiologists. Additionally, the study aimed to evaluate the correlation between the EF and MBTM, which is considered the gold standard for TKV. Materials and methods A retrospective evaluation was conducted on magnetic resonance imaging (MRI) data from 55 ADPKD patients who underwent abdominal MRI between January 2017 and November 2021 to evaluate TKV. TKV measurements were performed by three independent observers (observer 1, an abdominal imaging radiologist with 5 years of experience; observer 2, a fourth-year radiology resident; observer 3, a second-year radiology resident).To assess intraobserver variability, all observers repeated the measurements at two-week intervals. The ICC was used to assess both intraobserver and interobserver variability. A comparison of the two methods was performed by linear regression for all three observers. Results The ICC (95% CI) indicated excellent agreement between the observers for both methods (among all observers, p < 0.001). Furthermore, excellent intraobserver agreement was found between all observer measurements either EF or MBTM based on ICC (95% CI) (p < 0.001). The results of the linear regression analysis demonstrated high correlations between the two methods in all three observers (r = 0.992, p < 0.001 for the first observer; r = 0.975, p < 0.001 for the second observer; r = 0.989, p < 0.001 for the third observer). Conclusion Both the EF and MBTM methods used for the measurement of TKV provided excellent intra- and interobserver reproducibility. The EF is as accurate and precise as the MBTM. It may therefore be preferred in radiology departments with heavy workload, as it is a reliable method for rapid and easy assessment, independent of experience.
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Affiliation(s)
- Elif GÜNDOĞDU
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir,
Turkiye
| | - Çağatay CİHAN
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir,
Turkiye
| | - Celal YAZICI
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir,
Turkiye
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22
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Arjune S, Späth MR, Oehm S, Todorova P, Schunk SJ, Lettenmeier K, Chon SH, Bartram MP, Antczak P, Grundmann F, Fliser D, Müller RU. DKK3 as a potential novel biomarker in patients with autosomal polycystic kidney disease. Clin Kidney J 2024; 17:sfad262. [PMID: 38186869 PMCID: PMC10768788 DOI: 10.1093/ckj/sfad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 01/09/2024] Open
Abstract
Backgound Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease, and leads to a steady loss of kidney function in adulthood. The variable course of the disease makes it necessary to identify the patients with rapid disease progression who will benefit the most from targeted therapies and interventions. Currently, magnetic resonance imaging-based volumetry of the kidney is the most commonly used tool for this purpose. Biomarkers that can be easily and quantitatively determined, which allow a prediction of the loss of kidney function, have not yet been established in clinical practice. The glycoprotein Dickkopf 3 (DKK3) which is secreted in the renal tubular epithelium upon stress and contributes to tubulointerstitial fibrosis via the Wnt signaling pathway, was recently described as a biomarker for estimating risk of kidney function loss, but has not been investigated for ADPKD. This study aimed to obtain a first insight into whether DKK3 may indeed improve outcome prediction in ADPKD in the future. Methods In 184 ADPKD patients from the AD(H)PKD registry and 47 healthy controls, the urinary DKK3 (uDKK3) levels were determined using ELISA. Multiple linear regression was used to examine the potential of these values in outcome prediction. Results ADPKD patients showed significantly higher uDKK3 values compared with the controls (mean 1970 ± 5287 vs 112 ± 134.7 pg/mg creatinine). Furthermore, there was a steady increase in uDKK3 with an increase in the Mayo class (A/B 1262 ± 2315 vs class D/E 3104 ± 7627 pg/mg creatinine), the best-established biomarker of progression in ADPKD. uDKK3 also correlated with estimated glomerular filtration rate (eGFR). Patients with PKD1 mutations show higher uDKK3 levels compared with PKD2 patients (PKD1: 2304 ± 5119; PKD2: 506.6 ± 526.8 pg/mg creatinine). Univariate linear regression showed uDKK3 as a significant predictor of future eGFR slope estimation. In multiple linear regression this effect was not significant in models also containing height-adjusted total kidney volume and/or eGFR. However, adding both copeptin levels and the interaction term between copeptin and uDKK3 to the model resulted in a significant predictive value of all these three variables and the highest R2 of all models examined (∼0.5). Conclusion uDKK3 shows a clear correlation with the Mayo classification in patients with ADPKD. uDKK3 levels correlated with kidney function, which could indicate that uDKK3 also predicts a disproportionate loss of renal function in this collective. Interestingly, we found an interaction between copeptin and uDKK3 in our prediction models and the best model containing both variables and their interaction term resulted in a fairly good explanation of variance in eGFR slope compared with previous models. Considering the limited number of patients in these analyses, future studies will be required to confirm the results. Nonetheless, uDKK3 appears to be an attractive candidate to improve outcome prediction of ADPKD in the future.
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Affiliation(s)
- Sita Arjune
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Martin R Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Simon Oehm
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Polina Todorova
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefan J Schunk
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Katharina Lettenmeier
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, Cologne, Germany
- Department of Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany
| | - Malte P Bartram
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Philipp Antczak
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Franziska Grundmann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Danilo Fliser
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
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23
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Selen T, Merhametsiz O. YouTube TM as a source of information on autosomal dominant polycystic kidney disease: A quality analysis. Digit Health 2024; 10:20552076241248109. [PMID: 38638405 PMCID: PMC11025416 DOI: 10.1177/20552076241248109] [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] [Accepted: 03/29/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease in adults. As a social media platform, YouTube has tremendous potential to both support and hinder public health efforts. The aim of this study was to assess the reliability and quality of the most viewed English-language YouTube videos on ADPKD. Methods A YouTube search was conducted on 3 August 2023, using the keyword ADPKD disease and the top 200 videos were analyzed for relevance. Videos in the "Short" category that were duplicates, were not in English, were not audio or visual, and contained advertisements were excluded. Two reviewers divided the 159 included videos into groups based on their source and content. Results In 106 (66.7%) of the 159 videos, general information about the disease was given, 58 (36.5%) discussed medical treatment, 11 (6.9%) discussed surgical treatment, 30 (18.9%) included patient images and radiological images, and eight (5%) discussed the genetic and pathological features of the disease. Additionally, 16 (10.1%) videos fell into the "other" category. According to the Journal of the American Medical Association, Quality Criteria for Consumer Health Information and Global Quality Scale scoring systems, videos uploaded by health associations and foundations received the highest scores (3 (1-4), 54 (28-70), 4 (1-5), respectively). Conclusion Academic institutions and other official health organizations such as Health Associations/Foundations need to use YouTube more effectively to disseminate accurate, reliable and useful health-related information to society.
