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Hoang S, Pujar T, Bellorin-Font E, Edwards JC, Miyata KN. A case of ifosfamide-induced acute kidney injury, Fanconi syndrome, and nephrogenic diabetes insipidus. CEN Case Rep 2024; 13:194-198. [PMID: 37897631 PMCID: PMC11144167 DOI: 10.1007/s13730-023-00829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023] Open
Abstract
Ifosfamide, a cytotoxic antineoplastic drug, can induce rare complications of Fanconi syndrome and nephrogenic diabetes insipidus (DI). Ifosfamide-induced Fanconi syndrome tends to occur in patients with certain risk factors including young age, high cumulative ifosfamide dose, and coadministration of cisplatin. Nephrogenic DI causes polyuria from impaired urinary concentrating ability due to resistance to arginine vasopressin (AVP) at the collecting duct. These complications are serious and potentially fatal. Here, we describe a case of a middle-aged man without risk factors who was admitted for the management of acute kidney injury and electrolyte derangements after his fourth cycle of chemotherapy including ifosfamide for synovial sarcoma. He was found to have hypokalemia, hypophosphatemia, renal glycosuria, and aminoaciduria, likely from Fanconi syndrome, which were managed by electrolyte replacement therapy. In addition, polyuria and hypernatremia were considered due to nephrogenic DI, which partially responded to desmopressin treatment. This case highlights the importance of the routine electrolytes monitoring after ifosfamide treatment.
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Affiliation(s)
- Summer Hoang
- Saint Louis University School of Medicine, 1008 S. Spring Ave., St. Louis, MO, 63110, USA
| | - Thejeswi Pujar
- Saint Louis University School of Medicine, 1008 S. Spring Ave., St. Louis, MO, 63110, USA
| | - Ezequiel Bellorin-Font
- Saint Louis University School of Medicine, 1008 S. Spring Ave., St. Louis, MO, 63110, USA
| | - John C Edwards
- Saint Louis University School of Medicine, 1008 S. Spring Ave., St. Louis, MO, 63110, USA
| | - Kana N Miyata
- Saint Louis University School of Medicine, 1008 S. Spring Ave., St. Louis, MO, 63110, USA.
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2
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Bichet DG, Bockenhauer D. Thirst, Hunger, and Nephrogenic Diabetes Insipidus. N Engl J Med 2024; 390:1922-1924. [PMID: 38810192 DOI: 10.1056/nejmcibr2400066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Affiliation(s)
- Daniel G Bichet
- From the Departments of Medicine and of Pharmacology and Physiology, University of Montreal, and the Nephrology Service, Hôpital du Sacré-Coeur de Montréal - both in Montreal (D.G.B.); and the Department of Pediatric Nephrology, University Hospital Leuven, and the Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium (D.B.)
| | - Detlef Bockenhauer
- From the Departments of Medicine and of Pharmacology and Physiology, University of Montreal, and the Nephrology Service, Hôpital du Sacré-Coeur de Montréal - both in Montreal (D.G.B.); and the Department of Pediatric Nephrology, University Hospital Leuven, and the Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium (D.B.)
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3
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Jinnouchi T, Yoshimoto M, Ogino K, Oji T, Hayashi M. Lithium-induced Nephrogenic Diabetes Insipidus with Efficacy of Desmopressin in Combination with Thiazide Diuretics and Non-steroidal Anti-inflammatory Drugs: A Case Report with a Review of the Literature. Intern Med 2024; 63:1399-1404. [PMID: 37779064 PMCID: PMC11157307 DOI: 10.2169/internalmedicine.2437-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/20/2023] [Indexed: 10/03/2023] Open
Abstract
Nephrogenic diabetes insipidus (NDI) is characterized by excessive urination and an inability to concentrate urine. Lithium is the most common cause of acquired NDI. Treatment typically involves thiazide diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs). However, the efficacy of desmopressin in NDI remains unclear. We herein report a case of lithium-induced NDI in a 71-year-old woman with lithium-induced NDI. Thiazide diuretics and NSAIDs reduced the urine output by approximately 40% compared to pretreatment, while the addition of desmopressin reduced it by approximately 70%. This case suggests that desmopressin can be a viable treatment option for lithium-induced NDI.
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Affiliation(s)
- Takanobu Jinnouchi
- Department of Endocrinology and Diabetes, NTT Medical Center Tokyo, Japan
| | - Munehiro Yoshimoto
- Department of Endocrinology and Diabetes, NTT Medical Center Tokyo, Japan
| | - Kei Ogino
- Department of Psychosomatic Medicine, NTT Medical Center Tokyo, Japan
| | - Tomoatsu Oji
- Department of Psychosomatic Medicine, NTT Medical Center Tokyo, Japan
| | - Michio Hayashi
- Department of Endocrinology and Diabetes, NTT Medical Center Tokyo, Japan
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Kuramoto R, Kise R, Kanno M, Kawakami K, Ikuta T, Makita N, Inoue A. Therapeutic potentials of nonpeptidic V2R agonists for partial cNDI-causing V2R mutants. PLoS One 2024; 19:e0303507. [PMID: 38748623 PMCID: PMC11095762 DOI: 10.1371/journal.pone.0303507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
Loss-of-function mutations in the type 2 vasopressin receptor (V2R) are a major cause of congenital nephrogenic diabetes insipidus (cNDI). In the context of partial cNDI, the response to desmopressin (dDAVP) is partially, but not entirely, diminished. For those with the partial cNDI, restoration of V2R function would offer a prospective therapeutic approach. In this study, we revealed that OPC-51803 (OPC5) and its structurally related V2R agonists could functionally restore V2R mutants causing partial cNDI by inducing prolonged signal activation. The OPC5-related agonists exhibited functional selectivity by inducing signaling through the Gs-cAMP pathway while not recruiting β-arrestin1/2. We found that six cNDI-related V2R partial mutants (V882.53M, Y1283.41S, L1614.47P, T2736.37M, S3298.47R and S3338.51del) displayed varying degrees of plasma membrane expression levels and exhibited moderately impaired signaling function. Several OPC5-related agonists induced higher cAMP responses than AVP at V2R mutants after prolonged agonist stimulation, suggesting their potential effectiveness in compensating impaired V2R-mediated function. Furthermore, docking analysis revealed that the differential interaction of agonists with L3127.40 caused altered coordination of TM7, potentially contributing to the functional selectivity of signaling. These findings suggest that nonpeptide V2R agonists could hold promise as potential drug candidates for addressing partial cNDI.
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Affiliation(s)
- Ritsuki Kuramoto
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Ryoji Kise
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Mayu Kanno
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Kouki Kawakami
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Tatsuya Ikuta
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Noriko Makita
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asuka Inoue
- Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Miyagi, Japan
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Atila C, Refardt J, Christ-Crain M. Arginine vasopressin deficiency: diagnosis, management and the relevance of oxytocin deficiency. Nat Rev Endocrinol 2024:10.1038/s41574-024-00985-x. [PMID: 38693275 DOI: 10.1038/s41574-024-00985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Polyuria-polydipsia syndrome can be caused by central diabetes insipidus, nephrogenic diabetes insipidus or primary polydipsia. To avoid confusion with diabetes mellitus, the name 'central diabetes insipidus' was changed in 2022 to arginine vasopressin (AVP) deficiency and 'nephrogenic diabetes insipidus' was renamed as AVP resistance. To differentiate the three entities, various osmotic and non-osmotic copeptin-based stimulation tests have been introduced in the past decade. The hypertonic saline test plus plasma copeptin measurement emerged as the test with highest diagnostic accuracy, replacing the water deprivation test as the gold standard in differential diagnosis of the polyuria-polydipsia syndrome. The mainstay of treatment for AVP deficiency is AVP replacement with desmopressin, a synthetic analogue of AVP specific for AVP receptor 2 (AVPR2), which usually leads to rapid improvements in polyuria and polydipsia. The main adverse effect of desmopressin is dilutional hyponatraemia, which can be reduced by regularly performing the so-called desmopressin escape method. Evidence from the past few years suggests an additional oxytocin deficiency in patients with AVP deficiency. This potential deficiency should be further evaluated in future studies, including feasible provocation tests for clinical practice and interventional trials with oxytocin substitution.
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Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research University of Basel, University Hospital Basel, Basel, Switzerland
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research University of Basel, University Hospital Basel, Basel, Switzerland
- Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
- Department of Clinical Research University of Basel, University Hospital Basel, Basel, Switzerland.
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Kim B, Ahn YH, Park JH, Lim HS, Chae SW, Lee JS, Kang HG, Kim MJ, Seong MW. The First Case of Congenital Nephrogenic Diabetes Insipidus Caused by AVPR2 Disruption Because of 4q25 Insertional Translocation. Ann Lab Med 2024; 44:303-305. [PMID: 38145893 PMCID: PMC10813831 DOI: 10.3343/alm.2023.0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/11/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Boram Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Sol Lim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Won Chae
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jee-Soo Lee
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Man Jin Kim
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Zhang M, Chen T, Lu X, Lan X, Chen Z, Lu S. G protein-coupled receptors (GPCRs): advances in structures, mechanisms, and drug discovery. Signal Transduct Target Ther 2024; 9:88. [PMID: 38594257 PMCID: PMC11004190 DOI: 10.1038/s41392-024-01803-6] [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: 08/15/2023] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
G protein-coupled receptors (GPCRs), the largest family of human membrane proteins and an important class of drug targets, play a role in maintaining numerous physiological processes. Agonist or antagonist, orthosteric effects or allosteric effects, and biased signaling or balanced signaling, characterize the complexity of GPCR dynamic features. In this study, we first review the structural advancements, activation mechanisms, and functional diversity of GPCRs. We then focus on GPCR drug discovery by revealing the detailed drug-target interactions and the underlying mechanisms of orthosteric drugs approved by the US Food and Drug Administration in the past five years. Particularly, an up-to-date analysis is performed on available GPCR structures complexed with synthetic small-molecule allosteric modulators to elucidate key receptor-ligand interactions and allosteric mechanisms. Finally, we highlight how the widespread GPCR-druggable allosteric sites can guide structure- or mechanism-based drug design and propose prospects of designing bitopic ligands for the future therapeutic potential of targeting this receptor family.
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Affiliation(s)
- Mingyang Zhang
- Key Laboratory of Protection, Development and Utilization of Medicinal Resources in Liupanshan Area, Ministry of Education, Peptide & Protein Drug Research Center, School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ting Chen
- Department of Cardiology, Changzheng Hospital, Affiliated to Naval Medical University, Shanghai, 200003, China
| | - Xun Lu
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaobing Lan
- Key Laboratory of Protection, Development and Utilization of Medicinal Resources in Liupanshan Area, Ministry of Education, Peptide & Protein Drug Research Center, School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
| | - Ziqiang Chen
- Department of Orthopedics, Changhai Hospital, Affiliated to Naval Medical University, Shanghai, 200433, China.
| | - Shaoyong Lu
- Key Laboratory of Protection, Development and Utilization of Medicinal Resources in Liupanshan Area, Ministry of Education, Peptide & Protein Drug Research Center, School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China.
