1
|
Carboni J, Thomas E, Gipson DS, Brady TM, Srivastava T, Selewski DT, Greenbaum LA, Wang CS, Dell KM, Kaskel F, Massengill S, Reidy K, Tran CL, Trachtman H, Lafayette R, Almaani S, Hingorani S, Gbadegesin R, Gibson KL, Sethna CB. Longitudinal analysis of blood pressure and lipids in childhood nephrotic syndrome. Pediatr Nephrol 2024; 39:2161-2170. [PMID: 38319465 DOI: 10.1007/s00467-024-06301-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND In the current study, longitudinal BP and lipid measurements were examined in a NEPTUNE cohort of children with newly diagnosed nephrotic syndrome (cNEPTUNE). We hypothesized that hypertensive BP and dyslipidemia would persist in children with nephrotic syndrome, regardless of steroid treatment response. METHODS A multi-center longitudinal observational analysis of data obtained from children < 19 years of age with new onset nephrotic syndrome enrolled in the Nephrotic Syndrome Study Network (cNEPTUNE) was conducted. BP and lipid data were examined over time stratified by disease activity and steroid exposure. Generalized estimating equation regressions were used to find determinants of hypertensive BP and dyslipidemia. RESULTS Among 122 children, the prevalence of hypertensive BP at any visit ranged from 17.4% to 57.4%, while dyslipidemia prevalence ranged from 40.0% to 96.2% over a median of 30 months of follow-up. Hypertensive BP was found in 46.2% (116/251) of study visits during active disease compared with 31.0% (84/271) of visits while in remission. Dyslipidemia was present in 88.2% (120/136) of study visits during active disease and in 66.0% (101/153) while in remission. Neither dyslipidemia nor hypertensive BP were significantly different with/without medication exposure (steroids and/or CNI). In regression analysis, male sex and urine protein:creatinine ratio (UPC) were significant determinants of hypertensive BP over time, while eGFR was found to be a determinant of dyslipidemia over time. CONCLUSIONS Results demonstrate persistent hypertensive BPs and unfavorable lipid profiles in the cNEPTUNE cohort regardless of remission status or concurrent steroid or calcineurin inhibitor treatment.
Collapse
Affiliation(s)
- Johnathon Carboni
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA
| | - Elizabeth Thomas
- Division of Nephrology, Department of Pediatrics, Dell Children's Medical Center, University of Texas, Austin, TX, USA
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Tammy M Brady
- Division of Nephrology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tarak Srivastava
- Section of Nephrology, Children's Mercy Hospital and University of Missouri, Kansas City, MO, USA
| | - David T Selewski
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Larry A Greenbaum
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Chia-Shi Wang
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Katherine M Dell
- Center for Pediatric Nephrology and Hypertension, Cleveland Clinic Children's, Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Frederick Kaskel
- Division of Nephrology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Susan Massengill
- Division of Nephrology, Department of Pediatrics, Levine Children's Hospital, Charlotte, NC, USA
| | - Kimberly Reidy
- Division of Nephrology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Cheryl L Tran
- Division of Pediatric Nephrology, Department of Pediatrics and Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Richard Lafayette
- Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Salem Almaani
- Division of Nephrology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sangeeta Hingorani
- Division of Nephrology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Rasheed Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC, USA
| | - Keisha L Gibson
- Division of Pediatric Nephrology, UNC Kidney Center, Chapel Hill, North Carolina, USA
| | - Christine B Sethna
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of NY, New Hyde Park, NY, USA.
| |
Collapse
|
2
|
Ergunay T, Collino F, Bianchi G, Sedrakyan S, Perin L, Bussolati B. Extracellular vesicles in kidney development and pediatric kidney diseases. Pediatr Nephrol 2024; 39:1967-1975. [PMID: 37775581 PMCID: PMC11147923 DOI: 10.1007/s00467-023-06165-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
Extracellular vesicles (EVs) are membranous cargo particles that mediate intercellular communication. They are heterogeneous in size and mechanism of release, and found in all biological fluids. Since EV content is in relation to the originating cell type and to its physiopathological conditions, EVs are under study to understand organ physiology and pathology. In addition, EV surface cargo, or corona, can be influenced by the microenvironment, leading to the concept that EV-associated molecules can represent useful biomarkers for diseases. Recent studies also focus on the use of natural, engineered, or synthetic EVs for therapeutic purposes. This review highlights the role of EVs in kidney development, pediatric kidney diseases, including inherited disorders, and kidney transplantation. Although few studies exist, they have promising results and may guide researchers in this field. Main limitations, including the influence of age on EV analyses, are also discussed.
