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Wan S, Wang S, He X, Song C, Wang J. Noninvasive diagnosis of interstitial fibrosis in chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2024; 46:2367021. [PMID: 38938187 PMCID: PMC11216256 DOI: 10.1080/0886022x.2024.2367021] [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: 05/01/2024] [Accepted: 06/06/2024] [Indexed: 06/29/2024] Open
Abstract
RATIONALE AND OBJECTIVES Researchers have delved into noninvasive diagnostic methods of renal fibrosis (RF) in chronic kidney disease, including ultrasound (US), magnetic resonance imaging (MRI), and radiomics. However, the value of these diagnostic methods in the noninvasive diagnosis of RF remains contentious. Consequently, the present study aimed to systematically delineate the accuracy of the noninvasive diagnosis of RF. MATERIALS AND METHODS A systematic search covering PubMed, Embase, Cochrane Library, and Web of Science databases for all data available up to 28 July 2023 was conducted for eligible studies. RESULTS We included 21 studies covering 4885 participants. Among them, nine studies utilized US as a noninvasive diagnostic method, eight studies used MRI, and four articles employed radiomics. The sensitivity and specificity of US for detecting RF were 0.81 (95% CI: 0.76-0.86) and 0.79 (95% CI: 0.72-0.84). The sensitivity and specificity of MRI were 0.77 (95% CI: 0.70-0.83) and 0.92 (95% CI: 0.85-0.96). The sensitivity and specificity of radiomics were 0.69 (95% CI: 0.59-0.77) and 0.78 (95% CI: 0.68-0.85). CONCLUSIONS The current early noninvasive diagnostic methods for RF include US, MRI, and radiomics. However, this study demonstrates that US has a higher sensitivity for the detection of RF compared to MRI. Compared to US, radiomics studies based on US did not show superior advantages. Therefore, challenges still exist in the current radiomics approaches for diagnosing RF, and further exploration of optimized artificial intelligence (AI) algorithms and technologies is needed.
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Affiliation(s)
- Shanshan Wan
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shiping Wang
- Department of Radiology, The Affiliated Anning First People’s Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xinyu He
- Department of Radiology, The Affiliated Anning First People’s Hospital of Kunming University of Science and Technology, Kunming, China
| | - Chao Song
- Department of Radiology, The Affiliated Anning First People’s Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jiaping Wang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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2
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Nadim MK, Kellum JA, Forni L, Francoz C, Asrani SK, Ostermann M, Allegretti AS, Neyra JA, Olson JC, Piano S, VanWagner LB, Verna EC, Akcan-Arikan A, Angeli P, Belcher JM, Biggins SW, Deep A, Garcia-Tsao G, Genyk YS, Gines P, Kamath PS, Kane-Gill SL, Kaushik M, Lumlertgul N, Macedo E, Maiwall R, Marciano S, Pichler RH, Ronco C, Tandon P, Velez JCQ, Mehta RL, Durand F. Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting. J Hepatol 2024; 81:163-183. [PMID: 38527522 PMCID: PMC11193657 DOI: 10.1016/j.jhep.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
Patients with cirrhosis are prone to developing acute kidney injury (AKI), a complication associated with a markedly increased in-hospital morbidity and mortality, along with a risk of progression to chronic kidney disease. Whereas patients with cirrhosis are at increased risk of developing any phenotype of AKI, hepatorenal syndrome (HRS), a specific form of AKI (HRS-AKI) in patients with advanced cirrhosis and ascites, carries an especially high mortality risk. Early recognition of HRS-AKI is crucial since administration of splanchnic vasoconstrictors may reverse the AKI and serve as a bridge to liver transplantation, the only curative option. In 2023, a joint meeting of the International Club of Ascites (ICA) and the Acute Disease Quality Initiative (ADQI) was convened to develop new diagnostic criteria for HRS-AKI, to provide graded recommendations for the work-up, management and post-discharge follow-up of patients with cirrhosis and AKI, and to highlight priorities for further research.
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Affiliation(s)
- Mitra K Nadim
- Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lui Forni
- School of Medicine, University of Surrey and Critical Care Unit, Royal Surrey Hospital Guildford UK
| | - Claire Francoz
- Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France
| | | | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, Department of Critical Care, London, UK
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jody C Olson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED, University and Hospital of Padova, Padova, Italy
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth C Verna
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
| | - Ayse Akcan-Arikan
- Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, University and Teaching Hospital of Padua, Italy
| | - Justin M Belcher
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Scott W Biggins
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akash Deep
- Pediatric Intensive Care Unit, King's College Hospital, London, UK
| | - Guadalupe Garcia-Tsao
- Digestive Diseases Section, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Yuri S Genyk
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Abdominal Organ Transplantation at Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Pere Gines
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi-Sunyer and Ciber de Enfermedades Hepàticas y Digestivas, Barcelona, Catalonia, Spain
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Nuttha Lumlertgul
- Excellence Centre in Critical Care Nephrology and Division of Nephrology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Etienne Macedo
- Division of Nephrology, Department of Medicine, University of California San Diego, CA, USA
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Raimund H Pichler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza-Italy
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Juan-Carlos Q Velez
- Department of Nephrology, Ochsner Health, New Orleans, LA, USA; Ochsner Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Ravindra L Mehta
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - François Durand
- Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France; University Paris Cité, Paris, France.
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Tsai CH, Tang YS, Cheng CY, Hong WT. Complicated obstructive uropathy after kidney biopsy: A case report highlighting the risk of biopsy-related acute kidney injury in a patient with unilateral kidney hypoplasia. Nephrology (Carlton) 2024. [PMID: 38852614 DOI: 10.1111/nep.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/29/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
Unilateral kidney hypoplasia is a congenital condition characterized by the underdevelopment of one kidney. Although often asymptomatic, it can cause severe renal complications in patients combined with contralateral renal injury, leading to acute renal failure. This case report describes a patient with unilateral kidney hypoplasia who underwent a kidney biopsy on the contralateral normal-sized kidney and subsequently developed oliguric acute kidney injury. This report discusses the challenges encountered while diagnosing and managing this rare case, highlighting the importance of awareness and recognition to perform timely intervention and optimize the patient's outcome.
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Affiliation(s)
- Chi-Huan Tsai
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Shuo Tang
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chung-Yi Cheng
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Center of Urology and Kidney, Taipei, Taiwan
| | - Wei-Tse Hong
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Center of Urology and Kidney, Taipei, Taiwan
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4
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Plattner C, Sallaberger S, Bohn JP, Zavadil C, Keller F, Soleiman A, Tiefenthaler M, Mayer G, Pirklbauer M. Rationale and design of the Innsbruck Diabetic Kidney Disease Cohort (IDKDC)-a prospective study investigating etiology and progression of early-stage chronic kidney disease in type 2 diabetes. Clin Kidney J 2024; 17:sfae109. [PMID: 38726211 PMCID: PMC11079669 DOI: 10.1093/ckj/sfae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Indexed: 05/12/2024] Open
Abstract
Background The development of chronic kidney disease (CKD) in about 20%-40% of patients with type 2 diabetes (T2D) aggravates cardiovascular morbidity and mortality. Pathophysiology is of increasing relevance for individual management and prognosis, though it is largely unknown among T2D patients with CKD as histologic work-up is not routinely performed upon typical clinical presentation. However, as clinical parameters do not appropriately reflect underlying kidney pathology, reluctance regarding timely histologic assessment in T2D patients with CKD should be critically questioned. As the etiology of CKD in T2D is heterogeneous, we aim to assess the prevalence and clinical disease course of typical diabetic vs atypical/non-specific vs non-diabetic vs coexisting kidney pathologies among T2D patients with mild-to-moderate kidney impairment [KDIGO stage G3a/A1-3 or G2/A2-3; i.e. estimated glomerular filtration rate (eGFR) 59-45 mL/min irrespective of albuminuria or eGFR 89-60 mL/min and albuminuria >30 mg/g creatinine]. Methods The Innsbruck Diabetic Kidney Disease Cohort (IDKDC) study aims to enroll at least 65 T2D patients with mild-to-moderate kidney impairment to undergo a diagnostic kidney biopsy. Six-monthly clinical follow-ups for up to 5 years will provide clinical and laboratory data to assess cardio-renal outcomes. Blood, urine and kidney tissue specimen will be biobanked to identify diagnostic and prognostic biomarkers. Conclusions While current risk assessment is primarily based on clinical parameters, our study will provide the scientific background for a potential change of the diagnostic standard towards routine kidney biopsy and clarify its role for individual risk prediction regarding cardio-renal outcome in T2D patients with mild-to-moderate kidney impairment.
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Affiliation(s)
- Clemens Plattner
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Sallaberger
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan-Paul Bohn
- Department of Internal Medicine V – Haematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Zavadil
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Keller
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - Afschin Soleiman
- INNPATH, Institute of Pathology, Tirol Kliniken Innsbruck, Innsbruck, Austria
| | - Martin Tiefenthaler
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - Gert Mayer
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Pirklbauer
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
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5
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Zepeda-Quiroz I, Juarez-Villa D, Gomez-Johnson VH, Sanchez-Vazquez OH, Toledo-Ramirez SE, Rodriguez-Castellanos FE, Cortez-Flores BG, Garcia-Rivera A, Madero Rovalo M, Moguel-Gonzalez B. Feasibility and Safety of Percutaneous Kidney Biopsy in Small Kidneys: Breaking the Paradigm. Nephron Clin Pract 2024:1-8. [PMID: 38657584 DOI: 10.1159/000538817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION The percutaneous kidney biopsy (PKB) is an essential tool in nephrology; small kidney size has been a relative contraindication to PKB and there is limited data on the safety and utility of performing PKB in this setting. Our aim was to describe the complications of PKB in small kidneys and to assess if kidney biopsy results have an impact on medical decisions and outcomes. METHODS This was a retrospective, descriptive, and observational study. Patients older than 16 years of age with a decreased kidney size (≤8 cm) and undergoing PKB of native kidneys from July 2019 to December 2022 were included. RESULTS Twenty-five patients were included, 19 women and 6 men. The mean age was 42.3 ± 18.04. The mean kidney length was 7.56 ± 0.33 and the mean width was 4.2 cm. All patients received only 1 puncture, obtaining an average of 12 glomeruli. The mean blood urea nitrogen and serum creatinine were 36 mg/dL and 1.94 mg/dL, respectively and the mean Hgb (hemoglobin) was 12.87 ± 2.81 g/dL. Minor complications occurred in 5 patients, perirenal hematoma in 3 patients, hematuria in 1 patient, and hematoma plus hematuria in 1 patient. Histological examination showed FSGS, lupus nephritis, other Glomerular disease, crescentic glomerulonephritis, and tubulointerstitial nephritis in 36%, 20%, 16%, 16%, and 12% of the cases, respectively. Biopsy resulted in management modification in 64% of cases. In a bivariate analysis, kidney size was not associated with higher complication rates. CONCLUSIONS PKB in small kidneys is a feasible and safe procedure when properly planned, providing an adequate sample in all cases, with an insignificant number of minor complications, and that is clinically relevant.
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Affiliation(s)
- Ivan Zepeda-Quiroz
- Nephrology Department, Instituto Nacional de Cardiologia, Ciudad de Mexico, Mexico City, Mexico,
| | - Daniel Juarez-Villa
- Nephrology Department, Instituto Nacional de Cardiologia, Ciudad de Mexico, Mexico City, Mexico
| | | | | | | | | | | | - Alejandro Garcia-Rivera
- Nephrology Department, Instituto Mexicano del Seguro Social, Hospital General Regional #46, Guadalajara, Mexico
| | - Magdalena Madero Rovalo
- Nephrology Department, Instituto Nacional de Cardiologia, Ciudad de Mexico, Mexico City, Mexico
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6
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Sousa P, Brás C, Menezes C, Vizcaino R, Costa T, Faria MS, Mota C. Percutaneous kidney biopsies in children: a 24-year review in a tertiary center in northern Portugal. J Bras Nefrol 2024; 46:e20230143. [PMID: 38591825 DOI: 10.1590/2175-8239-jbn-2023-0143en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Percutaneous kidney biopsy (KB) is crucial to the diagnosis and management of several renal pathologies. National data on native KB in pediatric patients are scarce. We aimed to review the demographic and clinical characteristics and histopathological patterns in children who underwent native percutaneous KB over 24 years. METHODS Retrospective observational study of patients undergoing native percutaneous KB in a pediatric nephrology unit between 1998 and 2021, comparing 3 periods: period 1 (1998-2005), period 2 (2006-2013), and period 3 (2014-2021). RESULTS We found that 228 KB were performed, 78 (34.2%) in period 1, 91 (39.9%) in period 2, and 59 (25.9%) in period 3. The median age at KB was 11 (7-14) years. The main indications for KB were nephrotic syndrome (NS) (42.9%), hematuria and/or non-nephrotic proteinuria (35.5%), and acute kidney injury (13.2%). Primary glomerulopathies were more frequent (67.1%), particularly minimal change disease (MCD) (25.4%), IgA nephropathy (12.7%), and mesangioproliferative glomerulonephritis (GN) (8.8%). Of the secondary glomerulopathies, lupus nephritis (LN) was the most prevalent (11.8%). In group 1, hematuria and/or non-nephrotic proteinuria were the main reasons for KB, as opposed to NS in groups 2 and 3 (p < 0.01). LN showed an increasing trend (period 1-3: 2.6%-5.3%) and focal segmental glomerular sclerosis (FSGS) showed a slight decreasing trend (period 1-3: 3.1%-1.8%), without statistical significance. CONCLUSIONS The main indication for KB was NS, which increased over time, justifying the finding of MCD as main histological diagnosis. LN showed an increase in incidence over time, while FSGS cases did not increase.
