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Corthier A, Jachiet M, Bertin D, Servais A, Barbet C, Bigot A, Doutre MS, Bessis D, Bouffandeau A, Moranne O, Jarrot PA, Bardin N, Terrier B, Burtey S, Puéchal X, Daniel L, Jourde-Chiche N. Biopsy-proven kidney involvement in hypocomplementemic urticarial vasculitis. BMC Nephrol 2022; 23:67. [PMID: 35172758 PMCID: PMC8851735 DOI: 10.1186/s12882-022-02689-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypocomplementemic urticarial vasculitis (HUV) is a rare systemic vasculitis. We aimed to describe the kidney involvement of HUV in a multicenter national cohort with an extended follow-up. METHODS All patients with HUV (international Schwartz criteria) with a biopsy-proven kidney involvement, identified through a survey of the French Vasculitis Study Group (FVSG), were included. A systematic literature review on kidney involvement of HUV was performed. RESULTS Twelve patients were included, among whom 8 had positive anti-C1q antibodies. All presented with proteinuria, from mild to nephrotic, and 8 displayed acute kidney injury (AKI), requiring temporary haemodialysis in 2. Kidney biopsy showed membrano-proliferative glomerulonephritis (MPGN) in 8 patients, pauci-immune crescentic GN or necrotizing vasculitis in 3 patients (with a mild to severe interstitial inflammation), and an isolated interstitial nephritis in 1 patient. C1q deposits were observed in the glomeruli (n = 6), tubules (n = 4) or renal arterioles (n = 3) of 8 patients. All patients received corticosteroids, and 9 were also treated with immunosuppressants or apheresis. After a mean follow-up of 8.9 years, 6 patients had a preserved renal function, but 2 patients had developed stage 3-4 chronic kidney disease (CKD) and 4 patients had reached end-stage kidney disease (ESKD), among whom 1 had received a kidney transplant. CONCLUSION Renal involvement of HUV can be responsible for severe AKI, CKD and ESRD. It is not always associated with circulating anti-C1q antibodies. Kidney biopsy shows mostly MPGN or crescentic GN, with frequent C1q deposits in the glomeruli, tubules or arterioles.
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Affiliation(s)
- Alice Corthier
- Department of Nephrology, Aix-Marseille Univ, Hôpital de la Conception, AP-HM, 147 Bd Baille, 13005, Marseille, France
| | - Marie Jachiet
- Department of Dermatology, Hôpital Saint Louis, AP-HP, Université Paris Diderot, Paris, France
| | - Daniel Bertin
- Laboratory of Immunology, Hôpital de la Conception, AP-HM, Marseille, France
| | - Aude Servais
- Department of Nephrology, Hôpital Necker, AP-HP, Paris, France
| | | | - Adrien Bigot
- Department of Internal Medicine, CHU de Tours, Tours, France
| | | | - Didier Bessis
- Department of Dermatology, Hôpital Saint Eloi, Université de Montpellier, Montpellier, France
| | | | - Olivier Moranne
- Department of Nephrology, Dialysis, Apheresis, CHU Caremeau, Nimes, France.,Université de Montpellier-Nîmes, Nîmes, France
| | - Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, Hôpital de la Conception, AP-HM, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Marseille, France
| | - Nathalie Bardin
- Laboratory of Immunology, Hôpital de la Conception, AP-HM, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Marseille, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Stephane Burtey
- Department of Nephrology, Aix-Marseille Univ, Hôpital de la Conception, AP-HM, 147 Bd Baille, 13005, Marseille, France.,Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Marseille, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Laurent Daniel
- Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Marseille, France.,Department of Pathology, Aix-Marseille Univ, Hôpital de la Timone, AP-HM, Marseille, France
| | - Noémie Jourde-Chiche
- Department of Nephrology, Aix-Marseille Univ, Hôpital de la Conception, AP-HM, 147 Bd Baille, 13005, Marseille, France. .,Aix-Marseille Univ, C2VN, INSERM 1263, INRA 1260, Marseille, France.