Collapse
Affiliation(s)
- Tunahan Ergunay
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Federica Collino
- Laboratory of Translational Research in Paediatric Nephro-Urology, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
- Paediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Bianchi
- Laboratory of Translational Research in Paediatric Nephro-Urology, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Sargis Sedrakyan
- GOFARR Laboratory, Children's Hospital Los Angeles, Division of Urology, Saban Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura Perin
- GOFARR Laboratory, Children's Hospital Los Angeles, Division of Urology, Saban Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Benedetta Bussolati
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
- Molecular Biotechnology Center, University of Turin, via Nizza 52, 10126, Turin, Italy.
| |
Collapse
|
3
|
Zuccaro B, Perillo G, De Giorgi V. Massive Vulvar Edema: A Sign of Nephrotic Syndrome. Am J Med 2024; 137:595-596. [PMID: 38387542 DOI: 10.1016/j.amjmed.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Biancamaria Zuccaro
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriella Perillo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.
| |
Collapse
|
4
|
Han Y, Sha H, Yang Y, Yu Z, Zhou L, Wang Y, Yang F, Qiu L, Zhang Y, Zhou J. Mutations in the NUP93, NUP107 and NUP160 genes cause steroid-resistant nephrotic syndrome in Chinese children. Ital J Pediatr 2024; 50:81. [PMID: 38650033 PMCID: PMC11036785 DOI: 10.1186/s13052-024-01656-3] [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: 11/12/2023] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The variants of nucleoporins are extremely rare in hereditary steroid-resistant nephrotic syndrome (SRNS). Most of the patients carrying such variants progress to end stage kidney disease (ESKD) in their childhood. More clinical and genetic data from these patients are needed to characterize their genotype-phenotype relationships and elucidate the role of nucleoporins in SRNS. METHODS Four patients of SRNS carrying biallelic variants in the NUP93, NUP107 and NUP160 genes were presented. The clinical and molecular genetic characteristics of these patients were summarized, and relevant literature was reviewed. RESULTS All four patients in this study were female and initially presented with SRNS. The median age at the onset of the disease was 5.08 years, ranging from 1 to 10.5 years. Among the four patients, three progressed to ESKD at a median age of 7 years, ranging from 1.5 to 10.5 years, while one patient reached stage 3 chronic kidney disease (CKD3). Kidney biopsies revealed focal segmental glomerulosclerosis in three patients. Biallelic variants were detected in NUP93 in one patient, NUP107 in two patients, as well as NUP160 in one patient respectively. Among these variants, five yielded single amino acid substitutions, one led to nonsense mutation causing premature termination of NUP107 translation, one caused a single nucleotide deletion resulting in frameshift and truncation of NUP107. Furthermore, one splicing donor mutation was observed in NUP160. None of these variants had been reported previously. CONCLUSION This report indicates that biallelic variants in NUP93, NUP107 and NUP160 can cause severe early-onset SRNS, which rapidly progresses to ESKD. Moreover, these findings expand the spectrum of phenotypes and genotypes and highlight the importance of next-generation sequencing in elucidating the molecular basis of SRNS and allowing rational treatment for affected individuals.
Collapse
Affiliation(s)
- Yanxinli Han
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Hongyu Sha
- Department of Pharmacy, Yantai Yuhuangding Hospital, Yantai, Shandong Province, 264000, China
| | - Yuan Yang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Zhuowei Yu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Lanqi Zhou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Yi Wang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Fengjie Yang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Liru Qiu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Yu Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China
| | - Jianhua Zhou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei province, 430030, China.