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Affiliation(s)
- Patrícia Sousa
- Hospital Senhora da Oliveira, Serviço de Pediatria, Guimarães, Portugal
| | - Catarina Brás
- Hospital Professor Doutor Fernando Fonseca, Serviço de Nefrologia, Lisboa, Portugal
| | - Catarina Menezes
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Serviço de Pediatria, Porto, Portugal
| | - Ramon Vizcaino
- Centro Hospitalar Universitário de Santo António, Serviço de Anatomia Patológica, Porto, Portugal
| | - Teresa Costa
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Serviço de Pediatria, Porto, Portugal
| | - Maria Sameiro Faria
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Serviço de Pediatria, Porto, Portugal
- Unidade de Ciências Biomoleculares Aplicadas, Department of Biological Science, Porto, Portugal
| | - Conceição Mota
- Centro Hospitalar Universitário de Santo António, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Serviço de Pediatria, Porto, Portugal
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7
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Liu T, Yang YL, Zhou Y, Jiang YM. Noninvasive biomarkers for lupus nephritis. Lab Med 2024:lmae015. [PMID: 38493322 DOI: 10.1093/labmed/lmae015] [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] [Indexed: 03/18/2024] Open
Abstract
Lupus nephritis (LN) is one of the most severe clinical manifestations of systemic lupus erythematosus (SLE). Notably, the clinical manifestations of LN are not always consistent with the histopathological findings. Therefore, the diagnosis and activity monitoring of this disease are challenging and largely depend on invasive renal biopsy. Renal biopsy has side effects and is associated with the risk of bleeding and infection. There is a growing interest in the development of novel noninvasive biomarkers for LN. In this review, we summarize most of the LN biomarkers discovered so far by correlating current knowledge with future perspectives. These biomarkers fundamentally reflect the biological processes of kidney damage and repair during disease. Furthermore, this review highlights the role of urinary cell phenotype detection in the diagnosis, monitoring, and treatment of LN and summarizes the limitations and countermeasures of this test.
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Affiliation(s)
- Ting Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Biotherapy and Cancer Center/National Collaborative Innovation Center for Biotherapy, Sichuan University, Chengdu, China
| | - Yun-Long Yang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Zhou
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yong-Mei Jiang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), West China Second University Hospital, Sichuan University, Chengdu, China
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8
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Strnad BS, Kristeva M, Itani M, Fetzer DT, O'Connor SD, Patel MD, Middleton WD. Percutaneous Core Biopsy Devices: A Detailed Review and Comparison of Different Needle Designs. Ultrasound Q 2024; 40:1-19. [PMID: 37918119 DOI: 10.1097/ruq.0000000000000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT Percutaneous core-needle biopsy (PCNB) plays a growing and essential role in many medical specialties. Proper and effective use of various PCNB devices requires basic understanding of how they function. Current literature lacks a detailed overview and illustration of needle function and design differences, a potentially valuable reference for users ranging from early trainees to experts who are less familiar with certain devices. This pictorial aims to provide such an overview, using diagrams and magnified photographs to illustrate the intricate components of these devices. Following a brief historical review of biopsy needle technology for context, we emphasize distinctions in design between 2 major classes of PCNB devices (side- and end-cutting devices), focusing on practical implications for how each device is most effectively used. We believe a nuanced understanding of biopsy device function sheds light on certain lingering ambiguities in biopsy practice, such as the optimal needle gauge in organ biopsy, the benefits and risks associated with coaxial technique, the impact of needle selection and technique on bleeding, and the risk of unsuccessful sampling. In a subsequent pictorial, we will draw on the concepts presented here to illustrate examples of biopsy needle failure and how unrecognized needle failure can be an important and often preventable cause of increased biopsy risk and lower tissue yield.
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Affiliation(s)
- Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Mariya Kristeva
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Stacy D O'Connor
- Department of Radiology, University of North Carolina Medical Center, Chapel Hill, NC
| | | | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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Shyn PB, Seyal AR, Gottumukkala RV, Silverman SG, Bhagavatula SK, Alencar RO, Dabiri BE, Souza DAT, Cosman ER, Kapur T. Feasibility and safety of bipolar radiofrequency track cautery during percutaneous image-guided abdominal biopsy procedures. Abdom Radiol (NY) 2024; 49:586-596. [PMID: 37816800 DOI: 10.1007/s00261-023-04054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE The purpose of this study was to assess the feasibility and safety of using a bipolar radiofrequency track cautery device during percutaneous image-guided abdominal biopsy procedures in at-risk patients. METHODS Forty-two patients (26-79 years old; female 44%) with at least one bleeding risk factor who underwent an abdominal image-guided (CT or US) biopsy and intended bipolar radiofrequency track cautery (BRTC) were retrospectively studied. An 18G radiofrequency electrode was inserted through a 17G biopsy introducer needle immediately following coaxial 18G core biopsy, to cauterize the biopsy track using temperature control. Bleeding risk factors, technical success, and adverse events were recorded. RESULTS BRTC was technically successful in 41/42 (98%) of procedures; in one patient, the introducer needle retracted from the liver due to respiratory motion prior to BRTC. BRTC following percutaneous biopsy was applied during 41 abdominal biopsy procedures (renal mass = 12, renal parenchyma = 10, liver mass = 9, liver parenchyma = 5, splenic mass or parenchyma = 4, gastrohepatic mass = 1). All patients had one or more of the following risk factors: high-risk organ (spleen or renal parenchyma), hypervascular mass, elevated prothrombin time, renal insufficiency, thrombocytopenia, recent anticoagulation or anticoagulation not withheld for recommended interval, cirrhosis, intraprocedural hypertension, brisk back bleeding observed from the introducer needle, or subcapsular tumor location. No severe adverse events (grade 3 or higher) occurred. Two (2/41, 5%) mild (grade 1) bleeding events did not cause symptoms or require intervention. CONCLUSION Bipolar radiofrequency track cautery was feasible and safe during percutaneous image-guided abdominal biopsy procedures. IRB approval: MBG 2022P002277.
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Affiliation(s)
- Paul B Shyn
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Adeel R Seyal
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Ravi V Gottumukkala
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Stuart G Silverman
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Sharath K Bhagavatula
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Raquel O Alencar
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Borna E Dabiri
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Daniel A T Souza
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Eric R Cosman
- Cambridge Interventional, LLC, 78 Cambridge St., Burlington, MA, 01803, USA
| | - Tina Kapur
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
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Kavandi H, Itani M, Strnad B, Martin S, Ebrahimzadeh SA, Lubner MG, Noe-Kim V, Hinshaw JL, Bansal M, Karam AR, Khanna K, Hadied MO, Planz V, Glazer DI, Burgan CM, Galgano S, Brook A, Brook OR. A Multicenter Study of Needle Size and Safety for Splenic Biopsy. Radiology 2024; 310:e230453. [PMID: 38259204 DOI: 10.1148/radiol.230453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Splenic biopsy is rarely performed because of the perceived risk of hemorrhagic complications. Purpose To evaluate the safety of large bore (≥18 gauge) image-guided splenic biopsy. Materials and Methods This retrospective study included consecutive adult patients who underwent US- or CT-guided splenic biopsy between March 2001 and March 2022 at eight academic institutions in the United States. Biopsies were performed with needles that were 18 gauge or larger, with a comparison group of biopsies with needles smaller than 18 gauge. The primary outcome was significant bleeding after the procedure, defined by the presence of bleeding at CT performed within 30 days or angiography and/or surgery performed to manage the bleeding. Categorical variables were compared using the χ2 test and medians were compared using the Mann-Whitney test. Results A total of 239 patients (median age, 63 years; IQR, 50-71 years; 116 of 239 [48.5%] female patients) underwent splenic biopsy with an 18-gauge or smaller needle and 139 patients (median age, 58 years [IQR, 49-69 years]; 66 of 139 [47.5%] female patients) underwent biopsy with a needle larger than 18 gauge. Bleeding was detected in 20 of 239 (8.4%) patients in the 18-gauge or smaller group and 11 of 139 (7.9%) in the larger than 18-gauge group. Bleeding was treated in five of 239 (2.1%) patients in the 18-gauge or smaller group and one of 139 (1%) in the larger than 18-gauge group. No deaths related to the biopsy procedure were recorded during the study period. Patients with bleeding after biopsy had smaller lesions compared with patients without bleeding (median, 2.1 cm [IQR, 1.6-5.4 cm] vs 3.5 cm [IQR, 2-6.8 cm], respectively; P = .03). Patients with a history of lymphoma or leukemia showed a lower incidence of bleeding than patients without this history (three of 90 [3%] vs 28 of 288 [9.7%], respectively; P = .05). Conclusion Bleeding after splenic biopsy with a needle 18 gauge or larger was similar to biopsy with a needle smaller than 18 gauge and seen in 8% of procedures overall, with 2% overall requiring treatment. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grant in this issue.
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Affiliation(s)
- Hadiseh Kavandi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Malak Itani
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Benjamin Strnad
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Sooyoung Martin
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Seyed Amir Ebrahimzadeh
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Meghan G Lubner
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Victoria Noe-Kim
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - J Louis Hinshaw
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohit Bansal
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Adib R Karam
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Kanika Khanna
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohamad Omar Hadied
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Virginia Planz
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Daniel I Glazer
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Constantine M Burgan
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Samuel Galgano
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Olga R Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
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Ortiz A. Should we enlarge the indication for kidney biopsy in diabetics? The con part. Clin Kidney J 2024; 17:sfad267. [PMID: 38186897 PMCID: PMC10768755 DOI: 10.1093/ckj/sfad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Indexed: 01/09/2024] Open
Abstract
Diabetes is the most common cause of chronic kidney disease (CKD), a condition found in 850 million persons and projected to become the fifth global cause of death by 2040. Research is needed that examines kidney tissue to characterize distinct phenotypes in patients with diabetes mellitus (DM) and CKD so as to identify non-invasive biomarker signatures and develop targeted therapeutic approaches. However, from a routine care point of view, kidney biopsy is likely overused in patients with CKD and DM, as most biopsy results are not expected to be associated with a therapeutic approach that differs from standard kidney protection with triple or quadruple therapy (renin-angiotensin system blockade, sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists). Moreover, expanding the kidney biopsy criteria will increase the absolute number of complications from kidney biopsies, which may reach 27 000 to 108 000 deaths of persons that would derive little benefit from kidney biopsy if all people with DM and severe CKD were biopsied globally. Finally, limited resources should be optimally allocated. The cost of one kidney biopsy can fund 7000 semiquantitative urinary albumin:creatinine ratio assessments that could identify earlier stages of the disease and allow treatment that prevents progression to a stage at which kidney biopsy may be considered.