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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8
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Ghasemi S, Mojbafan M, Talebi S, Hooman N, Hoseini R. Genetic analysis of nephrogenic diabetes insipidus patients: A study on the Iranian population. Mol Genet Genomic Med 2024; 12:e2421. [PMID: 38622833 PMCID: PMC11019120 DOI: 10.1002/mgg3.2421] [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: 07/16/2023] [Revised: 02/19/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Nephrogenic diabetes insipidus (NDI) is a rare genetic disease that causes water imbalance. The kidneys play a crucial role in regulating body fluids by controlling water balance through urine excretion. This highlights their essential function in managing the body's water levels, but individuals with NDI may have excess urine production (polyuria), that leads to excessive thirst (polydipsia). Untreated affected individuals may exhibit poor feeding and failure to thrive. This disease is caused by mutations in the AVPR2 and the AQP2 genes which have the X-linked and autosomal recessive/dominant inheritance, respectively. Both of these genes are expressed in the kidney. METHODS Twelve Iranian patients from 10 consanguineous families were studied in this project. DNA was extracted from the whole blood samples of the patients and their parents. All coding exons and exon-intron boundaries of the AVPR2 and AQP2 genes were sequenced in the affected individuals, and the identified variants were investigated in the parents. All variants were analyzed according to the ACMG (American College of Medical Genetics and Genomics) guidelines. RESULTS In this study, 6 different mutations were identified in the patients, including 5 in the AQP2 gene (c.439G>A, c.538G>A, c.140C>T, c.450T>A, and the novel c.668T>C) and 1 in the AVPR2 gene (c.337C>T) in the present study. DISCUSSION As expected, all the detected mutations in this study were missense. According to the ACMG guideline, the identified mutations were categorized as pathogenic or likely pathogenic. Unlike previous studies which showed more than 90% of mutations were in the AVPR2 gene, and only less than 10% of the mutations were in the AQP2 gene, it was found that more than 90% of our identified mutations located in the AQP2 gene, and only one mutation was observed in the AVPR2 gene, which seems it may be a result of the high rate of consanguineous marriages in the Iranian population. We observed genotype-phenotype correlation in some of our affected individuals, and some of the mutations were observed in unrelated families from same ethnicity which could be suggestive of a founder mutation.
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Affiliation(s)
- Saeed Ghasemi
- Department of Medical GeneticsSchool of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
| | - Marzieh Mojbafan
- Department of Medical GeneticsSchool of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
- Department of Medical GeneticsAli‐Asghar Children's HospitalTehranIran
| | - Saeed Talebi
- Department of Medical GeneticsSchool of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
- Department of Medical GeneticsAli‐Asghar Children's HospitalTehranIran
| | - Nakysa Hooman
- Department of Pediatric NephrologyAli‐Asghar Children's HospitalTehranIran
- Clinical Research Development CenterIran University of Medical SciencesTehranIran
| | - Rozita Hoseini
- Department of Pediatric NephrologyAli‐Asghar Children's HospitalTehranIran
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Milano S, Saponara I, Gerbino A, Carmosino M, Svelto M, Procino G. The β3-AR agonist BRL37344 ameliorates the main symptoms of X-linked nephrogenic diabetes insipidus in the mouse model of the disease. J Cell Mol Med 2024; 28:e18301. [PMID: 38652212 PMCID: PMC11037407 DOI: 10.1111/jcmm.18301] [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: 09/21/2023] [Revised: 02/13/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
X-linked nephrogenic diabetes insipidus (X-NDI) is a rare congenital disease caused by inactivating mutations of the vasopressin type-2 receptor (AVPR2), characterized by impaired renal concentrating ability, dramatic polyuria, polydipsia and risk of dehydration. The disease, which still lacks a cure, could benefit from the pharmacologic stimulation of other GPCRs, activating the cAMP-intracellular pathway in the kidney cells expressing the AVPR2. On the basis of our previous studies, we here hypothesized that the β3-adrenergic receptor could be such an ideal candidate. We evaluated the effect of continuous 24 h stimulation of the β3-AR with the agonist BRL37344 and assessed the effects on urine output, urine osmolarity, water intake and the abundance and activation of the key renal water and electrolyte transporters, in the mouse model of X-NDI. Here we demonstrate that the β3-AR agonism exhibits a potent antidiuretic effect. The strong improvement in symptoms of X-NDI produced by a single i.p. injection of BRL37344 (1 mg/kg) was limited to 3 h but repeated administrations in the 24 h, mimicking the effect of a slow-release preparation, promoted a sustained antidiuretic effect, reducing the 24 h urine output by 27%, increasing urine osmolarity by 25% and reducing the water intake by 20%. At the molecular level, we show that BRL37344 acted by increasing the phosphorylation of NKCC2, NCC and AQP2 in the renal cell membrane, thereby increasing electrolytes and water reabsorption in the kidney tubule of X-NDI mice. Taken together, these data suggest that human β3-AR agonists might represent an effective possible treatment strategy for X-NDI.
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Affiliation(s)
- Serena Milano
- Department of Biosciences, Biotechnologies and EnvironmentUniversity of BariBariItaly
- Department of SciencesUniversity of BasilicataPotenzaItaly
| | - Ilenia Saponara
- Department of Biosciences, Biotechnologies and EnvironmentUniversity of BariBariItaly
| | - Andrea Gerbino
- Department of Biosciences, Biotechnologies and EnvironmentUniversity of BariBariItaly
| | | | - Maria Svelto
- Department of Biosciences, Biotechnologies and EnvironmentUniversity of BariBariItaly
| | - Giuseppe Procino
- Department of Biosciences, Biotechnologies and EnvironmentUniversity of BariBariItaly
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Geertsema P, Koorevaar IW, Ipema KJR, Kramers BJ, Casteleijn NF, Gansevoort RT, Meijer E. Effects of salt and protein intake on polyuria in V2RA-treated ADPKD patients. Nephrol Dial Transplant 2024; 39:707-716. [PMID: 37804179 DOI: 10.1093/ndt/gfad218] [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: 06/14/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND The only treatment proven to be renoprotective in autosomal dominant polycystic kidney disease (ADPKD) is a vasopressin V2-receptor antagonist (V2RA). However, aquaresis-associated side effects limit tolerability. We investigated whether salt and/or protein intake influences urine volume and related endpoints in V2RA-treated ADPKD patients. METHODS In this randomized, controlled, double-blind, crossover trial, ADPKD patients treated with maximally tolerated dose of a V2RA were included. While on a low salt and low protein diet, patients were given additional salt and protein to mimic regular intake, which was subsequently replaced by placebo in random order during four 2-week periods. Primary endpoint was change in 24-h urine volume. Secondary endpoints were change in quality of life, measured glomerular filtration rate (mGFR), blood pressure and copeptin level. RESULTS Twelve patients (49 ± 8 years, 25.0% male) were included. Baseline salt and protein intake were 10.8 ± 1.3 g/24-h and 1.2 ± 0.2 g/kg/24-h, respectively. During the low salt and low protein treatment periods, intake decreased to 5.8 ± 1.6 g/24-h and 0.8 ± 0.1 g/kg/24-h, respectively. Baseline 24-h urine volume (5.9 ± 1.2 L) decreased to 5.2 ± 1.1 L (-11%, P = .004) on low salt and low protein, and to 5.4 ± 0.9 L (-8%, P = .04) on low salt. Reduction in 24-h urine volume was two times greater in patients with lower urine osmolality (-16% vs -7%). Polyuria quality of life scores improved in concordance with changes in urine volume. mGFR decreased during the low salt and low protein, while mean arterial pressure did not change during study periods. Plasma copeptin decreased significantly during low salt and low protein periods. CONCLUSION Lowering dietary salt and protein intake has a minor effect on urine volume in V2RA-treated ADPKD patients. Reduced intake of osmoles decreased copeptin concentrations and might thus increase the renoprotective effect of a V2RA in ADPKD patients.
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Affiliation(s)
- Paul Geertsema
- Departments of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris W Koorevaar
- Departments of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin J R Ipema
- Dietetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart J Kramers
- Departments of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niek F Casteleijn
- Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Departments of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Meijer
- Departments of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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11
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Chen X, Yun L, Long Y, Sun Y, Chen T. First report on female monozygotic twins discordant for congenital nephrogenic diabetes insipidus. Am J Med Genet A 2024; 194:e63407. [PMID: 37909842 DOI: 10.1002/ajmg.a.63407] [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: 07/11/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023]
Abstract
Ninety percent of congenital nephrogenic diabetes insipidus (NDI) are X-linked inherited and are caused by mutations in the vasopressin type 2 receptor gene (AVPR2). Most affected individuals are males. Only sporadic female cases have been reported. Here, we first reported a female monozygotic twin with discordant phenotypes for NDI carrying a missense variant c.845T>C (p.Leu282Pro) in exon 4 of AVPR2. Intracellular cAMP concentrations in COS7 cells transfected with AVPR2-L282P were significantly decreased by about 60% compared with those in wild-type AVPR2 plasmid transfected cells, suggesting this variation was pathogenic. The X-inactivation pattern was investigated in peripheral leukocytes and urine sediments in both the unaffected and affected pair. Results showed that the affected pair had a skewed X chromosome inactivation (XCI) pattern in urine sediments and a random XCI pattern in leukocytes, while the unaffected pair showed a random XCI pattern both in leukocytes and urine sediments. This was the first report of monozygotic twins who developed different phenotypes of NDI. Our study suggested that the development of NDI symptoms is more closely associated with the XCI pattern in urine sediments compared with the XCI pattern in peripheral leukocytes. Analysis of XCI in peripheral leukocytes may not be enough to explore possible mechanisms.
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Affiliation(s)
- Xiang Chen
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Laboratory of Endocrinology and Metabolism, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Libing Yun
- Institute of Forensic Medicine, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yang Long
- Experimental Medicine Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yuxia Sun
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Tao Chen
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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12
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Yuan L, Zhao J, Liu Y, Zhao J, Olnood CG, Xu YJ, Liu Y. Multiomics analysis revealed the mechanism of the anti-diabetic effect of Salecan. Carbohydr Polym 2024; 327:121694. [PMID: 38171651 DOI: 10.1016/j.carbpol.2023.121694] [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: 09/13/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
Salecan, a natural β-glucan compromising nine residues connected by β-(1 → 3)/α-(1 → 3) glycosidic bonds, is one of the newly approved food ingredients. Salecan has multiple health-improving effects, yet its mechanism against Type 2 diabetes mellitus (T2DM) remains poorly understood. In this study, the hypoglycemic effect and underlying mechanism of Salecan intervention on STZ-induced diabetic model mice were investigated. After 8 weeks of gavage, Salecan attenuated insulin resistance and repaired pancreatic β cells in a dose-dependent manner. In addition, Salecan supplement remodel the structure of the gut microbiota and altered the level of intestinal metabolites. Serum metabolites, especially unsaturated fatty acids, were also affected significantly. In addition, tight junction proteins in the colon and autophagy-related proteins in the pancreas were upregulated. Multiomics analysis indicated that Lactobacillus johnsonii, Muribaculaceae, and Lachnoclostridium were highly associated with fatty acid esters of hydroxy fatty acids (FAHFA) levels in the colon, accordingly enhancing arachidonic acid and linoleic acid in serum, and promoting GLP-1 release in the intestine and insulin secretion in the pancreas, thus relieving insulin resistance and exhibiting hypoglycemic effects. These findings provide a novel understanding of the anti-diabetic effect of Salecan in mice from a molecular perspective, paving the way for the wide use of Salecan.