| |
Collapse
|
5
|
Zhu Y, Chen J, Zhang Y, Wang X, Wang J. Immunosuppressive agents for frequently relapsing/steroid-dependent nephrotic syndrome in children: a systematic review and network meta-analysis. Front Immunol 2024; 15:1310032. [PMID: 38464533 PMCID: PMC10920238 DOI: 10.3389/fimmu.2024.1310032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Aim This study aimed to systematically compare the efficacy of various immunosuppressive agents in treating pediatric frequently relapsing or steroid-dependent nephrotic syndrome (FRSDNS). Methods We conducted systematic searches of PubMed, Embase, the Cochrane Library, and the Web of Science up to May 23, 2023. Outcome measures included relapses within 1 year, mean cumulative exposure to corticosteroids, patients with treatment failure at 1 year, relapse-free survival during 1 year, and adverse events. The quality of the included studies was evaluated using the modified Jadad scale, the Methodological Index for Non-Randomized Studies (MINORS), and the modified Newcastle-Ottawa Scale (NOS). Results Rituximab was found to be the most likely (92.44%) to be associated with the fewest relapses within 1 year and was also most likely (99.99%) to result in the lowest mean cumulative exposure to corticosteroids. Rituximab had the highest likelihood (45.98%) of being associated with the smallest number of patients experiencing treatment failure at 1 year. CsA was most likely (57.93%) to achieve the highest relapse-free survival during 1 year, followed by tacrolimus (26.47%) and rituximab (30.48%). Rituximab showed no association with serious side effects and had comparable adverse effects to ofatumumab and tacrolimus. Conclusion Rituximab may be the most favorable immunosuppressive agent for treating pediatric FRSDNS. Nephrologists should consider this drug, along with their clinical experience, patient characteristics, and cost considerations, when choosing a treatment approach.
Collapse
Affiliation(s)
- Yu Zhu
- Department of Traditional Chinese Medicine, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Junyi Chen
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Yao Zhang
- Department of Traditional Chinese Medicine, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Xiaoai Wang
- Department of Traditional Chinese Medicine, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| | - Jingjing Wang
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, Hangzhou, China
| |
Collapse
|
6
|
Alssum LR. Repeated implants failure in young patient with idiopathic nephrotic syndrome: a case report with brief review of the literature. BMC Oral Health 2024; 24:25. [PMID: 38183071 PMCID: PMC10770943 DOI: 10.1186/s12903-023-03772-8] [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: 01/30/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Nephrotic syndrome is a chronic disorder characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Idiopathic minimal-change disease is the most common form encountered in children. Corticosteroids are the cornerstone for the treatment of idiopathic nephrotic syndrome (INS), with different regimens depending on the response to therapy and frequency of relapses. This case report presents complications after implant treatment in patient with INS. CASE PRESENTATION 20 years old female patient presented for implant consultation. Medical history includes INS since early childhood, and she is on different medications to control her condition, including long-term steroid use. Dental history revealed that implant treatment was unsuccessful after multiple attempts. She presented with an implant on the area of lower left first mandibular molar, that shows increased mobility and radiolucency on radiographic examination. A diagnosis of implant failure was made, the implant was removed, and the area was cleaned and sutured. The patient decided to replace her missing teeth with fixed partial denture and was referred for prosthodontist. The potential adverse effect of steroid use and the possible underlying mechanism that could affect bone metabolism and implants osseointegration are reviewed. CONCLUSION Clinical practice guidelines are needed for the management of dental implants in chronic steroid users.
Collapse
Affiliation(s)
- Lamees R Alssum
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
| |
Collapse
|
7
|
Yazılıtaş F, Kargın Çakıcı E, Karakaya D, Güngör T, Çelikkaya E, Bülbül M. Evaluation of immature granulocyte percentage and count in pediatric nephrotic syndrome. Postgrad Med 2024; 136:36-43. [PMID: 38197239 DOI: 10.1080/00325481.2024.2303973] [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: 02/08/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE The importance of immature granulocytes (IGs) in most infectious and inflammatory diseases has been highlighted. This study aimed to determine the clinical usability and importance of changes in the peripheral complete blood count profile, including IG percentage (IG%) and IG count (IG#), during the relapse and remission phases in pediatric nephrotic syndrome (NS) patients. METHODS This retrospective observational study was performed at a tertiary care hospital between February 2020 and August 2022. Demographic characteristics and laboratory parameters were recorded. The IG count and IG% were measured using an automated hematological analyzer. RESULTS IG% and IG# were both higher during the relapse phase of NS than during the remission phase (0.29% ± 0.14%, versus 0.23% ± 0.14%, p = 0.037 and 0.027 ± 0.015 × 103/µL, versus 0.018 ± 0.014 × 103/µL, p = 0.005, respectively). The neutrophil to lymphocyte ratio (NLR), platelet (PLT), white blood cell (WBC), and neutrophil counts had a strong positive correlation with IG# (r = 0.397, p < 0.001; r = 0.352, p < 0.001; r = 0.622, p < 0.001; r = 0.660, p < 0.001, respectively). The NLR, PLT, WBC, and neutrophil counts had a strong positive correlation with IG% (r = 0.348, p < 0.001; r = 0.187, p = 0.039; r = 0.303, p = 0.001; r = 0.426, p < 0.001, respectively). Receiver operating characteristic curve analysis showed that IG# had the best AUC value of 0.69 (95% CI: 0.58-0.77; p = 0.001) for the relapse phase of NS with a cutoff value of 0.025 × 103/µL (sensitivity: 81.0%, specificity: 78.1%). CONCLUSIONS It is probable that a high level of immature granulocyte count has a positive correlation for NS relapse in pediatric patients. The IG % and IG# can be used together as biomarkers of inflammation in pediatric NS relapse.
