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Kwenda EP, Hernandez AD, Di Valerio E, Canales BK. Renal papillary tip biopsy in stone formers: a review of clinical safety and insights. Urolithiasis 2024; 52:93. [PMID: 38888601 DOI: 10.1007/s00240-024-01596-x] [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: 05/07/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Alexander Randall first published renal papillary tip findings from stone formers in 1937, paving the way for endoscopic assessment to study stone pathogenesis. We performed a literature search to evaluate the safety of papillary tip biopsy and clinical insights gained from modern renal papillary investigations. A search on the topic of renal papillary biopsy provided an overview of Randall's plaques (RP), classification systems for renal papillary grading, and a summary of procedure type, complications, and outcomes. Within 26 identified manuscripts, 660 individuals underwent papillary tip biopsy percutaneously (n = 562), endoscopically (n = 37), or unspecified (n = 23). Post-operative hemoglobin changes were similar to controls. One individual (0.2%) reported fever > 38°, and long-term mean serum creatinine post-biopsy (n = 32) was unchanged. Biopsies during ureteroscopy or PCNL added ~20-30 min of procedure time. Compared to controls, papillary plaque-containing tissue had upregulation in pro-inflammatory genes, immune cells, and cellular apoptosis. Urinary calcium and papillary plaque coverage were found to differ between RP and non-RP stone formers, suggesting differing underlying pathophysiology for these groups. Two renal papillary scoring systems have been externally validated and are used to classify stone formers. Overall, this review shows that renal papillary biopsies have a low complication profile with high potential for further research. Systematic adaption of a papillary grading scale, newer tissue analysis techniques, and the development of animal models of Randall's plaque may allow further exploration of plaque pathogenesis and identify targets for prevention therapies in patients with nephrolithiasis.
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Affiliation(s)
- Elizabeth P Kwenda
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA.
| | | | | | - Benjamin K Canales
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA
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Dong C, Zhou J, Su X, He Z, Song Q, Song C, Ke H, Wang C, Liao W, Yang S. Understanding formation processes of calcareous nephrolithiasis in renal interstitium and tubule lumen. J Cell Mol Med 2024; 28:e18235. [PMID: 38509735 PMCID: PMC10955165 DOI: 10.1111/jcmm.18235] [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: 09/18/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
Kidney stone, one of the oldest known diseases, has plagued humans for centuries, consistently imposing a heavy burden on patients and healthcare systems worldwide due to their high incidence and recurrence rates. Advancements in endoscopy, imaging, genetics, molecular biology and bioinformatics have led to a deeper and more comprehensive understanding of the mechanism behind nephrolithiasis. Kidney stone formation is a complex, multi-step and long-term process involving the transformation of stone-forming salts from free ions into asymptomatic or symptomatic stones influenced by physical, chemical and biological factors. Among the various types of kidney stones observed in clinical practice, calcareous nephrolithiasis is currently the most common and exhibits the most intricate formation mechanism. Extensive research suggests that calcareous nephrolithiasis primarily originates from interstitial subepithelial calcified plaques and/or calcified blockages in the openings of collecting ducts. These calcified plaques and blockages eventually come into contact with urine in the renal pelvis, serving as a nidus for crystal formation and subsequent stone growth. Both pathways of stone formation share similar mechanisms, such as the drive of abnormal urine composition, involvement of oxidative stress and inflammation, and an imbalance of stone inhibitors and promoters. However, they also possess unique characteristics. Hence, this review aims to provide detailed description and present recent discoveries regarding the formation processes of calcareous nephrolithiasis from two distinct birthplaces: renal interstitium and tubule lumen.
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Affiliation(s)
- Caitao Dong
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Jiawei Zhou
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Xiaozhe Su
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Ziqi He
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Qianlin Song
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Chao Song
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Hu Ke
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Chuan Wang
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Wenbiao Liao
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Sixing Yang
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
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Prot-Bertoye C, Jung V, Tostivint I, Roger K, Benoist JF, Jannot AS, Van Straaten A, Knebelmann B, Guerrera IC, Courbebaisse M. Effect of urine alkalization on urinary inflammatory markers in cystinuric patients. Clin Kidney J 2024; 17:sfae040. [PMID: 38510798 PMCID: PMC10953617 DOI: 10.1093/ckj/sfae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Indexed: 03/22/2024] Open
Abstract
Background Cystinuria is associated with a high prevalence of chronic kidney disease (CKD). We previously described a urinary inflammatory-protein signature (UIS), including 38 upregulated proteins, in cystinuric patients (Cys-patients), compared with healthy controls (HC). This UIS was higher in Cys-patients with CKD. In the present observational study, we aimed to investigate the UIS in Cys-patients without CKD and patients with calcium nephrolithiasis (Lith-patients), versus HC and the effect of urine alkalization on the UIS of Cys-patients. Methods UIS was evaluated by nano-liquid chromatography coupled to high-resolution mass spectrometry in adult HC, Lith-patients and non-treated Cys-patients with an estimated glomerular filtration rate >60 mL/min/1.73 m2, and after a 3-month conventional alkalizing treatment in Cys-patients. Results Twenty-one Cys-patients [12 men, median age (interquartile range) 30.0 (25.0-44.0) years], 12 Lith-patients [8 men, 46.2 (39.5-54.2) years] and 7 HC [2 men, 43.1 (31.0-53.9) years] were included. Among the 38 proteins upregulated in our previous work, 11 proteins were also upregulated in Cys-patients compared with HC in this study (5 circulating inflammatory proteins and 6 neutrophil-derived proteins). This UIS was also found in some Lith-patients. Using this UIS, we identified two subclusters of Cys-patients (5 with a very high/high UIS and 16 with a moderate/low UIS). In the Cys-patients with very high/high UIS, urine alkalization induced a significant decrease in urinary neutrophil-derived proteins. Conclusion A high UIS is present in some Cys-patients without CKD and decreases under alkalizing treatment. This UIS could be a prognostic marker to predict the evolution towards CKD in cystinuria.
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Affiliation(s)
- Caroline Prot-Bertoye
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie – Explorations fonctionnelles, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- CNRS ERL 8228 – Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
- Association LUNNE Lithiases UriNaires Network, Paris, France
| | - Vincent Jung
- Proteomics Platform Necker, Université Paris Cité – Structure Fédérative de Recherche Necker, INSERM US24/CNRS UAR3633, Paris, France
| | - Isabelle Tostivint
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
- Association LUNNE Lithiases UriNaires Network, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Service de Néphrologie, Paris, France
- GRC 20 ARDELURO groupe de recherche clinique Analyse, Recherche, Développement et Evaluation en Endourologie et Lithiase Urinaire, Médecine Sorbonne Université, Paris, France
| | - Kevin Roger
- Proteomics Platform Necker, Université Paris Cité – Structure Fédérative de Recherche Necker, INSERM US24/CNRS UAR3633, Paris, France
| | - Jean-François Benoist
- Faculté de pharmacie, Université Paris Saclay, Orsay, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Service de Biochimie métabolique, Paris, France
| | - Anne-Sophie Jannot
- Assistance Publique-Hôpitaux de Paris – Centre, Université Paris Cité, Hôpital Européen Georges Pompidou, Service d'informatique Médicale, Santé Publique et Biostatistiques, Paris, France. HeKA, Centre de recherche des Cordeliers, INSERM, INRIA, Paris, France
| | - Alexis Van Straaten
- Assistance Publique-Hôpitaux de Paris – Centre, Université Paris Cité, Hôpital Européen Georges Pompidou, Service d'informatique Médicale, Santé Publique et Biostatistiques, Paris, France. HeKA, Centre de recherche des Cordeliers, INSERM, INRIA, Paris, France
| | - Bertrand Knebelmann
- Faculté de médecine, Université Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Service de Néphrologie, Paris, France
- INEM Unité Inserm U1151, Paris, France
| | - Ida Chiara Guerrera
- Proteomics Platform Necker, Université Paris Cité – Structure Fédérative de Recherche Necker, INSERM US24/CNRS UAR3633, Paris, France
| | - Marie Courbebaisse
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie – Explorations fonctionnelles, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
- Association LUNNE Lithiases UriNaires Network, Paris, France
- Faculté de médecine, Université Paris Cité, Paris, France
- INEM Unité Inserm U1151, Paris, France
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Dube P, Aradhyula V, Lad A, Khalaf FK, Breidenbach JD, Kashaboina E, Gorthi S, Varatharajan S, Stevens TW, Connolly JA, Soehnlen SM, Sood A, Marellapudi A, Ranabothu M, Kleinhenz AL, Domenig O, Dworkin LD, Malhotra D, Haller ST, Kennedy DJ. Novel Model of Oxalate Diet-Induced Chronic Kidney Disease in Dahl-Salt-Sensitive Rats. Int J Mol Sci 2023; 24:10062. [PMID: 37373209 DOI: 10.3390/ijms241210062] [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: 03/19/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
Diet-induced models of chronic kidney disease (CKD) offer several advantages, including clinical relevance and animal welfare, compared with surgical models. Oxalate is a plant-based, terminal toxic metabolite that is eliminated by the kidneys through glomerular filtration and tubular secretion. An increased load of dietary oxalate leads to supersaturation, calcium oxalate crystal formation, renal tubular obstruction, and eventually CKD. Dahl-Salt-Sensitive (SS) rats are a common strain used to study hypertensive renal disease; however, the characterization of other diet-induced models on this background would allow for comparative studies of CKD within the same strain. In the present study, we hypothesized that SS rats on a low-salt, oxalate rich diet would have increased renal injury and serve as novel, clinically relevant and reproducible CKD rat models. Ten-week-old male SS rats were fed either 0.2% salt normal chow (SS-NC) or a 0.2% salt diet containing 0.67% sodium oxalate (SS-OX) for five weeks.Real-time PCR demonstrated an increased expression of inflammatory marker interleukin-6 (IL-6) (p < 0.0001) and fibrotic marker Timp-1 metalloproteinase (p < 0.0001) in the renal cortex of SS-OX rat kidneys compared with SS-NC. The immunohistochemistry of kidney tissue demonstrated an increase in CD-68 levels, a marker of macrophage infiltration in SS-OX rats (p < 0.001). In addition, SS-OX rats displayed increased 24 h urinary protein excretion (UPE) (p < 0.01) as well as significant elevations in plasma Cystatin C (p < 0.01). Furthermore, the oxalate diet induced hypertension (p < 0.05). A renin-angiotensin-aldosterone system (RAAS) profiling (via liquid chromatography-mass spectrometry; LC-MS) in the SS-OX plasma showed significant (p < 0.05) increases in multiple RAAS metabolites including angiotensin (1-5), angiotensin (1-7), and aldosterone. The oxalate diet induces significant renal inflammation, fibrosis, and renal dysfunction as well as RAAS activation and hypertension in SS rats compared with a normal chow diet. This study introduces a novel diet-induced model to study hypertension and CKD that is more clinically translatable and reproducible than the currently available models.