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Affiliation(s)
- Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Lim CY, Khay SL. Bleeding complications after percutaneous kidney biopsies - nationwide experience from Brunei Darussalam. World J Nephrol 2023; 12:147-158. [PMID: 38230299 PMCID: PMC10789084 DOI: 10.5527/wjn.v12.i5.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Kidney biopsy serves as a valuable method for both diagnosing and monitoring kidney conditions. Various studies have identified several risk factors associated with bleeding complications following the procedure, but these findings have shown inconsistency and variation. AIM To investigate the risk of bleeding complications following percutaneous kidney biopsy in Brunei Darussalam. We sought to explore the relevant clinical and pathological risk factors associated with these complications while also considering the findings within the broader international literature context. METHODS We conducted a retrospective study of all adult patients who underwent kidney biopsy in Brunei Darussalam from October 2013 to September 2020. The outcomes of interest were post-biopsy bleeding and the need for blood transfusions. Demographics, clinical, laboratory and procedural-related data were collected. Logistic regression analysis was used to identify predictors of outcomes. RESULTS A total of 255 kidney biopsies were included, with 11% being performed on transplanted kidneys. The majority of biopsies were done under ultrasound guidance (83.1%), with the rest under computer tomography guidance (16.9%). The most common indications for biopsy were chronic kidney disease of undefined cause (36.1%), nephrotic syndrome (24.3%) and acute kidney injury (11%). Rate of bleeding complication was 6.3% - 2% frank hematuria and 4.3% perinephric hematoma. Blood transfusion was required in 2.8% of patients. No patient lost a kidney or died because of the biopsy. Multivariate logistic regression identified baseline hemoglobin [odds ratio (OR): 4.11; 95% confidence interval (95%CI): 1.12-15.1; P = 0.03 for hemoglobin ≤ 11 g/dL vs. > 11 g/dL) and the presence of microscopic hematuria (OR: 5.24; 95%CI: 1.43-19.1; P = 0.01) as independent risk factors for post-biopsy bleeding. Furthermore, low baseline platelet count was identified as the dominant risk factor for requiring post-biopsy transfusions. Specifically, each 10 109/L decrease in baseline platelet count was associated with an 12% increase risk of needing transfusion (OR: 0.88; 95%CI: 0.79-0.98; P = 0.02). CONCLUSION Kidney biopsies were generally well-tolerated. The identified risk factors for bleeding and transfusion can help clinicians to better identify patients who may be at increased risk for these outcomes and to provide appropriate monitoring and management.
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Affiliation(s)
- Chiao Yuen Lim
- Department of Renal Services, RIPAS Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
| | - Sai Laung Khay
- Department of Renal Services, RIPAS Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
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Shankar M, Shetty A, N S M, C G S, A K, Tennankore K. Urinary exosomal miRNA signature of IgA nephropathy: a case-control study. Sci Rep 2023; 13:21400. [PMID: 38049447 PMCID: PMC10695945 DOI: 10.1038/s41598-023-47751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/17/2023] [Indexed: 12/06/2023] Open
Abstract
IgA nephropathy is the most common primary glomerulonephritis worldwide and can progress to end-stage kidney disease (ESKD). The current "gold standard" for diagnosis is kidney biopsy, which is invasive and associated with morbidity. miRNAs are small, non-coding endogenous RNA that may serve as non-invasive biomarkers, and that are found in urinary exosomes. Thus far, there is a paucity of studies of the miRNA profile for the diagnosis of IgA nephropathy. Hence, we aimed to study the urinary exosomal miRNA signature of Indian patients with IgA nephropathy. Fifty biopsy-proven IgA nephropathy patients, 50 healthy controls and 25 patients with ESKD (IgA nephropathy) were recruited over 2 years (2020-2022). Urinary exosomes were isolated from which miRNA was extracted . Analysis of urinary exosomal miRNA was done using the digital multiplexed nCounter® human v3 miRNA Expression Assay which contains 799 unique miRNA barcodes. Candidate miRNAs were identified using Lasso regression and consensus clustering. The mean age of IgA nephropathy patients was 36.32 ± 3.067 years, mean creatinine was 2.26 ± 0.318 mg/dl and mean proteinuria was 2.69 ± 0.64 g/day. Compared to healthy controls, the majority (N = 150) of miRNAs were significantly downregulated. Five candidate miRNAs (hsa.miR.146b.3p, hsa.miR.599, hsa.miR.4532, hsa.miR.664b.5p and hsa.miR.221.5p) were able to differentiate between IgA nephropathy cases and controls (AUC > 0.90); the presence of all 5 was associated with 100% specificity and sensitivity for diagnosing IgA nephropathy cases. This study of Indian patients identified that there was a significant difference in the urinary exosomal miRNA profile between IgA nephropathy cases and healthy controls, suggesting that miRNAs may be valuable in the non-invasive diagnosis of IgA nephropathy.
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Affiliation(s)
- Mythri Shankar
- Department of Nephrology, Institute of NephroUrology, Bengaluru, India.
| | - Aditya Shetty
- Department of Nephrology, Institute of NephroUrology, Bengaluru, India
| | - Madhura N S
- Department of Biochemistry, Institute of NephroUrology, Bengaluru, India
| | - Sreedhara C G
- Department of Nephrology, Institute of NephroUrology, Bengaluru, India
| | - Kishan A
- Department of Nephrology, Institute of NephroUrology, Bengaluru, India
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Günay B, Uslu B, Çelik AO, Korkmaz S, Ustabaşıoğlu FE, Solak S, Kula O, Tunçbilek N. The Role of Superb Microvascular Imaging and Shear Wave Elastography in the Prediction of Hemorrhage Complications After Renal Parenchyma Biopsy. Ultrasound Q 2023; 39:242-249. [PMID: 37918031 DOI: 10.1097/ruq.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVES The aim of study was to evaluate the diagnostic utility of the renal parenchyma elasticity with the shear wave elastography (SWE) and microvascularization with the superb microvascular imaging (SMI) technique before kidney biopsy and to predict the complication of hemorrhage before kidney biopsy. METHODS A total of 75 patients were included in the prospective study. Before the biopsy, vascularity features of the kidney parenchyma in the area to be biopsied were assessed by SMI and parenchymal stiffness by SWE and were examined by 2 independent radiologists. RESULTS A statistically significant difference was found in the SMI and SWE values between the groups with and without hematoma and hematuria when compared with the Student t test and Mann-Whitney U test ( P < 0.05). The SWE hardness cutoff value, which maximizes the prediction of the development of hematuria, was found to be 18.40 kPa, and the sensitivity and specificity values were 84.4% and 62.8%, respectively. In SMI vascularity index values, the cutoff value was found to be 0.247410800 kPa, and sensitivity and specificity values were 81.3% and 83.7%, respectively. The cutoff value of the SMI vascularity index values that maximized the prediction of hematoma development was 0.297009650, and the sensitivity and specificity values were 87% and 87%, respectively. CONCLUSIONS We believe that evaluating and standardizing the microvascularization and elasticity of the kidney parenchyma before a percutaneous kidney biopsy will be potentially useful as a guiding method in the prediction of postbiopsy hemorrhage development.
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Affiliation(s)
- Burak Günay
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
| | - Burak Uslu
- Department of Radiology, Yüksekova State Hospital, Hakkari
| | | | - Selçuk Korkmaz
- Department of Biostatistics and Medical Informatics, Trakya University Faculty of Medicine, Edirne, Turkey
| | | | - Serdar Solak
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
| | - Osman Kula
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
| | - Nermin Tunçbilek
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
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Schnuelle P. Renal Biopsy for Diagnosis in Kidney Disease: Indication, Technique, and Safety. J Clin Med 2023; 12:6424. [PMID: 37835066 PMCID: PMC10573674 DOI: 10.3390/jcm12196424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Renal biopsies are the gold standard for diagnosis, staging, and prognosis of underlying parenchymal kidney disease. This article provides an overview of the current indications and highlights ways to reduce bleeding complications in order to achieve optimal diagnostic yield with minimal risk to the patient. Novel indications have emerged from the increasing use of new molecularly targeted oncologic therapies in recent years, which often induce immune-mediated renal disease. On the other hand, the detection of specific antibodies against target antigens on podocytes in the sera of patients with new-onset nephrotic syndrome has now relativized the indication for biopsy in membranous nephropathy. The use of semi-automatic spring-loaded biopsy devices and real-time ultrasound considerably declined the complication rate and is the current standard. Percutaneous renal biopsies are overall a safe procedure if contraindications are considered. A coagulation disorder needs to be excluded beforehand, and an elevated blood pressure must be reduced to the normotensive range with medications. A laparoscopic approach or a radiology interventional procedure through the internal jugular vein may be considered for obtaining a kidney tissue sample if there is an urgent indication and a bleeding tendency cannot be adequately corrected. Major bleeding after a percutaneous renal biopsy can usually be managed with selective arterial embolization of the injured renal vessel. The use of a 16-gauge needle is the most reasonable compromise between diagnostic benefit and risk of complication. In the routine diagnostic, the biopsy specimen is examined with light microscopy, immunohistochemistry, and electron microscopy. Combination with modern molecular pathology techniques will contribute to more precise insights into the development and progression of kidney disease, which will likely refine future treatments in nephrology.
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Affiliation(s)
- Peter Schnuelle
- Center for Renal Diseases Weinheim, Academic Teaching Practice of the University Medical Center Mannheim, University of Heidelberg, D-69469 Weinheim, Germany
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16
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Deniz R, Güner N, Ekmen ŞA, Mutlu IN, Özgür DS, Karaalioğlu B, Akkuzu G, Yıldırım F, Kalkan K, Güzelant-Özköse G, İnce B, Erdoğan M, Özlük Y, Kılıçaslan I, Bes C. Discrepancies between clinical and pathological findings seen at renal biopsy in rheumatological diseases. Reumatismo 2023; 75. [PMID: 37721346 DOI: 10.4081/reumatismo.2023.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVE Renal biopsy contributes to the diagnosis, follow-up, and treatment of many rheumatic conditions. This study assessed the diagnostic role and safety of renal biopsies in a tertiary rheumatology clinic. METHODS Renal biopsies performed between June 2020 and December 2022 were screened, and demographic, clinical, histopathological, and safety data were collected from patient records. RESULTS In this study, 33 males and 38 females were included. Except for 1 patient who received acetylsalicylic acid, antiaggregant, and/or anticoagulant drugs were stopped before the biopsy. Complications included a decrease of hemoglobin in 8 patients (11.3%) and microscopic hematuria in 40 patients (56.3%). Control ultrasonography was performed in 16 patients (22.5%), and a self-limiting hematoma was found in 4 of them (5.6%) without additional complications. While less than 10 glomeruli were obtained in 9 patients (9.9%), diagnosis success was 94.4%. Histopathological data were consistent with one of the pre-biopsy diagnoses in 54 of 67 cases (80.6%) but showed discrepancies in 19.4% (n=13) of patients. A repeat biopsy was performed in 7 patients for re-staging or insufficient biopsy. CONCLUSIONS Renal biopsy significantly contributes to rheumatology practice, especially in patients with complex clinical and laboratory findings or in whom different treatments can be given according to the presence, severity, and type of renal involvement. Although the possibility of obtaining insufficient tissue and the need for re-staging and repeat biopsy in the follow-up might be expected, complication risk does not seem to be a big concern. Renal biopsy often evidenced discrepancies between pre-biopsy diagnosis and histopathological findings.
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Affiliation(s)
- R Deniz
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - N Güner
- Department of Internal Medicine, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - Ş A Ekmen
- Department of Internal Medicine, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - I N Mutlu
- Department of Radiology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - D S Özgür
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - B Karaalioğlu
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - G Akkuzu
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - F Yıldırım
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - K Kalkan
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - G Güzelant-Özköse
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - B İnce
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - M Erdoğan
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
| | - Y Özlük
- Department of Pathology, Faculty of Medicine, University of İstanbul.
| | - I Kılıçaslan
- Department of Pathology, Faculty of Medicine, University of İstanbul.
| | - C Bes
- Department of Rheumatology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, İstanbul.
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17
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Seethapathy H, Mistry K, Sise ME. Immunological mechanisms underlying clinical phenotypes and noninvasive diagnosis of immune checkpoint inhibitor-induced kidney disease. Immunol Rev 2023; 318:61-69. [PMID: 37482912 PMCID: PMC10865966 DOI: 10.1111/imr.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have become a mainstay of cancer therapy, with over 80 FDA-approved indications. Used in a variety of settings and in combination with each other and with traditional chemotherapies, the hyperactive immune response induced by ICIs can often lead to immune-related adverse events in bystander normal tissues such as the kidneys, lungs, and the heart. In the kidneys, this immune-related adverse event manifests as acute interstitial nephritis (ICI-AIN). In the era of widespread ICI use, it becomes vital to understand the clinical manifestations of ICI-AIN and the importance of prompt diagnosis and management of these complications. In this review, we delve into the clinical phenotypes of ICI-AIN and how they differ from traditional drug-induced AIN. We also detail what is known about the mechanistic underpinnings of ICI-AIN and the important diagnostic and therapeutic implications behind harnessing those mechanisms to further our understanding of these events and to formulate effective treatment plans to manage ICI-AIN.