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Affiliation(s)
- Tamer Selen
- Nephrology Department, Duzce Ataturk State Hospital, Düzce, Turkey
| | - Ozgur Merhametsiz
- Nephrology Department, Universty of Yeni Yuzyil Private Gaziosmanpaşa Hospital, Istanbul, Turkey
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24
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Oberdhan D, Yarlas A, Bjorner JB, Krasa H. Patient-Reported Outcomes Measures, Polycystic Kidney Disease Burden, and Outcomes in Autosomal Dominant Polycystic Kidney Disease. Kidney Med 2024; 6:100755. [PMID: 38192435 PMCID: PMC10772284 DOI: 10.1016/j.xkme.2023.100755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Rationale & Objective Using OVERTURE (NCT01430494) study data on patient-perceived health, health care utilization, and productivity in autosomal dominant polycystic kidney disease (ADPKD), this research was conducted to characterize the burden of illness in patients with ADPKD and assess whether patient-reported outcome (PRO) assessment scores predict clinical and health-economic outcomes. Study Design Data were analyzed from a prospective, observational study. Setting & Participants The study cohort comprised 3,409 individuals with ADPKD in 20 countries who were aged 12-78 years and were in chronic kidney disease (CKD) stages G1-G5 and Mayo risk subclasses 1A-1E. Predictors Scores on PRO instruments, including disease-specific assessments [ADPKD-Impact Scale (ADPKD-IS), and ADPKD-Urinary Impact Scale (ADPKD-UIS)] and generic measures were assessed. Outcomes Clinical variables [eg, height-adjusted total kidney volume (htTKV), estimated glomerular filtration rate (eGFR), and abdominal girth] and health-economic outcomes were assessed. Analytical Approach Associations among variables were evaluated using Spearman correlations, logistic regression, and generalized linear mixed effects repeated measures models. Results Baseline CKD stage and Mayo risk classification showed little correlation with baseline PRO scores; however, scores on disease-specific instruments and measures of physical functioning were worse at more severe CKD stages. PRO scores predicted hospitalizations and sick days at 6-18 months, with strongest associations noted for the ADPKD-IS. PRO scores were not associated with htTKV and eGFR, but worse PRO scores were associated with greater abdominal girth. Poor baseline ADPKD-IS scores were positively associated with occurrence of ADPKD-related symptoms up to 18 months, including kidney pain (OR, 5.30; 95% CI, 2.75-10.24), hematuria (OR, 4.58; 95% CI, 1.99-10.53), and urinary tract infection (OR, 4.41; 95% CI, 1.93-10.11; P < 0.001 for all). Limitations A limitation of the study was the maximum 18 months of follow-up available to assess outcomes. Conclusions PRO scores predicted clinical and health-economic outcomes, such as hospitalization and absence from work, underscoring the importance of quality of life assessment of individuals with ADPKD. Plain-Language Summary Patient-reported outcomes (PROs) are increasingly recognized as important parameters for assessing the clinical and humanistic burden of autosomal dominant polycystic kidney disease (ADPKD). We analyzed data from the observational OVERTURE study to better characterize disease impact on quality of life and determine whether patient-perceived burden might predict outcomes. Scores on PRO assessment instruments predicted hospitalizations and sick days at 6-18 months, with associations strongest for the disease-specific ADPKD-Impact Scale. Compared to patients who rated their health-related quality of life as good, those with poor baseline scores were significantly more likely to report ADPKD-related signs and symptoms up to 18 months of follow-up. These findings support using disease-specific PRO assessment instruments to assess and predict the impact of ADPKD.
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Affiliation(s)
- Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD
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25
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Calvaruso L, Yau K, Akbari P, Nasri F, Khowaja S, Wang B, Haghighi A, Khalili K, Pei Y. Real-life use of tolvaptan in ADPKD: a retrospective analysis of a large Canadian cohort. Sci Rep 2023; 13:22257. [PMID: 38097698 PMCID: PMC10721810 DOI: 10.1038/s41598-023-48638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Tolvaptan is the first disease-modifying drug proven to slow eGFR decline in high-risk patients with ADPKD. However, barriers from the patient perspective to its use in real-life settings have not been systemically examined in a large cohort. This was a single-center, retrospective study of 523 existing or new patients with ADPKD followed at the Center for Innovative Management of PKD in Toronto, Ontario, between January 1, 2016 to December 31, 2018. All patients underwent clinical assessment including total kidney volume measurements and Mayo Clinic Imaging Class (MCIC). Those who were deemed to be at high risk were offered tolvaptan with their preference (yes or no) and reasons for their choices recorded. Overall, 315/523 (60%) patients had MCIC 1C-1E; however, only 96 (30%) of them were treated with tolvaptan at their last follow-up. Among these high-risk patients, those not treated versus treated with tolvaptan were more likely to have a higher eGFR (82 ± 26 vs. 61 ± 27 ml/min/1.73 m2), CKD stages 1-2 (79% vs. 41%), and MCIC 1C (63% vs. 31%). The most common reasons provided for not taking tolvaptan were lifestyle preference related to the aquaretic effect (51%), older age ≥ 60 (12%), and pregnancy/family planning (6%). In this real-world experience, at least 60% of patients with ADPKD considered to be at high risk for progression to ESKD by imaging were not treated with tolvaptan; most of them had early stages of CKD with well-preserved eGFR and as such, were prime targets for tolvaptan therapy to slow disease progression. Given that the most common reason for tolvaptan refusal was the concern for intolerability of the aquaretic side-effect, strategies to mitigate this may help to reduce this barrier to tolvaptan therapy.
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Affiliation(s)
- Luca Calvaruso
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Kevin Yau
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Pedram Akbari
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Fatemah Nasri
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Saima Khowaja
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Bill Wang
- Chair, Patient Liaison Advisory Group of the International Society of Nephrology, Hong Kong, China
| | - Amirreza Haghighi
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Korosh Khalili
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, ON, Canada
| | - York Pei
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
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Ha K, Loeb GB, Park M, Pinedo A, Park CH, Brandes N, Ritu F, Ye CJ, Reiter JF, Delling M. ADPKD-Causing Missense Variants in Polycystin-1 Disrupt Cell Surface Localization or Polycystin Channel Function. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.04.570035. [PMID: 38106161 PMCID: PMC10723288 DOI: 10.1101/2023.12.04.570035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the leading monogenic cause of kidney failure and affects millions of people worldwide. Despite the prevalence of this monogenic disorder, our limited mechanistic understanding of ADPKD has hindered therapeutic development. Here, we successfully developed bioassays that functionally classify missense variants in polycystin-1 (PC1). Strikingly, ADPKD pathogenic missense variants cluster into two major categories: 1) those that disrupt polycystin cell surface localization or 2) those that attenuate polycystin ion channel activity. We found that polycystin channels with defective surface localization could be rescued with a small molecule. We propose that small-molecule-based strategies to improve polycystin cell surface localization and channel function will be effective therapies for ADPKD patients.
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Grange C, Dalmasso A, Cortez JJ, Spokeviciute B, Bussolati B. Exploring the role of urinary extracellular vesicles in kidney physiology, aging, and disease progression. Am J Physiol Cell Physiol 2023; 325:C1439-C1450. [PMID: 37842748 PMCID: PMC10861146 DOI: 10.1152/ajpcell.00349.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
Extracellular vesicles (EVs), membranous vesicles present in all body fluids, are considered important messengers, carrying their information over long distance and modulating the gene expression profile of recipient cells. EVs collected in urine (uEVs) are mainly originated from the apical part of urogenital tract, following the urine flow. Moreover, bacterial-derived EVs are present within urine and may reflect the composition of microbiota. Consolidated evidence has established the involvement of uEVs in renal physiology, being responsible for glomerular and tubular cross talk and among different tubular segments. uEVs may also be involved in other physiological functions such as modulation of innate immunity, coagulation, or metabolic activities. Furthermore, it has been recently remonstrated that age, sex, endurance excise, and lifestyle may influence uEV composition and release, modifying their cargo. On the other hand, uEVs appear modulators of different urogenital pathological conditions, triggering disease progression. uEVs sustain fibrosis and inflammation processes, both involved in acute and chronic kidney diseases, aging, and stone formation. The molecular signature of uEVs collected from diseased patients can be of interest for understanding kidney physiopathology and for identifying diagnostic and prognostic biomarkers.