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Affiliation(s)
- Prabhatchandra Dube
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Vaishnavi Aradhyula
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Apurva Lad
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Fatimah K Khalaf
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
- Department of Medicine, University of Alkafeel College of Medicine, Najaf 54001, Iraq
| | - Joshua D Breidenbach
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Eshita Kashaboina
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Snigdha Gorthi
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Shangari Varatharajan
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Travis W Stevens
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Jacob A Connolly
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Sophia M Soehnlen
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Ambika Sood
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Amulya Marellapudi
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Meghana Ranabothu
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Andrew L Kleinhenz
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | | | - Lance D Dworkin
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Deepak Malhotra
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - Steven T Haller
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
| | - David J Kennedy
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, USA
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Ene MA, Geavlete PA, Simeanu CE, Bulai CA, Ene CV, Geavlete BF. The effectiveness of citrates and pyridoxine in the treatment of kidney stones. J Med Life 2023; 16:856-861. [PMID: 37675156 PMCID: PMC10478649 DOI: 10.25122/jml-2023-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 09/08/2023] Open
Abstract
The prevalence of nephrolithiasis is increasing across all demographic groups. Apart from the morbidity associated with an acute occurrence, preventative treatment is essential for stone disease, which can become a long-term problem. Simple interventions like fluid intake optimization and dietary modification are effective for most stone types. However, patients with specific metabolic abnormalities may require pharmaceutical therapy if lifestyle changes are insufficient to reduce the risk of stone recurrence. The treatment of citrates and/or pyridoxines may help eliminate or prevent recurrences of kidney stones, especially when they are composed of uric acid, calcium oxalate, calcium phosphate, or the latter two together. In cases of struvite stones, which often necessitate a surgical approach, acetohydroxamic acid emerges as a valuable second-line treatment option. Thiol-binding agents may be needed for cystinuria, as well as lifestyle modifications. Successful treatment reduces stone recurrence and the need to remove stones surgically.
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Affiliation(s)
- Mihai Andrei Ene
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Petrişor Aurelian Geavlete
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Cătălin Andrei Bulai
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cosmin Victor Ene
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Florin Geavlete
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Case-based review of dietary management of cystinuria. World J Urol 2022; 41:1215-1220. [PMID: 36565321 DOI: 10.1007/s00345-022-04263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The currently recommended treatment strategy for cystine stone formers is based on a progressive approach that starts with the most conservative measures. In patients with cystinuria, increased patient compliance with dietary management and medical treatment is associated with fewer stone interventions. In this case-based review, the dietary management of cystine stone former was reviewed under the guidance of evidence-based medicine. METHODS The dietary management of the 13-year-old cystinuria patient, who underwent 18 endourological stone interventions, was reviewed in the light of evidence-based medicine. A literature search was performed in Pubmed, MEDLINE, Embase, and Cochrane Library databases according to PRISMA guidelines published from 1993 to September 2022. A total of 304 articles were included in this paper. RESULTS In managing patients with cystinuria, hyperhydration, and alkalinization of the urine with medical treatment, the rational use of cystine-binding drugs by taking into account individual situations has come to the fore. A limited study has argued that a vegetarian diet is effective as the alkaline load from fruits and vegetables can reduce the amount of alkalizing substances required to achieve urinary alkalinization above pH 7.5, making it particularly suitable for the dietary treatment of cystine stone disease. CONCLUSION Life-long follow-up with dietary modification, hyperhydration, and personalized medical therapy (alkalinization and cystine-binding drugs) are critical in preventing chronic kidney disease and kidney failure in cystinuria.
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Fernandez RL, Juntunen ND, Brunold TC. Differences in the Second Coordination Sphere Tailor the Substrate Specificity and Reactivity of Thiol Dioxygenases. Acc Chem Res 2022; 55:2480-2490. [PMID: 35994511 PMCID: PMC9583696 DOI: 10.1021/acs.accounts.2c00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In recent years, considerable progress has been made toward elucidating the geometric and electronic structures of thiol dioxygenases (TDOs). TDOs catalyze the conversion of substrates with a sulfhydryl group to their sulfinic acid derivatives via the addition of both oxygen atoms from molecular oxygen. All TDOs discovered to date belong to the family of cupin-type mononuclear nonheme Fe(II)-dependent metalloenzymes. While most members of this enzyme family bind the Fe cofactor by two histidines and one carboxylate side chain (2-His-1-carboxylate) to provide a monoanionic binding motif, TDOs feature a neutral three histidine (3-His) facial triad. In this Account, we present a bioinformatics analysis and multiple sequence alignment that highlight the significance of the secondary coordination sphere in tailoring the substrate specificity and reactivity among the different TDOs. These insights provide the framework within which important structural and functional features of the distinct TDOs are discussed.The best studied TDO is cysteine dioxygenase (CDO), which catalyzes the conversion of cysteine to cysteine sulfinic acid in both eukaryotes and prokaryotes. Crystal structures of resting and substrate-bound mammalian CDOs revealed two surprising structural motifs in the first- and second coordination spheres of the Fe center. The first is the presence of the abovementioned neutral 3-His facial triad that coordinates the Fe ion. The second is the existence of a covalent cross-link between the sulfur of Cys93 and an ortho carbon of Tyr157 (mouse CDO numbering scheme). While the exact role of this cross-link remains incompletely understood, various studies established that it is needed for proper substrate Cys positioning and gating solvent access to the active site. Intriguingly, bacterial CDOs lack the Cys-Tyr cross-link; yet, they are as active as cross-linked eukaryotic CDOs.The other known mammalian TDO is cysteamine dioxygenase (ADO). Initially, it was believed that ADO solely catalyzes the oxidation of cysteamine to hypotaurine. However, it has recently been shown that ADO additionally oxidizes N-terminal cysteine (Nt-Cys) peptides, which indicates that ADO may play a much more significant role in mammalian physiology than was originally anticipated. Though predicted on the basis of sequence alignment, site-directed mutagenesis, and spectroscopic studies, it was not until last year that two crystal structures, one of wild-type mouse ADO (solved by us) and the other of a variant of nickel-substituted human ADO, finally provided direct evidence that this enzyme also features a 3-His facial triad. These structures additionally revealed several features that are unique to ADO, including a putative cosubstrate O2 access tunnel that is lined by two Cys residues. Disulfide formation under conditions of high O2 levels may serve as a gating mechanism to prevent ADO from depleting organisms of Nt-Cys-containing molecules.The combination of kinetic and spectroscopic studies in conjunction with structural characterizations of TDOs has furthered our understanding of enzymatic sulfhydryl substrate regulation. In this article, we take advantage of the fact that the ADO X-ray crystal structures provided the final piece needed to compare and contrast key features of TDOs, an essential family of metalloenzymes found across all kingdoms of life.
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Affiliation(s)
- Rebeca L. Fernandez
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, United States
| | - Nicholas D. Juntunen
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, United States
| | - Thomas C. Brunold
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin 53706, United States
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Bazin D, Rabant M, Mathurin J, Petay M, Deniset-Besseau A, Dazzi A, Su Y, Hessou EP, Tielens F, Borondics F, Livrozet M, Bouderlique E, Haymann JP, Letavernier E, Frochot V, Daudon M. Cystinuria and cystinosis are usually related to L-cystine: is this really the case for cystinosis? A physicochemical investigation at micrometre and nanometre scale. CR CHIM 2022. [DOI: 10.5802/crchim.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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9
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The causes and consequences of paediatric kidney disease on adult nephrology care. Pediatr Nephrol 2022; 37:1245-1261. [PMID: 34389906 DOI: 10.1007/s00467-021-05182-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
Adult nephrologists often look after patients who have been diagnosed with kidney disease in childhood. This does present unique challenges to the adult nephrologist, who may be unfamiliar with the underlying cause of kidney disease as well as the complications of chronic kidney disease (CKD) that may have accumulated during childhood. This review discusses common causes of childhood CKD, in particular congenital anomalies of the kidney and urinary tract (CAKUT), autosomal dominant tubulointerstitial kidney disease (ADTKD), polycystic kidney disease, hereditary stone disease, nephrotic syndrome and atypical haemolytic uraemic syndrome. The long-term consequences of childhood CKD, such as the cardiovascular consequences, cognition and education as well as bone health, nutrition and growth are also discussed.
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Differences in renal cortex transcriptional profiling of wild-type and novel type B cystinuria model rats. Urolithiasis 2022; 50:279-291. [PMID: 35416493 PMCID: PMC9110498 DOI: 10.1007/s00240-022-01321-6] [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: 09/05/2021] [Accepted: 03/03/2022] [Indexed: 11/20/2022]
Abstract
Cystinuria is a genetic disorder of cystine transport that accounts for 1–2% of all cases of renal lithiasis. It is characterized by hyperexcretion of cystine in urine and recurrent cystine lithiasis. Defective transport of cystine into epithelial cells of renal tubules occurs because of mutations of the transport heterodimer, including protein b0,+AT (encoded by SLC7A9) and rBAT (encoded by SLC3A1) linked through a covalent disulfide bond. Study generated a novel type B cystinuria rat model by artificially deleting 7 bp of Slc7a9 gene exon 3 using the CRISPR-Cas9 system, and those Slc7a9-deficient rats were proved to be similar with cystinuria in terms of genome, transcriptome, translation, and biologic phenotypes with no off-target editing. Subsequent comparisons of renal histopathology indicated model rats gained typical secondary changes as medullary fibrosis with no stone formation. A total of 689 DEGs (383 upregulated and 306 downregulated) were differentially expressed in the renal cortex of cystinuria rats. In accordance with the functional annotation of DEGs, the potential role of glutathione metabolism processes in the kidney of cystinuria rat model was proposed, and KEGG analysis results showed that knock-out of Slc7a9 gene triggered more biological changes which has not been studied. In short, for the first time, a rat model and its transcriptional database that mimics the pathogenesis and clinical consequences of human type B cystinuria were generated.