Collapse
Affiliation(s)
- Fatma Yazılıtaş
- Nephrology Department, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evrim Kargın Çakıcı
- Pediatric Nephrology Department, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Deniz Karakaya
- Pediatric Nephrology Department, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Tülin Güngör
- Pediatric Nephrology Department, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evra Çelikkaya
- Pediatric Nephrology Department, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bülbül
- Pediatric Nephrology and Rheumatology Department, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
8
|
Yufang W, Mingfang L, Nan H, Tingting W. Quercetin-targeted AKT1 regulates the Raf/MEK/ERK signaling pathway to protect against doxorubicin-induced nephropathy in mice. Tissue Cell 2023; 85:102229. [PMID: 37812949 DOI: 10.1016/j.tice.2023.102229] [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: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Doxorubicin is an anthracycline antitumor agent commonly used in clinical practice, which has some nephrotoxicity and is often used to establish mouse models of kidney injury for basic medical research. This study will investigate the protective effect of quercetin on renal function in doxorubicin-induced nephropathy mice. METHODS C57BL/6 mice were divided into control, model, and quercetin low-, and high-dose groups. Serum and urine were collected to analyze markers of kidney function. H&E staining was used to detect pathological changes in renal tissues. Transmission electron microscopy was performed to observe the ultrastructural changes in renal tissues. Immunohistochemistry was performed to detect the changes of Ang II. RT-qPCR was performed to detect the changes of cytokines. ELISA was used to detect changes in serum inflammatory factors. Molecular docking was performed to verify the targeting relationship between quercetin and AKT1. Western blot was performed to detect Bax, Bcl-2, Cyt-c, AKT1, Raf, MEK, and ERK proteins. RESULTS Quercetin could induce the recovery of kidney function in kidney-injured mice; H&E results showed that kidney tissue damage and tissue fibrosis were reduced in kidney-injured mice under quercetin. The mitochondrial swollen structure was destroyed by doxorubicin, while the mitochondrial structure was restored under quercetin. The levels of abnormal apoptotic proteins Bax and Bcl-2 were regulated to normal by quercetin. The high expression of Ang II caused by doxorubicin was down-regulated by quercetin. Abnormal inflammatory factors caused by doxorubicin were reversed by quercetin. Western blot experiments showed that quercetin regulated the protein levels of AKT1 and Raf/MEK/ERK and inhibited the detrimental effects of doxorubicin. CONCLUSION Quercetin may mitigate doxorubicin-induced kidney injury in mice by regulating renal cell inflammatory factors and Raf/MEK/ERK signaling pathway through AKT1 to promote recovery of renal function.
Collapse
Affiliation(s)
- Wang Yufang
- Department of Medical Laboratory Diagnosis Lecturer, Quanzhou Medical College, Quanzhou, Fujian Province, China.