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Affiliation(s)
- Cristina Grange
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alessia Dalmasso
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Judiel John Cortez
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Beatrice Spokeviciute
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Benedetta Bussolati
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
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Hogan MC, Simmons K, Ullman L, Gondal M, Dahl NK. Beyond Loss of Kidney Function: Patient Care in Autosomal Dominant Polycystic Kidney Disease. KIDNEY360 2023; 4:1806-1815. [PMID: 38010035 PMCID: PMC10758524 DOI: 10.34067/kid.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
Patients with autosomal dominant polycystic kidney disease benefit from specialized care over their lifetimes, starting with diagnosis of the condition with ongoing discussion of both the renal course and extra-renal issues. Both renal and extra-renal issues may continue to cause major morbidity even after successful kidney transplant or initiation of RRT, and extra-renal disease aspects should always be considered as part of routine management. In this review, we will focus on updates in pain/depression screening, cardiac manifestations, liver and pancreatic cysts, kidney stone management, and genetic counseling. In some instances, we have shared our current clinical practice rather than an evidence-based guideline. We anticipate more standardization of care after the release of the Kidney Disease Improving Global Outcomes guidelines for management in autosomal dominant polycystic kidney disease later this year.
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Affiliation(s)
- Marie C. Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Kathryn Simmons
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Lawrence Ullman
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Maryam Gondal
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Neera K. Dahl
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Zhu J, Liu F, Mao J. Clinical findings, underlying pathogenetic processes and treatment of vascular dysfunction in autosomal dominant polycystic kidney disease. Ren Fail 2023; 45:2282027. [PMID: 37970664 PMCID: PMC11001366 DOI: 10.1080/0886022x.2023.2282027] [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: 04/13/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the development of fluid-filled cysts in the kidneys. The primary cause of ADPKD is mutations in the PKD1 (polycystic kidney disease 1) or PKD2 (polycystic kidney disease 2) gene. Patients with ADPKD often develop a variety of vascular abnormalities, which have a major impact on the structure and function of the blood vessels and can lead to complications such as hypertension, intracranial aneurysm (ICAN), and atherosclerosis. The progression of ADPKD involves intricate molecular and cellular processes that lead to the development of these vascular abnormalities. Our understanding of these processes remains incomplete, and available treatment options are limited. The aim of this review is to delve into the underlying mechanisms of these vascular abnormalities and to explore potential interventions.
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Affiliation(s)
- Jinjun Zhu
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Liu
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianhua Mao
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Chen LC, Chu YC, Lu T, Lin HYH, Chan TC. Cardiometabolic comorbidities in autosomal dominant polycystic kidney disease: a 16-year retrospective cohort study. BMC Nephrol 2023; 24:333. [PMID: 37946153 PMCID: PMC10637020 DOI: 10.1186/s12882-023-03382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Autosomal-dominant polycystic kidney disease (ADPKD) is the most prevalent hereditary kidney disease and the fourth leading cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). Nevertheless, there is a paucity of epidemiological research examining the risk factors and survival on RRT for ADPKD. Thus, we aimed to investigate the cumulative effects of cardiometabolic comorbidities, including hypertension (HTN), type 2 diabetes mellitus (DM), and dyslipidemia (DLP) to clinical outcomes in ADPKD. METHODS We identified 6,142 patients with ADPKD aged ≥ 20 years from 2000 to 2015 using a nationwide population-based database. HTN, DM, and DLP diagnoses before or at the time of ADPKD diagnosis and different combinations of the three diagnoses were used as the predictors for the outcomes. Survival analyses were used to estimate the adjusted mortality risk from cardiometabolic comorbidities and the risk for renal survival. RESULTS Patients with ADPKD who developed ESRD had the higher all-cause mortality (HR, 5.14; [95% CI: 3.88-6.80]). Patients with all three of the diseases had a significantly higher risk of entering ESRD (HR:4.15, [95% CI:3.27-5.27]), followed by those with HTN and DM (HR:3.62, [95% CI:2.82-4.65]), HTN and DLP (HR:3.54, [95% CI:2.91-4.31]), and HTN alone (HR:3.10, [95% CI:2.62-3.66]) compared with those without any three cardiometabolic comorbidities. CONCLUSIONS Our study discovered the cumulative effect of HTN, DM, and DLP on the risk of developing ESRD, which reinforces the urgency of proactive prevention of cardiometabolic comorbidities to improve renal outcomes and overall survival in ADPKD patients.
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Affiliation(s)
- Li-Chi Chen
- Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115, Taiwan
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Yi-Chi Chu
- Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115, Taiwan
| | - Tzongshi Lu
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hugo Y-H Lin
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, No.68, Jhonghua 3rd Road, Cianjin, Kaohsiung, 807, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115, Taiwan.
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Arjune S, Oehm S, Todorova P, Gansevoort RT, Bakker SJL, Erger F, Benzing T, Burst V, Grundmann F, Antczak P, Müller RU. Copeptin in autosomal dominant polycystic kidney disease: real-world experiences from a large prospective cohort study. Clin Kidney J 2023; 16:2194-2204. [PMID: 37915893 PMCID: PMC10616446 DOI: 10.1093/ckj/sfad118] [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: 02/22/2023] [Indexed: 11/03/2023] Open
Abstract
Background The identification of new biomarkers in autosomal-dominant polycystic kidney disease (ADPKD) is crucial to improve and simplify prognostic assessment as a basis for patient selection for targeted therapies. Post hoc analyses of the TEMPO 3:4 study indicated that copeptin could be one of those biomarkers. Methods Copeptin was tested in serum samples from patients of the AD(H)PKD study. Serum copeptin levels were measured using a time-resolved amplified cryptate emission (TRACE)-based assay. In total, we collected 711 values from 389 patients without tolvaptan treatment and a total of 243 values (of which 64 were pre-tolvaptan) from 94 patients on tolvaptan. These were associated with rapid progression and disease-causing gene variants and their predictive capacity tested and compared with the Mayo Classification. Results As expected, copeptin levels showed a significant negative correlation with estimated glomerular filtration rate (eGFR). Measurements on tolvaptan showed significantly higher copeptin levels (9.871 pmol/L vs 23.90 pmol/L at 90/30 mg; P < .0001) in all chronic kidney disease stages. Linear regression models (n = 133) show that copeptin is an independent predictor of eGFR slope. A clinical model (including eGFR, age, gender, copeptin) was nearly as good (R2 = 0.1196) as our optimal model (including height-adjusted total kidney volume, eGFR, copeptin, R2 = 0.1256). Adding copeptin to the Mayo model improved future eGFR estimation. Conclusion Copeptin levels are associated with kidney function and independently explained future eGFR slopes. As expected, treatment with tolvaptan strongly increases copeptin levels.