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Dominguez B, Vigo R. Hypocomplementemic urticarial vasculitis syndrome associated with rapidly progressive glomerulonephritis: lessons for the clinical nephrologist. J Nephrol 2021; 34:953-957. [PMID: 33433859 DOI: 10.1007/s40620-020-00942-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ronald Vigo
- Delray Medical Center, Delray Beach, Florida, USA
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3
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Kidney Involvement in Hypocomplementemic Urticarial Vasculitis Syndrome-A Case-Based Review. J Clin Med 2020; 9:jcm9072131. [PMID: 32640739 PMCID: PMC7408727 DOI: 10.3390/jcm9072131] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022] Open
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS), or McDuffie syndrome, is a rare small vessel vasculitis associated with urticaria, hypocomplementemia and positivity of anti-C1q antibodies. In rare cases, HUVS can manifest as an immune-complex mediated glomerulonephritis with a membranoproliferative pattern of injury. Due to the rarity of this disorder, little is known about the clinical manifestation, pathogenesis, treatment response and outcome of such patients. We describe here three cases of HUVS with severe renal involvement. These patients had a rapidly progressive form of glomerulonephritis with severe nephrotic syndrome against a background of a membranoproliferative pattern of glomerular injury with extensive crescent formation. Therefore, these patients required aggressive induction and maintenance immunosuppressive therapy, with a clinical and renal response in two patients, while the third patient progressed to end-stage renal disease. Because of the rarity of this condition, there are few data regarding the clinical presentation, pathology and outcome of such patients. Accordingly, we provide an extensive literature review of cases reported from 1976 until 2020 and place them in the context of the current knowledge of HUVS pathogenesis. We identified 60 patients with HUVS and renal involvement that had adequate clinical data reported, out of which 52 patients underwent a percutaneous kidney biopsy. The most frequent renal manifestation was hematuria associated with proteinuria (70% of patients), while one third had abnormal kidney function on presentation (estimated glomerular filtration (GFR) below 60 mL/min/1.73 m2). The most frequent glomerular pattern of injury was membranoproliferative (35%), followed by mesangioproliferative (21%) and membranous (19%). Similar to other systemic vasculitis, renal involvement carries a poorer prognosis, but the outcome can be improved by aggressive immunosuppressive treatment.
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Ralli M, Campo F, Angeletti D, Minni A, Artico M, Greco A, Polimeni A, de Vincentiis M. Pathophysiology and therapy of systemic vasculitides. EXCLI JOURNAL 2020; 19:817-854. [PMID: 32665772 PMCID: PMC7355154 DOI: 10.17179/excli2020-1512] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
Systemic vasculitides represent uncommon conditions characterized by the inflammation of blood vessels that can lead to different complex disorders limited to one organ or potentially involving multiple organs and systems. Systemic vasculitides are classified according to the diameter of the vessel that they mainly affect (small, medium, large, or variable). The pathogenetic mechanisms of systemic vasculitides are still partly unknown, as well as their genetic basis. For most of the primary systemic vasculitides, a single gold standard test is not available, and diagnosis is often made after having ruled out other mimicking conditions. Current research has focused on new management protocol and therapeutic strategies aimed at improving long-term patient outcomes and avoiding progression to multiorgan failure with irreversible damage. In this narrative review, authors describe different forms of systemic vasculitides through a review of the literature, with the aim of highlighting the current knowledge and recent findings on etiopathogenesis, diagnosis and therapy.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Italy
| | | | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Marco Artico
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
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Boyer A, Gautier N, Comoz F, Hurault de Ligny B, Aouba A, Lanot A. [Nephropathy associated with hypocomplementemic urticarial vasculitis: A case report and literature review]. Nephrol Ther 2020; 16:124-135. [PMID: 31928955 DOI: 10.1016/j.nephro.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 11/25/2022]
Abstract
Hypocomplementemic urticarial vasculitis is a rare systemic vasculitis, affecting small vessels, characterised by chronicle urticaria, hypocomplementemia, and systemic manifestations. Renal involvement, whose prevalence varies between 9% and 60%, is mainly glomerular. We here report the case of a 59 years old woman presenting kidney failure, associated with chronicle urticaria and arthralgias. Laboratory investigation showed haematuria, proteinuria, hypocomplementemia and anti-SSa antibody positivity. A percutaneous kidney biopsy revealed focal and segmental glomerulonephritis associated with an acute interstitial nephritis. Hypocomplementemic urticarial vasculitis diagnosis was established after identifying anti-C1q antibodies. The lack of a dry syndrome, the negativity of a Schirmer test and the lack of sialadenitis on a salivary gland biopsy excluded an associated Gougerot-Sjögren Syndrome. The patient was treated with hydroxychloroquine and low-dose steroids, enabling a clinical and biological recovery. Of the 82 cases in the literature describing hypocomplementemic urticarial vasculitis associated nephropathies, 72 (88%) were a glomerular impairment, most frequently secondary to membranoproliferative glomerulonephritis. Only 6 (7%) tubulo-interstitial nephritis have been reported, 4 of them being associated with a glomerulonephritis. Patients were more likely to be women, aged in their third decade. The most frequent renal manifestations were haematuria (60%), and proteinuria (52%). Kidney failure was rarely observed (22%), with a fairly good renal prognosis. Hypocomplementemic urticarial vasculitis was associated with a systemic disease in 11 (13%) patients. In the absence of recommendations, the treatment strategy remains to be defined.