| | - Liu Mingfang
- The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Huang Nan
- Department of Medical Laboratory Diagnosis Lecturer, Quanzhou Medical College, Quanzhou, Fujian Province, China
| | - Wang Tingting
- Department of Medical Laboratory Diagnosis Lecturer, Quanzhou Medical College, Quanzhou, Fujian Province, China
| |
Collapse
|
9
|
Gambadauro A, Mangano GD, Galletta K, Granata F, Riva A, Massella L, Guzzo I, Farello G, Scorrano G, Di Francesco L, Di Donato G, Ianni C, Di Ludovico A, La Bella S, Striano P, Efthymiou S, Houlden H, Nardello R, Chimenz R. NUP85 as a Neurodevelopmental Gene: From Podocyte to Neuron. Genes (Basel) 2023; 14:2143. [PMID: 38136965 PMCID: PMC10743110 DOI: 10.3390/genes14122143] [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: 10/10/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023] Open
Abstract
Pathogenic gene variants encoding nuclear pore complex (NPC) proteins were previously implicated in the pathogenesis of steroid-resistant nephrotic syndrome (SRNS). The NUP85 gene, encoding nucleoporin, is related to a very rare form of SRNS with limited genotype-phenotype information. We identified an Italian boy affected with an SRNS associated with severe neurodevelopmental impairment characterized by microcephaly, axial hypotonia, lack of achievement of motor milestones, and refractory seizures with an associated hypsarrhythmic pattern on electroencephalography. Brain magnetic resonance imaging (MRI) showed hypoplasia of the corpus callosum and a simplified gyration of the cerebral cortex. Since the age of 3 years, the boy was followed up at our Pediatric Nephrology Department for an SRNS, with a focal segmental glomerulosclerosis at renal biopsy. The boy died 32 months after SRNS onset, and a Whole-Exome Sequencing analysis revealed a novel compound heterozygous variant in NUP85 (NM_024844.5): 611T>A (p.Val204Glu), c.1904T>G (p.Leu635Arg), inherited from the father and mother, respectively. We delineated the clinical phenotypes of NUP85-related disorders, reviewed the affected individuals so far reported in the literature, and overall expanded both the phenotypic and the molecular spectrum associated with this ultra-rare genetic condition. Our study suggests a potential occurrence of severe neurological phenotypes as part of the NUP85-related clinical spectrum and highlights an important involvement of nucleoporin in brain developmental processes and neurological function.
Collapse
Affiliation(s)
- Antonella Gambadauro
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy; (A.G.); (R.C.)
| | - Giuseppe Donato Mangano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy;
| | - Karol Galletta
- Department of Biomedical, Dental Science and Morphological and Functional Images, Neuroradiology Unit, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (K.G.); (F.G.)
| | - Francesca Granata
- Department of Biomedical, Dental Science and Morphological and Functional Images, Neuroradiology Unit, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (K.G.); (F.G.)
| | - Antonella Riva
- Unit of Medical Genetics, IRCSS Giannina Gaslini Institute, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (A.R.); (P.S.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (L.M.); (I.G.)
| | - Isabella Guzzo
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy; (L.M.); (I.G.)
| | - Giovanni Farello
- Department of Pediatrics, University of L’Aquila, 67100 L’Aquila, Italy; (G.F.); (G.S.); (L.D.F.); (G.D.D.); (C.I.); (A.D.L.)
| | - Giovanna Scorrano
- Department of Pediatrics, University of L’Aquila, 67100 L’Aquila, Italy; (G.F.); (G.S.); (L.D.F.); (G.D.D.); (C.I.); (A.D.L.)
| | - Ludovica Di Francesco
- Department of Pediatrics, University of L’Aquila, 67100 L’Aquila, Italy; (G.F.); (G.S.); (L.D.F.); (G.D.D.); (C.I.); (A.D.L.)
| | - Giulio Di Donato
- Department of Pediatrics, University of L’Aquila, 67100 L’Aquila, Italy; (G.F.); (G.S.); (L.D.F.); (G.D.D.); (C.I.); (A.D.L.)
| | - Carolina Ianni
- Department of Pediatrics, University of L’Aquila, 67100 L’Aquila, Italy; (G.F.); (G.S.); (L.D.F.); (G.D.D.); (C.I.); (A.D.L.)
| | - Armando Di Ludovico
- Department of Pediatrics, University of L’Aquila, 67100 L’Aquila, Italy; (G.F.); (G.S.); (L.D.F.); (G.D.D.); (C.I.); (A.D.L.)
| | - Saverio La Bella
- Department of Pediatrics, University of L’Aquila, 67100 L’Aquila, Italy; (G.F.); (G.S.); (L.D.F.); (G.D.D.); (C.I.); (A.D.L.)
| | - Pasquale Striano
- Unit of Medical Genetics, IRCSS Giannina Gaslini Institute, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; (A.R.); (P.S.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Stephanie Efthymiou
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (S.E.); (H.H.)