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Affiliation(s)
- Sita Arjune
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Simon Oehm
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Polina Todorova
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Florian Erger
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Human Genetics, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Benzing
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Volker Burst
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Emergency Department, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Franziska Grundmann
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Philipp Antczak
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
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Jost JS, Kaireit TF, Auber B, Beller J, Schmidt-Ott KM, Schmitt R, Wulfmeyer VC. Prevalence of pericardial effusion in autosomal dominant polycystic kidney disease. Clin Kidney J 2023; 16:2041-2047. [PMID: 37915895 PMCID: PMC10616529 DOI: 10.1093/ckj/sfad181] [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: 03/30/2023] [Indexed: 11/03/2023] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) has numerous extrarenal manifestations. Pericardial effusion (PE) may be an underrecognized complication with a reported prevalence of up to 35%. Our study is the first to systematically evaluate the prevalence of PE and associated risk factors in an ADPKD cohort outside the USA. Methods Clinically stable ADPKD patients from a specialized outpatient clinic were evaluated retrospectively. Magnetic resonance tomography and computed tomography scans were analysed regarding the presence of PE (≥4 mm). Imaging results were linked to clinical characteristics. Results Of 286 ADPKD patients, 208 had computed tomography or magnetic resonance imaging suitable for evaluation of PE. In this group we detected PE in 17 patients (8.2%). The overall prevalence of PE was 6.3%, with more females being affected (prevalence of PE was 7.8% in females and 3.8% in males). The PE mean size was 6.8 ± 3.3 mm. The prevalence of autoimmune diseases was higher in the patients with PE (11.8% versus 2.1%, P = .022), while the presence and size of PE was not associated with signs of rapid progressive disease, ADPKD genotype, patient age, body mass index and other clinical parameters. Exploratory investigation of individual characteristics of PE patients by regression tree analysis suggested renal functional impairment, sex and proteinuria as candidate variables. Conclusions PE prevalence in our cohort was lower than previously reported and showed a clear female preponderance. Our data suggest that patients with PEs >10 mm deserve further attention, as they may have additional non-ADPKD-related pathologies.
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Affiliation(s)
- Johanna Sophia Jost
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Till Frederik Kaireit
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | | | - Roland Schmitt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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Chasan O, Mirioglu S, Artan AS, Gursu M, Kazancioglu R, Elcioglu OC. Assessment of metabolic risk factors for nephrolithiasis in patients with autosomal dominant polycystic kidney disease: a cross-sectional study. Clin Exp Nephrol 2023; 27:912-918. [PMID: 37493903 DOI: 10.1007/s10157-023-02378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Nephrolithiasis is more common in autosomal dominant polycystic kidney disease (ADPKD) than in the normal population. We aimed to investigate the anatomical and metabolic factors that may be associated with nephrolithiasis in patients with ADPKD METHODS: In this cross-sectional study, a total of 180 participants were included. Eighty-five patients with ADPKD [42 patients with nephrolithiasis (PKD N +) and 43 without nephrolithiasis (PKD N -)] were recruited. Forty-seven nephrolithiasis patients without ADPKD (N) and 48 healthy controls (HC) were selected as control groups. 24-h urine collections were measured in all participants. 24-h urine citrate, calcium, urate, oxalate, magnesium and sodium, serum electrolytes, and eGFRs were compared. RESULTS Total kidney volumes were not different between patients with PKD N + and PKD N -. Hypocitraturia was common in all patients with ADPKD (69.4%), and it was not different between PKD N + (76.2%) and PKD N- (62.8%). However, hypocitraturia was statistically higher in PKD N + and PKD N - than in N (38.3%) and HC (12.5%) (p<0.05). 24-h urine calcium, urate, and oxalate levels were similar between PKD N + and PKD N - CONCLUSIONS: Hypocitraturia was found to be significantly higher in patients with ADPKD than in healthy adults and other kidney stone patients.
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Affiliation(s)
- Onour Chasan
- Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
- Division of Endocrinology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Meltem Gursu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Rumeyza Kazancioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Omer Celal Elcioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey.
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Kremer LE, Chapman AB, Armato SG. Magnetic resonance imaging preprocessing and radiomic features for classification of autosomal dominant polycystic kidney disease genotype. J Med Imaging (Bellingham) 2023; 10:064503. [PMID: 38156331 PMCID: PMC10752557 DOI: 10.1117/1.jmi.10.6.064503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Purpose Our study aims to investigate the impact of preprocessing on magnetic resonance imaging (MRI) radiomic features extracted from the noncystic kidney parenchyma of patients with autosomal dominant polycystic kidney disease (ADPKD) in the task of classifying PKD1 versus PKD2 genotypes, which differ with regard to cyst burden and disease outcome. Approach The effect of preprocessing on radiomic features was investigated using a single T2-weighted fat saturated (T2W-FS) MRI scan from PKD1 and PKD2 subjects (29 kidneys in total) from the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease study. Radiomic feature reproducibility using the intraclass correlation coefficient (ICC) was computed across MRI normalizations (z -score, reference-tissue, and original image), gray-level discretization, and upsampling and downsampling pixel schemes. A second dataset for genotype classification from 136 subjects T2W-FS MRI images previously enrolled in the HALT Progression of Polycystic Kidney Disease study was matched for age, gender, and Mayo imaging classification class. Genotype classification was performed using a logistic regression classifier and radiomic features extracted from (1) the noncystic kidney parenchyma and (2) the entire kidney. The area under the receiver operating characteristic curve (AUC) was used to evaluate the classification performance across preprocessing methods. Results Radiomic features extracted from the noncystic kidney parenchyma were sensitive to preprocessing parameters, with varying reproducibility depending on the parameter. The percentage of features with good-to-excellent ICC scores ranged from 14% to 58%. AUC values ranged between 0.47 to 0.68 and 0.56 to 0.73 for the noncystic kidney parenchyma and entire kidney, respectively. Conclusions Reproducibility of radiomic features extracted from the noncystic kidney parenchyma was dependent on the preprocessing parameters used, and the effect on genotype classification was sensitive to preprocessing parameters. The results suggest that texture features may be indicative of genotype expression in ADPKD.
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Affiliation(s)
- Linnea E. Kremer
- The University of Chicago, Committee on Medical Physics, Department of Radiology, Chicago, Illinois, United States
| | - Arlene B. Chapman
- The University of Chicago, Department of Medicine, Chicago, Illinois, United States
| | - Samuel G. Armato
- The University of Chicago, Committee on Medical Physics, Department of Radiology, Chicago, Illinois, United States
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Wigerinck S, Gregory AV, Smith BH, Iliuta IA, Hanna C, Chedid M, Kaidbay HDN, Senum SR, Shukoor S, Harris PC, Torres VE, Kline TL, Chebib FT. Evaluation of advanced imaging biomarkers at kidney failure in patients with ADPKD: a pilot study. Clin Kidney J 2023; 16:1691-1700. [PMID: 37779848 PMCID: PMC10539251 DOI: 10.1093/ckj/sfad114] [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: 12/20/2022] [Indexed: 10/03/2023] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) presents with variable disease severity and progression. Advanced imaging biomarkers may provide insights into cystic and non-cystic processes leading to kidney failure in different age groups. Methods This pilot study included 39 ADPKD patients with kidney failure, stratified into three age groups (<46, 46-56, >56 years old). Advanced imaging biomarkers were assessed using an automated instance cyst segmentation tool. The biomarkers were compared with an age- and sex-matched ADPKD cohort in early chronic kidney disease (CKD). Results Ht-total parenchymal volume correlated negatively with age at kidney failure. The median Ht-total parenchymal volume was significantly lower in patients older than 56 years. Cystic burden was significantly higher at time of kidney failure, especially in patients who reached it before age 46 years. The cyst index at kidney failure was comparable across age groups and Mayo Imaging Classes. Advanced imaging biomarkers showed higher correlation with Ht-total kidney volume in early CKD than at kidney failure. Cyst index and parenchymal index were relatively stable over 5 years prior to kidney failure, whereas Ht-total cyst volume and cyst parenchymal surface area increased significantly. Conclusion Age-related differences in advanced imaging biomarkers suggest variable pathophysiological mechanisms in ADPKD patients with kidney failure. Further studies are needed to validate the utility of these biomarkers in predicting disease progression and guiding treatment strategies.