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Affiliation(s)
- Harish Seethapathy
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kavita Mistry
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan E. Sise
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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18
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Nishino T, Hirano S, Takemura S, Tomori S, Ono S, Takahashi K, Mimaki M. Glomeruli Count and Arterial Injury in Real-Time Ultrasound-Guided Needle Kidney Biopsy Specimens: Adequacy of Three Approaches for Pig Kidneys. Am J Nephrol 2023; 54:528-535. [PMID: 37579726 DOI: 10.1159/000533593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Real-time ultrasound-guided percutaneous kidney biopsy is essential for diagnosis and treatment planning; nonetheless, the optimal puncture approach has yet to be established. In vivo, performing different approaches on the same patient at once is not possible. This study aimed to determine the impact of different approaches on the number of obtained glomeruli and their potential to cause arterial injury using pig kidneys, which are similar to humans. METHODS A total of 120 pig kidneys (60 right-sided kidneys and 60 left-sided kidneys) for research were obtained from a slaughterhouse. The specimens were collected from the lower pole on the sagittal plane of the kidney using three different approaches on the same kidney: caudocranial approach, caudal to cranial; craniocaudal approach, cranial to caudal; and vertical approach, through the surface cortex. Five blinded pediatric nephrologists assessed the number of glomeruli and arterial injuries. RESULTS Overall, 360 specimens were collected from the kidneys through biopsy using a 16-gauge needle (mean vertical kidney length, 11.2 ± 0.7 cm; mean depth, 3.47 ± 0.23 cm). No significant difference in the incidence of arterial injury was observed between the three approaches (caudocranial vs. craniocaudal vs. vertical approaches: 78% vs. 87% vs. 87%, p = 0.14). In contrast, the vertical approach retrieved significantly more glomeruli than the caudocranial and craniocaudal approaches (caudocranial approach: 7.5 ± 2.8, craniocaudal approach: 7.8 ± 2.7, and vertical approach: 8.9 ± 3.3, p < 0.001). CONCLUSIONS Considering its efficacy and safety profile, the vertical approach may be preferred, as more glomeruli can be obtained without increasing the incidence of arterial injury. Although the results cannot be directly extrapolated to humans due to the differences between species, they still offer important insights into the characteristics of each approach.
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Affiliation(s)
- Tomohiko Nishino
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Sakurako Hirano
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Shin Takemura
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinya Tomori
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Sayaka Ono
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
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19
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Vian J, Shabaka A, Lallena S, Gatius S, Lopez de la Manzanara V, Barrera-Ortega J, Méndez-Fernández RJ. Efficacy and Safety of CT-Guided Kidney Biopsy for the Diagnosis of Glomerular Diseases in Complicated Patients. Nephron Clin Pract 2023; 148:16-21. [PMID: 37429269 DOI: 10.1159/000531378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/29/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Kidney biopsy is the cornerstone for the diagnosis of glomerular diseases and to guide treatment. Percutaneous ultrasound-guided kidney biopsy is currently the gold standard to obtain cortical specimens. However, in cases where ultrasound-guided kidney biopsy is not deemed safe (obese patients, deep kidneys, or kidneys with a complicated anatomy), CT-guided kidney biopsy could be a convenient alternative to obtain renal tissue samples. The aim of this study was to describe the diagnostic yield and complications of CT-guided kidney biopsies in patients with glomerular diseases that were previously discarded for ultrasound-guided kidney biopsy. MATERIAL AND METHODS We performed a retrospective, single-center, observational study including patients who underwent CT-guided native kidney biopsies in our center after being contraindicated for ultrasound-guided biopsy. Patients' records were reviewed retrieving baseline characteristics and pre-biopsy clinical, laboratory parameters and concomitant medication. The biopsy needle gauge, site of puncture, and number of needle passes were recorded. The diagnostic yield was evaluated by the number of glomeruli obtained, the rate of specimens that were adequate to reach diagnosis, and the number of biopsies that had to be repeated. Complications were defined as minor (hypotension, hematoma) and major (arteriovenous fistulae, major bleeding requiring embolization, or nephrectomy). The diagnostic yield and complications were compared to ultrasound-guided native kidney biopsies performed during the same period. RESULTS 56 CT-guided native kidney biopsies were performed during the study period. The number of glomeruli obtained per patient was 11.5 ± 6.3, which was inferior to that obtained from ultrasound-guided biopsies (14.08 ± 8.47, p < 0.05). However, the rate of specimens that were adequate to reach a diagnosis was similar (92.9% vs. 90.8%, p = 0.437). The number of needle passes was higher in CT-guided kidney biopsies (2.0 ± 0.7 vs. 1.7 ± 0.5, p < 0.05), as well as the incidence of post-biopsy perirenal asymptomatic hematomas (66.1% vs. 24.5%, p < 0.01). There were no significant differences in other post-biopsy minor complications (1.8% vs. 2.5%, p = 0.621). There were no major complications after CT-guided kidney biopsies. CONCLUSIONS CT-guided percutaneous kidney biopsy is a valid alternative for the diagnosis of glomerular diseases in patients with special characteristics such as obesity or deep kidneys that contraindicate ultrasound-guided biopsy. In this population, CT-guided kidney biopsies are safe and provide a high diagnostic yield, reaching a diagnosis in >90% of patients that had been previously discarded for ultrasound-guided biopsy.
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Affiliation(s)
- Javier Vian
- Nephrology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Amir Shabaka
- Nephrology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Silvia Lallena
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Serena Gatius
- Nephrology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
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20
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Tan KS, McDonald S, Hoy W. The Diagnostic Performance of a Clinical Diagnosis of Diabetic Kidney Disease. Life (Basel) 2023; 13:1492. [PMID: 37511866 PMCID: PMC10381424 DOI: 10.3390/life13071492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD), a common cause of CKD and kidney failure, is usually diagnosed clinically. However, there is little evidence comparing the performance of a clinical diagnosis to biopsy-proven diagnosis. PURPOSE OF THE STUDY Diagnostic performance of a clinical diagnosis was determined in a group of patients with diabetes and chronic kidney disease who underwent kidney biopsy after an initial clinical diagnosis. METHODS A data analysis of 54 patients who were part of a study cohort for a prospective analysis of cardiovascular and kidney outcomes and who had undergone kidney biopsy after an initial clinical diagnosis of DKD or non-DKD (NDKD) at enrolment was used. We determined the sensitivity, specificity, and positive and negative predictive values of a clinical diagnosis of DKD. RESULTS A total of 37 of 43 patients clinically diagnosed with DKD also had biopsy-proven DKD, whilst only 1 of 11 patients who had clinically diagnosed NDKD had biopsy-proven DKD. Sensitivity was 97.4%, specificity was 62.5%, positive predictive value 86%, and negative predictive value 90.9%. Comparable values were obtained when analysis was restricted to those with primary rather than secondary diagnosis of DKD or when restricted to those with only DKD found at biopsy. CONCLUSION A clinical diagnosis of DKD has high sensitivity and is unlikely to overlook cases but may lead to overdiagnosis.
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Affiliation(s)
- Ken-Soon Tan
- School of Medicine (Centre for Chronic Disease), University of Queensland, Brisbane 4072, Australia
- School of Medicine and Dentistry, Griffith University, Southport 4222, Australia
| | - Stephen McDonald
- Adelaide Medical School, University of Adelaide, Adelaide 5000, Australia
- ANZDATA Registry, Adelaide 5001, Australia
| | - Wendy Hoy
- School of Medicine (Centre for Chronic Disease), University of Queensland, Brisbane 4072, Australia
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21
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Møller M, Borg R, Bressendorff I, Fink LN, Gravesen E, Jensen KH, Hansen T, Krustrup D, Persson F, Rossing P, Sembach FE, Thuesen ACB, Hansen D. Rationale and design of a prospective, clinical study of kidney biopsies in people with type 2 diabetes and severely increased albuminuria (the PRIMETIME 2 study). BMJ Open 2023; 13:e072216. [PMID: 37280026 PMCID: PMC10254618 DOI: 10.1136/bmjopen-2023-072216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Diabetic kidney disease is a severe complication of diabetes. The diagnosis is based on clinical characteristics such as persistently elevated albuminuria, hypertension and decline in kidney function, although this definition is not specific to kidney disease caused by diabetes. The only way to establish an accurate diagnosis-diabetic nephropathy-is by performing a kidney biopsy. The histological presentation of diabetic nephropathy can be associated with a heterogeneous range of histological features with many pathophysiological factors involved demonstrating the complexity of the condition. Current treatment strategies aim to slow disease progression and are not specific to the underlying pathological processes.This study will investigate the prevalence of diabetic nephropathy in individuals with type 2 diabetes (T2D) and severely elevated albuminuria. The deep molecular characterisation of the kidney biopsy and biological specimens may pave the way for improved diagnostic accuracy and a better understanding of the pathological processes involved and may also reveal new targets for individualised treatment. METHODS AND ANALYSIS In the PRecIsion MEdicine based on kidney TIssue Molecular interrogation in diabetic nEphropathy 2 study, research kidney biopsies will be performed in 300 participants with T2D, urine albumin/creatinine ratio ≥700 mg/g and estimated glomerular filtration ratio >30 mL/min/1.73 m2. Cutting-edge molecular technologies will be applied to the kidney, blood, urine, faeces and saliva samples for comprehensive multi-omics profiling. The associated disease course and clinical outcomes will be assessed by annual follow-up for 20 years. ETHICS AND DISSEMINATION The Danish Regional Committee on Health Research Ethics and the Knowledge Center on Data Protection (in the Capital Region of Denmark) have granted approval for the study. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04916132.
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Affiliation(s)
- Marie Møller
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Rikke Borg
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain Bressendorff
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Eva Gravesen
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Karina Haar Jensen
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorrit Krustrup
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Peter Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Anne C B Thuesen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Qi A, Kerachian M, Samanta R. Research Letter-Outcomes of Outpatient Native Kidney Biopsies at the McGill University Health Center: A Quality Assurance Audit. Can J Kidney Health Dis 2023; 10:20543581231177218. [PMID: 37313361 PMCID: PMC10259123 DOI: 10.1177/20543581231177218] [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: 06/22/2022] [Accepted: 03/26/2023] [Indexed: 06/15/2023] Open
Abstract
Background Percutaneous kidney biopsies are essential for diagnosis and management of kidney diseases. However, post-procedural bleeding is a significant risk associated with biopsies. At the McGill University Health Center, the 2 main hospitals, the Royal Victoria Hospital and the Montreal General Hospital, have different observation protocols for outpatient native kidney biopsies. Currently, patients are admitted for a 24-hour inpatient observation at the Montreal General Hospital, whereas patients biopsied at the Royal Victoria Hospital are discharged after 6 to 8 hours of observation at the end of the day. Most Canadian centers do not admit patients for an overnight observation, and it was unclear why this practice continued at the Montreal General Hospital. Objective Our objective was to determine the incidence of complications post-renal biopsy over the past 5 years at both hospital sites, and compare them to each other, as well as to established rates in the available literature. Design This assessment was designed as a quality assurance audit. Setting This audit was conducted from a local registry of renal biopsies performed at the McGill University Health Center between January 2015 to January 2020. Patients We included all adult patients (between the ages 18 and 80) with outpatient native kidney biopsies performed at the McGill University Health Center between 2015 and 2020. Measurements We collected the included patients' baseline demographics and risk factors at the time of biopsy, including age, BMI, creatinine, estimated glomerular filtration rate, pre- and post-biopsy hemoglobin, platelet, urea, coagulation profile, blood pressure, kidney side/size as well as needle size, and number of passes made. Methods We compared the incidence of both minor and major bleeding complications at the Montreal General and the Royal Victoria Hospital. Variables that were measured included hemoglobin before and after biopsy, incidence of minor bleeding complications (defined by hematomas and gross hematuria), and incidence of major complications (defined by post-biopsy bleeding requiring either transfusions or another procedure to stop the bleeding), as well as the incidence of admissions post-biopsy. Results The incidence of major complications was 2.87% over 5 years (5/174 patients), which is comparable with that reported in the literature. Our transfusion incidence was 1.72% (3/174 patients) and our embolization incidence was 2.3% (4/174 patients) over the 5 study years. Our total number of major events was low and the patients who had major events had significant risk factors for bleeding. All events occurred within 6 hours of observation. Limitations This was a retrospective study with a low event number. Additionally, since the events included only those recorded at the McGill University Health Center, it is possible that the events of interest may have occurred at other hospital sites without the author's knowledge. Conclusions Based on the results of this audit, all major bleeding events occurred within 6 hours of a percutaneous kidney biopsy, suggesting that patients should be monitored for 6 to 8 hours following biopsy. The next step after this quality assurance audit is a quality improvement project and a cost-effectiveness analysis to assess whether post-biopsy practices should be amended at the McGill University Health Center.