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Affiliation(s)
- Liyang Yuan
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, National Engineering Laboratory for Cereal Fermentation Technology, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China
| | - Juan Zhao
- Sichuan Synlight Biotech Ltd, 88 Keyuan South Road, Chengdu 610000, Sichuan, China
| | - Yanjun Liu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, National Engineering Laboratory for Cereal Fermentation Technology, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China
| | - Jialiang Zhao
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, National Engineering Laboratory for Cereal Fermentation Technology, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China
| | - Chen Guang Olnood
- Sichuan Synlight Biotech Ltd, 88 Keyuan South Road, Chengdu 610000, Sichuan, China
| | - Yong-Jiang Xu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, National Engineering Laboratory for Cereal Fermentation Technology, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China.
| | - Yuanfa Liu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, National Engineering Research Center for Functional Food, National Engineering Laboratory for Cereal Fermentation Technology, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China.
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13
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Bais T, Meijer E, Kramers BJ, Vart P, Vervloet M, Salih M, Bammens B, Demoulin N, Todorova P, Müller RU, Halbritter J, Paliege A, Gall ECL, Knebelmann B, Torra R, Ong ACM, Karet Frankl FE, Gansevoort RT. HYDROchlorothiazide versus placebo to PROTECT polycystic kidney disease patients and improve their quality of life: study protocol and rationale for the HYDRO-PROTECT randomized controlled trial. Trials 2024; 25:120. [PMID: 38355627 PMCID: PMC10865620 DOI: 10.1186/s13063-024-07952-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) leads to progressive renal cyst formation and loss of kidney function in most patients. Vasopressin 2 receptor antagonists (V2RA) like tolvaptan are currently the only available renoprotective agents for rapidly progressive ADPKD. However, aquaretic side effects substantially limit their tolerability and therapeutic potential. In a preliminary clinical study, the addition of hydrochlorothiazide (HCT) to tolvaptan decreased 24-h urinary volume and appeared to increase renoprotective efficacy. The HYDRO-PROTECT study will investigate the long-term effect of co-treatment with HCT on tolvaptan efficacy (rate of kidney function decline) and tolerability (aquaresis and quality of life) in patients with ADPKD. METHODS The HYDRO-PROTECT study is an investigator-initiated, multicenter, double-blind, placebo-controlled, randomized clinical trial. The study is powered to enroll 300 rapidly progressive patients with ADPKD aged ≥ 18 years, with an eGFR of > 25 mL/min/1.73 m2, and on stable treatment with the highest tolerated dose of tolvaptan in routine clinical care. Patients will be randomly assigned (1:1) to daily oral HCT 25 mg or matching placebo treatment for 156 weeks, in addition to standard care. OUTCOMES The primary study outcome is the rate of kidney function decline (expressed as eGFR slope, in mL/min/1.73 m2 per year) in HCT versus placebo-treated patients, calculated by linear mixed model analysis using all available creatinine values from week 12 until the end of treatment. Secondary outcomes include changes in quality-of-life questionnaire scores (TIPS, ADPKD-UIS, EQ-5D-5L, SF-12) and changes in 24-h urine volume. CONCLUSION The HYDRO-PROTECT study will demonstrate whether co-treatment with HCT can improve the renoprotective efficacy and tolerability of tolvaptan in patients with ADPKD.
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Affiliation(s)
- Thomas Bais
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Esther Meijer
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart J Kramers
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marc Vervloet
- Department of Nephrology, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mahdi Salih
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bert Bammens
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Demoulin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Polina Todorova
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department 2 for Internal Medicine, Cologne, Germany
| | - Roman-Ulrich Müller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department 2 for Internal Medicine, Cologne, Germany
| | - Jan Halbritter
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Paliege
- Department of Nephrology, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Emilie Cornec-Le Gall
- University Brest, Inserm, UMR 1078, GGB, Brest, 29609, France
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, CHRU Brest, Brest, 29609, France
| | - Bertrand Knebelmann
- Department of Nephrology, Necker-Enfants Malades Hospital AP-HP, Paris, France
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Albert C M Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Fiona E Karet Frankl
- Department of Medical Genetics and Division of Renal Medicine, University of Cambridge, Cambridge, UK
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
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14
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Strych L, Černá M, Hejnalová M, Zavoral T, Komrsková P, Tejcová J, Bitar I, Sládková E, Sýkora J, Šubrt I. Targeted long-read sequencing identified a causal structural variant in X-linked nephrogenic diabetes insipidus. BMC Med Genomics 2024; 17:29. [PMID: 38254165 PMCID: PMC10804598 DOI: 10.1186/s12920-024-01801-1] [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: 07/18/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND X-linked nephrogenic diabetes insipidus (NDI) is a rare genetic renal disease caused by pathogenic variants in the AVPR2 gene. Single nucleotide variants and small insertions/deletions in AVPR2 are reliably detected by routine clinical sequencing. Nevertheless, structural variants involving AVPR2 are challenging to identify accurately by conventional genetic testing. Here, we report a novel deletion of AVPR2 in a Czech family identified for the first time by targeted long-read sequencing (T-LRS). METHODS A male proband with X-linked NDI underwent clinical sequencing of the AVPR2 gene that failed and thus indicated possible whole-gene deletion. Therefore, PCR mapping and subsequent targeted long-read sequencing (T-LRS) using a Pacific Biosciences sequencer were applied to search for the suspected deletion. To validate the deletion breakpoints and prove variant segregation in the family with X-linked NDI, Sanger sequencing of the deletion junction was performed. Quantitative real-time PCR was further carried out to confirm the carrier status of heterozygous females. RESULTS By T-LRS, a novel 7.5 kb deletion of AVPR2 causing X-linked NDI in the proband was precisely identified. Sanger sequencing of the deletion junction confirmed the variant breakpoints and detected the deletion in the probands´ mother, maternal aunt, and maternal cousin with X-linked NDI. The carrier status in heterozygous females was further validated by quantitative real-time PCR. CONCLUSIONS Identifying the 7.5 kb deletion gave a precise molecular diagnosis for the proband, enabled genetic counselling and genetic testing for the family, and further expanded the spectrum of structural variants causing X-linked NDI. Our results also show that T-LRS has significant potential for accurately identifying putative structural variants.
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Affiliation(s)
- Lukáš Strych
- Department of Medical Genetics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic.
| | - Monika Černá
- Department of Medical Genetics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Markéta Hejnalová
- Department of Medical Genetics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Tomáš Zavoral
- Department of Medical Genetics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Pavla Komrsková
- Department of Medical Genetics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Jitka Tejcová
- Department of Medical Genetics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Ibrahim Bitar
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Microbiology, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Eva Sládková
- Department of Pediatrics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Josef Sýkora
- Department of Pediatrics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic
| | - Ivan Šubrt
- Department of Medical Genetics, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Pilsen, Czech Republic.
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15
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Refardt J, Atila C, Chifu I, Ferrante E, Erlic Z, Drummond JB, Indirli R, Drexhage RC, Sailer CO, Widmer A, Felder S, Powlson AS, Hutter N, Vogt DR, Gurnell M, Soares BS, Hofland J, Beuschlein F, Fassnacht M, Winzeler B, Christ-Crain M. Arginine or Hypertonic Saline-Stimulated Copeptin to Diagnose AVP Deficiency. N Engl J Med 2023; 389:1877-1887. [PMID: 37966286 DOI: 10.1056/nejmoa2306263] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Distinguishing between arginine vasopressin (AVP) deficiency and primary polydipsia is challenging. Hypertonic saline-stimulated copeptin has been used to diagnose AVP deficiency with high accuracy but requires close sodium monitoring. Arginine-stimulated copeptin has shown similar diagnostic accuracy but with a simpler test protocol. However, data are lacking from a head-to-head comparison between arginine-stimulated copeptin and hypertonic saline-stimulated copeptin in the diagnosis of AVP deficiency. METHODS In this international, noninferiority trial, we assigned adult patients with polydipsia and hypotonic polyuria or a known diagnosis of AVP deficiency to undergo diagnostic evaluation with hypertonic-saline stimulation on one day and with arginine stimulation on another day. Two endocrinologists independently made the final diagnosis of AVP deficiency or primary polydipsia with use of clinical information, treatment response, and the hypertonic-saline test results. The primary outcome was the overall diagnostic accuracy according to prespecified copeptin cutoff values of 3.8 pmol per liter after 60 minutes for arginine and 4.9 pmol per liter once the sodium level was more than 149 mmol per liter for hypertonic saline. RESULTS Of the 158 patients who underwent the two tests, 69 (44%) received the diagnosis of AVP deficiency and 89 (56%) received the diagnosis of primary polydipsia. The diagnostic accuracy was 74.4% (95% confidence interval [CI], 67.0 to 80.6) for arginine-stimulated copeptin and 95.6% (95% CI, 91.1 to 97.8) for hypertonic saline-stimulated copeptin (estimated difference, -21.2 percentage points; 95% CI, -28.7 to -14.3). Adverse events were generally mild with the two tests. A total of 72% of the patients preferred testing with arginine as compared with hypertonic saline. Arginine-stimulated copeptin at a value of 3.0 pmol per liter or less led to a diagnosis of AVP deficiency with a specificity of 90.9% (95% CI, 81.7 to 95.7), whereas levels of more than 5.2 pmol per liter led to a diagnosis of primary polydipsia with a specificity of 91.4% (95% CI, 83.7 to 95.6). CONCLUSIONS Among adult patients with polyuria polydipsia syndrome, AVP deficiency was more accurately diagnosed with hypertonic saline-stimulated copeptin than with arginine-stimulated copeptin. (Funded by the Swiss National Science Foundation; CARGOx ClinicalTrials.gov number, NCT03572166.).