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Affiliation(s)
- Stijn Wigerinck
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | | | - Byron H Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Ioan-Andrei Iliuta
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Christian Hanna
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Maroun Chedid
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Sarah R Senum
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Shebaz Shukoor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Fouad T Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
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Sagar PS, Rangan GK. Cardiovascular Manifestations and Management in ADPKD. Kidney Int Rep 2023; 8:1924-1940. [PMID: 37850017 PMCID: PMC10577330 DOI: 10.1016/j.ekir.2023.07.017] [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: 03/16/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 10/19/2023] Open
Abstract
Cardiovascular disease (CVD) is the major cause of mortality in autosomal dominant polycystic kidney disease (ADPKD) and contributes to significant burden of disease. The manifestations are varied, including left ventricular hypertrophy (LVH), intracranial aneurysms (ICAs), valvular heart disease, and cardiomyopathies; however, the most common presentation and a major modifiable risk factor is hypertension. The aim of this review is to detail the complex pathogenesis of hypertension and other extrarenal cardiac and vascular conditions in ADPKD drawing on preclinical, clinical, and epidemiological evidence. The main drivers of disease are the renin-angiotensin-aldosterone system (RAAS) and polycystin-related endothelial cell dysfunction, with the sympathetic nervous system (SNS), nitric oxide (NO), endothelin-1 (ET-1), and asymmetric dimethylarginine (ADMA) likely playing key roles in different disease stages. The reported rates of some manifestations, such as LVH, have decreased likely due to the use of antihypertensive therapies; and others, such as ischemic cardiomyopathy, have been reported with increased prevalence likely due to longer survival and higher rates of chronic disease. ADPKD-specific screening and management guidelines exist for hypertension, LVH, and ICAs; and these are described in this review.
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Affiliation(s)
- Priyanka S. Sagar
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Gopala K. Rangan
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
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Wang X, Zheng R, Liu Z, Qi L, Gu L, Wang X, Zhu S, Zhang M, Jia D, Su Z. Development and Validation of a Nomogram for Renal Survival Prediction in Patients with Autosomal Dominant Polycystic Kidney Disease. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:398-407. [PMID: 37901714 PMCID: PMC10601962 DOI: 10.1159/000531329] [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: 08/13/2022] [Accepted: 05/23/2023] [Indexed: 10/31/2023]
Abstract
Introduction Due to the wide variation in the prognosis of autosomal dominant polycystic kidney disease (ADPKD), prediction of risk of renal survival in ADPKD patients is a tough challenge. We aimed to establish a nomogram for the prediction of renal survival in ADPKD patients. Methods We conducted a retrospective observational cohort study in 263 patients with ADPKD. The patients were randomly assigned to a training set (N = 198) and a validation set (N = 65), and demographic and statistical data at baseline were collected. The total kidney volume was measured using stereology. A clinical prediction nomogram was developed based on multivariate Cox regression results. The performance and clinical utility of the nomogram were assessed by calibration curves, the concordance index (C-index), and decision curve analysis (DCA). The nomogram was compared with the height-adjusted total kidney volume (htTKV) model by receiver operating characteristic curve analysis and DCA. Results The five independent factors used to construct the nomogram for prognosis prediction were age, htTKV, estimated glomerular filtration rate, hypertension, and hemoglobin. The calibration curve of predicted probabilities against observed renal survival indicated excellent concordance. The model showed very good discrimination with a C-index of 0.91 (0.83-0.99) and an area under the curve of 0.94, which were significantly higher than those of the htTKV model. Similarly, DCA demonstrated that the nomogram had a better net benefit than the htTKV model. Conclusion The risk prediction nomogram, incorporating easily assessable clinical parameters, was effective for the prediction of renal survival in ADPKD patients. It can be a useful clinical adjunct for clinicians to evaluate the prognosis of ADPKD patients and provide individualized decision-making.
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Affiliation(s)
- Xiaomei Wang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Nephrology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Zheng
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhende Liu
- Research Center for Intelligent Supercomputing, Zhejiang Laboratory, Hangzhou, China
| | - Ling Qi
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Gu
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoping Wang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shan Zhu
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mingyue Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Danya Jia
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Su
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Gulati A, Watnick T. Vascular Complications in Autosomal Dominant Polycystic Kidney Disease: Perspectives, Paradigms, and Current State of Play. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:429-439. [PMID: 38097333 DOI: 10.1053/j.akdh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the leading cause of inherited kidney disease with significant contributions to CKD and end-stage kidney disease. The underlying polycystin proteins (PC1 and PC2) have widespread tissue expression and complex functional roles making ADPKD a systemic disease. Vascular complications, particularly intracranial aneurysms (ICA) are the most feared due to their potential for devastating neurological complications and sudden death. Intracranial aneurysms occur in 8-12% of all patients with ADPKD, but the risk is intensified 4-5-fold in those with a positive family history. The basis for this genetic risk is not well understood and could conceivably be due to features of the germline mutation with a significant contribution of other genetic modifiers and/or environmental factors. Here we review what is known about the natural history and genetics of unruptured ICA in ADPKD including the prevalence and risk factors for aneurysm formation and subarachnoid hemorrhage. We discuss two alternative screening strategies and recommend a practical algorithm that targets those at highest risk for ICA with a positive family history for screening.
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Affiliation(s)
- Ashima Gulati
- Division of Nephrology, Children's National Hospital and Children's National Research Institute, Washington, DC
| | - Terry Watnick
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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de Chickera S, Alam A. Dialysis and Transplant Considerations in Autosomal Dominant Polycystic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:461-467. [PMID: 38097334 DOI: 10.1053/j.akdh.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the fourth leading cause of kidney replacement therapy. Unfortunately, the need for dialysis or kidney transplantation is a foreseeable outcome for many patients affected by ADPKD. We review some of the unique issues that should be considered in the management of patients with ADPKD who require dialysis or kidney transplantation. The choice of dialysis modality may be influenced by the enlarged kidneys and liver, but peritoneal dialysis should not be excluded as an option, as studies do not consistently show that there is an increased risk for technique failure or peritonitis. The optimal kidney replacement therapy option remains kidney transplantation; however, nephrectomy may be needed if there is insufficient space for the allograft. Living donor candidates from at-risk families need to be excluded from carrying the disease either by diagnostic imaging criteria or genetic testing. Other potential transplant issues, such as malignancy and cardiovascular and metabolic risks, should also be recognized. Despite these issues, patients with ADPKD requiring dialysis or kidney transplantation generally have more favorable outcomes as compared to those with other causes of chronic kidney disease. Further studies are still needed to personalize the therapeutic approach for those receiving kidney replacement therapy and eventually improve clinical outcomes.