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Affiliation(s)
- Amy Qi
- University of Toronto, Toronto, ON, Canada
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23
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Kaczmarek M, Halimi JM, de Fréminville JB, Gatault P, Gueguen J, Goin N, Longuet H, Barbet C, Bisson A, Sautenet B, Herbert J, Buchler M, Fauchier L. A Universal Bleeding Risk Score in Native and Allograft Kidney Biopsies: A French Nationwide Cohort Study. J Clin Med 2023; 12:jcm12103527. [PMID: 37240634 DOI: 10.3390/jcm12103527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The risk of bleeding after percutaneous biopsy in kidney transplant recipients is usually low but may vary. A pre-procedure bleeding risk score in this population is lacking. METHODS We assessed the major bleeding rate (transfusion, angiographic intervention, nephrectomy, hemorrhage/hematoma) at 8 days in 28,034 kidney transplant recipients with a kidney biopsy during the 2010-2019 period in France and compared them to 55,026 patients with a native kidney biopsy as controls. RESULTS The rate of major bleeding was low (angiographic intervention: 0.2%, hemorrhage/hematoma: 0.4%, nephrectomy: 0.02%, blood transfusion: 4.0%). A new bleeding risk score was developed (anemia = 1, female gender = 1, heart failure = 1, acute kidney failure = 2 points). The rate of bleeding varied: 1.6%, 2.9%, 3.7%, 6.0%, 8.0%, and 9.2% for scores 0 to 5, respectively, in kidney transplant recipients. The ROC AUC was 0.649 (0.634-0.664) in kidney transplant recipients and 0.755 (0.746-0.763) in patients who had a native kidney biopsy (rate of bleeding: from 1.2% for score = 0 to 19.2% for score = 5). CONCLUSIONS The risk of major bleeding is low in most patients but indeed variable. A new universal risk score can be helpful to guide the decision concerning kidney biopsy and the choice of inpatient vs. outpatient procedure both in native and allograft kidney recipients.
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Affiliation(s)
- Mathieu Kaczmarek
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
- INI-CRCT, F-54500 Nancy, France
| | - Jean-Baptiste de Fréminville
- Paris-Cardiovascular Research Center, INSERM, UMR970, Université de Paris, F-75006 Paris, France
- Unité Fonctionnelle d'Hypertension Artérielle, Centre de Référence des Maladies Rares de la Surrénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
| | - Juliette Gueguen
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Nicolas Goin
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- INI-CRCT, F-54500 Nancy, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
- Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
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Abuduwupuer Z, Lei Q, Liang S, Xu F, Liang D, Yang X, Liu X, Zeng C. The Spectrum of Biopsy-Proven Kidney Diseases, Causes, and Renal Outcomes in Acute Kidney Injury Patients. Nephron Clin Pract 2023; 147:541-549. [PMID: 37094563 DOI: 10.1159/000530615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/19/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a group of highly heterogeneous, complicated clinical syndromes. Although kidney biopsy plays an irreplaceable role in evaluating complex AKI, a few studies have focused on the clinicopathology of AKI biopsies. This study analyzed the pathological disease spectrum, causes, and renal outcomes of biopsied AKI patients. METHODS We retrospectively included 2,027 AKI patients who underwent kidney biopsies at a national clinical research center of kidney diseases from 2013 through 2018. To compare the biopsied AKI cases without and with coexisting glomerulopathy, patients were classified into acute tubular/tubulointerstitial nephropathy-associated AKI (ATIN-AKI) and glomerular disease-associated AKI (GD-AKI) groups. RESULTS Of 2,027 biopsied AKI patients, 65.1% were male, with a median age of 43 years. A total of 1,590 (78.4%) patients had coexisting GD, while only 437 (21.6%) patients had ATIN alone. The AKI patients with GD mainly (53.5%) manifested as stage 1 AKI, while most ATIN-AKI patients (74.8%) had stage 3 AKI. In the ATIN-AKI group, 256 (58.6%) patients had acute interstitial nephritis (AIN), and 77 (17.6%) had acute tubular injury (ATI). ATIN-AKI was mainly caused by drugs in 85.5% of AIN and 63.6% of ATI cases, respectively. In AKI patients with coexisting GD, the leading pathological diagnoses in over 80% of patients were IgA nephropathy (IgAN, 22.5%), minimal change disease (MCD, 17.5%), focal segmental glomerulosclerosis (FSGS, 15.3%), lupus nephritis (LN, 11.9%), membranous nephropathy (MN, 10.2%), and ANCA-associated vasculitis (AAV, 4.7%). A total of 775 patients were followed up within 3 months after renal biopsy; ATIN-AKI patients achieved statistically higher complete renal recovery than the GD-AKI patients (83.5% vs. 70.5%, p < 0.001). CONCLUSIONS Most biopsied AKI patients have coexisting GD, while ATIN alone is seen less frequently. ATIN-AKI is mainly caused by drugs. In GD-AKI patients, IgAN, MCD, FSGS, LN, MN, and AAV are the leading diagnoses. Compared to AKI patients without GD, patients with GD suffer from worse renal function recovery.
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Affiliation(s)
- Zulihumaer Abuduwupuer
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Qunjuan Lei
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Dandan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xue Yang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xumeng Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Gandhi DB, Al Saeedi M, Krier JD, Jiang K, Glockner JF, Lerman LO. Evaluation of Renal Fibrosis Using Magnetization Transfer Imaging at 1.5T and 3T in a Porcine Model of Renal Artery Stenosis. J Clin Med 2023; 12:jcm12082956. [PMID: 37109291 PMCID: PMC10140905 DOI: 10.3390/jcm12082956] [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: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Renal fibrosis is an important marker in the progression of chronic kidney disease, and renal biopsy is the current reference standard for detecting its presence. Currently, non-invasive methods have only been partially successful in detecting renal fibrosis. Magnetization transfer imaging (MTI) allows estimates of renal fibrosis but may vary with scanning conditions. We hypothesized that MTI-derived renal fibrosis would be reproducible at 1.5T and 3T MRI and over time in fibrotic kidneys. Fifteen pigs with unilateral renal artery stenosis (RAS, n = 9) or age-matched sham controls (n = 6) underwent MTI-MRI at both 1.5T and 3T 6 weeks post-surgery and again 4 weeks later. Magnetization transfer ratio (MTR) measurements of fibrosis in both kidneys were compared between 1.5T and 3T, and the reproducibility of MTI at the two timepoints was evaluated at 1.5T and 3T. MTR at 3T with 600 Hz offset frequency successfully distinguished between normal, stenotic, and contralateral kidneys. There was excellent reproducibility of MTI at 1.5T and 3T over the two timepoints and no significant differences between MTR measurements at 1.5T and 3T. Therefore, MTI is a highly reproducible technique which is sensitive to detect changes in fibrotic compared to normal kidneys in the RAS porcine model at 3T.
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Affiliation(s)
- Deep B Gandhi
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Mina Al Saeedi
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - James D Krier
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - James F Glockner
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Alexander LF, McComb BL, Bowman AW, Bonnett SL, Ghazanfari SM, Caserta MP. Ultrasound Simulation Training for Radiology Residents-Curriculum Design and Implementation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:777-790. [PMID: 36106721 DOI: 10.1002/jum.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Medical simulation training can be used to improve clinician performance, teach communication and professionalism skills, and enhance team training. Radiology residents can benefit from simulation training in diagnostic ultrasound, procedural ultrasound, and communication skills prior to direct patient care experiences. This paper details a weeklong ultrasound simulation training curriculum for radiology residents during the PGY-1 clinical internship. The organization of established teaching methods into a dedicated course early in radiology residency training with the benefit of a multi-disciplinary approach makes this method unique. This framework can be adapted to fit learners at different skill levels or with specific procedural needs.
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Affiliation(s)
- Lauren F Alexander
- Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Barbara L McComb
- Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Andrew W Bowman
- Division Chair of Hospital & Emergency Imaging | Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | | | - Melanie P Caserta
- Division Chair of Sonography | Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida, USA
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Lin Y, Chen J, Huang Y, Lin Y, Su Z. A methodological study of 2D shear wave elastography for noninvasive quantitative assessment of renal fibrosis in patients with chronic kidney disease. Abdom Radiol (NY) 2023; 48:987-998. [PMID: 36565332 DOI: 10.1007/s00261-022-03753-5] [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: 08/03/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the optimal measurement method of 2D shear wave elastography (2D-SWE) for noninvasive quantitative assessment of renal fibrosis in chronic kidney disease (CKD) patients. METHODS A total of 190 CKD patients were enrolled for 2D-SWE of right kidney. The success rates, coefficients of variation (CV), and pathological correlation of different measurement sites, body positions, and depths were compared. RESULTS (1) Measurement sites: Success rate in the middle part (100%) was higher than that in the lower pole (97.3%, P > 0.05). CV in the middle part (10.2%) was lower than that in the lower pole (16.4%, P < 0.05). Pathological correlation of the middle part (r = - 0.452, P < 0.05) was higher than that of the lower pole (r = 0.097, P > 0.05). (2) Body positions: Success rate in left lateral decubitus position (100%) was higher than that in supine (99.4%, P > 0.05) and prone position (99.4%, P > 0.05). CV was lowest (11.9%) and pathological correlation was highest (r = -0.256, P < 0.05) in prone position. (3) Measurement depths: Success rate at depth < 4 cm (100%) was higher than that at depth ≥ 4 cm (98.8%, P > 0.05). CV at depth < 4 cm (11.1%) was lower than that at depth ≥ 4 cm (14.4%, P < 0.05). Pathological correlation at depth < 4 cm (r = - 0.303, P < 0.05) was higher than that at depth ≥ 4 cm (r = - 0.156, P > 0.05). CONCLUSION The optimal measurement method of 2D-SWE for renal fibrosis assessment was prone position, renal middle part, and measurement depth < 4 cm.
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Affiliation(s)
- Yanjun Lin
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Jiaxin Chen
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Yongquan Huang
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China
| | - Yuhong Lin
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China.
| | - Zhongzhen Su
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong Province, China.
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Guan Y, Bai C, Li F, Li T, Zhao X, He Z, Guo N. The impact of blood pressure on the risk of postbiopsy bleeding during the whole procedure of percutaneous kidney biopsy. Abdom Radiol (NY) 2023; 48:1140-1147. [PMID: 36574058 DOI: 10.1007/s00261-022-03781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate whether BP is related to postbiopsy bleeding in patients undergoing native percutaneous kidney biopsy (PKB) and to evaluate the dynamic changes in blood pressure (BP) pre- and post-kidney biopsy. METHODS A retrospective cross-sectional study was conducted. The whole-procedural systolic (SBP) and diastolic (DBP) BP for patients undergoing ultrasound-guided native PKB from October 2017 to December 2020 were recorded in the study. Propensity score matching was used to minimize selection bias. SBP and DBP were analyzed as the main risk factors for bleeding complications. Receiver operating characteristic (ROC) curves were employed to explore the optimal BP thresholds to differentiate between bleeding and nonbleeding. The rates of major bleeding complications were analyzed according to BP thresholds through logistic analysis. RESULTS Of 1146 biopsies, 432 (37.7%) patients suffered from postbiopsy bleeding, 88 (7.7%) patients had major bleeding complications, and 344 (30.0%) patients had minor bleeding complications. In the original data, for patients with SBP ≥ 160 mmHg before PKB, the rate of major bleeding complications was 17.6% (7.5% for SBP < 160 mmHg), and the rate of major bleeding complications was 19.0% in patients with DBP ≥ 100 mmHg (7.5% for DBP < 100 mmHg). For patients with DBP ≥ 85 mmHg to 100 mmHg after PKB, the rate of major bleeding complications ranged from 9.5 to 17.5%. The rate of major bleeding complications was lower (6.6-7.3%) in patients with DBP < 100 mmHg to 85 mmHg. CONCLUSION Patients who have high-level BP during the native PKB perioperative period are at higher risk for postbiopsy bleeding. High-level BP here does not refer to traditional hypertension according to the guidelines for the diagnosis and treatment of hypertension, but rather BP above a certain threshold related to bleeding risk.