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Affiliation(s)
- Julie Refardt
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Cihan Atila
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Irina Chifu
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Emanuele Ferrante
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Zoran Erlic
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Juliana B Drummond
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Rita Indirli
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Roosmarijn C Drexhage
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Clara O Sailer
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Andrea Widmer
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Susan Felder
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Andrew S Powlson
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Nina Hutter
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Deborah R Vogt
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Mark Gurnell
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Beatriz S Soares
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Johannes Hofland
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Felix Beuschlein
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Martin Fassnacht
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Bettina Winzeler
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
| | - Mirjam Christ-Crain
- From the Departments of Endocrinology, Diabetology, and Metabolism (J.R., C.A., C.O.S., A.W., S.F., N.H., B.W., M.C.-C.) and Clinical Research (J.R., C.A., C.O.S., A.W., S.F., N.H., D.R.V., B.W., M.C.-C.), University Hospital Basel, University of Basel, Basel, and the Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich (Z.E., F.B.), and the LOOP Zurich-Medical Research Center (F.B.), Zurich - all in Switzerland; the Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands (J.R., R.C.D., J.H.); the Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg (I.C., M.F.), and Central Laboratory, University Hospital Würzburg (M.F.), Würzburg, and Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig Maximilians Universität München, Munich (F.B.) - all in Germany; the Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.F., R.I.), and the Department of Clinical Sciences and Community Health, University of Milan (R.I.) - both in Milan; the Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, Brazil (J.B.D., B.S.S.); and Wellcome-MRC Institute of Metabolic Science, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus (A.S.P., M.G.) and Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals (M.G.) - both in Cambridge, United Kingdom
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Naraki K, Ghasemzadeh Rahbardar M, Ajiboye BO, Hosseinzadeh H. The effect of ellagic acid on the metabolic syndrome: A review article. Heliyon 2023; 9:e21844. [PMID: 38027887 PMCID: PMC10661066 DOI: 10.1016/j.heliyon.2023.e21844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Objective (s): Metabolic syndrome is a collection of metabolic abnormalities that includes hyperglycemia, dyslipidemia, hypertension, and obesity. Ellagic acid is found in various fruits and vegetables. It has been reported to have several pharmacological properties, such as antibacterial, antifungal, antiviral, anti-inflammatory, hepatoprotective, cardioprotective, chemopreventive, neuroprotective, gastroprotective, and antidiabetic. Our current study aims to shed light on the probable efficiency of ellagic acid in managing metabolic syndrome and its complications. Materials and methods To prepare the present review, the databases or search engines utilized included Scopus, PubMed, Science Direct, and Google Scholar, and relevant articles have been gathered with no time limit until March 2023. Results Several investigations indicated that ellagic acid could be a potent compound for the treatment of many disorders such as diabetes, hypertension, and hyperlipidemia by various mechanisms, including increasing insulin secretion, insulin receptor substrate protein 1 expression, regulating glucose transporter 4, triglyceride, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), attenuating tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), reactive oxygen species (ROS), malondialdehyde (MDA), and oxidative stress in related tissues. Furthermore, ellagic acid ameliorates mitochondrial function, upregulates uncoupling protein 1 (found in brown and white adipose tissues), and regulates blood levels of nitrate/nitrite and vascular relaxations in response to acetylcholine and sodium nitroprusside. Conclusion Ellagic acid can treat or manage metabolic syndrome and associated complications, according to earlier studies. To validate the beneficial effects of ellagic acid on metabolic syndrome, additional preclinical and clinical research is necessary.
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Affiliation(s)
- Karim Naraki
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Basiru Olaitan Ajiboye
- Phytomedicine and Molecular Toxicology Research Laboratory, Department of Biochemistry, Federal University Oye-Ekiti, Ekiti State, Nigeria
| | - Hossein Hosseinzadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Hagströmer CJ, Hyld Steffen J, Kreida S, Al-Jubair T, Frick A, Gourdon P, Törnroth-Horsefield S. Structural and functional analysis of aquaporin-2 mutants involved in nephrogenic diabetes insipidus. Sci Rep 2023; 13:14674. [PMID: 37674034 PMCID: PMC10482962 DOI: 10.1038/s41598-023-41616-1] [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: 03/14/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
Aquaporins are water channels found in the cell membrane, where they allow the passage of water molecules in and out of the cells. In the kidney collecting duct, arginine vasopressin-dependent trafficking of aquaporin-2 (AQP2) fine-tunes reabsorption of water from pre-urine, allowing precise regulation of the final urine volume. Point mutations in the gene for AQP2 may disturb this process and lead to nephrogenic diabetes insipidus (NDI), whereby patients void large volumes of highly hypo-osmotic urine. In recessive NDI, mutants of AQP2 are retained in the endoplasmic reticulum due to misfolding. Here we describe the structural and functional characterization of three AQP2 mutations associated with recessive NDI: T125M and T126M, situated close to a glycosylation site and A147T in the transmembrane region. Using a proteoliposome assay, we show that all three mutants permit the transport of water. The crystal structures of T125M and T126M together with biophysical characterization of all three mutants support that they retain the native structure, but that there is a significant destabilization of A147T. Our work provides unique molecular insights into the mechanisms behind recessive NDI as well as deepens our understanding of how misfolded proteins are recognized by the ER quality control system.
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Affiliation(s)
| | - Jonas Hyld Steffen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Kreida
- Department of Biochemistry and Structural Biology, Lund University, Lund, Sweden
| | - Tamim Al-Jubair
- Department of Biochemistry and Structural Biology, Lund University, Lund, Sweden
| | - Anna Frick
- Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden
| | - Pontus Gourdon
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Experimental Medical Science, Lund University, Lund, Sweden
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18
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Münch J, Goodyer PR, Wagner CA. Tubular Diseases and Stones Seen From Pediatric and Adult Nephrology Perspectives. Semin Nephrol 2023; 43:151437. [PMID: 37968178 DOI: 10.1016/j.semnephrol.2023.151437] [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: 11/17/2023]
Abstract
The tubular system of the kidneys is a complex series of morphologic and functional units orchestrating the content of tubular fluid as it flows along the nephron and collecting ducts. Renal tubules maintain body water, regulate electrolytes and acid-base balance, reabsorb precious organic solutes, and eliminate specific metabolites, toxins, and drugs. In addition, decisive mechanisms to adjust blood pressure are governed by the renal tubules. Genetic as well as acquired disorders of these tubular functions may cause serious diseases that manifest both in childhood and adulthood. This article addresses a selection of tubulopathies and the underlying pathomechanisms, while highlighting the important differences in pediatric and adult nephrology care. These range from rare monogenic conditions such as nephrogenic diabetes insipidus, cystinosis, and Bartter syndrome that present in childhood, to the genetic and acquired tubular pathologies causing hypertension or nephrolithiasis that are more prevalent in adults. Both pediatric and adult nephrologists must be aware of these conditions and the age-dependent manifestations that warrant close interaction between the two subspecialties.
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Affiliation(s)
- Johannes Münch
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Institute of Human Genetics, University of Zurich, Zurich, Switzerland; National Center of Competence in Research, NCCR Kidney.CH, Switzerland
| | - Paul R Goodyer
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland; National Center of Competence in Research, NCCR Kidney.CH, Switzerland.
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19
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Erdélyi LS, Hunyady L, Balla A. V2 vasopressin receptor mutations: future personalized therapy based on individual molecular biology. Front Endocrinol (Lausanne) 2023; 14:1173601. [PMID: 37293495 PMCID: PMC10244717 DOI: 10.3389/fendo.2023.1173601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
The diluting and concentrating function of the kidney plays a crucial role in regulating the water homeostasis of the body. This function is regulated by the antidiuretic hormone, arginine vasopressin through the type 2 vasopressin receptor (V2R), allowing the body to adapt to periods of water load or water restriction. Loss-of-function mutations of the V2R cause X-linked nephrogenic diabetes insipidus (XNDI), which is characterized by polyuria, polydipsia, and hyposthenuria. Gain-of-function mutations of the V2R lead to nephrogenic syndrome of inappropriate antidiuresis disease (NSIAD), which results in hyponatremia. Various mechanisms may be responsible for the impaired receptor functions, and this review provides an overview of recent findings about the potential therapeutic interventions in the light of the current experimental data.
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Affiliation(s)
- László Sándor Erdélyi
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - László Hunyady
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Institute of Enzymology, Research Center for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - András Balla
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- ELKH-SE Laboratory of Molecular Physiology, Eötvös Loránd Research Network, Budapest, Hungary
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20
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Makretskaya NA, Nanzanova US, Hamaganova IR, Eremina ER, Tiulpakov AN. [Clinical and laboratory characteristics of arginine vasopressin resistance, caused by a new homozygous mutation p.R113C in AQP2]. PROBLEMY ENDOKRINOLOGII 2023; 69:75-79. [PMID: 37448274 DOI: 10.14341/probl13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 07/15/2023]
Abstract
Congenital nephrogenic diabetes insipidus (CNDI, arginine vasopressin resistance) is a rare inherited disorder characterized by insensitivity of the kidney to the antidiuretic effect of vasopressin. NDI is clinically characterized by polyuria with hyposthenuria and nocturia and polydipsia. In the majority of cases, about 90%, nephrogenic diabetes insipidus is an X-linked recessive disorder caused by mutations in the AVP V2 receptor gene (AVPR2). In the remaining cases, about 10%, the disease is autosomal recessive or dominant and, for these patients, mutations in the aquaporin 2 gene (AQP2) have been reported. To date, the nucleotide variants registered in AQP2 were sporadic, there is no data on the presence of «frequent» mutations and the prevalence of the disease both among the global population and among individual ethnic groups. In this paper, we describe 12 cases of arginine vasopressin resistance caused by a new homozygous mutation p.R113C in AQP2 presented among the indigenous population of the Republic of Buryatia.
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Affiliation(s)
| | | | | | - E R Eremina
- Perinatal Center of Republica; Buryat State University; Scientific Centre for Family Health and Human Reproduction Problems
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21
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Desai D, Pati S, Evangelista MCA. A Case of Hypernatremia With Dementia. Cureus 2023; 15:e39603. [PMID: 37384102 PMCID: PMC10299756 DOI: 10.7759/cureus.39603] [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: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
The authors report a case of hypernatremia in a patient with a history of dementia. This case highlights the challenges and scope of taking care of such patients. It also highlights the hardships in diagnosing and caring for patients with inadequate documentation of past diagnoses and treatments.
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Affiliation(s)
- Drashti Desai
- Internal Medicine, New York City Health and Hospitals Corporation (NYC HHC) Lincoln Medical Center, New York City, USA
| | - Shefali Pati
- Internal Medicine, New York City Health and Hospitals Corporation (NYC HHC) Lincoln Medical Center, New York City, USA
| | - Ma Carla Angela Evangelista
- Internal Medicine, New York City Health and Hospitals Corporation (NYC HHC) Lincoln Medical Center, New York City, USA
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22
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Miyauchi W, Matsunaga T, Sakano Y, Makinoya M, Shimizu S, Miyatani K, Shishido Y, Sakamoto T, Fujiwara Y. Perioperative Infusion Management for Adhesive Bowel Obstruction with Congenital Nephrogenic Diabetes Insipidus: A Case Report. Yonago Acta Med 2023; 66:311-316. [PMID: 37229364 PMCID: PMC10203649 DOI: 10.33160/yam.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
Congenital nephrogenic diabetes insipidus (CNDI) is a rare disease that results in polyuria due to decreased responsiveness to the antidiuretic hormone in the collecting ducts of the kidney. Without compensation by drinking large amounts of water, dehydration and hypernatremia can rapidly develop. We present a case of a patient originally diagnosed with CNDI who required surgery and a fasting period due to adhesive bowel obstruction. The patient was a 46-year-old man who was originally diagnosed with CNDI. He was prescribed trichlormethiazide but self-discontinued treatment in the process. His normal urine output was about 7,000-8,000 mL/day. He underwent robot-assisted radical cystectomy and uretero-cutaneostomy for bladder cancer. Two years later, he was hospitalized due to adhesive bowel obstruction. A 5% glucose solution was infused, and the dose was adjusted according to the urine volume and electrolytes. An adhesiotomy was performed due to recurrent bowel obstruction in a short period of time. A 5% glucose solution was used as the main infusion during the perioperative period. Once drinking water was resumed after surgery, urinary output and electrolytes were easily controlled. In conclusion, patients with CNDI should be given a 5% glucose solution as the primary infusion, and the infusion volume should be adjusted by monitoring daily urine output, electrolytes, and blood glucose levels. Infusion management is easier if oral intake is initiated as early as possible.