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Affiliation(s)
- Annabel Boyer
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - Nicolas Gautier
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - François Comoz
- Service d'anatomopathologie, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France
| | - Bruno Hurault de Ligny
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - Achille Aouba
- Service de médecine interne, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France
| | - Antoine Lanot
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la côte de Nacre, 14033 Caen cedex 9, France; Unicaen, UFR de médecine, Normandie Université, 2, rue des Rochambelles, 14032 Caen cedex, France.
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Hypocomplementemic urticarial vasculitis syndrome with gastrointestinal vasculitis and crescentic membranoproliferative glomerulonephritis without immune complex deposits. CEN Case Rep 2019; 9:30-35. [PMID: 31586313 DOI: 10.1007/s13730-019-00421-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 09/19/2019] [Indexed: 12/25/2022] Open
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a small vessel vasculitis characterized by hypocomplementemia and urticaria-like exanthema. Some cases also display abdominal pain and membranoproliferative glomerulonephritis (MPGN) with immune complex deposits. We treated a case of HUVS with biopsy-proven gastrointestinal vasculitis and atypical histological findings in a kidney biopsy. The 36-year-old Japanese man, who was previously diagnosed with diffuse panbronchiolitis, visited our hospital due to transient urticaria-like exanthema and rapid deterioration of kidney function. On admission, the skin lesion was found to be only pigmentation, showing no vasculitis by skin biopsy. In laboratory findings, renal dysfunction with hematuria and proteinuria and hypocomplementemia were observed. Gastrointestinal vasculitis was proven by endoscopy and biopsy of the mucosa. Kidney biopsy revealed MPGN with crescents. No immune complex deposits were observed by immunofluorescence or electron microscopy. Additional examination revealed high titers of anti-C1q antibody. The patient was diagnosed with HUVS and treated with corticosteroids and plasma exchange. Although renal function and gastrointestinal vasculitis partially improved, infectious pneumonia frequently recurred. His renal dysfunction began to progress again and reached end-stage kidney disease. This is the first case of HUVS with biopsy-proven gastrointestinal vasculitis and MPGN without immune complex deposits. Notably, in some case of HUVS, anti-C1q antibody may activate the alternative complement pathway without immune complex deposits, resulting in renal injury.