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (S.E.); (H.H.)
| | - Rosaria Nardello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy;
| | - Roberto Chimenz
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy; (A.G.); (R.C.)
| |
Collapse
|
10
|
Ji B, Liu J, Yin Y, Xu H, Shen Q, Yu J. Minnelide combined with anti-ANGPTL3-FLD monoclonal antibody completely protects mice with adriamycin nephropathy by promoting autophagy and inhibiting apoptosis. Cell Death Dis 2023; 14:601. [PMID: 37689694 PMCID: PMC10492865 DOI: 10.1038/s41419-023-06124-0] [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: 02/04/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
Minimal change disease (MCD) is the common type of nephrotic syndrome (NS) in children. Currently, there is an urgent need to explore new treatments because of the significant side effects of long-term use of glucocorticoids and immunosuppressive drugs and the failure to reduce proteinuria in some patients. Angiopoietin-like protein 3 (Angptl3) is an essential target of NS, and anti-ANGPTL3-FLD monoclonal antibody (mAb) significantly reduces proteinuria in mice with adriamycin nephropathy (AN). However, some proteinuria is persistent. Minnelide, a water-soluble prodrug of triptolide, has been used for the treatment of glomerular disease. Therefore, the present study aimed to investigate whether minnelide combined with mAb could further protect mice with AN and the underlying mechanisms. 8-week-old C57BL/6 female mice were injected with 25 mg/kg of Adriamycin (ADR) by tail vein to establish the AN model. A dose of 200 μg/kg of minnelide or 20 mg/kg of mAb was administered intraperitoneally for the treatment. In vitro, the podocytes were treated with 0.4 μg/mL of ADR for 24 h to induce podocyte injury, and pretreatment with 10 ng/mL of triptolide for 30 min or 100 ng/mL of mAb for 1 h before ADR exposure was used to treat. The results showed that minnelide combined with mAb almost completely ameliorates proteinuria and restores the ultrastructure of the podocytes in mice with AN. In addition, minnelide combined with mAb restores the distribution of Nephrin, Podocin, and CD2AP and reduces the level of inflammatory factors in mice with AN. Mechanistically, minnelide combined with mAb could further alleviate apoptosis and promote autophagy in mice with AN by inhibiting the mTOR signaling pathway. In vitro, triptolide combined with mAb increases the expression of Nephrin, Podocin, and CD2AP, alleviates apoptosis, and promotes autophagy. Overall, minnelide combined with mAb completely protects the mice with AN by promoting autophagy and inhibiting apoptosis.
Collapse
Affiliation(s)
- Baowei Ji
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Junchao Liu
- Department of Traditional Chinese Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Ye Yin
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.
| | - Qian Shen
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Jian Yu
- Department of Traditional Chinese Medicine, Children's Hospital of Fudan University, Shanghai, China
| |
Collapse
|
11
|
Usuda H, Ikeda H, Watanabe S, Sato S, Fee EL, Carter SWD, Kumagai Y, Saito Y, Takahashi T, Takahashi Y, Kawamura S, Hanita T, Saito M, Kikuchi A, Choolani MA, Yaegashi N, Kemp MW. Artificial placenta support of extremely preterm ovine fetuses at the border of viability for up to 336 hours with maintenance of systemic circulation but reduced somatic and organ growth. Front Physiol 2023; 14:1219185. [PMID: 37692998 PMCID: PMC10484719 DOI: 10.3389/fphys.2023.1219185] [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: 05/08/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction: Artificial placenta therapy (APT) is an experimental life support system to improve outcomes for extremely preterm infants (EPI) less than 1,000 g by obviating the need for pulmonary gas exchange. There are presently no long-term survival data for EPI supported with APT. To address this, we aimed to maintain 95d-GA (GA; term-150d) sheep fetuses for up to 2 weeks using our APT system. Methods: Pregnant ewes (n = 6) carrying singleton fetuses underwent surgical delivery at 95d GA. Fetuses were adapted to APT and maintained for up to 2 weeks with constant monitoring of key physiological parameters and extensive time-course blood and urine sampling, and ultrasound assessments. Six age-matched in-utero fetuses served as controls. Data were tested for group differences with ANOVA. Results: Six APT Group fetuses (100%) were adapted to APT successfully. The mean BW at the initiation of APT was 656 ± 42 g. Mean survival was 250 ± 72 h (Max 336 h) with systemic circulation and key physiological parameters maintained mostly within normal ranges. APT fetuses had active movements and urine output constantly exceeded infusion volume over the experiment. At delivery, there were no differences in BW (with edema in three APT group animals), brain weight, or femur length between APT and in-utero Control animals. Organ weights and humerus lengths were significantly reduced in the APT group (p < 0.05). Albumin, IGF-1, and phosphorus were significantly decreased in the APT group (p < 0.05). No cases of positive blood culture were detected. Conclusion: We report the longest use of APT to maintain extremely preterm fetuses to date. Fetal systemic circulation was maintained without infection, but growth was abnormal. This achievement suggests a need to focus not only on cardiovascular stability and health but also on the optimization of fetal growth and organ development. This new challenge will need to be overcome prior to the clinical translation of this technology.