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Affiliation(s)
- Sonali de Chickera
- Division of Nephrology and Multiorgan Transplant Program, McGill University Health Centre, Montreal, QC, Canada
| | - Ahsan Alam
- Division of Nephrology and Multiorgan Transplant Program, McGill University Health Centre, Montreal, QC, Canada.
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40
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Bugazia S, Hogan MC. Extrarenal Manifestations: Polycystic Liver Disease and Its Complications. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:440-453. [PMID: 37943238 DOI: 10.1053/j.akdh.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The liver is the commonest site of involvement outside of the kidney in autosomal dominant polycystic kidney disease. Most individuals with polycystic liver disease are asymptomatic and require no therapeutic interventions, but a small number of affected individuals who experience symptomatic polycystic liver disease develop medical complications as a result of massive enlargement of cyst number and size and hepatic parenchyma and its subsequent associated complications. This can lead to deterioration in overall health and quality of life, increasing morbidity and mortality. In this review, we will touch upon disease pathogenesis, prevalence, and complications and discuss recent advances in surgical and medical management.
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Affiliation(s)
- Seif Bugazia
- Division of Nephrology & Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Marie C Hogan
- Division of Nephrology & Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
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41
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Camargo JT, González CA, Herrera L, Yomayusa-González N, Ibañez M, Valbuena-García AM, Acuña-Merchán L. Autosomal dominant polycystic kidney disease in Colombia. BMC Nephrol 2023; 24:211. [PMID: 37460967 DOI: 10.1186/s12882-023-03266-3] [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: 01/10/2023] [Accepted: 07/09/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of chronic kidney disease (CKD) that requires dialysis. Knowing geographical clusters can be critical for early diagnosis, progression control, and genetic counseling. The objective was to establish the prevalence, geographic location, and ethnic groups of patients with ADPKD who underwent dialysis or kidney transplant in Colombia between 2015 and 2019. METHODS We did a cross-sectional study with data from the National Registry of Chronic Kidney Disease (NRCKD) managed by the High-Cost Diseases Fund (Cuenta de Alto Costo [CAC] in Spanish) between July 1, 2015, and June 30, 2019. We included Colombian population with CKD with or without renal replacement therapy (RRT) due to ADPKD. Crude and adjusted prevalence rates were estimated by state and city. RESULTS 3,339 patients with ADPKD were included, period prevalence was 9.81 per 100,000 population; there were 4.35 cases of RRT per 100,000 population, mean age of 52.58 years (± 13.21), and 52.78% women. Seventy-six patients were Afro-Colombians, six were indigenous, and one Roma people. A total of 46.07% began scheduled dialysis. The highest adjusted prevalence rate was in Valle del Cauca (6.55 cases per 100,000 population), followed by Risaralda, and La Guajira. Regarding cities, Cali had the highest prevalence rate (9.38 cases per 100,000 population), followed by Pasto, Medellin, and Bucaramanga. CONCLUSIONS ADPKD prevalence is lower compared to Europe and US; some states with higher prevalence could be objective to genetic prevalence study.
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Affiliation(s)
| | - Camilo A González
- Unidad Renal, Clínica Colsanitas, Calle 127 No 20-78 Piso 2, Bogotá, D.C, Colombia.
| | - Lina Herrera
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, D.C, Colombia
| | | | - Milciades Ibañez
- Instituto de Investigación, Fundación Universitaria Sanitas, Bogotá, DC, Colombia
| | - Ana M Valbuena-García
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, D.C, Colombia
| | - Lizbeth Acuña-Merchán
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, D.C, Colombia
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42
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Hanna C, Iliuta IA, Besse W, Mekahli D, Chebib FT. Cystic Kidney Diseases in Children and Adults: Differences and Gaps in Clinical Management. Semin Nephrol 2023; 43:151434. [PMID: 37996359 DOI: 10.1016/j.semnephrol.2023.151434] [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] [Indexed: 11/25/2023]
Abstract
Cystic kidney diseases, when broadly defined, have a wide differential diagnosis extending from recessive diseases with a prenatal or pediatric diagnosis, to the most common autosomal-dominant polycystic kidney disease primarily affecting adults, and several other genetic or acquired etiologies that can manifest with kidney cysts. The most likely diagnoses to consider when assessing a patient with cystic kidney disease differ depending on family history, age stratum, radiologic characteristics, and extrarenal features. Accurate identification of the underlying condition is crucial to estimate the prognosis and initiate the appropriate management, identification of extrarenal manifestations, and counseling on recurrence risk in future pregnancies. There are significant differences in the clinical approach to investigating and managing kidney cysts in children compared with adults. Next-generation sequencing has revolutionized the diagnosis of inherited disorders of the kidney, despite limitations in access and challenges in interpreting the data. Disease-modifying treatments are lacking in the majority of kidney cystic diseases. For adults with rapid progressive autosomal-dominant polycystic kidney disease, tolvaptan (V2-receptor antagonist) has been approved to slow the rate of decline in kidney function. In this article, we examine the differences in the differential diagnosis and clinical management of cystic kidney disease in children versus adults, and we highlight the progress in molecular diagnostics and therapeutics, as well as some of the gaps meriting further attention.
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Affiliation(s)
- Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Ioan-Andrei Iliuta
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Whitney Besse
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Djalila Mekahli
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Fouad T Chebib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL.
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Khan A, Anwar M, Zaidi FN, Ghabsha S, Rehman AU. Scar Epilepsy as a Complication of Subarachnoid Hemorrhage in a Patient With Adult Polycystic Kidney Disease: A Case Report. Cureus 2023; 15:e41537. [PMID: 37554616 PMCID: PMC10404565 DOI: 10.7759/cureus.41537] [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: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
Polycystic kidney disease (PKD) is the most common hereditary disorder of kidneys. In adults, PKD1 gene mutation almost always signifies its subtype, autosomal dominant polycystic kidney disease (ADPKD), or adult polycystic kidney disease. ADPKD is a multisystemic disorder giving rise to renal and extra-renal manifestations. The renal shutdown is the most feared renal complication while the development of intracranial aneurysms is considered the most lethal extra-renal feature. This can be attributed to the increased risk of rupture associated with aneurysms leading to a condition called subarachnoid hemorrhage (SAH). While being notorious for the subtle situations SAH often leads to, its association with the onset of seizures is a matter of high clinical significance. We present a patient with a kidney disorder (ADPKD) that has led to the onset of epilepsy. Five years after the diagnosis of ADPKD, he developed an aneurysm in the right internal carotid artery, for which he was treated conservatively. After four months, he presented with the onset of symptoms of SAH, which was confirmed by computed tomography angiography. Clipping was unable to be performed, and the patient was treated conservatively, this time as well. Recently, the patient presented with the onset of generalized tonic-clonic seizures, unable to be controlled with single anti-epileptics. He was stabilized by dual intravenous antiepileptics but on further workup, he was found to have a recurrence of a berry aneurysm for which he was referred to a neurosurgeon for a clipping procedure to be performed. The operation was successful, but the patient was still found to be an epileptic for which he was discharged with a long-term course of double anti-epileptics.