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Affiliation(s)
- Yuxia Guan
- Department of Nephrological, Peking Union Medical College Hospital, Beijing, China
| | - Chenxiao Bai
- Department of Nephrological, Peking Union Medical College Hospital, Beijing, China
| | - Fangfang Li
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Tongxin Li
- Department of Nephrological, Peking Union Medical College Hospital, Beijing, China
| | - Xuesong Zhao
- Department of Nephrological, Peking Union Medical College Hospital, Beijing, China
| | - Zixia He
- Department of Nephrological, Peking Union Medical College Hospital, Beijing, China
| | - Na Guo
- Department of Nursing, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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Jaturapisanukul S, Chavanisakun C, Benjakul N, Ngamvichchukorn T, Laungchuaychok P, Kurathong S, Pongsittisak W. Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial. Int J Nephrol Renovasc Dis 2023; 16:93-101. [PMID: 37013086 PMCID: PMC10066630 DOI: 10.2147/ijnrd.s400639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Background Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance. Methods This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle. Results A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, p = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, p = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥10% after kidney biopsy, perinephric hematoma size ≥1 cm, hematuria, and the need for blood transfusion, than the CD group. Conclusion The CD technique of the percutaneous kidney biopsy in the native kidney has fewer complications and was possibly more effective than the CN technique.
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Affiliation(s)
- Solos Jaturapisanukul
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand
| | - Chutima Chavanisakun
- Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nontawat Benjakul
- Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tanun Ngamvichchukorn
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Punnawit Laungchuaychok
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sathit Kurathong
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand
| | - Wanjak Pongsittisak
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand
- Correspondence: Wanjak Pongsittisak, Tel +66818345228, Email
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Fontana F, Cazzato S, Giaroni F, Bertolini F, Alfano G, Mori G, Giovanella S, Ligabue G, Magistroni R, Cappelli G, Donati G. Risk of bleeding after percutaneous native kidney biopsy in patients receiving low-dose aspirin: a single-center retrospective study. J Nephrol 2023; 36:475-483. [PMID: 36131134 DOI: 10.1007/s40620-022-01441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although discontinuation of antiplatelet agents at least 5 days before kidney biopsy is commonly recommended, the evidence behind this practice is of low level. Indeed, few non-randomized studies previously showed an equivalent risk of bleeding in patients receiving aspirin therapy. METHODS We conducted a single center retrospective study comparing the risk of complications after percutaneous native kidney biopsy in patients who received low-dose aspirin (ASA) within 5 days from biopsy and those who did not. The main outcome was the difference in the incidence of major complications (red blood cell transfusion, need for selective arterial embolization, surgery, nephrectomy). Secondary outcomes included difference in minor complications, comparison between patients who received ASA within 48 h or within 3-5 days, identification of independent factors predictive of major complications. RESULTS We analyzed data on 750 patients, of whom 94 received ASA within 5 days from biopsy. There were no significant differences in the proportion of major complications in patients receiving or not receiving ASA (2.59% and 3.19%, respectively, percentage point difference 1%, 95% CI - 3 to 4%, p = 0.74). Groups were also comparable for minor complications; among patients receiving ASA, there were no differences in major bleeding between those who received ASA within 48 h or 3-5 days from biopsy. Significant baseline predictors of major bleeding in our cohort were platelet count lower than 120*103/microliter, higher diastolic blood pressure and higher blood urea. CONCLUSIONS Treatment with low-dose ASA within 5 days from kidney biopsy did not increase the risk of complications after the procedure.
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Affiliation(s)
- Francesco Fontana
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
| | - Silvia Cazzato
- Nephrology and Dialysis Unit, Ospedale Ramazzini di Carpi, Azienda Unità Sanitaria Locale di Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Giaroni
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Bertolini
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gaetano Alfano
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giacomo Mori
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Silvia Giovanella
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Ligabue
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Magistroni
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Hadisurya M, Lee ZC, Luo Z, Zhang G, Ding Y, Zhang H, Iliuk AB, Pili R, Boris RS, Tao WA. Data-independent acquisition phosphoproteomics of urinary extracellular vesicles enables renal cell carcinoma grade differentiation. Mol Cell Proteomics 2023; 22:100536. [PMID: 36997065 PMCID: PMC10165457 DOI: 10.1016/j.mcpro.2023.100536] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Translating the research capability and knowledge in cancer signaling into clinical settings has been slow and ineffective. Recently, extracellular vesicles (EVs) have emerged as a promising source for developing disease phosphoprotein markers to monitor disease status. This study focuses on the development of a robust data-independent acquisition (DIA) using mass spectrometry to profile urinary EV phosphoproteomics for renal cell cancer (RCC) grades differentiation. We examined gas-phase fractionated (GPF) library, direct DIA (library-free), forbidden zones, and several different windowing schemes. After the development of a DIA mass spectrometry method for EV phosphoproteomics, we applied the strategy to identify and quantify urinary EV phosphoproteomes from 57 individuals representing low-grade clear cell RCC, high-grade clear cell RCC, chronic kidney disease (CKD), and healthy control (HC) individuals. Urinary EVs were efficiently isolated by functional magnetic beads, and EV phosphopeptides were subsequently enriched by PolyMAC. We quantified 2,584 unique phosphosites and observed that multiple prominent cancer-related pathways, such as ErbB signaling, renal cell carcinoma, and regulation of actin cytoskeleton, were only upregulated in high-grade clear cell RCC. These results show that EV phosphoproteome analysis utilizing our optimized procedure of EV isolation, phosphopeptide enrichment, and DIA method provides a powerful tool for future clinical applications.
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The ethics of “net-risk” pediatric research:Views of IRB members and the US public. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2023. [DOI: 10.1016/j.ijpam.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Tepus M, Tonoli E, Verderio EAM. Molecular profiling of urinary extracellular vesicles in chronic kidney disease and renal fibrosis. Front Pharmacol 2023; 13:1041327. [PMID: 36712680 PMCID: PMC9877239 DOI: 10.3389/fphar.2022.1041327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Chronic kidney disease (CKD) is a long-term kidney damage caused by gradual loss of essential kidney functions. A global health issue, CKD affects up to 16% of the population worldwide. Symptoms are often not apparent in the early stages, and if left untreated, CKD can progress to end-stage kidney disease (ESKD), also known as kidney failure, when the only possible treatments are dialysis and kidney transplantation. The end point of nearly all forms of CKD is kidney fibrosis, a process of unsuccessful wound-healing of kidney tissue. Detection of kidney fibrosis, therefore, often means detection of CKD. Renal biopsy remains the best test for renal scarring, despite being intrinsically limited by its invasiveness and sampling bias. Urine is a desirable source of fibrosis biomarkers as it can be easily obtained in a non-invasive way and in large volumes. Besides, urine contains biomolecules filtered through the glomeruli, mirroring the pathological state. There is, however, a problem of highly abundant urinary proteins that can mask rare disease biomarkers. Urinary extracellular vesicles (uEVs), which originate from renal cells and carry proteins, nucleic acids, and lipids, are an attractive source of potential rare CKD biomarkers. Their cargo consists of low-abundant proteins but highly concentrated in a nanosize-volume, as well as molecules too large to be filtered from plasma. Combining molecular profiling data (protein and miRNAs) of uEVs, isolated from patients affected by various forms of CKD, this review considers the possible diagnostic and prognostic value of uEVs biomarkers and their potential application in the translation of new experimental antifibrotic therapeutics.
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Affiliation(s)
- Melanie Tepus
- Centre for Health, Ageing and the Understanding of Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Elisa Tonoli
- Centre for Health, Ageing and the Understanding of Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Elisabetta A. M. Verderio
- Centre for Health, Ageing and the Understanding of Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom,Department of Biological, Geological, and Environmental Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy,*Correspondence: Elisabetta A. M. Verderio,
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Sise ME, Wang Q, Seethapathy H, Moreno D, Harden D, Smith RN, Rosales IA, Colvin RB, Chute S, Cornell LD, Herrmann SM, Fadden R, Sullivan RJ, Yang NJ, Barmettler S, Wells S, Gupta S, Villani AC, Reynolds KL, Farmer J. Soluble and cell-based markers of immune checkpoint inhibitor-associated nephritis. J Immunother Cancer 2023; 11:e006222. [PMID: 36657813 PMCID: PMC9853261 DOI: 10.1136/jitc-2022-006222] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Non-invasive biomarkers of immune checkpoint inhibitor-associated acute tubulointerstitial nephritis (ICI-nephritis) are urgently needed. Because ICIs block immune checkpoint pathways that include cytotoxic T lymphocyte antigen 4 (CTLA4), we hypothesized that biomarkers of immune dysregulationpreviously defined in patients with congenital CTLA4 deficiency, including elevated soluble interleukin-2 receptor alpha (sIL-2R) and flow cytometric cell-based markers of B and T cell dysregulation in peripheral blood may aid the diagnosis of ICI-nephritis. METHODS A retrospective cohort of patients diagnosed with ICI-nephritis was compared with three prospectively enrolled control cohorts: ICI-treated controls without immune-related adverse events, patients not on ICIs with hemodynamic acute kidney injury (hemodynamic AKI), and patients not on ICIs with biopsy proven acute interstitial nephritis from other causes (non-ICI-nephritis). sIL-2R level and flow cytometric parameters were compared between groups using Wilcoxon rank sum test or Kruskal-Wallis test. Receiver operating characteristic curves were generated to define the accuracy of sIL-2R and flow cytometric biomarkers in diagnosing ICI-nephritis. The downstream impact of T cell activation in the affected kidney was investigated using archived biopsy samples to evaluate the gene expression of IL2RA, IL-2 signaling, and T cell receptor signaling in patients with ICI-nephritis compared with other causes of drug-induced nephritis, acute tubular injury, and histologically normal controls. RESULTS sIL-2R level in peripheral blood was significantly higher in patients with ICI-nephritis (N=24) (median 2.5-fold upper limit of normal (ULN), IQR 1.9-3.3), compared with ICI-treated controls (N=10) (median 0.8-fold ULN, IQR 0.5-0.9, p<0.001) and hemodynamic AKI controls (N=6) (median 0.9-fold-ULN, IQR 0.7-1.1, p=0.008). A sIL-2R cut-off point of 1.75-fold ULN was highly diagnostic of ICI-nephritis (area under the curve >96%) when compared with either ICI-treated or hemodynamic AKI controls. By peripheral blood flow cytometry analysis, lower absolute CD8+T cells, CD45RA+CD8+ T cells, memory CD27+B cells, and expansion of plasmablasts were prominent features of ICI-nephritis compared with ICI-treated controls. Gene expressions for IL2RA, IL-2 signaling, and T cell receptor signaling in the kidney tissue with ICI-nephritis were significantly higher compared with controls. CONCLUSION Elevated sIL-2R level and flow cytometric markers of both B and T cell dysregulation may aid the diagnosis of ICI-nephritis.
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Affiliation(s)
- Meghan E Sise
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Qiyu Wang
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Harish Seethapathy
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daiana Moreno
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Destiny Harden
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - R Neal Smith
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ivy A Rosales
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert B Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Chute
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lynn D Cornell
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sandra M Herrmann
- Department of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Riley Fadden
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan J Sullivan
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy J Yang
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara Barmettler
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sophia Wells
- Department of Medicine, Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shruti Gupta
- Department of Medicine, Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Oncology, Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alexandra-Chloe Villani
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jocelyn Farmer
- Division of Allergy and Inflammation, Beth Israel Lahey Health, Boston, Massachusetts, USA
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Qian L, Menez S, Hu D, Weinstein J, Melchinger H, Thiessen-Philbrook H, Luciano RL, Turner JM, Perazella MA, Corona Villalobos CP, Shaw MM, Wilson FP, Parikh CR, Moledina DG. Safety and Adequacy of Kidney Biopsy Procedure in Patients with Obesity. KIDNEY360 2023; 4:98-101. [PMID: 36700910 PMCID: PMC10101611 DOI: 10.34067/kid.0006602022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2022]
Abstract
Patients with obesity did not have any larger hematocrit drop after kidney biopsy compared with those without obesity. Patients with obesity had fewer glomeruli sampled from kidney biopsy compared with those without obesity. For patients with obesity, kidney biopsy is a safe procedure but may have lower diagnostic adequacy.