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11
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Singh P, Harris PC, Sas DJ, Lieske JC. The genetics of kidney stone disease and nephrocalcinosis. Nat Rev Nephrol 2022; 18:224-240. [PMID: 34907378 DOI: 10.1038/s41581-021-00513-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/15/2022]
Abstract
Kidney stones (also known as urinary stones or nephrolithiasis) are highly prevalent, affecting approximately 10% of adults worldwide, and the incidence of stone disease is increasing. Kidney stone formation results from an imbalance of inhibitors and promoters of crystallization, and calcium-containing calculi account for over 80% of stones. In most patients, the underlying aetiology is thought to be multifactorial, with environmental, dietary, hormonal and genetic components. The advent of high-throughput sequencing techniques has enabled a monogenic cause of kidney stones to be identified in up to 30% of children and 10% of adults who form stones, with ~35 different genes implicated. In addition, genome-wide association studies have implicated a series of genes involved in renal tubular handling of lithogenic substrates and of inhibitors of crystallization in stone disease in the general population. Such findings will likely lead to the identification of additional treatment targets involving underlying enzymatic or protein defects, including but not limited to those that alter urinary biochemistry.
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Affiliation(s)
- Prince Singh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Division of Molecular Biology and Biochemistry, Mayo Clinic, Rochester, MN, USA
| | - David J Sas
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. .,Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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12
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Prot-Bertoye C, Daudon M, Tostivint I, Dousseaux MP, Defazio J, Traxer O, Knebelmann B, Courbebaisse M. [Cystinuria]. Nephrol Ther 2021; 17S:S100-S107. [PMID: 33910689 DOI: 10.1016/j.nephro.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 10/21/2022]
Abstract
Cystinuria is the most common monogenic nephrolithiasis disorder. Because of its poor solubility at a typical urine pH of less than 7, cystine excretion results in recurrent urinary cystine stone formation. A high prevalence of high blood pressure and of chronic kidney disease has been reported in these patients. Alkaline hyperdiuresis remains the cornerstone of the preventive medical treatment. To reach a urine pH between 7.5 and 8 and a urine specific gravity less than or equal to 1.005 should be the goal of medical treatment. D-penicillamine and tiopronin, two cysteine-binding thiol agents, should be considered as second line treatments with frequent adverse events that should be closely monitored.
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Affiliation(s)
- Caroline Prot-Bertoye
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - Michel Daudon
- Service de physiologie-explorations fonctionnelles, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Isabelle Tostivint
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie-Paule Dousseaux
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Jérôme Defazio
- Association pour l'information et la recherche sur les maladies génétiques (AIRG-France), BP 78, 75261 Paris cedex 06, France
| | - Olivier Traxer
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Bertrand Knebelmann
- Service de néphrologie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - Marie Courbebaisse
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Kum F, Wong K, Game D, Bultitude M, Thomas K. Hypertension and renal impairment in patients with cystinuria: findings from a specialist cystinuria centre. Urolithiasis 2019; 47:357-363. [PMID: 30805669 PMCID: PMC6647081 DOI: 10.1007/s00240-019-01110-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
Abstract
Higher blood pressures (mean systolic difference 16.8 mmHg) when compared to matched individuals are already reported in patients with calcium urolithiasis. We present the prevalence of hypertension and renal impairment in patients with cystinuria from our specialist single centre. We analysed our prospective database of adult patients with cystinuria who attend our cystinuria service. This included details of the medical and operative management of their disease. Descriptive statistics were used to analyse and present the data. 120 patients were included with a median age of 40 (19-76) years, 66 were male (55%) and 54 were female (45%). 54/120 patients (45%) were taking medications to prevent stone formation. 78% (94/120) patients reported having undergone one or more stone-related procedure. 59% (55/94) of these having required at least one PCNL or open procedure during their lifetime. Prevalence of hypertension was 50.8% (61/120), and double in males compared to females (62.1% vs. 37.0%, P = 0.0063). Mean baseline creatinine was 88.2 (49-153) µmol/l and eGFR was 77.6 (32-127) ml/min/1.73 m2. When categorized by CKD stage, only 24.6% (27% vs. 21%, M vs. F) patients had normal renal function (being an eGFR > 89 ml/min/1.73 m2). 57.6% patients were CKD stage 2 and 17.8% CKD stage 3. Females had a slightly greater incidence of renal impairment. All patients who have previously undergone a nephrectomy (n = 10) or have a poorly functioning kidney (n = 19) have renal impairment (CKD stage 2 or 3). Incidence of hypertension in patients with cystinuria is 51%, with a male preponderance. Only 25% of patients with cystinuria have normal renal function. This highlights the long-term cardiovascular and renal risks that the metabolic effects of cystinuria pose, in addition to the challenges of managing recurrent urolithiasis in a young population.
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Affiliation(s)
- Francesca Kum
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Kathie Wong
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK
| | - David Game
- Department of Nephrology, Guy's Hospital, 6th Floor Borough Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Matthew Bultitude
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Kay Thomas
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK.
- King's College London Medical School, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK.
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14
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Liang X, Lai Y, Wu W, Chen D, Zhong F, Huang J, Zeng T, Duan X, Huang Y, Zhang S, Li S, Wu W. LncRNA-miRNA-mRNA expression variation profile in the urine of calcium oxalate stone patients. BMC Med Genomics 2019; 12:57. [PMID: 31036010 PMCID: PMC6489260 DOI: 10.1186/s12920-019-0502-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/12/2019] [Indexed: 12/19/2022] Open
Abstract
Background To explore long-non-coding RNA (lncRNA), microRNA (miRNA) and messenger RNA (mRNA) expression profiles and their biological functions in the urine samples in calcium oxalate (CaOx) patients. Methods Five CaOx kidney stone patients were recruited in CaOx stone group and six healthy people were included as control group, whose midstream morning urine was collected before the patients were given any medicine on admission. After total RNA was extracted from urine, microarray of miRNA, mRNA and lncRNA were applied to explore their expression variation. Gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were performed to reveal the gene functions of the dysregulated lncRNA-associated competing endogenous RNA (ceRNA) network. Quantitative real-time PCR were performed on HK-2 cells treated with sodium oxalate (NaOx) to further screen out the differentially expression profiles of these RNAs. Results A total of nine miRNAs, 883 mRNAs and 1002 lncRNAs were differentially expressed in urine of CaOx patients compared with normal population. GO analysis revealed that most of mRNAs from ceRNA network were enriched in terms of respiratory burst, regulation of mitophagy, and protein kinase regulator activity. KEGG pathway analysis of these genes related to ceRNA network highlight their critical role in pentose phosphate pathway, glyoxylate and dicarboxylate metabolism, and Janus kinase/signal transducer and activator of transcription (JAK-STAT) signaling pathway. Five miRNAs (miR-6796-3p, miR-30d-5p, miR-3192–3p, miR-518b and miR-6776-3p), four mRNAs (NT5E, CDH4, CLEC14A, CCNL1) and six lncRNAs (lnc-TIGD1L2–3, lnc-KIN-1, lnc-FAM72B-4, lnc-EVI5L-1, lnc-SERPINI1–2, lnc-MB-6) from the HK-2 cells induced by NaOx were consistent with the expression changes of microarray results. Conclusion The differential expressed miRNAs, mRNAs and lncRNAs may be associated with numerous variations of the signaling pathways or regulation of metabolism and kinase activity, providing potential biomarkers for early diagnosis of urolithiasis and new basis for further research of urolithiasis mechanism. Electronic supplementary material The online version of this article (10.1186/s12920-019-0502-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiongfa Liang
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Yongchang Lai
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Weizhou Wu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Dong Chen
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Fangling Zhong
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Jian Huang
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Tao Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Xiaolu Duan
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Yapeng Huang
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Shike Zhang
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Shujue Li
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China
| | - Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Urology Research Institute, Guangdong Key Laboratory of Urology, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China.
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15
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Kovacevic L, Caruso JA, Lu H, Kovacevic N, Lakshmanan Y, Carruthers NJ, Goldfarb DS. Urine proteomic profiling in patients with nephrolithiasis and cystinuria. Int Urol Nephrol 2018; 51:593-599. [PMID: 30519981 DOI: 10.1007/s11255-018-2044-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/23/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of the study was to assess the differences in the concentration and function of urinary proteins between patients with cystine stones (CYS) and healthy controls (HC). We postulated that CYS and HC groups would demonstrate different proteomic profiles. METHODS A pilot study was performed comparing urinary proteomes of 10 patients with CYS and 10 age- and gender-matched HC, using liquid chromatography-mass spectrometry. Proteins which met the selection criteria (i) ≥ 2 unique peptide identifications; (ii) ≥ twofold difference in protein abundance; and (iii) ≤ 0.05 p value for the Fisher's Exact Test were analyzed using Gene Ontology classifications. RESULTS Of the 2097 proteins identified by proteomic analysis, 398 proteins were significantly different between CYS and HC. Of those, 191 were involved in transport processes and 61 in inflammatory responses. The majority were vesicle-mediated transport proteins (78.5%), and 1/3 of them were down-regulated; of those, 12 proteins were involved in endosomal transport (including 6 charged multivesicular body proteins (CHMP) and 3 vacuolar sorting-associated proteins) and 9 in transmembrane transport. Myosin-2 and two actin-related proteins were significantly up-regulated in the vesicle-mediated transport group. CONCLUSION We provide proteomic evidence of impaired endocytosis, dysregulation of actin and myosin cytoskeleton, and inflammation in CYS. Endosomal transport proteins were down-regulated mainly through defective CHMP. These findings may contribute to further understanding of the pathogenesis of CYS, potentially affecting its management.