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Affiliation(s)
- Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yu Sakano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masahiro Makinoya
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shota Shimizu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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23
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Bockenhauer D, Knoers NVAM, Bichet DG. What's in a name? That which we call diabetes does not taste sweet! Pediatr Nephrol 2023; 38:937-939. [PMID: 36369299 DOI: 10.1007/s00467-022-05815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Detlef Bockenhauer
- UCL Department of Renal Medicine and Paediatric Nephrology Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Nine V A M Knoers
- Department of Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Daniel G Bichet
- Nephrology Service, Departments of Medicine, Pharmacology and Physiology, University of Montreal, Montreal, QC, Canada
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24
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Iglesias P, Silvestre RA, Fernández-Reyes MJ, Díez JJ. The role of copeptin in kidney disease. Endocrine 2023; 79:420-429. [PMID: 36242751 DOI: 10.1007/s12020-022-03219-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
Abstract
Copeptin is a 39-amino acid glycopeptide that is secreted equimolecularly with arginine-vasopressin (AVP) from the prepro-hormone AVP in the posterior pituitary. While AVP is a very unstable molecule and is accompanied by significant technical troubles in its quantification, copeptin is a stable and easily quantifiable molecule. For this reason, circulating copeptin is currently used as a surrogate for AVP in different pathological conditions, including renal diseases. In recent years it has been shown that copeptin is associated with an increased risk of developing chronic kidney disease in the general population. In addition, copeptin has also been associated with multiple renal diseases with relevant clinical consequences and potential therapeutic implications. In the present review, we update and summarize the clinical significance of copeptin as a surrogate marker for AVP concentrations in different kidney diseases, as well as in renal replacement therapy (hemodialysis and peritoneal dialysis) and renal transplantation.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Ramona A Silvestre
- Department of Clinical Biochemistry, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Department of Physiology, Medical School, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Juan J Díez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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25
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Boivin E, Le Daré B, Bellay R, Vigneau C, Mercerolle M, Bacle A. Long-term lithium therapy and risk of chronic kidney disease, hyperparathyroidism and hypercalcemia: a cohort study. Int J Bipolar Disord 2023; 11:4. [PMID: 36709463 PMCID: PMC9884717 DOI: 10.1186/s40345-023-00286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Lithium is well recognized as the first-line maintenance treatment for bipolar disorder (BD). However, besides therapeutic benefits attributed to lithium therapy, the associated side effects including endocrinological and renal disorders constitute important parameters in prescribing patterns and patient adherence. The objectives of this study is to (i) determine whether long-term lithium therapy is associated with a decrease in renal function, hyperparathyroidism and hypercalcemia and (ii) identify risk factors for lithium-induced chronic kidney disease (CKD). METHODS We conducted a single-centered cohort study of adult patients (≥ 18 years) treated with lithium, who were enrolled at Rennes University Hospital in France between January 1, 2018 and June 1, 2020. Required data were collected from the patient's medical records: demographics characteristics (age, sex, body mass index), biologic parameters (GFR, lithium blood level, PTH and calcium), medical comorbidities (hypertension and diabetes), lithium treatment duration and dosage, and length of hospitalization. RESULTS A total of 248 patients were included (mean age: 60.2 ± 16.5 years). Duration of lithium treatment correlated with (i) deterioration of renal function estimated at - 2.9 mL/min/year (p < 0.0001) and (ii) the development of hyperparathyroidism (p < 0.01) and hypercalcemia (p < 0.01). We also noted that patients with lithium blood level > 0.8 mEq/mL had significantly lower GFR than patients with lithium blood level < 0.8 mEq/mL (61.8 mL/min versus 77.6 mL/min, respectively, p = 0.0134). Neither diabetes mellitus nor hypertension was associated with more rapid deterioration of renal function. CONCLUSION This study suggests that the duration of lithium treatment contribute to the deterioration of renal function, raising the question of reducing dosages in patients with a GFR < 60 mL/min. Overdoses has been identified as a risk factor for CKD, emphasizing the importance of regular re-evaluation of the lithium dose regimen. Also, long-term lithium therapy was associated with hyperparathyroidism and hypercalcemia. Particular vigilance is required on these points in order to limit the occurrence of endocrinological and renal lithium adverse effects.
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Affiliation(s)
- Elise Boivin
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France
| | - Brendan Le Daré
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284Institut NuMeCan (Nutrition, Metabolismes et Cancer), Réseau PREVITOX, INSERM, INRAE, Université de Rennes 1, Rennes, France
| | - Romain Bellay
- grid.488406.60000 0000 9139 4930Service Pharmacie, Centre Hospitalier Guillaume Regnier, Rennes, France
| | - Cécile Vigneau
- grid.414271.5Service de Néphrologie, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Marion Mercerolle
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France
| | - Astrid Bacle
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000 Rennes, France
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26
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Hureaux M, Vargas-Poussou R. Genetic basis of nephrogenic diabetes insipidus. Mol Cell Endocrinol 2023; 560:111825. [PMID: 36460218 DOI: 10.1016/j.mce.2022.111825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 12/02/2022]
Abstract
Nephrogenic diabetes insipidus is defined as an inability to concentrate urine due to a complete or partial alteration of the renal tubular response to arginine vasopressin hormone, resulting in excessive diluted urine excretion. Hereditary forms are caused by molecular defects in the genes encoding either of the two main renal effectors of the arginine vasopressin pathway: the AVPR2 gene, which encodes for the type 2 vasopressin receptor, or the AQP2 gene, which encodes for the water channel aquaporin-2. About 90% of cases of nephrogenic diabetes insipidus result from loss-of-function variants in the AVPR2 gene, which are inherited in a X-linked recessive manner. The remaining 10% of cases result from loss-of-function variants in the AQP2 gene, which can be inherited in either a recessive or a dominant manner. The main symptoms of the disease are polyuria, chronic dehydration and hypernatremia. These symptoms usually occur in the first year of life, although some patients present later. Diagnosis is based on abnormal response in urinary osmolality after water restriction and/or administration of exogenous vasopressin. Treatment involves ensuring adequate water intake on demand, possibly combined with thiazide diuretics, non-steroidal anti-inflammatory drugs, and a low-salt and protein diet. In this review, we provide an update on current understanding of the molecular basis of inherited nephrogenic insipidus diabetes.
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Affiliation(s)
- Marguerite Hureaux
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Department of Genetics, France and University of Paris Cité, Paris, France; Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
| | - Rosa Vargas-Poussou
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Department of Genetics, France and University of Paris Cité, Paris, France; Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.
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27
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Genome-Engineered mpkCCDc14 Cells as a New Resource for Studying AQP2. Int J Mol Sci 2023; 24:ijms24021684. [PMID: 36675199 PMCID: PMC9866188 DOI: 10.3390/ijms24021684] [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: 09/21/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
mpkCCDc14 cells, a polarized epithelial cell line derived from mouse kidney cortical collecting ducts, are known to express the vasopressin V2 receptor (V2R) and aquaporin-2 (AQP2) that are responsive to vasopressin. However, a low abundance of the endogenous AQP2 protein in the absence of vasopressin and heterogeneity of AQP2 protein abundance among the cultured cells may limit the further application of the cell line in AQP2 studies. To overcome the limitation, we aimed to establish mpkCCDc14 cells constitutively expressing V2R and AQP2 via CRISPR/Cas9-mediated genome engineering technology (i.e., V2R-AQP2 cells). 3'- and 5'-Junction PCR revealed that the V2R-AQP2 expression cassette with a long insert size (~2.2 kb) was correctly integrated. Immunoblotting revealed the expression of products of integrated Aqp2 genes. Cell proliferation rate and dDAVP-induced cAMP production were not affected by the knock-in of Avpr2 and Aqp2 genes. The AQP2 protein abundance was significantly higher in V2R-AQP2 cells compared with control mpkCCDc14 cells in the absence of dDAVP and the integrated AQP2 was detected. Immunocytochemistry demonstrated that V2R-AQP2 cells exhibited more homogenous and prominent AQP2 labeling intensity in the absence of dDAVP stimulation. Moreover, prominent AQP2 immunolabeling (both AQP2 and pS256-AQP2) in the apical domain of the genome-edited cells was observed in response to dDAVP stimulation, similar to that in the unedited control mpkCCDc14 cells. Taken together, mpkCCDc14 cells constitutively expressing V2R and AQP2 via genome engineering could be exploited for AQP2 studies.
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28
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Angelousi A, Alexandraki KI, Mytareli C, Grossman AB, Kaltsas G. New developments and concepts in the diagnosis and management of diabetes insipidus (AVP-deficiency and resistance). J Neuroendocrinol 2023; 35:e13233. [PMID: 36683321 DOI: 10.1111/jne.13233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/10/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
Diabetes insipidus (DI) is a disorder characterised by the excretion of large amounts of hypotonic urine, with a prevalence of 1 per 25,000 population. Central DI (CDI), better now referred to as arginine vasopressin (AVP)-deficiency, is the most common form of DI resulting from deficiency of the hormone AVP from the pituitary. The less common nephrogenic DI (NDI) or AVP-resistance develops secondary to AVP resistance in the kidneys. The majority of causes of DI are acquired, with CDI developing when more than 80% of AVP-secreting neurons are damaged. Inherited/familial CDI causes account for approximately 1% of cases. Although the pathogenesis of NDI is unclear, more than 280 disease-causing mutations affecting the AVP2 protein or AVP V2 receptor, as well as in aquaporin 2 (AQP2), have been described. Although the cAMP/protein kinase A pathway remains the major regulatory pathway of AVP/AQP2 action, in vitro data have also revealed additional cAMP independent pathways of NDI pathogenesis. Diagnosing partial forms of DI, and distinguishing them from primary polydipsia, can be challenging, previously necessitating the use of the water deprivation test. However, measurements of circulating copeptin levels, especially after stimulation, are increasingly replacing the classical tests in clinical practice because of their ease of use and high sensitivity and specificity. The treatment of CDI relies on desmopressin administration, whereas NDI requires the management of any underlying diseases, removal of offending drugs and, in some cases, administration of diuretics. A better understanding of the pathophysiology of DI has led to novel evolving therapeutic agents that are under clinical trial.
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Affiliation(s)
- Anna Angelousi
- First Department of Internal Medicine, Unit of Endocrinology, Laikon Hospital, Athens, Greece
| | | | - Chrysoula Mytareli
- First Department of Internal Medicine, Unit of Endocrinology, Laikon Hospital, Athens, Greece
| | - Ashley B Grossman
- Green Templeton College, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
- NET Unit, Royal Free Hospital, London, UK
| | - Gregory Kaltsas
- First Department of Propaedeutic Internal Medicine, Laikon Hospital, National & Kapodistrian University of Athens, Athens, Greece
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29
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Kermond R, Mallett A, McCarthy H. A clinical approach to tubulopathies in children and young adults. Pediatr Nephrol 2023; 38:651-662. [PMID: 35585366 PMCID: PMC9842573 DOI: 10.1007/s00467-022-05606-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/21/2023]
Abstract
Kidney tubules are responsible for the preservation of fluid, electrolyte and acid-base homeostasis via passive and active mechanisms. These physiological processes can be disrupted by inherited or acquired aetiologies. The net result is a tubulopathy. It is important to make a prompt and accurate diagnosis of tubulopathies in children and young adults. This allows timely and appropriate management, including disease-specific therapies, and avoids complications such as growth failure. Tubulopathies can present with a variety of non-specific clinical features which can be diagnostically challenging. In this review, we build from this common anatomical and physiological understanding to present a tangible appreciation of tubulopathies as they are likely to be clinically encountered among affected children and young adults.