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Affiliation(s)
- Long Qian
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Steven Menez
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Hu
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason Weinstein
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Hannah Melchinger
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Randy L. Luciano
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M. Turner
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Mark A. Perazella
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Melissa M. Shaw
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - F. Perry Wilson
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Chirag R. Parikh
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dennis G. Moledina
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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36
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Ni J, Tian S, Bai L, Lv Q, Liu J, Liu J, Fang Y, Zhai Y, Shen Q, Rao J, Ding C, Xu H. Comparative proteomic analysis of children FSGS FFPE tissues. BMC Pediatr 2022; 22:707. [PMID: 36503536 PMCID: PMC9743561 DOI: 10.1186/s12887-022-03764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In children, focal segmental glomerulosclerosis (FSGS) is the main cause of steroid resistant nephrotic syndrome (SRNS). To identify specific candidates and the mechanism of steroid resistance, we examined the formalin-fixed paraffin embedded (FFPE) renal tissue protein profiles via liquid chromatography tandem mass spectrometry (LC-MS/MS). METHODS Renal biopsies from seven steroid-sensitive (SS) and eleven steroid-resistant (SR) children FSGS patients were obtained. We examined the formalin-fixed paraffin embedded (FFPE) renal tissue protein profiles via liquid chromatography tandem mass spectrometry (LC-MS/MS). Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment and Gene Ontology (GO) analysis, as well as the construction of protein-protein interaction (PPI) network were performed. Two proteins were further valiadated by immunohistochemistry staining in FSGS patients and mice models. RESULTS In total, we quantified more than 4000 proteins, of which 325 were found to be differentially expressed proteins (DEPs) between the SS and SR group (foldchange ≥2, P<0.05). The results of GO revealed that the most significant up-regulated proteins were primarily related to protein transportation, regulation of the complement activation process and cytolysis. Moreover, clustering analysis showed differences in the pathways (lysosome, terminal pathway of complement) between the two groups. Among these potential candidates, validation analyses for LAMP1 and ACSL4 were conducted. LAMP1 was observed to have a higher expression in glomerulus, while ACSL4 was expressed more in tubular epithelial cells. CONCLUSIONS In this study, the potential mechanism and candidates related to steroid resistance in children FSGS patients were identified. It could be helpful in identifying potential therapeutic targets and predicting outcomes with these proteomic changes for children FSGS patients.
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Affiliation(s)
- Jiajia Ni
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Sha Tian
- grid.413087.90000 0004 1755 3939State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433 China
| | - Lin Bai
- grid.413087.90000 0004 1755 3939State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433 China
| | - Qianying Lv
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Jialu Liu
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Jiaojiao Liu
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Ye Fang
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Yihui Zhai
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Qian Shen
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Jia Rao
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
| | - Chen Ding
- grid.413087.90000 0004 1755 3939State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Institute of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai, 200433 China
| | - Hong Xu
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China ,Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
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Vu T, Shin B, Mittal A, Sarwani N, McGillen KL. Ultrasound Versus Computed Tomography-Guided Native Parenchymal Kidney Biopsies for Hospitalized Patients: Comparison of Clinical Outcomes and Complications. Ultrasound Q 2022; 38:328-333. [PMID: 35816176 DOI: 10.1097/ruq.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Percutaneous native kidney biopsies performed with ultrasound (US) or computed tomography (CT) guidance are important in the workup of medical renal disease, with modality choice often dependent on the performing institution, with various complication rates reported. We compared the complication rates and types of complication of US- versus CT-guided native parenchymal renal biopsy among hospitalized patients. One hundred five consecutive inpatient US- and CT-guided native parenchymal renal biopsies performed by radiologists at a tertiary care academic center between 2006 and 2020 were reviewed retrospectively. Complication rates of biopsy were calculated and compared between the 2 modalities. Comparisons with regard to types of complications were made using the Society of Interventional Radiology grading scale, American Society of Anesthesiologists score, and other clinical data. One hundred five hospitalized adult patients (58 women and 47 men; average age, 53 years) underwent native parenchymal kidney biopsy during the study period. Sixty-three (60%) were CT-guided and 42 (40%) were US-guided. Complication rates between CT- versus US-guided biopsies were 40% versus 19% ( P = 0.03), respectively. There were 7 major and 18 minor complications for CT-guided biopsies and 3 major and 5 minor complications for US-guided biopsies. No statistically significant difference was found in preprocedural American Society of Anesthesiologists Classification score, international normalized ratio, platelet count, or body mass index. Computed tomography-guided native parenchymal kidney biopsy was associated with a higher overall complication rate compared with US-guided biopsy for hospitalized patients. Most complications were minor, which required no treatment or additional follow-up.
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Affiliation(s)
| | | | | | - Nabeel Sarwani
- Abdominal Imaging Division, Department of Radiology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
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Jadoul M, Awan A, Berenguer M, Bruchfeld A, Fabrizi F, Goldberg D, Jia J, Kamar N, Mohamed R, Pessôa M, Pol S, Sise M, Martin P. KDIGO 2022 Clinical Practice Guideline FOR the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int 2022; 102:S129-S205. [PMID: 36410841 DOI: 10.1016/j.kint.2022.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
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Development of ileocolic artery pseudoaneurysm after renal biopsy. Radiol Case Rep 2022; 17:4413-4416. [PMID: 36188086 PMCID: PMC9520494 DOI: 10.1016/j.radcr.2022.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 11/23/2022] Open
Abstract
The rate of bleeding complications related to percutaneous native renal biopsy is low, and pseudoaneurysms of the extrarenal arteries are rare. There have been a few reports of extrarenal artery injuries related to renal biopsy; however, to the best of our knowledge, there have not been any reports of injuries to the ileocolic artery or multiple injuries to extrarenal arteries. Herein, we report the case of an 87-year-old man who developed multiple vascular injuries: an arteriovenous fistula at the lower pole of the right kidney, pseudoaneurysms of the second lumbar artery, and an ileocolic artery 19 days after renal biopsy. Although identifying an ileocolic artery pseudoaneurysm was slightly delayed due to its rarity, all vascular injuries were successfully embolized with microcoils.
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Alfano G, Perrone R, Fontana F, Ligabue G, Giovanella S, Ferrari A, Gregorini M, Cappelli G, Magistroni R, Donati G. Rethinking Chronic Kidney Disease in the Aging Population. Life (Basel) 2022; 12:1724. [PMID: 36362879 PMCID: PMC9699322 DOI: 10.3390/life12111724] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/15/2022] [Accepted: 10/20/2022] [Indexed: 07/23/2023] Open
Abstract
The process of aging population will inevitably increase age-related comorbidities including chronic kidney disease (CKD). In light of this demographic transition, the lack of an age-adjusted CKD classification may enormously increase the number of new diagnoses of CKD in old subjects with an indolent decline in kidney function. Overdiagnosis of CKD will inevitably lead to important clinical consequences and pronounced negative effects on the health-related quality of life of these patients. Based on these data, an appropriate workup for the diagnosis of CKD is critical in reducing the burden of CKD worldwide. Optimal management of CKD should be based on prevention and reduction of risk factors associated with kidney injury. Once the diagnosis of CKD has been made, an appropriate staging of kidney disease and timely prescriptions of promising nephroprotective drugs (e.g., RAAS, SGLT-2 inhibitors, finerenone) appear crucial to slow down the progression toward end-stage kidney disease (ESKD). The management of elderly, comorbid and frail patients also opens new questions on the appropriate renal replacement therapy for this subset of the population. The non-dialytic management of CKD in old subjects with short life expectancy features as a valid option in patient-centered care programs. Considering the multiple implications of CKD for global public health, this review examines the prevalence, diagnosis and principles of treatment of kidney disease in the aging population.
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Affiliation(s)
- Gaetano Alfano
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy
| | - Rossella Perrone
- General Medicine and Primary Care, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Francesco Fontana
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy
| | - Giulia Ligabue
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Silvia Giovanella
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Annachiara Ferrari
- Nephrology and Dialysis, AUSL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy
| | | | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Riccardo Magistroni
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Gabriele Donati
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, 41124 Modena, Italy
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Diagnostic test accuracy of novel biomarkers for lupus nephritis-An overview of systematic reviews. PLoS One 2022; 17:e0275016. [PMID: 36215243 PMCID: PMC9550089 DOI: 10.1371/journal.pone.0275016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiorgan inflammatory involvement and a mortality rate that is 2.6-fold higher than individuals of the same age and sex in the general population. Approximately 50% of patients with SLE develop renal impairment (lupus nephritis). Delayed diagnosis of lupus nephritis is associated with a higher risk of progression to end-stage renal disease, the need for replacement therapy, and mortality. The initial clinical manifestations of lupus nephritis are often discrete or absent and are usually detected through complementary tests. Although widely used in clinical practice, their accuracy is limited. A great scientific effort has been exerted towards searching for new, more sensitive, and specific biomarkers in recent years. Some systematic reviews have individually evaluated new serum and urinary biomarkers tested in patients with lupus nephritis. This overview aimed to summarize systematic reviews on the accuracy of novel serum and urinary biomarkers for diagnosing lupus nephritis in patients with SLE, discussing how our results can guide the clinical management of the disease and the direction of research in this area. METHODS The research question is "What is the accuracy of the new serum and urinary biomarkers studied for the diagnosis of LN in patients with SLE?". We searched for systematic reviews of observational studies evaluating the diagnostic accuracy of new serum or urinary biomarkers of lupus nephritis. The following databases were included: PubMed, EMBASE, BIREME/LILACS, Scopus, Web of Science, and Cochrane, including gray literature found via Google Scholar and PROQUEST. Two authors assessed the reviews for inclusion, data extraction, and assessment of the risk of bias (ROBIS tool). RESULTS Ten SRs on the diagnostic accuracy of new serum and urinary BMs in LN were selected. The SRs evaluated 7 distinct BMs: (a) antibodies (anti-Sm, anti-RNP, and anti-C1q), (b) cytokines (TWEAK and MCP-1), (c) a chemokine (IP-10), and (d) an acute phase glycoprotein (NGAL), in a total of 20 review arms (9 that analyzed serum BMs, and 12 that analyzed BMs in urine). The population evaluated in the primary studies was predominantly adults. Two SRs included strictly adults, 5 reviews also included studies in the paediatric population, and 4 did not report the age groups. The results of the evaluation with the ROBIS tool showed that most of the reviews had a low overall risk of bias. CONCLUSIONS There are 10 SRs of evidence relating to the diagnostic accuracy of serum and urinary biomarkers for lupus nephritis. Among the BMs evaluated, anti-C1q, urinary MCP-1, TWEAK, and NGAL stood out, highlighting the need for additional research, especially on LN diagnostic panels, and attempting to address methodological issues within diagnostic accuracy research. This would allow for a better understanding of their usefulness and possibly validate their clinical use in the future. REGISTRATION This project is registered on the International Prospective Registry of Systematic Reviews (PROSPERO) database (CRD42020196693).
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Niroshan V, Balagobi B, Brammah T, Weerasinghe N, Gowribahan T. Surgically managed acute Page kidney following renal biopsy-A case report. Int J Surg Case Rep 2022; 99:107641. [PMID: 36122422 PMCID: PMC9568784 DOI: 10.1016/j.ijscr.2022.107641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion
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Affiliation(s)
- V Niroshan
- University Surgical Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - B Balagobi
- University Surgical Unit, Teaching Hospital of Jaffna, Sri Lanka.
| | - T Brammah
- University Medical Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - N Weerasinghe
- Urology Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - T Gowribahan
- Urology Unit, Teaching Hospital of Jaffna, Sri Lanka
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de Fallois J, Schenk S, Kowald J, Lindner TH, Engesser M, Münch J, Meigen C, Halbritter J. The diagnostic value of native kidney biopsy in low grade, subnephrotic, and nephrotic range proteinuria: A retrospective cohort study. PLoS One 2022; 17:e0273671. [PMID: 36054109 PMCID: PMC9439248 DOI: 10.1371/journal.pone.0273671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background In nephrotic range proteinuria of adult-onset, kidney biopsy is the diagnostic gold standard in determining the underlying cause of disease. However, in low grade or subnephrotic proteinuria the diagnostic value of kidney biopsy as first-line diagnostics is less well established. Methods We conducted a retrospective analysis of all native kidney biopsies at our institution (n = 639) between 01/2012 and 05/2021 for comparison of histological diagnoses and clinical outcomes stratified by amount of proteinuria at the time of kidney biopsy: A: <300mg/g creatinine (low grade), B: 300-3500mg/g creatinine (subnephrotic), C >3500mg/g creatinine (nephrotic). Results Nephrotic range proteinuria was associated with the highest frequency (49.3%) of primary glomerulopathies followed by subnephrotic (34.4%) and low grade proteinuria (37.7%). However, within the subnephrotic group, the amount of proteinuria at kidney biopsy was linearly associated with renal and overall survival (HR 1.05 per Δ100mg protein/g creatinine (95% CI: 1.02–1.09, p = 0.001)) independent of present histological diagnoses and erythrocyturia. Conclusion Frequency of primary glomerulopathies supports to perform kidney biopsy in patients with subnephrotic proteinuria. These patients have a substantial risk of ESKD and death upon follow-up. Therefore, diagnostic accuracy including histopathology is essential to guide personalized treatment and avert detrimental courses.