Collapse
Affiliation(s)
- Haruo Usuda
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hideyuki Ikeda
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shimpei Watanabe
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shinichi Sato
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Erin L. Fee
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
| | - Sean W. D. Carter
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yusaku Kumagai
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yuya Saito
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Tsukasa Takahashi
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yuki Takahashi
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | - Takushi Hanita
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Masatoshi Saito
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Atsuo Kikuchi
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mahesh A. Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nobuo Yaegashi
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Matthew W. Kemp
- Division of Obstetrics and Gynecology, The University of Western Australia, Crawley, WA, Australia
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| |
Collapse
|
12
|
Downie ML, Gupta S, Voinescu C, Levine AP, Sadeghi-Alavijeh O, Dufek-Kamperis S, Cao J, Christian M, Kari JA, Thalgahagoda S, Ranawaka R, Abeyagunawardena A, Gbadegesin R, Parekh R, Kleta R, Bockenhauer D, Stanescu HC, Gale DP. Common Risk Variants in AHI1 Are Associated With Childhood Steroid Sensitive Nephrotic Syndrome. Kidney Int Rep 2023; 8:1562-1574. [PMID: 37547536 PMCID: PMC10403666 DOI: 10.1016/j.ekir.2023.05.018] [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: 02/03/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Steroid-sensitive nephrotic syndrome (SSNS) is the most common form of kidney disease in children worldwide. Genome-wide association studies (GWAS) have demonstrated the association of SSNS with genetic variation at HLA-DQ/DR and have identified several non-HLA loci that aid in further understanding of disease pathophysiology. We sought to identify additional genetic loci associated with SSNS in children of Sri Lankan and European ancestry. Methods We conducted a GWAS in a cohort of Sri Lankan individuals comprising 420 pediatric patients with SSNS and 2339 genetic ancestry matched controls obtained from the UK Biobank. We then performed a transethnic meta-analysis with a previously reported European cohort of 422 pediatric patients and 5642 controls. Results Our GWAS confirmed the previously reported association of SSNS with HLA-DR/DQ (rs9271602, P = 1.12 × 10-27, odds ratio [OR] = 2.75). Transethnic meta-analysis replicated these findings and identified a novel association at AHI1 (rs2746432, P = 2.79 × 10-8, OR = 1.37), which was also replicated in an independent South Asian cohort. AHI1 is implicated in ciliary protein transport and immune dysregulation, with rare variation in this gene contributing to Joubert syndrome type 3. Conclusions Common variation in AHI1 confers risk of the development of SSNS in both Sri Lankan and European populations. The association with common variation in AHI1 further supports the role of immune dysregulation in the pathogenesis of SSNS and demonstrates that variation across the allele frequency spectrum in a gene can contribute to disparate monogenic and polygenic diseases.