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Hypocomplementemic Urticarial Vasculitis Syndrome With Crescentic Glomerulonephritis. Am J Med Sci 2018; 355:195-200. [DOI: 10.1016/j.amjms.2017.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 11/21/2022]
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8
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Tanaka M, Moniwa N, Mita T, Tobisawa T, Matsumoto T, Mochizuki A, Yamashita T, Yano T, Furuhashi M, Miura T. A Case of Crescentic Glomerulonephritis Complicated with Hypocomplementemic Urticarial Vasculitis Syndrome and ANCA-Associated Vasculitis. Case Rep Nephrol Dial 2017; 7:144-153. [PMID: 29594143 PMCID: PMC5836219 DOI: 10.1159/000484476] [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: 09/11/2017] [Accepted: 10/23/2017] [Indexed: 12/02/2022] Open
Abstract
Systemic urticaria in a 64-year-old woman was diagnosed as leukocytoclastic vasculitis by a punch biopsy of the skin. Her physical findings improved after prescription of prednisolone at a dose of 20 mg/day, but the skin rash relapsed with renal dysfunction, proteinuria, and hematuria when the dose of prednisolone was reduced over a period of 9 months to 1 mg/day. She was admitted to our institute for further examination, when urinary protein and plasma creatinine levels were 0.8 g/day and 1.7 mg/dL, respectively. Complement analysis showed that levels of total hemolytic component, component C3 fraction, and component C4 fraction were 30∼60% of normal values and the titer of anti-neutrophil cytoplasmic antibody for myeloperoxidase (MPO-ANCA) was 89 EU (normal range, <10 EU), though there were no immunologic disorders such as systemic lupus erythematosus. Cellular crescentic glomerulonephritis was observed by light microscopy, and immunofluorescent studies showed positive staining for IgG, IgM, C3, C4, and C1q. Electron microscopy showed mesangial and subendothelial deposits with circumferential mesangial interposition. She fulfilled the diagnostic criteria for hypocomplementemic urticarial vasculitis syndrome (HUV), and ANCA-associated vasculitis (AAV) was also indicated by small vessel vasculitis and positive MPO-ANCA. Steroid pulse therapy with methylprednisolone followed by oral prednisolone improved her general condition and hypocomplementemia, and MPO-ANCA became negative. HUV and AAV are distinct clinical disorders, though both affect small blood vessels. Here we report a case of AAV-complicated HUV with crescentic glomerulonephritis.
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Affiliation(s)
- Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Norihito Moniwa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomohiro Mita
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiyuki Tobisawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tamaki Matsumoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomohisa Yamashita
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Gheerbrant H, Giovannini D, Falque L, Andry F, Lugosi M, Deroux A. Vascularite hypocomplémentémique urticarienne associée à une glomérulonéphrite membrano-proliférative sévère et polyadénopathies. Presse Med 2017; 46:547-550. [DOI: 10.1016/j.lpm.2017.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/05/2017] [Indexed: 11/16/2022] Open
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Hauser B. Systemic Manifestations of Hypocomplementemic Urticarial Vasculitis: Comment on the Article by Jachiet et al. Arthritis Rheumatol 2015; 67:1984-5. [DOI: 10.1002/art.39097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/31/2015] [Indexed: 11/10/2022]
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Yamazaki M, Sugai K, Kobayashi Y, Kaburagi Y, Murashita K, Saito N, Hitoshi N, Imagawa T, Tsukagoshi H, Kimura H. A case of hypocomplementaemic urticarial vasculitis in a child due to coxsackievirus type A9. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.000596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mayumi Yamazaki
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Kazuko Sugai
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Yoshinori Kobayashi
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Yoichi Kaburagi
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Kazuaki Murashita
- Department of Plastic Surgery, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Norimitsu Saito
- Department of Dermatology, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Niino Hitoshi
- Department of Pathology, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Tomoyuki Imagawa
- Department of Pediatrics, Yokohama City University School of Medicine, 3‐9, Fukuura, Yokohama, 236‐0004, Japan
| | - Hiroyuki Tsukagoshi
- Gunma Prefectural Institute of Public Health and Environmental Sciences, 378, Kamioki‐cho, Maebashi, Gunma, 371‐0052, Japan
| | - Hirokazu Kimura
- National Institute of Infectious Disease, Infectious Disease Surveillance Center, 4‐7‐1, Gakuen, Musashimurayama, Tokyo 208‐0011, Japan
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Ozçakar ZB, Foster J, Diaz-Horta O, Kasapcopur O, Fan YS, Yalçınkaya F, Tekin M. DNASE1L3 mutations in hypocomplementemic urticarial vasculitis syndrome. ACTA ACUST UNITED AC 2013; 65:2183-9. [PMID: 23666765 DOI: 10.1002/art.38010] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/02/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Hypocomplementemic urticarial vasculitis syndrome (HUVS) is characterized by recurrent urticaria along with dermal vasculitis, arthritis, and glomerulonephritis. Systemic lupus erythematosus (SLE) develops in >50% of patients with HUVS, although the pathogenesis is unknown. The aim of this study was to identify the causative DNA mutations in 2 families with autosomal-recessive HUVS, in order to reveal the pathogenesis and facilitate the laboratory diagnosis. METHODS Autozygosity mapping was combined with whole-exome sequencing. RESULTS In a family with 3 affected children, we identified a homozygous frameshift mutation, c.289_290delAC, in DNASE1L3. We subsequently identified another homozygous DNASE1L3 mutation leading to exon skipping, c.320+4delAGTA, in an unrelated family. The detected mutations led to loss of function, via either nonsense-mediated messenger RNA decay or abolished endonuclease activity, as demonstrated by a plasmid nicking assay. CONCLUSION These results show that HUVS is caused by mutations in DNASE1L3, encoding an endonuclease that previously has been associated with SLE.