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Affiliation(s)
- Larisa Kovacevic
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
| | - Joseph A Caruso
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, USA
| | - Hong Lu
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
| | - Natalija Kovacevic
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
- Vattikuti Urology Institute, Henri Ford Hospital, Detroit, MI, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
| | - Nicholas J Carruthers
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, USA
| | - David S Goldfarb
- Nephrology Division, New York University Langone Medical Center, New York, NY, USA
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16
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Mohammadi M, Shohani A, Khorami H, Nouri Mahdavi K, IzadPanahi MH, Alizadeh F, Azizi M. The effect of selenium supplementation on cystine crystal volume in patients with cystinuria. Biomedicine (Taipei) 2018; 8:26. [PMID: 30474607 PMCID: PMC6254100 DOI: 10.1051/bmdcn/2018080426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cystinuria as an autosomal recessive sickness is a relatively rare disease. Formation of cystine stones indicates cystinuria. Few studies are considered the cysteine crystal volume in management of cystinuria. Selenium may inhibit organization of crystal stone, growth and stone aggregation. Since the role of selenium on inhibition of cystine crystal formation is not known, the aim of this study was to evaluate the effect of selenium supplementation on cystine crystals volume in patients with cystinuria. MATERIALS AND METHODS This double-blind clinical trial study was conducted on 48 patients in Al-Zahra hospital, Isfahan, Iran from 2015 to 2017. These patients received selenium (200 mg/ daily) for 6 weeks. The urine crystal volume was evaluated before and after treatment. Data were entered SPSS and analyzed by Paired sample T test, Spearman and Pearson coefficient correlation. P- value < 0.05 was considered significant. RESULTS In current study, mean cystine crystal volume before and after treatment was 6787.4 ± 11902.6 and 3110.9 ± 7225.4, respectively. Significant difference was observed before and after treatment in terms of cystine crystal volume (p < 0.001). No relation was observed between the mean cystine crystal volume with sex, age and type of medical procedures (p > 0.05). CONCLUSION In this study, selenium treatment affected cystine crystal volume. It seems that selenium had the potential value to alleviate the volume of cystine crystal. Therefore, since reducing of cystine crystal volume decreases crystal formation, selenium may be effective to cure patients with cystinuria. However, age, sex and type of medical procedures did not affect cysteine crystal volume.
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Affiliation(s)
- Mehrdad Mohammadi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Amin Shohani
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Hatef Khorami
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Kia Nouri Mahdavi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Mohammad hossein IzadPanahi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Farshid Alizadeh
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Mohammad Azizi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
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Abstract
PURPOSE OF REVIEW We sought to review currently available data on the safety and efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in type 2 diabetes mellitus patients with hypertension. RECENT FINDINGS Inhibition of SGLT2 in the renal proximal tubule results in increased urinary glucose excretion and modest improvements of hemoglobin A1C. Treatment with any of the three currently FDA-approved SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) results in sustained systolic and diastolic blood pressure reduction, in part via minimal natriuresis and possible reductions in sympathetic tone. Recent randomized clinical trials in high cardiovascular risk patients with type 2 diabetes suggest that the unique effects of SGLT2 inhibitors on blood pressure and body weight may translate into reduced cardiovascular events and slowed kidney disease progression. However, concerns about volume depletion and acute kidney injury have been raised. SGLT2 inhibitors are viable second-line glucose-lowering agents for people with type 2 diabetes with high cardiovascular risk.
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18
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Anatomically-specific intratubular and interstitial biominerals in the human renal medullo-papillary complex. PLoS One 2017; 12:e0187103. [PMID: 29145401 PMCID: PMC5690653 DOI: 10.1371/journal.pone.0187103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 10/15/2017] [Indexed: 01/03/2023] Open
Abstract
Limited information exists on the anatomically-specific early stage events leading to clinically detectable mineral aggregates in the renal papilla. In this study, quantitative multiscale correlative maps of structural, elemental and biochemical properties of whole medullo-papillary complexes from human kidneys were developed. Correlative maps of properties specific to the uriniferous and vascular tubules using high-resolution X-ray computed tomography, scanning and transmission electron microscopy, energy dispersive X-ray spectroscopy, and immunolocalization of noncollagenous proteins (NCPs) along with their association with anatomy specific biominerals were obtained. Results illustrated that intratubular spherical aggregates primarily form at the proximal regions distant from the papillary tip while interstitial spherical and fibrillar aggregates are distally located near the papillary tip. Biominerals at the papillary tip were closely localized with 10 to 50 μm diameter vasa recta immunolocalized for CD31 inside the medullo-papillary complex. Abundant NCPs known to regulate bone mineralization were localized within nanoparticles, forming early pathologic mineralized regions of the complex. Based on the physical association between vascular and urothelial tubules, results from light and electron microscopy techniques suggested that these NCPs could be delivered from vasculature to prompt calcification of the interstitial regions or they might be synthesized from local vascular smooth muscle cells after transdifferentiation into osteoblast-like phenotypes. In addition, results provided insights into the plausible temporal events that link the anatomically specific intratubular mineral aggregates with the interstitial biomineralization processes within the functional unit of the kidney.
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19
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Mulay SR, Anders HJ. Crystal nephropathies: mechanisms of crystal-induced kidney injury. Nat Rev Nephrol 2017; 13:226-240. [DOI: 10.1038/nrneph.2017.10] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Abstract
How stones are retained within the kidney while small in size is still not fully understood. In this paper, we show two examples of how stones are retained during early growth: one is growth on Randall's (interstitial) plaque, and the other is growth on mineral that has formed as a luminal plug in a terminal collecting duct. These two mechanisms of stone retention during early growth have distinctive morphologic features that can be seen by methods that show the microscopic structure of the stones. Stones growing on Randall's plaque display an apatite region that is typically not large in size (<0.5 mm across) but which usually shows luminal spaces, which are signs of its origin in the connective tissue of the papilla. Stones growing on ductal plugs also show attachment to a piece of apatite, but the apatite regions are typically larger (often >1 mm long and >0.5 mm wide), and they are solid, without spaces running through them. We propose that knowing the mechanisms of stone retention during early stone formation could allow for better treatment of stone diseases.
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21
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Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 2016; 29:715-734. [PMID: 27456839 PMCID: PMC5080344 DOI: 10.1007/s40620-016-0329-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. DESIGN A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. RESULTS Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. CONCLUSIONS This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified.
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Affiliation(s)
- Giovanni Gambaro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Fredric Coe
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - Orson Moe
- Department of Internal Medicine, Southwestern Medical Center, University of Texas, Dallas, USA
| | - Elen Worcester
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - Noor Buchholz
- Department of Urological Surgery, Sobeh's Vascular and Medical Center, Dubai, UAE
| | - David Bushinsky
- Department of Nephrology, Medical Center, University of Rochester, Rochester, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, USA
| | - Pietro Manuel Ferraro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniel Fuster
- Department of Nephrology, University of Bern, Bern, Switzerland
| | - David S Goldfarb
- Department of Nephrology, New York Harbor VA Health Care System, New York, USA
| | | | - Bernard Hess
- Department of Internal Medicine and Nephrology, Klinik Im Park Hospital, Zurich, Switzerland
| | - John Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Martino Marangella
- Department of Nephrology, A.S.O Ordine Mauriziano Hospital, Turin, Italy
| | - Dawn Milliner
- Department of Nephrology, Mayo Clinic, Rochester, USA
| | - Glen M Preminger
- Department of Urology, Duke University Medical Center, Durham, USA
| | | | - Khashayar Sakhaee
- Southwestern Medical Center, Mineral Metabolism Research, University of Texas, Dallas, USA
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey
| | | | | | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indiana, USA
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Combining field effect scanning electron microscopy, deep UV fluorescence, Raman, classical and synchrotron radiation Fourier transform Infra-Red Spectroscopy in the study of crystal-containing kidney biopsies. CR CHIM 2016. [DOI: 10.1016/j.crci.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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23
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Analysis of altered microRNA expression profiles in the kidney tissues of ethylene glycol-induced hyperoxaluric rats. Mol Med Rep 2016; 14:4650-4658. [PMID: 27748900 PMCID: PMC5102036 DOI: 10.3892/mmr.2016.5833] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 08/26/2016] [Indexed: 11/25/2022] Open
Abstract
Calcium oxalate stones account for >80% of urinary stones, however the mechanisms underlying their formation remains to be elucidated. Hyperoxaluria serves an important role in the pathophysiological process of stone formation. In the present study, differences in the miRNA expression profiles between experimental hyperoxaluric rats and normal rats were analyzed, in order to identify target genes and signaling pathways involved in the pathogenesis of hyperoxaluria. Ethylene glycol and ammonium chloride was fed to male hyperoxaluric rats (EXP) and normal age-matched male rats (CON). The oxalate concentration in the urine of each experimental rat was collected every 24 h and measured on day 14. Three rats exhibiting the highest concentrations were selected for microarray analysis. Microarray analysis was performed to evaluate differences in the expression of microRNA (miRNA) in the kidney tissues from EXP and CON groups, and miRNAs that exhibited a >2-fold or a <0.5-fold alteration in expression between these groups were screened for differential expression patterns according to the threshold P-values. Reverse transcription-quantitative polymerase chain reaction analysis was employed to confirm the microarray results. In order to predict the potential role of miRNAs in pathophysiological processes, gene ontology (GO), pathway and target prediction analyses were conducted. A total of 28 miRNAs were observed to be differentially expressed (>2-fold change) between EXP and CON groups. Among these miRNAs, 20 were upregulated and 8 were downregulated. GO and pathway analyses revealed that the insulin resistance and phosphatidylinositol-bisphosphonate 3-kinase/AKT serine threonine kinase signaling pathways were potentially associated with miRNA regulation in this setting. In conclusion, the results of the present study identified differentially expressed miRNAs in hyperoxaluric rats, and provided a novel perspective for the role of miRNAs in the formation of calcium oxalate stones.
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Abstract
The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall's plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone disease.
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Affiliation(s)
- Fredric L Coe
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Elaine M Worcester
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5055, Indianapolis, IN 46220, Indiana, USA
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Abstract
Nephrolithiasis, or stones, is one of the oldest urological diseases, with descriptions and treatment strategies dating back to ancient times. Despite the enormous number of patients affected by stones, a surprising lack of conceptual understanding of many aspects of this disease still exists. This lack of understanding includes mechanisms of stone formation and retention, the clinical relevance of different stone compositions and that of formation patterns and associated pathological features to the overall course of the condition. Fortunately, a number of new tools are available to assist in answering such questions. New renal endoscopes enable kidney visualization in much higher definition than was previously possible, while micro-CT imaging is the optimal technique for assessment of stone microstructure and mineral composition in a nondestructive fashion. Together, these tools have the potential to provide novel insights into the aetiology of stone formation that might unlock new prevention and treatment strategies, and enable more effective management of patients with nephrolithiasis.