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Affiliation(s)
- Rachael Kermond
- Department of Renal Medicine, Sydney Children’s Hospital Network, Sydney, NSW Australia
| | - Andrew Mallett
- Department of Renal Medicine, Townsville University Hospital, Douglas, QLD, Australia. .,College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia. .,Institute for Molecular Bioscience & Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Hugh McCarthy
- Department of Renal Medicine, Sydney Children's Hospital Network, Sydney, NSW, Australia. .,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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Yang LL, Xu Y, Qiu JL, Zhao QY, Li MM, Shi H. Congenital nephrogenic diabetes insipidus arginine vasopressin receptor 2 gene mutation at new site: A case report. World J Clin Cases 2022; 10:13443-13450. [PMID: 36683631 PMCID: PMC9850987 DOI: 10.12998/wjcc.v10.i36.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/11/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Congenital nephrogenic diabetes insipidus (CNDI) is a rare hereditary disorder. It is associated with mutations in the arginine vasopressin receptor 2 (AVPR2) gene and aquaporin 2 (AQP2) gene, and approximately 270 different mutation sites have been reported for AVPR2. Therefore, new mutations and new manifestations are crucial to complement the clinical deficiencies in the diagnosis of this disease. We report a case of a novel AVPR2 gene mutation locus and a new clinical mani-festation.
CASE SUMMARY We describe the case of a 48-d-old boy who presented with recurrent fever and diarrhea 5 d after birth. Laboratory tests showed electrolyte disturbances and low urine specific gravity, and imaging tests showed no abnormalities. Genetic testing revealed a novel X-linked recessive missense mutation, c.283 (exon 2) C>T (p.P95S). This mutation results in the substitution of a proline residue with a serine residue in the AVPR2 protein sequence. The diagnosis of CNDI was confirmed based on the AVPR2 gene mutation. The treatment strategy for this patient was divided into two stages, including physical cooling supplemented with appropriate amounts of water in the early stage and oral hydrochlorothia-zide (1-2 mg/kg) after a clear diagnosis. After follow-up of one and a half years, the patient gradually improved.
CONCLUSION AVPR2 gene mutations in new loci and new clinical symptoms help clinicians understand this disease and shorten the diagnosis cycle.
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Affiliation(s)
- Lu-Lu Yang
- Department of Pediatrics, Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Yan Xu
- Department of Pediatrics, Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Jian-Li Qiu
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Qian-Yi Zhao
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Man-Man Li
- Department of Pediatrics, Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
| | - Hui Shi
- Department of Pediatrics, Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
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Wang B, Wang Y, Wen Y, Zhang YL, Ni WJ, Tang TT, Cao JY, Yin Q, Jiang W, Yin D, Li ZL, Lv LL, Liu BC. Tubular-specific CDK12 knockout causes a defect in urine concentration due to premature cleavage of the slc12a1 gene. Mol Ther 2022; 30:3300-3312. [PMID: 35581939 PMCID: PMC9552909 DOI: 10.1016/j.ymthe.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/21/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022] Open
Abstract
Cyclin-dependent kinase 12 (CDK12) plays a critical role in regulating gene transcription. CDK12 inhibition is a potential anticancer therapeutic strategy. However, several clinical trials have shown that CDK inhibitors might cause renal dysfunction and electrolyte disorders. CDK12 is abundant in renal tubular epithelial cells (RTECs), but the exact role of CDK12 in renal physiology remains unclear. Genetic knockout of CDK12 in mouse RTECs causes polydipsia, polyuria, and hydronephrosis. This phenotype is caused by defects in water reabsorption that are the result of reduced Na-K-2Cl cotransporter 2 (NKCC2) levels in the kidney. In addition, CKD12 knockout causes an increase in Slc12a1 (which encodes NKCC2) intronic polyadenylation events, which results in Slc12a1 truncated transcript production and NKCC2 downregulation. These findings provide novel insight into CDK12 being necessary for maintaining renal homeostasis by regulating NKCC2 transcription, which explains the critical water and electrolyte disturbance that occurs during the application of CDK12 inhibitors for cancer treatment. Therefore, there are safety concerns about the clinical use of these new anticancer drugs.
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Affiliation(s)
- Bin Wang
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Yao Wang
- Nanjing Medical University, Nanjing, Jiangsu, China; Department of Nephrology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yi Wen
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China.
| | - Yi-Lin Zhang
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Wei-Jie Ni
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Tao-Tao Tang
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Jing-Yuan Cao
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Qing Yin
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Wei Jiang
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Di Yin
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Zuo-Lin Li
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Lin-Li Lv
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhong da Hospital, Southeast University School of Medicine, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, Jiangsu Province, China; Nanjing Medical University, Nanjing, Jiangsu, China.
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Atila C, Loughrey PB, Garrahy A, Winzeler B, Refardt J, Gildroy P, Hamza M, Pal A, Verbalis JG, Thompson CJ, Hemkens LG, Hunter SJ, Sherlock M, Levy MJ, Karavitaki N, Newell-Price J, Wass JAH, Christ-Crain M. Central diabetes insipidus from a patient's perspective: management, psychological co-morbidities, and renaming of the condition: results from an international web-based survey. Lancet Diabetes Endocrinol 2022; 10:700-709. [PMID: 36007536 DOI: 10.1016/s2213-8587(22)00219-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Central diabetes insipidus is a rare neuroendocrine condition. Data on treatment-associated side-effects, psychological comorbidities, and incorrect management are scarce. The aim of this study was to investigate patients' perspectives on their disease. METHODS This study used a cross-sectional, web-based, anonymous survey, developed by endocrinologists and patient representatives, to collect the opinions of patients with central diabetes insipidus on management and complications of their disease, psychological comorbidities, degree of knowledge and awareness of the condition among health-care professionals, and renaming the disease to avoid confusion with diabetes mellitus (diabetes). FINDINGS Between Aug 23, 2021, and Feb 7, 2022, 1034 patients with central diabetes insipidus participated in the survey. 91 (9%) participants were children and adolescents (37 [41%] girls and 54 [59%] boys; median age 10 years [IQR 6-15]) and 943 (91%) were adults (757 [80%] women and 186 [20%] men]; median age 44 years [34-54]). 488 (47%) participants had isolated posterior pituitary dysfunction and 546 (53%) had combined anterior and posterior pituitary dysfunction. Main aetiologies were idiopathic (315 [30%] of 1034 participants) and tumours and cysts (pre-surgical 217 [21%]; post-surgical 254 [25%]). 260 (26%; 95% CI [0·23-0·29]) of 994 patients on desmopressin therapy had hyponatraemia leading to hospitalisation. Patients who routinely omitted or delayed desmopressin to allow intermittent aquaresis had a significantly lower prevalence of hyponatraemia compared with those not aware of this approach (odds ratio 0·55 [95% CI 0·39-0·77]; p=0·0006). Of patients who had to be hospitalised for any medical reason, 71 (13%; 95% CI 0·10-0·16) of 535 patients did not receive desmopressin while in a fasting state (nil by mouth) without intravenous fluid replacement and reported symptoms of dehydration. 660 (64%; 0·61-0·67) participants reported lower quality of life, and 369 (36%; 0·33-0·39) had psychological changes subjectively associated with their central diabetes insipidus. 823 (80%; 0·77-0·82) participants encountered a situation where central diabetes insipidus was confused with diabetes mellitus (diabetes) by health-care professionals. 884 (85%; 0·83-0·88) participants supported renaming the disease; the most favoured alternative names were vasopressin deficiency and arginine vasopressin deficiency. INTERPRETATION This is the largest survey of patients with central diabetes insipidus, reporting a high prevalence of treatment-associated side-effects, mismanagement during hospitalisation, psychological comorbidities, and a clear support for renaming the disease. Our data are the first to indicate the value of routinely omitting or delaying desmopressin. FUNDING Swiss National Science Foundation, Swiss Academy of Medical Sciences, and G&J Bangerter-Rhyner-Foundation.
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Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Paul Benjamin Loughrey
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, UK
| | - Aoife Garrahy
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | - Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Malak Hamza
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Aparna Pal
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | | | - Christopher J Thompson
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lars G Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center Berlin, Berlin Institute of Health, Berlin, Germany
| | - Steven J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Mark Sherlock
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miles J Levy
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - John Newell-Price
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - John A H Wass
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
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Abstract
ABSTRACT Each year, nearly one-fifth of adults in the United States are prescribed at least one psychotropic medication. An increased trend in psychiatric polypharmacy has heightened awareness of drug-drug interactions and the tracking of adverse drug reactions. This article describes a patient who developed concomitant neuroleptic malignant syndrome (NMS) and nephrogenic diabetes insipidus during cross-titration of his antipsychotics while on lithium. The patient's mild form of NMS in turn caused hypovolemia and acute kidney injury. This case study highlights the dangers of polypharmacy and how it can obscure the presentation of even classic adverse reactions.
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Affiliation(s)
- Carlee Zaki
- At Bellevue Hospital in New York City, Carlee Zaki, Meredith Ugell, Trang Vo , and Steven Liu practice in the Department of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Klepalova VV, Pushkareva OS, Iziurova NV, Aksenov AV. [Family form of nephrogenic X-linked diabetes indiabetes]. PROBLEMY ENDOKRINOLOGII 2022; 68:87-90. [PMID: 36337022 DOI: 10.14341/probl13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
Abstract
There is a global trend towards an increase in the prevalence of diabetes insipidus. Symptoms of nephrogenic diabetes insipidus with X-linked inheritance appear in men, in women with heterozygous mutations, are characterized by an isolated symptom complex of polyuria, polydipsia, hypostenuria. In children, more often than in adults, with fluid restriction, a clinic of water-deficient dehydration develops with hypernatremia, hyperthermia, and plasma hyperosmolality. This manuscript presents a case of Nephrogenic diabetes insipidus, X-linked familial form in male patients.At the same time, in the family along the female line, the mother and grandmother also had an increased need for water, the use of minirin was ineffective. In the older brother and younger brother, clinical manifestations of diabetes insipidus in the form of severe thirst and polyuria were noted from infancy, after the examination, the diagnosis was made - diabetes insipidus and desmopressin was prescribed.Due to the lack of effect from the use of desmopressin, the analysis of exons and adjacent sections of the introns of the AQP2 and AVPR2 genes was carried out by PCR and subsequent direct sequencing. No mutations were found in the AQP2 gene. The hemizygous substitution S315I was found in the AVPR2 gene. The familial form X was confirmed - linked nephrogenic diabetes insipidus. A hypothiazide was recommended, against the background of constant intake of which only a slight positive trend is observed.