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Affiliation(s)
- Adil Khan
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Maryem Anwar
- Family Medicine, National Health Service (NHS), Slough, GBR
| | - Farah N Zaidi
- Medicine, Queen Elizabeth Hospital, King's Lynn, GBR
| | - Shaima Ghabsha
- Gastroenterology, Royal Bournemouth Hospital, Bournemouth , GBR
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Capelli I, Lerario S, Aiello V, Provenzano M, Di Costanzo R, Squadrani A, Vella A, Vicennati V, Poli C, La Manna G, Baraldi O. Diet and Physical Activity in Adult Dominant Polycystic Kidney Disease: A Review of the Literature. Nutrients 2023; 15:nu15112621. [PMID: 37299584 DOI: 10.3390/nu15112621] [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: 05/17/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
Autosomal polycystic kidney disease is the most common inherited kidney disease determining 5% of all end-stage kidney disease. The only therapy approved for this condition is Tolvaptan, which, with its aquaretic effect, has a strong effect on patients' daily life. Recently, the literature has been enriched with new works that analyze possible non-pharmacological therapeutic strategies to slow cysts' enlargement and chronic kidney disease progression. Among them, dietary schemes reducing carbohydrate intake and inducing ketoses have been demonstrated to have efficacy in several pre-clinical and clinical studies. A ketogenic diet, calorie restriction, intermittent fasting, and time-restricted feeding can reduce aerobic glycolysis and inhibit the mTOR pathway, producing a reduction in cyst cell proliferation, a reduction in kidney volume, and helping to preserve kidney function. ADPKD's burden of disease has an impact on patients' quality of life, and the possibility to play sports or carry out physical exercise can help people in everyday life. The multisystemic character of the disease, especially cardiovascular involvement, needs to be carefully evaluated to establish the quality and quantity of physical activity that patients can safely carry out.
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Affiliation(s)
- Irene Capelli
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Sarah Lerario
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Valeria Aiello
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Roberta Di Costanzo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Andrea Squadrani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Anna Vella
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Valentina Vicennati
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Carolina Poli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Sviluppo Professionale e Implementazione della Ricerca nelle Professioni Sanitarie, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Olga Baraldi
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Trinh A, Huang Y, Shao H, Ram A, Morival J, Wang J, Chung EJ, Downing TL. Targeting the ADPKD methylome using nanoparticle-mediated combination therapy. APL Bioeng 2023; 7:026111. [PMID: 37305656 PMCID: PMC10257530 DOI: 10.1063/5.0151408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
DNA methylation aberrancies are found in autosomal dominant polycystic kidney disease (ADPKD), which suggests the methylome to be a promising therapeutic target. However, the impact of combining DNA methylation inhibitors (DNMTi) and ADPKD drugs in treating ADPKD and on disease-associated methylation patterns has not been fully explored. To test this, ADPKD drugs, metformin and tolvaptan (MT), were delivered in combination with DNMTi 5-aza-2'-deoxycytidine (Aza) to 2D or 3D cystic Pkd1 heterozygous renal epithelial cells (PKD1-Het cells) as free drugs or within nanoparticles to enable direct delivery for future in vivo applications. We found Aza synergizes with MT to reduce cell viability and cystic growth. Reduced representation bisulfite sequencing (RRBS) was performed across four groups: PBS, Free-Aza (Aza), Free-Aza+MT (F-MTAza), and Nanoparticle-Aza+MT (NP-MTAza). Global methylation patterns showed that while Aza alone induces a unimodal intermediate methylation landscape, Aza+MT recovers the bimodality reminiscent of somatic methylomes. Importantly, site-specific methylation changes associated with F-MTAza and NP-MTAza were largely conserved including hypomethylation at ADPKD-associated genes. Notably, we report hypomethylation of cancer-associated genes implicated in ADPKD pathogenesis as well as new target genes that may provide additional therapeutic effects. Overall, this study motivates future work to further elucidate the regulatory mechanisms of observed drug synergy and apply these combination therapies in vivo.
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Affiliation(s)
| | - Yi Huang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, USA
| | | | - Aparna Ram
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, USA
| | | | - Jonathan Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, USA
| | - Eun Ji Chung
- Authors to whom correspondence should be addressed: and
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Russo E, Bussalino E, Macciò L, Verzola D, Saio M, Esposito P, Leoncini G, Pontremoli R, Viazzi F. Non-Haemodynamic Mechanisms Underlying Hypertension-Associated Damage in Target Kidney Components. Int J Mol Sci 2023; 24:ijms24119422. [PMID: 37298378 DOI: 10.3390/ijms24119422] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Arterial hypertension (AH) is a global challenge that greatly impacts cardiovascular morbidity and mortality worldwide. AH is a major risk factor for the development and progression of kidney disease. Several antihypertensive treatment options are already available to counteract the progression of kidney disease. Despite the implementation of the clinical use of renin-angiotensin aldosterone system (RAAS) inhibitors, gliflozins, endothelin receptor antagonists, and their combination, the kidney damage associated with AH is far from being resolved. Fortunately, recent studies on the molecular mechanisms of AH-induced kidney damage have identified novel potential therapeutic targets. Several pathophysiologic pathways have been shown to play a key role in AH-induced kidney damage, including inappropriate tissue activation of the RAAS and immunity system, leading to oxidative stress and inflammation. Moreover, the intracellular effects of increased uric acid and cell phenotype transition showed their link with changes in kidney structure in the early phase of AH. Emerging therapies targeting novel disease mechanisms could provide powerful approaches for hypertensive nephropathy management in the future. In this review, we would like to focus on the interactions of pathways linking the molecular consequences of AH to kidney damage, suggesting how old and new therapies could aim to protect the kidney.
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Affiliation(s)
- Elisa Russo
- U.O.C. Nefrologia e Dialisi, Ospedale San Luca, 55100 Lucca, Italy
| | - Elisabetta Bussalino
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Lucia Macciò
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Michela Saio
- S.S.D. Nefrologia e Dialisi, Ospedale di Sestri Levante, 16124 Genova, Italy
| | - Pasquale Esposito
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Giovanna Leoncini
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Roberto Pontremoli
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
| | - Francesca Viazzi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
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Smith J, Harris OO, Adey D, Park M. Barriers and facilitators to the transplant process among patients living with polycystic kidney disease: a qualitative Approach. BMC Nephrol 2023; 24:119. [PMID: 37127564 PMCID: PMC10150665 DOI: 10.1186/s12882-023-03174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Kidney transplant is the gold standard for renal replacement therapy in patients with autosomal dominant polycystic kidney disease (ADPKD), which is the fourth leading cause of kidney failure. Despite the medical and economic benefits of preemptive kidney transplant over dialysis before transplant, only 9-21% of qualifying patients receive preemptive transplants. Given the low rates of preemptive transplant, the aim of this study was to determine perceived facilitators and barriers to preemptive transplant among ADPKD patients using a qualitative approach. METHODS Data were collected between July 2021 and January 2022 from virtual individual semi-structured interviews of 16 adult participants with ADPKD. Qualitative analysis of the recorded interviews was conducted to generate themes. RESULTS Our findings revealed two themes specific for facilitators to preemptive transplant (social support and patient agency) and three themes specific to barriers for preemptive transplant (inadequate social support, gaps in knowledge, and institutional and systemic policies). The results also include various subthemes and the application of these themes to the social ecological model. CONCLUSIONS These findings suggest that increasing social support and patient agency, such as through patient navigator programs and encouraging effective communication between health care providers and patients, can facilitate the transplant process. Increasing dissemination of transplant knowledge from institutions and systems to patients through paired kidney exchange education and live donor outreach can also increase timely access to preemptive kidney transplants for patients with ADPKD. Our findings are limited by our single site study in the US, which may not apply to individuals experiencing different social, cultural, and health access conditions.