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Morizane R, Konishi K, Hashiguchi A, Tokuyama H, Wakino S, Kawabe H, Hayashi M, Hayashi K, Itoh H. MPO-ANCA associated crescentic glomerulonephritis with numerous immune complexes: case report. BMC Nephrol 2012; 13:32. [PMID: 22656245 PMCID: PMC3470990 DOI: 10.1186/1471-2369-13-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/17/2012] [Indexed: 11/30/2022] Open
Abstract
Background Antineutrophil cytoplasmic antibody (ANCA)-associated crescentic glomerulonephritis (CGN) is a major cause of rapidly progressive glomerulonephritis (RPGN). ANCA-associated CGN is generally classified into pauci-immune RPGN, in which there are few or no immune complexes. Case Presentation A 78-year-old man presented with RPGN after a 7-year course of chronic proteinuria and hematuria with stable renal function. A blood examination showed a high titer of myeloperoxidase (MPO)-ANCA. A renal biopsy showed crescentic glomerulonephritis with abundant subepithelial, intramenbranous and subendothelial deposits by electron microscopy, leading to the diagnosis of ANCA-associated CGN superimposed on type 3 membranoproliferative glomerulonephritis (MPGN). Conclusions This case is unique in that type 3 MPGN and MPO-ANCA-associated CGN coexisted, and no similar case has been reported to date. Because ANCA-associated CGN has a predilection for elderly individuals and primary type 3 MPGN is rarely seen in this age group, coincidental existence appears less likely. This case may confer valuable information regarding the link between immune complex and ANCA-associated CGN.
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Affiliation(s)
- Ryuji Morizane
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Kroshinsky D, Stone JH, Nazarian RM. Case records of the Massachusetts General Hospital. Case 22-2011. A 79-year-old man with a rash, arthritis, and ocular erythema. N Engl J Med 2011; 365:252-62. [PMID: 21774714 DOI: 10.1056/nejmcpc1100929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, and the Harvard Medical School, Boston, USA
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Haris Á, Arányi J, Braunitzer H, Kálmán É, Merán Z, Soltész M, Polner K. Role of plasmapheresis in immunological kidney diseases. Experience from 1050 completed plasmapheresis treatment sessions. Orv Hetil 2011; 152:1110-9. [DOI: 10.1556/oh.2011.29155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Plasmapheresis is an effective treatment modality in several immunological kidney diseases. It is also indicated in certain neurological and hematological abnormalities, and some other diseases. Aims: In this study the indications and outcomes of the plasma exchange treatments performed in the Plasmapheresis Unit of the authors during the last 12 years are summarized, and the findings are compared to those published in the literature. The procedure, mechanisms of action and adverse effects are also briefly discussed. Methods: Between 1999 and 2010 authors completed 1050 plasma exchanges in 195 patients with an average 5.4 (1-20) treatments/person. In the 78 males and 117 females (age 57±16 years) the indications were as follows: 47% anti-cytoplasmic antibody-associated vasculitis, 4% anti-glomerular basement membrane disease, 3% rapidly progressing immunocomplex glomerulonephritis, 11% severe complications of systemic lupus erythematosus, 1% treatment resistant focal segmental glomerular sclerosis, 5% hemolytic uremic syndrome, 13% complications of multiple myeloma, 4% HELLP syndrome, 10% neurological diseases, and 2% other abnormalities. Results: Plasmapheresis, completed as part of combined immunosuppressive treatment, resulted in remarkable improvements in patients with anti-cytoplasmic antibody-associated vasculitis. Out of the 91 patients, 54 needed urgent dialysis on admission, and renal replacement therapy could be discontinued in 44% of them. Renal functions in those patients who did not need dialysis also improved significantly, and pulmonary hemorrhage ceased in all affected subjects. Survival of the patients with anti-glomerular basement membrane diseases was 100%. The treatment significantly improved the renal function in rapidly progressive lupus nephritis, and all the 5 cases of lupus cerebritis were successfully cured. The results showed less effectiveness in therapy resistant focal segmental glomerular sclerosis and in rapidly progressing immunocomplex glomerulonephritis. Plasmapheresis proved to be very efficient in cases with the primary hemolytic uremic syndrome, and each patient with HELLP syndrome recovered completely. The outcome of those with multiple myeloma was less favorable, although hyperviscosity was rapidly and effectively decreased by the plasmapheresis. The treatment improved the conditions of almost all patients with neurological diseases. Discussion: According to these findings plasmapheresis treatment, introduced by proper indications, effectively improves the outcomes of several diseases. Early diagnosis and immediate introduction of the plasmapheresis are very important – in conjunction with the appropriate therapy of the underlying diseases. Orv. Hetil., 2011, 152, 1110–1119.