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AQP2 trafficking in health and diseases: an updated overview. Int J Biochem Cell Biol 2022; 149:106261. [DOI: 10.1016/j.biocel.2022.106261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022]
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Yang HH, Su SH, Ho CH, Yeh AH, Lin YJ, Yu MJ. Glucocorticoid Receptor Maintains Vasopressin Responses in Kidney Collecting Duct Cells. Front Physiol 2022; 13:816959. [PMID: 35685285 PMCID: PMC9173664 DOI: 10.3389/fphys.2022.816959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
Water permeability of the kidney collecting ducts is regulated in part by the amount of the molecular water channel protein aquaporin-2 (AQP2), whose expression, in turn, is regulated by the pituitary peptide hormone vasopressin. We previously showed that stable glucocorticoid receptor knockdown diminished the vasopressin-induced Aqp2 gene expression in the collecting duct cell model mpkCCD. Here, we investigated the pathways regulated by the glucocorticoid receptor by comparing transcriptomes of the mpkCCD cells with or without stable glucocorticoid receptor knockdown. Glucocorticoid receptor knockdown downregulated 5,394 transcripts associated with 55 KEGG pathways including "vasopressin-regulated water reabsorption," indicative of positive regulatory roles of these pathways in the vasopressin-induced Aqp2 gene expression. Quantitative RT-PCR confirmed the downregulation of the vasopressin V2 receptor transcript upon glucocorticoid receptor knockdown. Glucocorticoid receptor knockdown upregulated 3,785 transcripts associated with 42 KEGG pathways including the "TNF signaling pathway" and "TGFβ signaling pathway," suggesting the negative regulatory roles of these pathways in the vasopressin-induced Aqp2 gene expression. Quantitative RT-PCR confirmed the upregulation of TNF and TGFβ receptor transcripts upon glucocorticoid receptor knockdown. TNF or TGFβ inhibitor alone, in the absence of vasopressin, did not induce Aqp2 gene transcription. However, TNF or TGFβ blunted the vasopressin-induced Aqp2 gene expression. In particular, TGFβ reduced vasopressin-induced increases in Akt phosphorylation without inducing epithelial-to-mesenchymal transition or interfering with vasopressin-induced apical AQP2 trafficking. In summary, our RNA-seq transcriptomic comparison revealed positive and negative regulatory pathways maintained by the glucocorticoid receptor for the vasopressin-induced Aqp2 gene expression.
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Affiliation(s)
| | | | | | | | | | - Ming-Jiun Yu
- Institute of Biochemistry and Molecular Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Christ-Crain M, Refardt J, Winzeler B. Approach to the Patient: "Utility of the Copeptin Assay". J Clin Endocrinol Metab 2022; 107:1727-1738. [PMID: 35137148 PMCID: PMC9113794 DOI: 10.1210/clinem/dgac070] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Indexed: 11/19/2022]
Abstract
Copeptin derives from the same precursor peptide preprovasopressin as arginine vasopressin (AVP). The secretion of both peptides is stimulated by similar physiological processes, such as osmotic stimulation, hypovolemia, or stress. AVP is difficult to measure due to complex preanalytical requirements and due to technical difficulties. In the last years, copeptin was found to be a stable, sensitive, and simple to measure surrogate marker of AVP release. Different immunoassays exist to measure copeptin. The 2 assays which have most often be used in clinical studies are the original sandwich immunoluminometric assay and its automated immunofluorescent successor. In addition, various enzyme-linked immunosorbent assay have been developed. With the availability of the copeptin assay, the differential diagnosis of diabetes insipidus was recently revisited. The goal for this article is therefore to first review the physiology of copeptin, and second to describe its use as marker for the differential diagnosis of vasopressin-dependent fluid disorders, mainly diabetes insipidus but also hyper- and hyponatremia. Furthermore, we highlight the role of copeptin as prognostic marker in other acute and chronic diseases.
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Affiliation(s)
- Mirjam Christ-Crain
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence: Mirjam Christ-Crain, MD, PhD, Department of Endocrinology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Julie Refardt
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
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Tu R, Yu J, Zhang X, Zhu Y, Zeng G. Renal tubular acidosis and nephrogenic diabetes insipidus caused by Sjögren's syndrome with hypokalemic periodic paralysis as the first symptom: A case report. Rev Neurol (Paris) 2022; 178:861-864. [PMID: 35568514 DOI: 10.1016/j.neurol.2022.02.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Affiliation(s)
- R Tu
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - J Yu
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China.
| | - X Zhang
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Y Zhu
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - G Zeng
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
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Alhasan K, D'Alessandri-Silva C, Mongia A, Topaloglu R, Tasic V, Filler G. Young Adults With Hereditary Tubular Diseases: Practical Aspects for Adult-Focused Colleagues. Adv Chronic Kidney Dis 2022; 29:292-307. [PMID: 36084976 DOI: 10.1053/j.ackd.2021.11.004] [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: 09/21/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
Recent advances in the management of kidney tubular diseases have resulted in a significant cohort of adolescents and young adults transitioning from pediatric- to adult-focused care. Most of the patients under adult-focused care have glomerular diseases, whereas rarer tubular diseases form a considerable proportion of pediatric patients. The purpose of this review is to highlight the clinical signs and symptoms of tubular disorders, as well as their diagnostic workup, including laboratory findings and imaging, during young adulthood. We will then discuss more common disorders such as cystinosis, cystinuria, distal kidney tubular acidosis, congenital nephrogenic diabetes insipidus, Dent disease, rickets, hypercalciuria, and syndromes such as Bartter, Fanconi, Gitelman, Liddle, and Lowe. This review is a practical guide on the diagnostic and therapeutic approach of tubular conditions affecting young adults who are transitioning to adult-focused care.
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Affiliation(s)
- Khalid Alhasan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Cynthia D'Alessandri-Silva
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, and Nephrology, Connecticut Children's Medical Center, Hartford, CT
| | - Anil Mongia
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY
| | - Rezan Topaloglu
- Department of Paediatrics, Division of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Velibor Tasic
- University Children's Hospital, Medical School, Skopje, North Macedonia
| | - Guido Filler
- Department of Paediatrics, Division of Pediatric Nephrology, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada.
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40
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10/m mit starkem Durst und häufigem Harndrang. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01468-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vaz de Castro PAS, Bitencourt L, de Oliveira Campos JL, Fischer BL, Soares de Brito SBC, Soares BS, Drummond JB, Simões E Silva AC. Nephrogenic diabetes insipidus: a comprehensive overview. J Pediatr Endocrinol Metab 2022; 35:421-434. [PMID: 35146976 DOI: 10.1515/jpem-2021-0566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
Nephrogenic diabetes insipidus (NDI) is characterized by the inability to concentrate urine that results in polyuria and polydipsia, despite having normal or elevated plasma concentrations of arginine vasopressin (AVP). In this study, we review the clinical aspects and diagnosis of NDI, the various etiologies, current treatment options and potential future developments. NDI has different clinical manifestations and approaches according to the etiology. Hereditary forms of NDI are mainly caused by mutations in the genes that encode key proteins in the AVP signaling pathway, while acquired causes are normally associated with specific drug exposure, especially lithium, and hydroelectrolytic disorders. Clinical manifestations of the disease vary according to the degree of dehydration and hyperosmolality, being worse when renal water losses cannot be properly compensated by fluid intake. Regarding the diagnosis of NDI, it is important to consider the symptoms of the patient and the diagnostic tests, including the water deprivation test and the baseline plasma copeptin measurement, a stable surrogate biomarker of AVP release. Without proper treatment, patients may developcomplications leading to high morbidity and mortality, such as severe dehydration and hypernatremia. In that sense, the treatment of NDI consists in decreasing the urine output, while allowing appropriate fluid balance, normonatremia, and ensuring an acceptable quality of life. Therefore, therapeutic options include nonpharmacological interventions, including sufficient water intake and a low-sodium diet, and pharmacological treatment. The main medications used for NDI are thiazide diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), and amiloride, used isolated or in combination.
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Affiliation(s)
- Pedro Alves Soares Vaz de Castro
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Letícia Bitencourt
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Juliana Lacerda de Oliveira Campos
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Bruna Luisa Fischer
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Stephanie Bruna Camilo Soares de Brito
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Beatriz Santana Soares
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, Brazil
| | - Juliana Beaudette Drummond
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Yang Y, Lei T, Bi W, Xiao Z, Zhang X, Du H. The combined therapy of mesenchymal stem cell transplantation and resveratrol for diabetes: Future applications and challenges. Life Sci 2022; 301:120563. [PMID: 35460708 DOI: 10.1016/j.lfs.2022.120563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 12/22/2022]
Abstract
Diabetes mellitus (DM) is a worldwide chronic epidemic disease of impaired glucose metabolism. Transplantation of mesenchymal stem cells (MSCs) is considered a promising emerging treatment strategy for diabetes. However, the harsh internal environment of DM patients can inhibit the treatment effects of transplanted MSCs. Fortunately, this adverse effect can be reversed by resveratrol (Res). Therefore, we investigated and summarized relevant studies on the combined treatment of diabetes with MSCs and resveratrol. This review presents the therapeutic effects of this combination therapy strategy on DM in glycemic control, anti-inflammatory, anti-oxidative stress and anti-fibrotic. Moreover, this review explained the mechanisms of MSCs and resveratrol in diabetes treatment from 3 aspects, including promoting cell survival and inhibiting apoptosis, inhibiting histiocyte fibrosis, and improving glucose metabolism. These findings help to understand in-depth mechanisms of the treatment of DM and help to propose a potential treatment strategy for DM and its complications.
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Affiliation(s)
- Yanjie Yang
- Daxing Research Institute, University of Science and Technology Beijing, Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Tong Lei
- Daxing Research Institute, University of Science and Technology Beijing, Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Wangyu Bi
- Daxing Research Institute, University of Science and Technology Beijing, Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Zhuangzhuang Xiao
- Daxing Research Institute, University of Science and Technology Beijing, Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Xiaoshuang Zhang
- Daxing Research Institute, University of Science and Technology Beijing, Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Hongwu Du
- Daxing Research Institute, University of Science and Technology Beijing, Beijing 100083, China; School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China.
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Tsai JL, Chen CH, Wu MJ, Tsai SF. New Approaches to Diabetic Nephropathy from Bed to Bench. Biomedicines 2022; 10:biomedicines10040876. [PMID: 35453626 PMCID: PMC9031931 DOI: 10.3390/biomedicines10040876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
Diabetic nephropathy (DN) is the main cause of end-stage kidney disease (ESKD). DN-related ESKD has the worst prognosis for survival compared with other causes. Due to the complex mechanisms of DN and the heterogeneous presentations, unmet needs exist for the renal outcome of diabetes mellitus. Clinical evidence for treating DN is rather solid. For example, the first Kidney Disease: Improving Global Outcomes (KDIGO) guideline was published in October 2020: KDIGO Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. In December of 2020, the International Society of Nephrology published 60 (+1) breakthrough discoveries in nephrology. Among these breakthroughs, four important ones after 1980 were recognized, including glomerular hyperfiltration theory, renal protection by renin-angiotensin system inhibition, hypoxia-inducible factor, and sodium-glucose cotransporter 2 inhibitors. Here, we present a review on the pivotal and new mechanisms of DN from the implications of clinical studies and medications.