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Affiliation(s)
- Juliana Smith
- University of California, San Francisco School of Medicine, 505 Parnassus Ave, San Francisco, CA, 94143, United States
| | - Orlando O Harris
- Department of Community Health Systems, School of Nursing, University of California, San Francisco 2 Koret Way, N 531E, Box 0608, San Francisco, CA, 94143, United States
| | - Deborah Adey
- Department of Medicine, Division of Nephrology, University of California, San Francisco, 400 Parnassus, ACC Box 701 KTU, Box 0532, San Francisco, CA, 94143, United States
| | - Meyeon Park
- Department of Medicine, Division of Nephrology, University of California, San Francisco, 400 Parnassus, ACC Box 701 KTU, Box 0532, San Francisco, CA, 94143, United States.
- , 500 Parnassus Ave MUW 418, Box 0532, San Francisco, CA, 94143, United States.
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Shin JH, Kim YH, Lee MK, Min HS, Cho H, Kim H, Kim YC, Lee YS, Shin TY. Feasibility of artificial intelligence-based decision supporting system in tolvaptan prescription for autosomal dominant polycystic kidney disease. Investig Clin Urol 2023; 64:255-264. [PMID: 37341005 DOI: 10.4111/icu.20220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/12/2023] [Accepted: 03/26/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Total kidney volume (TKV) measurement is crucial for selecting treatment candidates in autosomal dominant polycystic kidney disease (ADPKD). We developed and investigated the performance of fully-automated 3D-volumetry model and applied it to software as a service (SaaS) for clinical support on tolvaptan prescription in ADPKD patients. MATERIALS AND METHODS Computed tomography scans of ADPKD patients taken between January 2000 and June 2022 were acquired from seven institutions. The quality of the images was manually reviewed in advance. The acquired dataset was split into training, validation, and test datasets at a ratio of 8.5:1:0.5. Convolutional, neural network-based automatic segmentation model was trained to obtain 3D segment mask for TKV measurement. The algorithm consisted of three steps: data preprocessing, ADPKD area extraction, and post-processing. After performance validation with the Dice score, 3D-volumetry model was applied to SaaS which is based on Mayo imaging classification for ADPKD. RESULTS A total of 753 cases with 95,117 slices were included. The differences between the ground-truth ADPKD kidney mask and the predicted ADPKD kidney mask were negligible, with intersection over union >0.95. The post-process filter successfully removed false alarms. The test-set performance was homogeneously equal and the Dice score of the model was 0.971; after post-processing, it improved to 0.979. The SaaS calculated TKV from uploaded Digital Imaging and Communications in Medicine images and classified patients according to height-adjusted TKV for age. CONCLUSIONS Our artificial intelligence-3D volumetry model exhibited effective, feasible, and non-inferior performance compared with that of human experts and successfully predicted the rapid ADPKD progressor.
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Affiliation(s)
- Jung Hyun Shin
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | | | | | | | | | - Hyunsuk Kim
- Department of Nephrology, Hallym University Chuncheon Sacred Hospital, Chuncheon, Korea
| | - Yong Chul Kim
- Department of Nephrology, Seoul National University Hospital, Seoul, Korea
| | - Yong Seong Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
| | - Tae Young Shin
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
- Synergy A.I. Co., Ltd, Seoul, Korea.
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Schultz C, Chiesa J, Philippe Khau VK, Marie-Pierre A, Moranne O. Polycystic kidney disease associated with intracranial hypertension revealing a mutation of the OFD1 gene. J Nephrol 2023; 36:643-645. [PMID: 36571587 DOI: 10.1007/s40620-022-01481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/01/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Céline Schultz
- Service de Néphrologie Dialyse Aphérèse, Nîmes Hôpital Universitaire, Nîmes, France
| | - Jean Chiesa
- Département de Cytogénétique et Génétique Médicale, Hôpital Carémeau, CHU Nîmes, Nîmes University Hospital, Nîmes, France
| | - Van Kien Philippe Khau
- Département de Cytogénétique et Génétique Médicale, Hôpital Carémeau, CHU Nîmes, Nîmes University Hospital, Nîmes, France
| | | | - Olivier Moranne
- Service de Néphrologie Dialyse Aphérèse, Nîmes Hôpital Universitaire, Nîmes, France.
- IDESP, UMR-INSERM, Montpellier, France.
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The impact of pre-transplantation nephrectomy on quality of life in patients with autosomal dominant polycystic kidney disease. World J Urol 2023; 41:1193-1203. [PMID: 36930253 PMCID: PMC10160200 DOI: 10.1007/s00345-023-04349-4] [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: 10/07/2022] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE In selected ADPKD patients, a nephrectomy is required in the work-up for a kidney transplantation. Because the impact of this procedure is unknown, we investigated the effect of pre-transplantation nephrectomy on quality of life in this group. METHODS In this retrospective cohort study all ADPKD patients, ≥ 18 years, who received a kidney transplantation in 2 ADPKD expertise centers between January 2000 and January 2016, were asked to participate. Quality of life was assessed using three validated questionnaires on three time points. Nephrectomy was performed in preparation for transplantation. RESULTS Two hundred seventy-six ADPKD patients (53 ± 9 years, 56.2% male) were included. 98 patients (35.5%) underwent native nephrectomy in preparation for transplantation, of which 43 underwent bilateral nephrectomy. Pre-transplantation, ADPKD-IS scores were worse in the nephrectomy group vs. no-nephrectomy group (physical: 2.9 vs. 2.3, p < 0.001; emotional: 2.0 vs. 1.8, p = 0.03; fatigue: 3.0 vs. 2.3, p = 0.01). Post-transplantation and post-nephrectomy, ADPKD-IS scores improved significantly in both groups, with a significantly higher improvement in the nephrectomy group. During follow-up, all scores were still better compared to pre-transplantation. Observed physical QoL (ADPKD-IS physical 1.3 vs. 1.7, p = 0.04; SF-36 physical 50.0 vs. 41.3, p = 0.03) was better post-transplantation after bilateral nephrectomy compared to unilateral nephrectomy. In retrospect, 19.7% of patients would have liked to undergo a nephrectomy, while the decision not to perform nephrectomy was made by the treating physician. CONCLUSION This study shows that pre-transplantation nephrectomy improves quality of life in selected ADPKD patients. Bilateral nephrectomy may be preferred, although the risk of additional complications should be weighted.
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