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Abstract
Kidney stones are mineral deposits in the renal calyces and pelvis that are found free or attached to the renal papillae. They contain crystalline and organic components and are formed when the urine becomes supersaturated with respect to a mineral. Calcium oxalate is the main constituent of most stones, many of which form on a foundation of calcium phosphate called Randall's plaques, which are present on the renal papillary surface. Stone formation is highly prevalent, with rates of up to 14.8% and increasing, and a recurrence rate of up to 50% within the first 5 years of the initial stone episode. Obesity, diabetes, hypertension and metabolic syndrome are considered risk factors for stone formation, which, in turn, can lead to hypertension, chronic kidney disease and end-stage renal disease. Management of symptomatic kidney stones has evolved from open surgical lithotomy to minimally invasive endourological treatments leading to a reduction in patient morbidity, improved stone-free rates and better quality of life. Prevention of recurrence requires behavioural and nutritional interventions, as well as pharmacological treatments that are specific for the type of stone. There is a great need for recurrence prevention that requires a better understanding of the mechanisms involved in stone formation to facilitate the development of more-effective drugs.
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How should patients with cystine stone disease be evaluated and treated in the twenty-first century? Urolithiasis 2015; 44:65-76. [PMID: 26614112 DOI: 10.1007/s00240-015-0841-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023]
Abstract
Cystinuria continues to be one of the most challenging stone diseases. During the latest decades our knowledge of the molecular basis of cystinuria has expanded. Today 160 different mutations in the SLC3A1 gene and 116 in the SLC7A9 gene are listed. The full implications of type A, B or AB status are not yet fully understood but may have implications for prognosis, management and treatment. Despite better understanding of the molecular basis of cystinuria the principles of recurrence prevention have remained essentially the same through decades. No curative treatment of cystinuria exists, and patients will have a life long risk of stone formation, repeated surgery, impaired renal function and quality of life. Therapy to reduce stone formation is directed towards lowering urine cystine concentration and increasing cystine solubility. Different molecules that could play a role in promoting nucleation and have a modulating effect on cystine solubility may represent new targets for cystinuria research. Investigation of newer thiol-containing drugs with fewer adverse effects is also warranted. Determining cystine capacity may be an effective tool to monitor the individual patient's response. Compliance in cystinuric patients concerning both dietary and pharmacological intervention is poor. Frequent clinical follow-up visits in dedicated centres seem to improve compliance. Cystinuric patients should be managed in dedicated centres offering the complete range of minimal invasive treatment modalities, enabling a personalized treatment approach in order to reduce risk and morbidity of multiple procedures.
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Borofsky MS, Paonessa JE, Evan AP, Williams JC, Coe FL, Worcester EM, Lingeman JE. A Proposed Grading System to Standardize the Description of Renal Papillary Appearance at the Time of Endoscopy in Patients with Nephrolithiasis. J Endourol 2015; 30:122-7. [PMID: 26414908 DOI: 10.1089/end.2015.0298] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The appearance of the renal papillae in patients with nephrolithiasis can be quite variable and can range from entirely healthy to markedly diseased. The implications of such findings remain unknown. One potential reason is the lack of a standardized system to describe such features. We propose a novel grading scale to describe papillary appearance at the time of renal endoscopy. METHODS Comprehensive endoscopic renal assessment and mapping were performed on more than 300 patients with nephrolithiasis. Recurring abnormal papillary characteristics were identified and quantified based on degree of severity. RESULTS Four unique papillary features were chosen for inclusion in the PPLA scoring system- ductal Plugging, Pitting, Loss of contour, and Amount of Randall's plaque. Unique scores are calculated for individual papillae based on reference examples. CONCLUSIONS The description and study of renal papillary appearance in stone formers have considerable potential as both a clinical and research tool; however, a standardized grading system is necessary before using it for these purposes.
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Affiliation(s)
- Michael S Borofsky
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Jessica E Paonessa
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Andrew P Evan
- 2 Department of Anatomy and Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana
| | - James C Williams
- 2 Department of Anatomy and Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Fredric L Coe
- 3 Section of Nephrology, The University of Chicago , Chicago, Illinois
| | | | - James E Lingeman
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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29
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Do kidney stone formers have a kidney disease? Kidney Int 2015; 88:1240-1249. [PMID: 26376133 PMCID: PMC4675687 DOI: 10.1038/ki.2015.254] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/09/2015] [Accepted: 07/15/2015] [Indexed: 12/13/2022]
Abstract
Nephrolithiasis is a highly prevalent disorder affecting approximately one in eleven people and is associated with multiple complications including hypertension, cardiovascular disease, and chronic kidney disease. Significant epidemiologic associations with chronic kidney disease and ESRD have been noted and are reviewed herein, but debate persists in the literature as to whether kidney stone formation is a pathogenic process contributing to kidney disease. Corroborating evidence supporting the presence of kidney disease in stone formers includes the variability of renal function by stone type, the positive association of stone size with renal dysfunction, the presence of markers of renal injury in the urine of even asymptomatic stone formers, and direct evidence of renal tissue injury on histopathology. Proposed pathogenic mechanisms include recurrent obstruction and comorbid conditions such as recurrent urinary tract infections and structural abnormalities. Recent work evaluating the renal histopathology of different groups of stone formers adds further granularity, suggesting variability in mechanisms of renal injury by stone type and confirming the pathogenic effects of crystal formation. Genetic abnormalities leading to stone formation including cystinuria and primary hyperoxaluria, among others, contribute to the burden of disease in the stone-forming population.
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Kovacevic L, Lu H, Goldfarb DS, Lakshmanan Y, Caruso JA. Urine proteomic analysis in cystinuric children with renal stones. J Pediatr Urol 2015; 11:217.e1-6. [PMID: 26076823 PMCID: PMC4540695 DOI: 10.1016/j.jpurol.2015.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/25/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The gene mutations responsible for cystinuria do not fully explain kidney stone activity, suggesting that specific proteins may serve as promoters of cystine precipitation, aggregation or epithelial adherence. In this study we assessed (1) the differences in the urinary proteins between children with cystinuria and kidney stones (CYS) and healthy controls (HC), with particular attention to the fibrosis-related proteins, and (2) the presence of diagnostic biomarkers for CYS. MATERIAL AND METHODS We conducted a pilot study comparing individual urinary proteomes of 2 newly diagnosed children with CYS and 2 age- and gender-matched HC, using liquid chromatography-mass spectrometry. Relative protein abundance was estimated using spectral counting. Proteins of interest in both CYS and HC were selected using the following criteria: i) ≥5 spectral counts; ii) ≥2-fold difference in spectral counts; and iii) ≤0.05 p-value for the Fisher's Exact Test. DISCUSSION This study demonstrates a different urinary polypeptide profile in two children with CYS compared to two HC. Of the 623 proteins identified by proteomic analysis, 180 exhibited at least a 2-fold increased relative abundance in CYS compared to HC. Of these, 39 were involved in response to stress, 26 in response to wounding, 21 in inflammatory response, 18 in immune response, and 4 in cellular response to oxidative stress. 133 proteins were found only in children with CYS, 33 of which met the selection criteria. Of these 33 unique proteins, six are known to be associated with fibrosis pathways (Table). The major limitation of this study is the small number of samples that were analyzed. Validation using highly specific methods such as ELISA is needed. CONCLUSION We provide proteomic evidence of oxidative injury, inflammation, wound healing and fibrosis in two children with CYS. We speculate that oxidative stress and inflammation may cause remodeling via actin and vimentin pathways, leading to fibrosis. Additionally, we identified ITIH and MMP-9 as potential diagnostic biomarkers and novel therapeutic targets in CYS. These proteins merit further investigation.
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Affiliation(s)
- Larisa Kovacevic
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA.
| | - Hong Lu
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - David S Goldfarb
- Nephrology Division, NYU Langone Medical Center, New York, NY, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Joseph A Caruso
- Proteomic Facility, Wayne State University, Detroit, MI, USA
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Prot-Bertoye C, Lebbah S, Daudon M, Tostivint I, Bataille P, Bridoux F, Brignon P, Choquenet C, Cochat P, Combe C, Conort P, Decramer S, Doré B, Dussol B, Essig M, Gaunez N, Joly D, Le Toquin-Bernard S, Méjean A, Meria P, Morin D, N'Guyen HV, Noël C, Normand M, Pietak M, Ronco P, Saussine C, Tsimaratos M, Friedlander G, Traxer O, Knebelmann B, Courbebaisse M. CKD and Its Risk Factors among Patients with Cystinuria. Clin J Am Soc Nephrol 2015; 10:842-51. [PMID: 25717071 DOI: 10.2215/cjn.06680714] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 01/12/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Cystinuria is an autosomal recessive disorder affecting renal cystine reabsorption; it causes 1% and 8% of stones in adults and children, respectively. This study aimed to determine epidemiologic and clinical characteristics as well as comorbidities among cystinuric patients, focusing on CKD and high BP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective study was conducted in France, and involved 47 adult and pediatric nephrology and urology centers from April 2010 to January 2012. Data were collected from 442 cystinuric patients. RESULTS Median age at onset of symptoms was 16.7 (minimum to maximum, 0.3-72.1) years and median diagnosis delay was 1.3 (0-45.7) years. Urinary alkalinization and cystine-binding thiol were prescribed for 88.8% and 52.2% of patients, respectively, and 81.8% had at least one urological procedure. Five patients (1.1%, n=4 men) had to be treated by dialysis at a median age of 35.0 years (11.8-70.7). Among the 314 patients aged ≥16 years, using the last available plasma creatinine, 22.5% had an eGFR≥90 ml/min per 1.73 m(2) (calculated by the Modification of Diet in Renal Disease equation), whereas 50.6%, 15.6%, 7.6%, 2.9%, and 0.6% had an eGFR of 60-89, 45-59, 30-44, 15-29, and <15, respectively. Among these 314 patients, 28.6% had high BP. In multivariate analysis, CKD was associated with age (odds ratio, 1.05 [95% confidence interval, 1.03 to 1.07]; P<0.001), hypertension (3.30 [1.54 to 7.10]; P=0.002), and severe damage of renal parenchyma defined as a past history of partial or total nephrectomy, a solitary congenital kidney, or at least one kidney with a size <10 cm in patients aged ≥16 years (4.39 [2.00 to 9.62]; P<0.001), whereas hypertension was associated with age (1.06 [1.04 to 1.08]; P<0.001), male sex (2.3 [1.3 to 4.1]; P=0.003), and an eGFR<60 ml/min per 1.73 m(2) (2.7 [1.5 to 5.1]; P=0.001). CONCLUSIONS CKD and high BP occur frequently in patients with cystinuria and should be routinely screened.
