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Zhang T, Zhang W, Zuo K, Cheng Z. Clinicopathologic Features and Outcomes in Fibronectin Glomerulopathy: A Case Series of 19 Patients. Front Med (Lausanne) 2020; 7:439. [PMID: 32923447 PMCID: PMC7456819 DOI: 10.3389/fmed.2020.00439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/06/2020] [Indexed: 01/15/2023] Open
Abstract
Aims: To describe the characteristics and prognosis of 19 patients with fibronectin glomerulopathy (FNG) and evaluate prognostic factors associated with poor renal outcomes. Methods: Included in this retrospective study was 19 FNG patients in Nanjing Glomerulonephritis Registry system. Associations between the clinical parameters, pathological features, and renal outcomes were evaluated by Kaplan-Meier survival analysis. Results: Of the 19 FNG patients included in this study, 8 (42.1%) were women. The median age of the 19 FNG patients was 31 (17–71) years, and the median disease duration 48 (1–175) months at diagnosis. At the time of renal biopsy, the mean serum creatinine (Scr) was 1.22 ± 0.16 mg/dl and urinary protein was 6.24 ± 0.97 mg/24 h. Renal biopsy showed a lobular appearance with cellular mesangial nodules expanded by matrix in 14 cases. After a median follow-up period of 87 months (interquartile range 34–114.5 months), 8 FNG patients developed renal function decline, including 7 progressing into end-stage renal disease (ESRD) and 1 presenting with by a 2-fold-increase in Scr. Scr and proteinuria remained stable in the remaining 11 patients. Kaplan-Meier survival analysis showed that nephrotic range proteinuria (P = 0.022) and focal glomerular sclerosis (P = 0.028) were associated with renal function decline. Conclusions: Nephrotic range proteinuria and focal glomerular sclerosis were associated with renal function decline during the follow-up period of the FNG patients in our series. FNG Patients at risk of renal function decline should be identified preferentially and given more progressive and effective therapies to prevent further disease progression.
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Affiliation(s)
- Ti Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wei Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ke Zuo
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhen Cheng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Takii M, Suehiro T, Shima A, Yotsueda H, Hisano S, Katafuchi R. Fibronectin glomerulopathy complicated with persistent cloaca and congenital esophageal atresia: a case report and literature review. BMC Nephrol 2017; 18:288. [PMID: 28877681 PMCID: PMC5588616 DOI: 10.1186/s12882-017-0704-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/22/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Fibronectin glomerulopathy is a rare, inherited, autosomal dominant, glomerular disease characterized by proteinuria, microscopic hematuria, hypertension, massive glomerular deposits of fibronectin, and slow progression to end-stage renal failure. Because the incident of fibronectin glomerulopathy is extremely low, the pathophysiology, genetic abnormalities, epidemiology, and mechanisms remain to be elucidated. CASE PRESENTATION We report a 21-year-old woman with fibronectin glomerulopathy, who had been diagnosed with persistent cloaca and congenital esophageal atresia at birth. She developed proteinuria and hematuria 7 months before admission. Urinary protein and serum creatinine levels were 3.38 g/gCr and 0.73 mg/dL. Renal biopsy showed severe mesangial widening due to massive deposits, which was positive periodic acid-Schiff and negative methenamine silver. Immunostaining was negative for immunoglobulin but positive for fibronectin. Electron microscopy showed diffuse mesangial granular deposits. Thus she was diagnosed with fibronectin glomerulopathy, despite a negative family history of kidney disease and lack of any known missense mutations of fibronectin 1 gene. CONCLUSION We report a patient who developed fibronectin glomerulopathy during the clinical course of extremely rare congenital malformations, including persistent cloaca and congenital esophageal atresia. We describe a case of this condition in detail and summarize the 75 case reports of fibronectin glomerulopathy.
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Affiliation(s)
- Misaki Takii
- Department of Nephrology, Harasanshin Hospital, Fukuoka, Japan
| | - Takaichi Suehiro
- Department of Nephrology, Harasanshin Hospital, Fukuoka, Japan. .,Department of Internal Medicine, Social Insurance Nakabaru Hospital, 2-12-1 Befukita, Shimemachi, Kasuya-gun, Fukuoka, 811-2233, Japan.
| | - Aya Shima
- Department of Nephrology, Harasanshin Hospital, Fukuoka, Japan
| | - Hideki Yotsueda
- Department of Nephrology, Harasanshin Hospital, Fukuoka, Japan
| | - Satoshi Hisano
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ritsuko Katafuchi
- Kidney Unit, National Fukuoka-Higashi Medical Center, Fukuoka, Japan
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Cheng G, Wang Z, Yuan W, Dou Y, Liu D, Xiao J, Zhao Z. Fibronectin glomerulopathy in a 88 year-old male with acute kidney injury on chronic kidney disease: A case report and a review of the literature. Nefrologia 2016; 37:93-96. [PMID: 27836185 DOI: 10.1016/j.nefro.2016.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/09/2016] [Accepted: 09/23/2016] [Indexed: 01/17/2023] Open
Affiliation(s)
- Genyang Cheng
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Zheng Wang
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Wenming Yuan
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Yanna Dou
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Dong Liu
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Jing Xiao
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University Institute of Nephrology, Zhengzhou, China
| | - Zhanzheng Zhao
- The Nephrology Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou University Institute of Nephrology, Zhengzhou, China.