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Affiliation(s)
- Ágnes Haris
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032
| | - József Arányi
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032
| | - Henrik Braunitzer
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032
| | - Éva Kálmán
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032
| | - Zoltán Merán
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032
| | - Mariann Soltész
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032
| | - Kálmán Polner
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032
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The "other" vasculitis syndromes and kidney involvement. Pediatr Nephrol 2010; 25:1633-9. [PMID: 19898878 PMCID: PMC2908464 DOI: 10.1007/s00467-009-1327-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 09/03/2009] [Accepted: 09/03/2009] [Indexed: 11/16/2022]
Abstract
There are a number of vasculitides that are not confined to a specific vessel size, do not have characteristic features, and/or are not secondary to another disease. Most of these vasculitides are rare in childhood. Behçet disease is representative of this group as it involves vessels of any size on both the arterial and venous side. In addition to renal vascular involvement, Behçet disease may involve the kidney through glomerulonephritis, secondary amyloidosis and, rarely, tubulointerstital involvement. Vasculitis secondary to infections, malignancy, and drugs are not common among children. However, vasculitis may be associated with a number of rheumatic diseases in childhood and the auto-inflammatory syndromes (periodic fever syndromes). Auto-inflammatory syndromes are diseases characterized by periodic attacks of clinical and laboratory inflammation. Studies carried out during the past decade have provided valuable information on the mechanism of inflammation and innate immunity in general. This group of vasculitides is associated with secondary amyloidosis of the kidney if not treated. Hypocomplementemic urticarial vasculitis is an interesting vasculitic disease with frequent kidney involvement. Here, we introduce the reader to the wide scope of these diseases; although rare, such diseases represent a challenge to the nephrologist.
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Jara LJ, Navarro C, Medina G, Vera-Lastra O, Saavedra MA. Hypocomplementemic urticarial vasculitis syndrome. Curr Rheumatol Rep 2010; 11:410-5. [PMID: 19922730 DOI: 10.1007/s11926-009-0060-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS) is an uncommon immune complex-mediated entity characterized by urticaria with persistent acquired hypocomplementemia. First described in 1973, HUVS is associated with several systemic findings including leukocytoclastic vasculitis, severe angioedema, laryngeal edema, pulmonary involvement, arthritis, arthralgia, glomerulonephritis, and uveitis. These manifestations should be present for at least 6 months. Laboratory findings include low complement levels of classical pathway, namely C1q, C2, C3, and C4. The disease marker is the serum presence of anti-C1q antibodies. Treatment, based on disease severity, involves corticosteroids and other immunosuppressive agents that have demonstrated some success. Patients may have significant morbidity and mortality, most commonly caused by chronic obstructive pulmonary disease and acute laryngeal edema.
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Affiliation(s)
- Luis J Jara
- Director of Education and Research, Hospital de Especialidades Centro Medico La Raza, Seris/Zaachila S/N Colonia La Raza, ZP 02990, Mexico City, Mexico.
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