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Affiliation(s)
- Caroline Prot-Bertoye
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Saïd Lebbah
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Daudon
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Isabelle Tostivint
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Bataille
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Franck Bridoux
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Brignon
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Choquenet
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Cochat
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Combe
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Conort
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Stéphane Decramer
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Bertrand Doré
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Bertrand Dussol
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Marie Essig
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Nicolas Gaunez
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Dominique Joly
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Sophie Le Toquin-Bernard
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Arnaud Méjean
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Paul Meria
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Denis Morin
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Hung Viet N'Guyen
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Noël
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Normand
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Pietak
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Ronco
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Saussine
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Tsimaratos
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Gérard Friedlander
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Olivier Traxer
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Bertrand Knebelmann
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Marie Courbebaisse
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material.
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32
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Evan AP, Worcester EM, Williams JC, Sommer AJ, Lingeman JE, Phillips CL, Coe FL. Biopsy proven medullary sponge kidney: clinical findings, histopathology, and role of osteogenesis in stone and plaque formation. Anat Rec (Hoboken) 2015; 298:865-77. [PMID: 25615853 DOI: 10.1002/ar.23105] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/25/2014] [Accepted: 11/12/2014] [Indexed: 11/11/2022]
Abstract
Medullary sponge kidney (MSK) is associated with recurrent stone formation, but the clinical phenotype is unclear because patients with other disorders may be incorrectly labeled MSK. We studied 12 patients with histologic findings pathognomonic of MSK. All patients had an endoscopically recognizable pattern of papillary malformation, which may be segmental or diffuse. Affected papillae are enlarged and billowy, due to markedly enlarged inner medullary collecting ducts (IMCD), which contain small, mobile ductal stones. Patients had frequent dilation of Bellini ducts, with occasional mineral plugs. Stones may form over white (Randall's) plaque, but most renal pelvic stones are not attached, and have a similar morphology as ductal stones, which are a mixture of calcium oxalate and apatite. Patients had no abnormalities of urinary acidification or acid excretion; the most frequent metabolic abnormality was idiopathic hypercalciuria. Although both Runx2 and Osterix are expressed in papillae of MSK patients, no mineral deposition was seen at the sites of gene expression, arguing against a role of these genes in this process. Similar studies in idiopathic calcium stone formers showed no expression of these genes at sites of Randall's plaque. The most likely mechanism for stone formation in MSK appears to be crystallization due to urinary stasis in dilated IMCD with subsequent passage of ductal stones into the renal pelvis where they may serve as nuclei for stone formation.
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Affiliation(s)
- Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
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33
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Aqueous extract of Costus arabicus inhibits calcium oxalate crystal growth and adhesion to renal epithelial cells. Urolithiasis 2015; 43:119-24. [DOI: 10.1007/s00240-015-0749-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
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Khan SR, Canales BK. Unified theory on the pathogenesis of Randall's plaques and plugs. Urolithiasis 2014; 43 Suppl 1:109-23. [PMID: 25119506 DOI: 10.1007/s00240-014-0705-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/23/2014] [Indexed: 01/19/2023]
Abstract
Kidney stones develop attached to sub-epithelial plaques of calcium phosphate (CaP) crystals (termed Randall's plaque) and/or form as a result of occlusion of the openings of the Ducts of Bellini by stone-forming crystals (Randall's plugs). These plaques and plugs eventually extrude into the urinary space, acting as a nidus for crystal overgrowth and stone formation. To better understand these regulatory mechanisms and the pathophysiology of idiopathic calcium stone disease, this review provides in-depth descriptions of the morphology and potential origins of these plaques and plugs, summarizes existing animal models of renal papillary interstitial deposits, and describes factors that are believed to regulate plaque formation and calcium overgrowth. Based on evidence provided within this review and from the vascular calcification literature, we propose a "unified" theory of plaque formation-one similar to pathological biomineralization observed elsewhere in the body. Abnormal urinary conditions (hypercalciuria, hyperoxaluria, and hypocitraturia), renal stress or trauma, and perhaps even the normal aging process lead to transformation of renal epithelial cells into an osteoblastic phenotype. With this de-differentiation comes an increased production of bone-specific proteins (i.e., osteopontin), a reduction in crystallization inhibitors (such as fetuin and matrix Gla protein), and creation of matrix vesicles, which support nucleation of CaP crystals. These small deposits promote aggregation and calcification of surrounding collagen. Mineralization continues by calcification of membranous cellular degradation products and other fibers until the plaque reaches the papillary epithelium. Through the activity of matrix metalloproteinases or perhaps by brute physical force produced by the large sub-epithelial crystalline mass, the surface is breached and further stone growth occurs by organic matrix-associated nucleation of CaOx or by the transformation of the outer layer of CaP crystals into CaOx crystals. Should this theory hold true, developing an understanding of the cellular mechanisms involved in progression of a small, basic interstitial plaque to that of an expanding, penetrating plaque could assist in the development of new therapies for stone prevention.
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Affiliation(s)
- Saeed R Khan
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, 32610, USA,
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35
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Evan AP, Worcester EM, Coe FL, Williams J, Lingeman JE. Mechanisms of human kidney stone formation. Urolithiasis 2014; 43 Suppl 1:19-32. [PMID: 25108546 DOI: 10.1007/s00240-014-0701-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/23/2014] [Indexed: 01/08/2023]
Abstract
The precise mechanisms of kidney stone formation and growth are not completely known, even though human stone disease appears to be one of the oldest diseases known to medicine. With the advent of the new digital endoscope and detailed renal physiological studies performed on well phenotyped stone formers, substantial advances have been made in our knowledge of the pathogenesis of the most common type of stone former, the idiopathic calcium oxalate stone former as well as nine other stone forming groups. The observations from our group on human stone formers and those of others on model systems have suggested four entirely different pathways for kidney stone formation. Calcium oxalate stone growth over sites of Randall's plaque appear to be the primary mode of stone formation for those patients with hypercalciuria. Overgrowths off the ends of Bellini duct plugs have been noted in most stone phenotypes, do they result in a clinical stone? Micro-lith formation does occur within the lumens of dilated inner medullary collecting ducts of cystinuric stone formers and appear to be confined to this space. Lastly, cystinuric stone formers also have numerous small, oval, smooth yellow appearing calyceal stones suggestive of formation in free solution. The scientific basis for each of these four modes of stone formation are reviewed and used to explore novel research opportunities.
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Affiliation(s)
- Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5055, Indianapolis, IN, 46220, USA,
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Williams JC, Lingeman JE, Coe FL, Worcester EM, Evan AP. Micro-CT imaging of Randall's plaques. Urolithiasis 2014; 43 Suppl 1:13-7. [PMID: 25096802 DOI: 10.1007/s00240-014-0702-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/23/2014] [Indexed: 11/26/2022]
Abstract
Micro-computed tomographic imaging (micro-CT) provides unprecedented information on stone structure and mineral composition. High-resolution micro-CT even allows visualization of the lumens of tubule and/or vessels within Randall's plaque, on stones or in papillary biopsies, thus giving a non-destructive way to study these sites of stone adhesion. This paper also shows an example of a stone growing on a different anchoring mechanism: a mineral plug within the lumen of a Bellini duct (BD plug). Micro-CT shows striking structural differences between stones that have grown on Randall's plaque and those that have grown on BD plugs. Thus, Randall's plaque can be distinguished by micro-CT, and this non-destructive method shows great promise in helping to elucidate the different mechanisms by which small stones are retained in the kidney during the development of nephrolithiasis.
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Affiliation(s)
- James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive MS 5055Y, Indianapolis, IN, 46202-5120, USA,
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Ciudin A, Luque MP, Salvador R, Diaconu MG, Franco A, Constantin V, Alvarez-Vijande R, Nicolau C, Alcaraz A. Abdominal computed tomography--a new tool for predicting recurrent stone disease. J Endourol 2014; 27:965-9. [PMID: 23668633 DOI: 10.1089/end.2013.0161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate whether CT-identified Randall plaques can be used to foresee the recurrence of stone disease (SD); to define a cut point that could identify a high-risk population. MATERIALS AND METHODS A retrospective study of patients attended for SD from January 2004 to December 2009 was conducted. Study population was patients with a first episode of calcium SD that was diagnosed by abdominal CT. Papillae tip attenuation was measured in Hounsfield units (HU) on unenhanced abdominal CT images. Patients with recurrent SD were identified; t test, Pearson correlation, and receiver operating characteristic (ROC) curve analysis were used. RESULTS A total of 543 patients were evaluated; 187 fulfilled the criteria and were included, and 49 (26.2%) had recurrent SD. Mean follow-up: 5 years (3-7 years). Papillae tip attenuation was significantly higher in the recurrent group (46.2 HU vs 40.1 HU, P=0.01) and correlated well with the possibility of developing SD (R=0.83). Attenuation >43 HU showed a ROC curve area under the curve=0.87 with sensitivity=77% and specificity=84% separating patients with a RR=8.7 of development of recurrent SD. The number of papillae >43 HU correlated with recurrent SD (RR=11.2 for ≥3 papillae vs <3 papillae with density >43 HU). CONCLUSIONS The presence of the Randall plaques can be used as a marker for predicting SD recurrence. A cut point of 43 HU could be used to identify a high-risk population.