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Affiliation(s)
- Jun-Li Tsai
- Division of Family Medicine, Cheng Ching General Hospital, Taichung 407, Taiwan;
- Division of Family Medicine, Cheng Ching Rehabilitation Hospital, Taichung 407, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-H.C.); (M.-J.W.)
- Department of Life Science, Tunghai University, Taichung 407, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-H.C.); (M.-J.W.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan; (C.-H.C.); (M.-J.W.)
- Department of Life Science, Tunghai University, Taichung 407, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Correspondence:
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Chronic lithium therapy and urine concentrating ability in individuals with bipolar disorder: association between daily dose and resistance to vasopressin and polyuria. Kidney Int Rep 2022; 7:1557-1564. [PMID: 35812274 PMCID: PMC9263256 DOI: 10.1016/j.ekir.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Lithium treatment can induce nephrogenic diabetes insipidus (NDI), but no consensus intervention is offered to date. We evaluated in these patients patterns of urine concentration and the correlates of 24-hour urine output. Methods Prospective, single-center, observational study of 217 consecutive lithium-treated individuals, with 24-hour urine collection, desmopressin (1-deamino-arginine vasopressin [DDAVP]) concentrating test, fasting plasma vasopressin measurement (copeptin measurement in n = 119), and measured glomerular filtration rate (mGFR). Maximal urine osmolality (MaxUosm) was the highest level during the DDAVP test. Results Of the individuals, 21% displayed polyuria (>3 l/d), but 55% displayed elevated fasting vasopressin level (>5 pg/ml). Uosm was significantly lower and urinary output and free water clearance were significantly higher in individuals treated for >10 years. MaxUosm was >600 mOsm/KgH2O in 128 patients (59%), among which vasopressin was increased in 51%, associated with higher lithium dose (950 [750–1200] vs. 800 [500–1000] mg/d, P < 0.001). All patients with lithium daily dose ≥1400 mg/d had high vasopressin levels. In multivariable analysis, 24-hour urine output was associated with higher lithium daily dose (β 0.49 ± 0.17, P = 0.005), female sex (β −359 ± 123, P = 0.004), daily osmolar intake (β 2.21 ± 0.24, P < 0.001), MaxUosm (β −2.89 ± 0.35, P < 0.001), and plasma vasopressin level (β 10.17 ± 4.76, P = 0.03). Conclusion Higher lithium daily dose was associated with higher vasopressin levels and higher urine output, independently of other factors. Daily osmolar intake was also associated with higher 24-hour urine output. These results suggest that controlled salt and protein intake and lithium dose might reduce polyuria in these patients.
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Kramers BJ, Koorevaar IW, van Gastel MDA, van Goor H, Hallows KR, Heerspink HL, Li H, Leonhard WN, Peters DJM, Qiu J, Touw DJ, Gansevoort RT, Meijer E. Effects of Hydrochlorothiazide and Metformin on Aquaresis and Nephroprotection by a Vasopressin V2 Receptor Antagonist in ADPKD: A Randomized Crossover Trial. Clin J Am Soc Nephrol 2022; 17:507-517. [PMID: 35314480 PMCID: PMC8993480 DOI: 10.2215/cjn.11260821] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES The vasopressin V2 receptor antagonist tolvaptan is the only drug that has been proven to be nephroprotective in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan also causes polyuria, limiting tolerability. We hypothesized that cotreatment with hydrochlorothiazide or metformin may ameliorate this side effect. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a clinical study and an animal study. In a randomized, controlled, double-blind, crossover trial, we included 13 tolvaptan-treated patients with ADPKD. Patients were treated for three 2-week periods with hydrochlorothiazide, metformin, or placebo in random order. Primary outcome was change in 24-hour urine volume. We also measured GFR and a range of metabolic and kidney injury markers. RESULTS Patients (age 45±8 years, 54% women, measured GFR of 55±11 ml/min per 1.73 m2) had a baseline urine volume on tolvaptan of 6.9±1.4 L/24 h. Urine volume decreased to 5.1 L/24 h (P<0.001) with hydrochlorothiazide and to 5.4 L/24 h (P<0.001) on metformin. During hydrochlorothiazide treatment, plasma copeptin (surrogate for vasopressin) decreased, quality of life improved, and several markers of kidney damage and glucose metabolism improved. Metformin did not induce changes in these markers or in quality of life. Given these results, the effect of adding hydrochlorothiazide to tolvaptan was investigated on long-term kidney outcome in an animal experiment. Water intake in tolvaptan-hydrochlorothiazide cotreated mice was 35% lower than in mice treated with tolvaptan only. Combination treatment was superior to "no treatment" on markers of disease progression (kidney weight, P=0.003 and cystic index, P=0.04) and superior or equal to tolvaptan alone. CONCLUSIONS Both metformin and hydrochlorothiazide reduced tolvaptan-caused polyuria in a short-term study. Hydrochlorothiazide also reduced polyuria in a long-term animal model without negatively affecting nephroprotection. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_03_21_CJN11260821.mp3.
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Affiliation(s)
- Bart J Kramers
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris W Koorevaar
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maatje D A van Gastel
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kenneth R Hallows
- Division of Nephrology and Hypertension, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.,University of Southern California/University Kidney Research Organization Kidney Research Center, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Hiddo L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University, Hospital Groningen, Groningen, The Netherlands
| | - Hui Li
- Division of Nephrology and Hypertension, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.,University of Southern California/University Kidney Research Organization Kidney Research Center, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Wouter N Leonhard
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorien J M Peters
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jiedong Qiu
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University, Hospital Groningen, Groningen, The Netherlands.,Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Meijer
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Vasopressin and Its Analogues: From Natural Hormones to Multitasking Peptides. Int J Mol Sci 2022; 23:ijms23063068. [PMID: 35328489 PMCID: PMC8955888 DOI: 10.3390/ijms23063068] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Human neurohormone vasopressin (AVP) is synthesized in overlapping regions in the hypothalamus. It is mainly known for its vasoconstricting abilities, and it is responsible for the regulation of plasma osmolality by maintaining fluid homeostasis. Over years, many attempts have been made to modify this hormone and find AVP analogues with different pharmacological profiles that could overcome its limitations. Non-peptide AVP analogues with low molecular weight presented good affinity to AVP receptors. Natural peptide counterparts, found in animals, are successfully applied as therapeutics; for instance, lypressin used in treatment of diabetes insipidus. Synthetic peptide analogues compensate for the shortcomings of AVP. Desmopressin is more resistant to proteolysis and presents mainly antidiuretic effects, while terlipressin is a long-acting AVP analogue and a drug recommended in the treatment of varicose bleeding in patients with liver cirrhosis. Recently published results on diverse applications of AVP analogues in medicinal practice, including potential lypressin, terlipressin and ornipressin in the treatment of SARS-CoV-2, are discussed.
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Shrestha DB, Jasaraj RB, Dhital R, Georges E, Havrylyan A. A Diagnostic Enigma of Central Versus Nephrogenic Diabetes Insipidus: What Does the Value of Copeptin Signify? Cureus 2022; 14:e22633. [PMID: 35371639 PMCID: PMC8959102 DOI: 10.7759/cureus.22633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 11/09/2022] Open
Abstract
Diabetes insipidus (DI) is a rare disease characterized by hypotonic urine output and polydipsia. We report the case of a 50-year-old male admitted for diabetic ketoacidosis (DKA) in an intensive care unit with sepsis and alcoholic pancreatitis who later developed DI. He had a high copeptin level of >21.4 pmol/L, suggesting DI of nephrogenic origin. At presentation, he had DKA-associated osmotic diuresis. His later finding of elevated copeptin suggesting partial nephrogenic DI created a diagnostic enigma.
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48
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Mu D, Ma C, Cheng J, Zou Y, Qiu L, Cheng X. Copeptin in fluid disorders and stress. Clin Chim Acta 2022; 529:46-60. [PMID: 35143773 DOI: 10.1016/j.cca.2022.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Abstract
Copeptin, a glycosylated peptide of 39 amino acids, is the C-terminal segment of arginine vasopressin (AVP) precursor peptide, which is consisted of two other fragments, vasopressin and neurophysin Ⅱ. The main physiological functions of AVP are fluid and osmotic balance, cardiovascular homeostasis and regulation of the endocrine stress response. Numerous studies have demonstrated that the endogenous AVP in plasma is a meaningful biomarker to guide diagnosis and therapy of diseases associated with fluids disorders and stress. However, due to its instability, short half-time life in circulation and lack of readily available AVP assays, clinical measurement of AVP is restricted. In contrast to AVP, copeptin which is released in an equimolar mode with AVP from the pituitary, has emerged as a stable and simple-to-measure surrogate marker of AVP and displays excellent potential in diagnosis, differentiation and prognosis of various diseases. This review will discuss the studies on the clinical value of copeptin in different diseases, especially in AVP-dependent fluids disorders, as well as issues and prospects of the application of this potential biomarker.
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Affiliation(s)
- Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Yutong Zou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
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Mishra S, McCormick ET, Marks BE. Polydipsia and Polyuria in a 12-year-old Girl. Pediatr Rev 2022; 43:104-107. [PMID: 35102404 DOI: 10.1542/pir.2020-003202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Shelly Mishra
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Erika T McCormick
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Brynn E Marks
- George Washington University School of Medicine and Health Sciences, Washington, DC.,Division of Endocrinology, Children's National Hospital, Washington, DC
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50
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Ishida A, Mizuno H, Aoyama K, Sasaki S, Negishi Y, Arakawa T, Mori T. Partial nephrogenic diabetes insipidus with a novel arginine vasopressin receptor 2 gene variant. Clin Pediatr Endocrinol 2022; 31:44-49. [PMID: 35002068 PMCID: PMC8713061 DOI: 10.1297/cpe.2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022] Open
Abstract
X-linked nephrogenic diabetes insipidus (NDI) is caused by variations in arginine vasopressin receptor 2 (AVPR2). Some patients show partial resistance to arginine vasopressin (AVP). A 19-month-old Japanese boy presented with polydipsia since infancy. His mother had a history of polydipsia during pregnancy, and his maternal granduncle also had polydipsia. Intermediate urine osmolality and markedly high plasma AVP levels were observed in the water deprivation test. Subsequent pitressin administration caused no further elevation in urine osmolality. We diagnosed the patient with partial NDI, initiated therapy with hydrochlorothiazide, and placed him on a low-sodium diet. Although his urine volume decreased by 20-30% after the initiation of therapy, progressive hydronephrosis and growth retardation developed 2 years later. We investigated his genetic background by multiplex targeted sequencing of genes associated with inherited renal diseases, including AVPR2 and aquaporin-2 (AQP2). We identified a hemizygous missense variant in AVPR2 NM_000054:c.371A>G,p.(Tyr124Cys) in the boy and a heterozygous variant in the mother at the same locus. Distinguishing partial NDI from primary polydipsia is difficult because of its mild symptoms. Markedly elevated plasma AVP levels with intermediate urine osmolality may suggest partial NDI, and genetic analysis can be useful for such patients.
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Affiliation(s)
- Atsushi Ishida
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Haruo Mizuno
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kohei Aoyama
- Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Shiori Sasaki
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.,Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yutaka Negishi
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.,Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Takeshi Arakawa
- Department of Pediatrics, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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