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Ishimoto I, Sohara E, Ito E, Okado T, Rai T, Uchida S. Fibronectin glomerulopathy. Clin Kidney J 2013; 6:513-5. [PMID: 26064516 PMCID: PMC4438411 DOI: 10.1093/ckj/sft097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/17/2013] [Indexed: 11/12/2022] Open
Abstract
Fibronectin glomerulopathy occurs between the second and fifth decades of life in most patients, and it is known to be slowly progressive with mild proteinuria leading to kidney failure. The case of a 78-year-old woman with a rapid course of nephrotic syndrome due to fibronectin glomerulopathy is reported. She had proteinuria that rapidly increased to 6.8 g/day in a month and microscopic haematuria. A renal biopsy specimen showed lobular glomerulopathy and membranoproliferative glomerulonephritis-like lesions on light microscopy. There was scanty staining for immunoglobulins and complement. Electron microscopy revealed granular deposits with fibril formation. Immunohistochemistry of the fibronectin showed intense staining in the mesangium and peripheral loop. Therefore, this case was diagnosed as fibronectin glomerulopathy. The kidney function was rapidly decreasing, necessitating haemodialysis 2 months after renal biopsy. It is important to consider fibronectin glomerulopathy in the differential diagnosis of nephrotic syndrome in older people.
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Affiliation(s)
- Ikue Ishimoto
- Department of Nephrology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University , Tokyo , Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University , Tokyo , Japan
| | - Eisaku Ito
- Department of Pathology, Graduate School of Medicine , Tokyo Medical and Dental University , Tokyo , Japan
| | - Tomokazu Okado
- Department of Nephrology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University , Tokyo , Japan
| | - Tatemitsu Rai
- Department of Nephrology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University , Tokyo , Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University , Tokyo , Japan
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Otsuka Y, Takeda A, Horike K, Inaguma D, Goto N, Watarai Y, Uchida K, Mihatsch MJ, Joh K, Morozumi K. A recurrent fibronectin glomerulopathy in a renal transplant patient: a case report. Clin Transplant 2012; 26 Suppl 24:58-63. [DOI: 10.1111/j.1399-0012.2012.01644.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Yasuhiro Otsuka
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
| | - Asami Takeda
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
| | - Keiji Horike
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
| | - Daijyo Inaguma
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
| | - Norihiko Goto
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
| | - Yoshihiko Watarai
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
| | - Kazuharu Uchida
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
| | | | - Kensuke Joh
- Division of Pathology; Sendai Shakaihoken Hospital; Sendai; Japan
| | - Kunio Morozumi
- Department of Nephrology and Transplantation Center; Japanese Red Cross Nagoya Daini Hospital; Nagoya; Japan
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Castelletti F, Donadelli R, Banterla F, Hildebrandt F, Zipfel PF, Bresin E, Otto E, Skerka C, Renieri A, Todeschini M, Caprioli J, Caruso RM, Artuso R, Remuzzi G, Noris M. Mutations in FN1 cause glomerulopathy with fibronectin deposits. Proc Natl Acad Sci U S A 2008; 105:2538-43. [PMID: 18268355 PMCID: PMC2268172 DOI: 10.1073/pnas.0707730105] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Indexed: 12/12/2022] Open
Abstract
Glomerulopathy with fibronectin (FN) deposits (GFND) is an autosomal dominant disease with age-related penetrance, characterized by proteinuria, microscopic hematuria, hypertension, and massive glomerular deposits of FN that lead to end-stage renal failure. The genetic abnormality underlying GFND was still unknown. We hypothesized that mutations in FN1, which encodes FN, were the cause of GFND. In a large Italian pedigree with eight affected subjects, we found linkage with GFND at the FN1 locus at 2q32. We sequenced the FN1 in 15 unrelated pedigrees and found three heterozygous missense mutations, the W1925R, L1974R, and Y973C, that cosegregated with the disease in six pedigrees. The mutations affected two domains of FN (Hep-II domain for the W1925R and the L1974R, and Hep-III domain for the Y973C) that play key roles in FN-cell interaction and in FN fibrillogenesis. Mutant recombinant Hep-II fragments were expressed, and functional studies revealed a lower binding to heparin and to endothelial cells and podocytes compared with wild-type Hep-II and an impaired capability to induce endothelial cell spreading and cytoskeletal reorganization. Overall dominant mutations in FN1 accounted for 40% of cases of GFND in our study group. These findings may help understanding the pathogenesis of proteinuria and glomerular FN deposits in GFND and possibly in more common renal diseases such as diabetic nephropathy, IgA nephropathy, and lupus nephritis. To our knowledge no FN1 mutation causing a human disease was previously reported.
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Affiliation(s)
- Federica Castelletti
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Roberta Donadelli
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Federica Banterla
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Friedhelm Hildebrandt
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI 48109
| | - Peter F. Zipfel
- Department of Infection Biology, Leibniz Institute for Natural Products Research and Infection Biology, Hans Knoell Institute D-07745, Jena, Germany
| | - Elena Bresin
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Edgar Otto
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI 48109
| | - Christine Skerka
- Department of Infection Biology, Leibniz Institute for Natural Products Research and Infection Biology, Hans Knoell Institute D-07745, Jena, Germany
| | | | - Marta Todeschini
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Jessica Caprioli
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Rosa Maria Caruso
- Department of Nephrology and Dialysis, Azienda Ospedaliera, Ospedali Riuniti di Bergamo 24128, Italy
| | - Rosangela Artuso
- University of Siena Policlinico Le Scotte, Siena 53100, Italy; and
| | - Giuseppe Remuzzi
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
- Department of Nephrology and Dialysis, Azienda Ospedaliera, Ospedali Riuniti di Bergamo 24128, Italy
| | - Marina Noris
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
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Quiz Page Answers November 2006. Am J Kidney Dis 2006. [DOI: 10.1053/j.ajkd.2006.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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