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Abstract
PURPOSE OF REVIEW Nephrolithiasis is a common systemic disease associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). The purpose of this review is to discuss recent publications regarding nephrolithiasis-associated kidney damage, with an emphasis on AKI. RECENT FINDINGS Nephrolithiasis is not a common cause of adult AKI (1-2% of cases), although it may be a more important factor in young children (up to 30%). The primary mechanism of nephrolithiasis-associated AKI is obstructive nephropathy, and factors on presentation with obstructive uropathy predict the likelihood of long-term renal recovery. Crystalline nephropathy is another potential pathway in certain circumstances that is often associated with a worse outcome. Recent studies have elucidated additional pathways whereby calcium oxalate crystals can cause acute injury, implicating innate immunity and intracellular inflammasome pathways. Several large cohort studies have demonstrated an independent association of nephrolithiasis with CKD and end-stage renal disease, although the effect size is modest. Urologic comorbidities, urinary infection, and shared underlying risk factors (e.g., diabetes, hypertension) all impact nephrolithiasis-associated CKD risk. SUMMARY Obstructive nephropathy and crystalline nephropathy both contribute to nephrolithiasis-associated AKI, although the latter appears to have a worse prognosis. Nephrolithiasis is an independent, albeit small, risk factor for CKD. Further study is needed to clarify the incidence and mechanisms of nephrolithiasis-associated AKI, and the relationship between nephrolithiasis-associated AKI and CKD.
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Affiliation(s)
- Xiaojing Tang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
- Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Ciudin A, Luque MP, Salvador R, Diaconu MG, Franco A, Collado-Belvis A, Sanchez J, Constantin V, Alvarez-Vijande R, Nicolau C, Alcaraz A. The evolution of CT diagnosed papillae tip microcalcifications: can we predict the development of stones? J Endourol 2014; 28:1016-21. [PMID: 24735416 DOI: 10.1089/end.2014.0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the incidence of computed tomography (CT) identifiable Randall plaques in a CT explored population; to determine the clinical relevance of this radiological finding by a 7-year follow-up; to determine a cut point to identify a population with high risk of developing calcium stone disease (SD). MATERIALS AND METHODS Retrospective study of all patients explored by abdominal CT in our center between January and March 2005. INCLUSION CRITERIA age 30-60 years and no SD. Papillae attenuation was measured on nonenhanced CT in Hounsfield units (HU) and the mean of all papillae was calculated. Patients were re-evaluated after 7 years to identify calcium stone formers. Anamnesis and already available CT, ultrasound, kidney, ureter, and bladder radiograph (KUB) or intravenous urography (IVU) images performed as part of their follow-up were used. In patients with no follow-up, ultrasound and KUB were to be performed. Pearson correlation, Student t-test, and the receiver operator curve were used for statistical analysis. RESULTS A total of 362 patients fulfilled the inclusion criteria and were analyzed; 12 developed calcium SD after 7 years. A significant difference was encountered between the papillae attenuation of stone formers (SF) versus non-SF (47.2HU vs. 35.5HU, p=0.001). There was good correlation between papillae attenuation and the possibility of developing SD (R=0.87). An optimal cut point of 43HU with a sensitivity of 81% and specificity of 97%, area under the curve 0.91, separated SF and non-SF. CONCLUSION Patients with high papillae density have a higher risk of developing SD. A cut point of 43HU could accurately be used to identify a high-risk population.
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Affiliation(s)
- Alexandru Ciudin
- 1 Urology Department, Hospital Clínic Barcelona , Barcelona, Spain
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Abstract
Cystinuria is a genetic disease that leads to frequent formation of stones. In patients with recurrent stone formation, particularly patients <30 years old or those who have siblings with stone disease, urologists should maintain a high index of suspicion of the diagnosis of cystinuria. Patients with cystinuria require frequent follow-up and a multidisciplinary approach to diagnosis, prevention and management. Patients have reported success in preventing stone episodes by maintaining dietary changes using a tailored review from a specialist dietician. For patients who do not respond to conservative lifestyle measures, medical therapy to alkalinize urine and thiol-binding drugs can help. A pre-emptive approach to the surgical management of cystine stones is recommended by treating smaller stones with minimally invasive techniques before they enlarge to a size that makes management difficult. However, a multimodal approach can be required for larger complex stones. Current cystinuria research is focused on methods of monitoring disease activity, novel drug therapies and genotype-phenotype studies. The future of research is collaboration at a national and international level, facilitated by groups such as the Rare Kidney Stone Consortium and the UK Registry of Rare Kidney Diseases.
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Khan A, Wang W, Khan SR. Calcium oxalate nephrolithiasis and expression of matrix GLA protein in the kidneys. World J Urol 2014; 32:123-30. [PMID: 23475213 PMCID: PMC3731399 DOI: 10.1007/s00345-013-1050-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/25/2013] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Polymorphism of the gene for matrix GLA protein (MGP), a calcification inhibitor, is associated with nephrolithiasis. However, experimental investigations of MGP role in stone pathogenesis are limited. We determined the effect of renal epithelial exposure to oxalate (Ox), calcium oxalate (CaOx) monohydrate (COM) or hydroxyapatite (HA) crystal on the expression of MGP. METHODS MDCK cells in culture were exposed to 0.3, 0.5 or 1 mM Ox and 33, 66 or 133-150 μg/cm(2) of COM/HA for 3-72 h. MGP expression and production were determined by Western blotting and densitometric analysis. Enzyme-linked immunosorbent assay was performed to determine MGP release into the medium. Hyperoxaluria was induced in male Sprague-Dawley rats by feeding hydroxyl-L-proline. Immunohistochemistry was performed to detect renal MGP expression. RESULTS Exposure to Ox and crystals led to time- and concentration-dependent increase in expression of MGP in MDCK cells. Cellular response was quicker to crystal exposure than to the Ox, expression being significantly higher after 3-h exposure to COM or HA crystals and more than 6 h of exposure to Ox. MGP expression was increased in kidneys of hyperoxaluric rats particularly in renal peritubular vessels. CONCLUSION We demonstrate increased expression of MGP in renal tubular epithelial cells exposed to Ox or CaOx crystals as well as the HA crystals. The most significant finding of this study is the increased staining seen in renal peritubular vessels of the hyperoxaluric rats, indicating involvement of renal endothelial cells in the synthesis of MGP.
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Affiliation(s)
- Aslam Khan
- Department of Pathology, Immunology & Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA
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Evan AP, Lingeman JE, Worcester EM, Sommer AJ, Phillips CL, Williams JC, Coe FL. Contrasting histopathology and crystal deposits in kidneys of idiopathic stone formers who produce hydroxy apatite, brushite, or calcium oxalate stones. Anat Rec (Hoboken) 2014; 297:731-48. [PMID: 24478243 DOI: 10.1002/ar.22881] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 12/16/2013] [Indexed: 12/11/2022]
Abstract
Our previous work has shown that stone formers who form calcium phosphate (CaP) stones that contain any brushite (BRSF) have a distinctive renal histopathology and surgical anatomy when compared with idiopathic calcium oxalate stone formers (ICSF). Here we report on another group of idiopathic CaP stone formers, those forming stone containing primarily hydroxyapatite, in order to clarify in what ways their pathology differs from BRSF and ICSF. Eleven hydroxyapatite stone formers (HASF) (2 males, 9 females) were studied using intra-operative digital photography and biopsy of papillary and cortical regions to measure tissue changes associated with stone formation. Our main finding is that HASF and BRSF differ significantly from each other and that both differ greatly from ICSF. Both BRSF and ICSF patients have significant levels of Randall's plaque compared with HASF. Intra-tubular deposit number is greater in HASF than BRSF and nonexistent in ICSF while deposit size is smaller in HASF than BRSF. Cortical pathology is distinctly greater in BRSF than HASF. Four attached stones were observed in HASF, three in 25 BRSF and 5-10 per ICSF patient. HASF and BRSF differ clinically in that both have higher average urine pH, supersaturation of CaP, and calcium excretion than ICSF. Our work suggests that HASF and BRSF are two distinct and separate diseases and both differ greatly from ICSF.
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Affiliation(s)
- Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana; Department of Urology, International Kidney Stone Institute, Methodist Hospital, Indianapolis, Indiana
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Abstract
PURPOSE OF REVIEW The prevalence of nephrolithiasis has been on the rise over recent decades. There have also been extensive efforts to identify risk factors for chronic kidney disease (CKD). The purpose of this review is to highlight recent evidence on the association of nephrolithiasis with the development of CKD and end-stage renal disease (ESRD). RECENT FINDINGS Several epidemiologic studies over the past decade assessed the relationship between history of nephrolithiasis and CKD. Across several studies, patients with nephrolithiasis had about a two-fold higher risk for decreased renal function or need for renal replacement therapy. This risk appears to be independent of risk factors for CKD that are common in stone formers such as hypertension and diabetes mellitus. Specific risk factors for CKD in stone formers include recurrent urinary tract infections, struvite and possibly uric acid stone composition, symptomatic stones, solitary kidney, ileal conduit, neurogenic bladder, and hydronephrosis. SUMMARY Recent evidence has shown a consistent relationship between nephrolithiasis history and an increased risk of CKD and ESRD. Understanding the characteristics that predispose to CKD may better inform how to optimally manage patients with nephrolithiasis and prevent this complication.
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Antonelli JA, Langman CB, Odom C, Poindexter J, Huet B, Pearle MS. Defining variation in urinary oxalate in hyperoxaluric stone formers. J Endourol 2013; 27:1530-4. [PMID: 24147733 DOI: 10.1089/end.2013.0199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The development of effective preventive therapy for renal calculi in patients with secondary hyperoxaluria (2°HO) relies on establishing the pattern of normal variation in urinary oxalate (uOx) and attempting to reduce it. Therefore, we evaluated uOx at baseline and at subsequent time points in stone formers with 2°HO. METHODS We reviewed the charts of 201 recurrent stone formers with 2°HO (uOx ≥ 40 mg/day). The 24-hour urine collections at baseline and after initiation of clinician-directed therapies were analyzed. Mixed models were constructed to analyze uOx over time for individual patients and as a group. Subgroup analyses were performed for enteric and idiopathic 2°HO. Coefficients of variation were computed using the root mean square error from linear models. RESULTS The etiology of 2°HO was enteric in 17.9% and idiopathic in 82.1% of patients. Among the 943 urine collections analyzed, 196 oxalate values were derived from the enteric group and 747 from the idiopathic group. The median number of uOx values measured per person was four. The median 24-hour uOx (mg/day) was significantly higher for the enteric group than for the idiopathic group at the time of diagnosis: 64.4 (interquartile range [IQR]=48-90) vs 46.0 (IQR=38-56), P<0.001) and during follow-up (58.2 [IQR=46-86] vs 44.2 [IQR=35-53], P<0.001). Over a median follow-up of 22.5 months, 44.4% of the enteric and 61.8% of the idiopathic patients had at least one normal uOx value (P=0.06). The coefficients of variation for the enteric and idiopathic groups were 40.8% and 27.3%, respectively, with variation randomly displayed in either direction for both groups. CONCLUSIONS Among patients with 2°HO, uOx demonstrates significant random variation over time even with the incorporation of standard treatments, with enteric HO demonstrating higher values and greater variance than idiopathic HO.