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Affiliation(s)
- Jonathan de Fallois
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
- * E-mail:
| | - Soeren Schenk
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Jan Kowald
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Tom H. Lindner
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Marie Engesser
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Johannes Münch
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
- Departement of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christof Meigen
- LIFE Child, Hospital for Children and Adolescents, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jan Halbritter
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
- Departement of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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Kunin H, Wijetunga NA, Erinjeri JP, Noy A, Deipolyi AR. Predictors of Major Hemorrhage After Spleen Core Biopsy in Cancer Patients. J Vasc Interv Radiol 2022; 33:1055-1060.e1. [PMID: 36049840 DOI: 10.1016/j.jvir.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/26/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022] Open
Abstract
In this retrospective study, 232 spleen biopsies from 218 patients with cancer were assessed. Biopsies resulting in hemorrhage requiring hospitalization, transfusion, or other interventions were compared with those that did not. The maximization of the Youden index helped determine the optimal systolic blood pressure (SBP) and platelet count thresholds. There were 15 (7%) major hemorrhages among 211 core biopsies. A multivariate logistic regression model showed that higher SBP, lower platelet count, and the lack of ultrasound guidance were independently associated with major hemorrhage (P < .05). The optimal SBP cutoff was 140 mm Hg, and the platelet count cutoff was 120,000 platelets/μL. In conclusion, the high major hemorrhage rate of 7% among percutaneous core spleen biopsies in patients with cancer may be mitigated by controlling SBP to <140 mm Hg and avoiding biopsy in patients with thrombocytopenia.
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Affiliation(s)
- Henry Kunin
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, Manhattan, New York City
| | - N Ari Wijetunga
- Department of Radiation Oncology, Weill Cornell Medical College, Manhattan, New York City
| | - Joseph P Erinjeri
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, Manhattan, New York City
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, Manhattan, New York City
| | - Amy R Deipolyi
- Department of Surgery, West Virginia University/Charleston Division, Charleston Area Medical Center, Charleston, West Virginia.
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Mattiazzi AD, Cortesi CA, Patil RJ, Carias Martinez KG, Sedki M, Cabeza Rivera FH, Ruiz P, Salsamendi JT, Guerra G. Percutaneous Ultrasound-Guided Kidney Transplant Biopsy Outcomes: From the Nephrologist to the Radiologist Standpoint. KIDNEY360 2022; 3:1746-1753. [PMID: 36514719 PMCID: PMC9717654 DOI: 10.34067/kid.0000332022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 01/28/2023]
Abstract
Background Kidney transplant biopsies are the gold standard for evaluating allograft dysfunction. These biopsies are performed by nephrologists and radiologists under real-time ultrasound guidance. A few studies have examined the outcomes of ultrasound-guided kidney transplant biopsy in transplant recipients; however, none have compared these outcomes between both specialties. Methods We retrospectively analyzed a cohort of 678 biopsies performed in a single center during a 44-month study period. Biopsies were stratified into two groups based upon the specialist performing the procedure: interventional radiology (IR; N=447) and transplant nephrology (TN; N=231). Results There were 55 (8%) complications related to biopsies in the entire cohort: 37 (8.2%) in the IR group and 18 (7.7%) in the TN group, without statistical difference between the groups (P=0.94). Blood pressure control and prior use of anticoagulation were significant predictors of complicated biopsies (P=0.004 and 0.02, respectively). Being a woman and prior use of anticoagulation were significant predictors of transfusion of blood products (P=0.01 and 0.01, respectively). Being a woman and blood pressure control were significant predictors of overall perinephric hematoma (P=0.01 and 0.01, respectively), and Black race was a significant predictor of perinephric hematoma without worsening of renal function (P=0.005). The specialist team performing the procedure was not a statistically significant predictor of biopsy complications, transfusion of blood products, or perinephric hematoma with comparable sample yield. Conclusions Percutaneous ultrasound-guided kidney transplant biopsy performed by transplant nephrologists have similar complication rates when compared with interventional radiologists in an academic center.
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Affiliation(s)
- Adela D. Mattiazzi
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Camilo A. Cortesi
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California
| | - Rhea J. Patil
- School of Medicine, University of Miami, Miami, Florida
| | - Karla G. Carias Martinez
- Department of Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Mai Sedki
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Franco H. Cabeza Rivera
- Department of Medicine, Division of Nephrology, University of Mississippi, Oxford, Mississippi
| | - Phillip Ruiz
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida,Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jason T. Salsamendi
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
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Strnad BS, Itani M, Middleton WD. Detection and management of bleeding in the setting of image-guided percutaneous needle biopsy. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2681-2696. [PMID: 34882270 DOI: 10.1007/s00261-021-03357-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/18/2023]
Abstract
Image-guided percutaneous needle biopsy (PNB) is an important and increasingly utilized method of minimally invasive tissue sampling for a broad variety of disease processes. While infrequent, major bleeding is a potential complication of PNB and can be life-threatening, especially when unrecognized. On the other hand, prompt recognition and treatment of major bleeding in this setting can prevent significant morbidity or mortality. It is therefore crucial for anyone performing PNB to be familiar with the diagnosis and management of bleeding complications. This article reviews the risk factors for major bleeding in the setting of PNB, the presentation and imaging findings of a spectrum of bleeding complications encountered during and following PNB, and the management of those findings based on experience at a single, high volume, biopsy center.
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Affiliation(s)
- Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA.
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA
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47
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Postoperative and Recurrent Hematuria after Pretransplant Core Needle Biopsy in Living Donor Kidney Transplant. Case Rep Transplant 2022; 2022:5274521. [PMID: 35937758 PMCID: PMC9352472 DOI: 10.1155/2022/5274521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Core needle and wedge biopsies are the two main pathologic ways to determine the suitability of a kidney allograft and to have a baseline allograft biopsy in case of future rejection. Case Presentation. A 57-year-old patient developed a renal arteriovenous fistula causing postoperative and recurrent hematuria after allograft pretransplant renal core needle biopsy and treated with selective Interventional radiology coil embolization. Conclusion Delayed profound hematuria can be seen after pretransplant core needle renal biopsies and can recur again even after complete resolution, due to arteriovenous fistula formation in the renal calyceal system.
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Exfoliated Kidney Cells from Urine for Early Diagnosis and Prognostication of CKD: The Way of the Future? Int J Mol Sci 2022; 23:ijms23147610. [PMID: 35886957 PMCID: PMC9324667 DOI: 10.3390/ijms23147610] [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: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease (CKD) is a global health issue, affecting more than 10% of the worldwide population. The current approach for formal diagnosis and prognostication of CKD typically relies on non-invasive serum and urine biomarkers such as serum creatinine and albuminuria. However, histological evidence of tubulointerstitial fibrosis is the 'gold standard' marker of the likelihood of disease progression. The development of novel biomedical technologies to evaluate exfoliated kidney cells from urine for non-invasive diagnosis and prognostication of CKD presents opportunities to avoid kidney biopsy for the purpose of prognostication. Efforts to apply these technologies more widely in clinical practice are encouraged, given their potential as a cost-effective approach, and no risk of post-biopsy complications such as bleeding, pain and hospitalization. The identification of biomarkers in exfoliated kidney cells from urine via western blotting, enzyme-linked immunosorbent assay (ELISA), immunofluorescence techniques, measurement of cell and protein-specific messenger ribonucleic acid (mRNA)/micro-RNA and other techniques have been reported. Recent innovations such as multispectral autofluorescence imaging and single-cell RNA sequencing (scRNA-seq) have brought additional dimensions to the clinical application of exfoliated kidney cells from urine. In this review, we discuss the current evidence regarding the utility of exfoliated proximal tubule cells (PTC), podocytes, mesangial cells, extracellular vesicles and stem/progenitor cells as surrogate markers for the early diagnosis and prognostication of CKD. Future directions for development within this research area are also identified.
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Xu S, Ma L, Lin J, Zhang Z, Wang X, Yin J. Efficacy and safety of percutaneous renal biopsy performed using 18G needle versus 16G needle: a single-center retrospective study. Int Urol Nephrol 2022; 54:3255-3261. [PMID: 35781773 PMCID: PMC9605925 DOI: 10.1007/s11255-022-03276-4] [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: 05/19/2021] [Accepted: 02/27/2022] [Indexed: 12/09/2022]
Abstract
Background At present, both 16G and 18G needles are used for percutaneous renal biopsy in China. This study aimed to compare the efficacy and safety of biopsy performed with the 18G needle vs. the 16G needle. Methods The data of patients who underwent percutaneous renal biopsy at our hospital between January 2015 and December 2019 were retrospectively analyzed. The number of glomeruli obtained by puncture and postoperative complications were compared between patients undergoing biopsy with the 16G and 18G needles. Continuous variables were compared by the t test or the Mann–Whitney U test, and categorical variables by the chi-square test. Correlation analysis was used to examine the relationship of different variables with hematoma size. Results Of the total 3138 kidney biopsies, 2526 were performed with the18G needle and 612 with the 16G needle. The number of glomeruli obtained was not significantly different between the two groups (P = 0.078). Large hematomas were significantly more common the 16G group than in the 18G group (9.31% vs. 5.98%, P = 0.003). Arteriovenous fistula was also more common in the 16G group (1.14% vs. 0.23%, P = 0.005). Other complications were rare, with similar incidence in the two groups. Conclusion The 18G needle is as effective as the 16G needle for percutaneous renal biopsy. The risk of large hematoma and arteriovenous fistula appear to be lower with the 18G needle.
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Affiliation(s)
- Senyin Xu
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Lili Ma
- Department of Ultrasound, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiazhen Lin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhengxian Zhang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaoya Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiazhen Yin
- Department of Nephrology (Key Laboratory of Management of Kidney Disease in Zhejiang Province), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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50
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Butler CR, Appelbaum PS, Ascani H, Aulisio M, Campbell CE, de Boer IH, Dighe AL, Hall DE, Himmelfarb J, Knight R, Mehl K, Murugan R, Rosas SE, Sedor JR, O'Toole JF, Tuttle KR, Waikar SS, Freeman M. A Participant-Centered Approach to Understanding Risks and Benefits of Participation in Research Informed by the Kidney Precision Medicine Project. Am J Kidney Dis 2022; 80:132-138. [PMID: 34871700 PMCID: PMC9166631 DOI: 10.1053/j.ajkd.2021.10.006] [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: 06/30/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
An understanding of the ethical underpinnings of human subjects research that involves some risk to participants without anticipated direct clinical benefit-such as the kidney biopsy procedure as part of the Kidney Precision Medicine Project (KPMP)-requires a critical examination of the risks as well as the diverse set of countervailing potential benefits to participants. This kind of deliberation has been foundational to the development and conduct of the KPMP. Herein, we use illustrative features of this research paradigm to develop a more comprehensive conceptualization of the types of benefits that may be important to research participants, including respecting pluralistic values, supporting the opportunity to act altruistically, and enhancing benefits to a participant's community. This approach may serve as a model to help researchers, ethicists, and regulators to identify opportunities to better respect and support participants in future research that entails some risk to these participants as well as to improve the quality of research for people with kidney disease.
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Affiliation(s)
- Catherine R Butler
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington; Seattle-Denver Health Services Research and Development Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
| | - Paul S Appelbaum
- Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Heather Ascani
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mark Aulisio
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Biomedical Ethics, MetroHealth System, Cleveland, Ohio
| | - Catherine E Campbell
- Kidney Precision Medicine Project Patient Partner, American Association of Kidney Patients, Tampa, Florida; Sigma Theta Tau International Honor Society, Case Management Society of America, AARP Volunteer Nursing Leadership Board
| | - Ian H de Boer
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - Ashveena L Dighe
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - Daniel E Hall
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Wolff Center at UPMC, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion and Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Jonathan Himmelfarb
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - Richard Knight
- Kidney Precision Medicine Project Patient Partner, American Association of Kidney Patients, Tampa, Florida; American Association of Kidney Patients, Pittsburgh, Pennsylvania
| | - Karla Mehl
- Division of Nephrology, Irving Medical Center, Columbia University, New York, New York
| | - Raghavan Murugan
- Center for Critical Care Nephrology, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - John R Sedor
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Nephrology and Hypertension, Glickman Urological and Kidney and Lerner Research Institutes, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John F O'Toole
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Nephrology and Hypertension, Glickman Urological and Kidney and Lerner Research Institutes, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Katherine R Tuttle
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Renal Division, Brigham & Women's Hospital, Boston, Massachusetts
| | - Michael Freeman
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics and Humanities, Penn State College of Medicine, Hershey, Pennsylvania
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