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Affiliation(s)
- Jodi A Antonelli
- 1 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
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Worcester EM, Evan AP, Coe FL, Lingeman JE, Krambeck A, Sommers A, Phillips CL, Milliner D. A test of the hypothesis that oxalate secretion produces proximal tubule crystallization in primary hyperoxaluria type I. Am J Physiol Renal Physiol 2013; 305:F1574-84. [PMID: 24089413 DOI: 10.1152/ajprenal.00382.2013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The sequence of events by which primary hyperoxaluria type 1 (PH1) causes renal failure is unclear. We hypothesize that proximal tubule (PT) is vulnerable because oxalate secretion raises calcium oxalate (CaOx) supersaturation (SS) there, leading to crystal formation and cellular injury. We studied cortical and papillary biopsies from two PH1 patients with preserved renal function, and seven native kidneys removed from four patients at the time of transplant, after short-term (2) or longer term (2) dialysis. In these patients, and another five PH1 patients without renal failure, we calculated oxalate secretion, and estimated PT CaOx SS. Plasma oxalate was elevated in all PH1 patients and inverse to creatinine clearance. Renal secretion of oxalate was present in all PH1 but rare in controls. PT CaOx SS was >1 in all nonpyridoxine-responsive PH1 before transplant and most marked in patients who developed end stage renal disease (ESRD). PT from PH1 with preserved renal function had birefringent crystals, confirming the presence of CaOx SS, but had no evidence of cortical inflammation or scarring by histopathology or hyaluronan staining. PH1 with short ESRD showed CaOx deposition and hyaluronan staining particularly at the corticomedullary junction in distal PT while cortical collecting ducts were spared. Longer ESRD showed widespread cortical CaOx, and in both groups papillary tissue had marked intratubular CaOx deposits and fibrosis. CaOx SS in PT causes CaOx crystal formation, and CaOx deposition in distal PT appears to be associated with ESRD. Minimizing PT CaOx SS may be important for preserving renal function in PH1.
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Affiliation(s)
- Elaine M Worcester
- Nephrology Section, MC5100, Univ. of Chicago, School of Medicine, 5841 South Maryland Ave., Chicago, IL 60637.
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Edvardsson VO, Goldfarb DS, Lieske JC, Beara-Lasic L, Anglani F, Milliner DS, Palsson R. Hereditary causes of kidney stones and chronic kidney disease. Pediatr Nephrol 2013; 28:1923-42. [PMID: 23334384 PMCID: PMC4138059 DOI: 10.1007/s00467-012-2329-z] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 09/13/2012] [Accepted: 09/17/2012] [Indexed: 01/27/2023]
Abstract
Adenine phosphoribosyltransferase (APRT) deficiency, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC), and primary hyperoxaluria (PH) are rare but important causes of severe kidney stone disease and/or chronic kidney disease in children. Recurrent kidney stone disease and nephrocalcinosis, particularly in pre-pubertal children, should alert the physician to the possibility of an inborn error of metabolism as the underlying cause. Unfortunately, the lack of recognition and knowledge of the five disorders has frequently resulted in an unacceptable delay in diagnosis and treatment, sometimes with grave consequences. A high index of suspicion coupled with early diagnosis may reduce or even prevent the serious long-term complications of these diseases. In this paper, we review the epidemiology, clinical features, diagnosis, treatment, and outcome of patients with APRT deficiency, cystinuria, Dent disease, FHHNC, and PH, with an emphasis on childhood manifestations.
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MESH Headings
- Adenine Phosphoribosyltransferase/deficiency
- Adenine Phosphoribosyltransferase/genetics
- Animals
- Child
- Cystinuria/diagnosis
- Cystinuria/epidemiology
- Cystinuria/genetics
- Cystinuria/therapy
- Dent Disease/diagnosis
- Dent Disease/epidemiology
- Dent Disease/genetics
- Dent Disease/therapy
- Genetic Predisposition to Disease
- Heredity
- Humans
- Hypercalciuria/diagnosis
- Hypercalciuria/epidemiology
- Hypercalciuria/genetics
- Hypercalciuria/therapy
- Hyperoxaluria, Primary/diagnosis
- Hyperoxaluria, Primary/epidemiology
- Hyperoxaluria, Primary/genetics
- Hyperoxaluria, Primary/therapy
- Kidney Calculi/diagnosis
- Kidney Calculi/epidemiology
- Kidney Calculi/genetics
- Kidney Calculi/therapy
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/epidemiology
- Metabolism, Inborn Errors/genetics
- Metabolism, Inborn Errors/therapy
- Nephrocalcinosis/diagnosis
- Nephrocalcinosis/epidemiology
- Nephrocalcinosis/genetics
- Nephrocalcinosis/therapy
- Phenotype
- Prognosis
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/genetics
- Renal Insufficiency, Chronic/therapy
- Renal Tubular Transport, Inborn Errors/diagnosis
- Renal Tubular Transport, Inborn Errors/epidemiology
- Renal Tubular Transport, Inborn Errors/genetics
- Renal Tubular Transport, Inborn Errors/therapy
- Risk Factors
- Urolithiasis/diagnosis
- Urolithiasis/epidemiology
- Urolithiasis/genetics
- Urolithiasis/therapy
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Retention and growth of urinary stones: insights from imaging. J Nephrol 2013; 26:25-31. [PMID: 22976521 DOI: 10.5301/jn.5000208] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 11/20/2022]
Abstract
Recent work in nephrolithiasis has benefited from 2 special kinds of imaging: endoscopic study of patient kidneys with high-quality instruments, and examination of stones with microscopic computed tomography (micro CT). The combination of these has provided new evidence that there is more than 1 mechanism by which stones are retained in the kidney until they achieve sizes to be clinically relevant. This review describes what is known about the formation of stones on Randall's plaque, the formation of stones on ductal plugs and the ways in which stones may grow in free solution within the calyceal or pelvic spaces. Studies of urolithiasis need to recognize that any group of "stone formers" likely includes patients who differ fundamentally regarding which mechanism of stone formation is the primary route for their stones. Separation of patients on the basis of which mechanism (or combination of mechanisms) underlies their disease will be important for advancing research in the area of urolithiasis.
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Koraishy FM, Cohen RA, Israel GM, Dahl NK. Cystic kidney disease in a patient with systemic toxicity from long-term D-penicillamine use. Am J Kidney Dis 2013; 62:806-9. [PMID: 23796907 DOI: 10.1053/j.ajkd.2013.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/16/2013] [Indexed: 11/11/2022]
Abstract
D-penicillamine, used to treat cystinuria, is known to cause impaired collagen deposition and dysfunction in elastic fibers. D-penicillamine also has been associated with glomerular abnormalities, typically membranous glomerulonephritis. We describe a patient with severe bilateral cystic kidney disease that developed after long-term D-penicillamine use for treatment of cystinuria. The cysts in the kidneys were noted during an evaluation for acute kidney injury. The patient had no evidence of cysts on prior renal imaging at a time when his kidney function was normal. Simultaneously, he presented with multiorgan manifestations of D-penicillamine toxicity, including the skin findings of cutix laxa and elastosis perforans serpiginosa. Consequently, D-penicillamine treatment was discontinued, after which the progression of cystic kidney disease gradually ceased, along with the other systemic manifestations of toxicity. To our knowledge, this is the first report of cystic kidney disease associated with and perhaps caused by long-term d-penicillamine therapy. The proposed mechanism of cyst formation is the malfunction of the extracellular matrix of the kidney by d-penicillamine that leads to an impaired repair process after kidney injury.
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Affiliation(s)
- Farrukh M Koraishy
- Section of Nephrology, Yale University School of Medicine, New Haven, CT.
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Bilateral urinary calculi with discordant stone composition. World J Urol 2013; 32:281-5. [PMID: 23743736 DOI: 10.1007/s00345-013-1113-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To describe a cohort of bilateral stone formers with significantly different compositions between renal units. METHODS Patients treated for bilateral nephrolithiasis over a 4-year period (2007-2010) were identified. Stones were categorized by dominant (≥50%) mineralogical component. Patients with significant compositional differences between renal units (discordant stone formers) were compared to patients with a similar stone type in each kidney. RESULTS Fifteen of the 59 bilateral stone formers (25.4%) were discordant stone formers with significant differences in stone composition between renal units. Forty-four of the 59 patients (74.6%) had the same stone composition on each side. Thirty percent of discordant stones had calcium phosphate as the dominant stone component. Discordant stone formers were younger, had better renal function, and tended to have a larger stone burden (p < 0.05). CONCLUSIONS A significant minority of bilateral stone formers form a different type of stone in each kidney. Local or micro-environmental etiologies may explain this phenomenon and may also account for failure of preventive therapy in some patients.
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50
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Claes DJ, Jackson E. Cystinuria: mechanisms and management. Pediatr Nephrol 2012; 27:2031-2038. [PMID: 22281707 DOI: 10.1007/s00467-011-2092-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/18/2011] [Accepted: 11/29/2011] [Indexed: 11/24/2022]
Abstract
Cystinuria is a relatively uncommon cause of pediatric stone disease, but has significant morbidity if not properly controlled because of its significant stone recurrence rate. Cystinuria is caused by the inability of the renal tubules to reabsorb filtered cystine, which is poorly soluble at a typical urine pH <7. Although many advances have been made in the understanding of the genetic and physiological basis of cystinuria, the cornerstones of treatment still involve stone prevention with dietary measures and pharmacological therapy, coupled with surgical interventions for stone removal. Pharmacological treatments can carry significant side effects that must be monitored and can limit therapy as well as impede compliance. Most patients will require surgical intervention for stone removal, although compliance with prevention strategies reduces the need for intervention.
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Affiliation(s)
- Donna J Claes
- Division of Pediatric Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA.
| | - Elizabeth Jackson
- Division of Pediatric Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA
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