Collapse
Affiliation(s)
- Mallory L. Downie
- Department of Renal Medicine, University College London, London, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sanjana Gupta
- Department of Renal Medicine, University College London, London, UK
| | - Catalin Voinescu
- Department of Renal Medicine, University College London, London, UK
| | - Adam P. Levine
- Department of Pathology, University College London, London, UK
| | | | | | - Jingjing Cao
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | | | - Jameela A. Kari
- Pediatric Nephrology Centre of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | | | - Randula Ranawaka
- Department of Pediatrics, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Rasheed Gbadegesin
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rulan Parekh
- Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Department of Medicine, Women’s College Hospital, Toronto, Canada
| | - Robert Kleta
- Department of Renal Medicine, University College London, London, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Daniel P. Gale
- Department of Renal Medicine, University College London, London, UK
| |
Collapse
|
13
|
Lella G, Pecoraro L, Benetti E, Arnone OC, Piacentini G, Brugnara M, Pietrobelli A. Nutritional Management of Idiopathic Nephrotic Syndrome in Pediatric Age. Med Sci (Basel) 2023; 11:47. [PMID: 37606426 PMCID: PMC10443265 DOI: 10.3390/medsci11030047] [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: 06/29/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
Nephrotic syndrome (NS) is a common pediatric disease characterized by a dysfunction in the glomerular filtration barrier that leads to protein, fluid, and nutrient loss in urine. Corticosteroid therapy is the conventional treatment in children. Long-term complications of NS and prolonged exposure to steroids affect bones, growth, and the cardiovascular system. Diet can play an important role in preventing these complications, but there is a scarcity of scientific literature about nutritional recommendations for children with NS. They need individualized nutrition choices not only during the acute phase of the disease but also during remission to prevent the progression of kidney damage. The correct management of diet in these children requires a multidisciplinary approach that involves family pediatricians, pediatric nephrologists, dietitians, and parents.
Collapse
Affiliation(s)
- Graziana Lella
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Elisa Benetti
- Pediatric Nephrology, Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy
| | - Olivia Chapin Arnone
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Milena Brugnara
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
| | - Angelo Pietrobelli
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy (O.C.A.); (A.P.)
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| |
Collapse
|
14
|
Mbanefo NR, Ogbuka FN, Nwaoha CA, Odimegwu CL, Uwaezuoke SN, Okafor HU. The pattern of steroid sensitivity and steroid resistance in childhood idiopathic nephrotic syndrome: A 5-year retrospective observational descriptive study in a South-East Nigerian tertiary hospital. Niger J Clin Pract 2023; 26:1017-1022. [PMID: 37635589 DOI: 10.4103/njcp.njcp_1_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background/Aim Nephrotic syndrome is the most common glomerular disease of childhood. Majority of the idiopathic cases frequently respond to steroid therapy and are regarded as steroid-sensitive nephrotic syndrome. Several studies have reported a change in this usual pattern to steroid-resistant nephrotic syndrome in Nigerian children. This study aimed to determine the pattern of steroid sensitivity and steroid resistance in childhood idiopathic nephrotic syndrome seen at a tertiary hospital in Enugu, south-east Nigeria. Materials and Methods A retrospective study conducted in children with idiopathic nephrotic syndrome seen at the University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, over 5 years (from 2016 to 2020). The demographic variables, clinical data, and histopathological pattern were documented. Renal biopsies were studied by light microscope only. Results Of a total of 150 patients, 105 (70%) were males, while 45 (30%) were females. Ninety six (64%) were aged 1-10 years. Fifty four (36%) were aged 11-18 years. Forty eight (32%) were aged 1-5 years. Mean age was 8.67 ± 4.69 years. One hundred and six (71%) initially had steroid-sensitive nephrotic syndrome; 12 (11.3%) and seven (6.6%) later became frequent-relapsers and steroid-dependent, respectively. Forty four (29.3%) had steroid-resistant nephrotic syndrome. Sixty eight had renal biopsy; the most common indication being steroid-resistance. The most common histological pattern was focal segmental glomerulosclerosis seen in 63.2% of these patients. Only four (9%) had renal transplant. Conclusion Although the prevalence of steroid-sensitive nephrotic syndrome is higher in this clime, there is a rising incidence of steroid-resistant pattern attributed to incident cases of focal segmental glomerulosclerosis.
Collapse
Affiliation(s)
- N R Mbanefo
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - F N Ogbuka
- Department of Paediatrics, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Nigeria
| | - C A Nwaoha
- Department of Paediatrics, Federal Medical Center, Owerri, Imo, Nigeria
| | - C L Odimegwu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - S N Uwaezuoke
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - H U Okafor
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| |
Collapse
|
15
|
Mbanefo NR, Igbokwe OO, Iloh ON, Chikani UN, Bisi-Onyemaechi AI, Muoneke VU, Okafor HU, Uwaezuoke SN, Odetunde OI. Percutaneous kidney biopsy and the histopathologic patterns of kidney diseases in children: An observational descriptive study at a South-East Nigerian tertiary hospital. Niger J Clin Pract 2023; 26:795-801. [PMID: 37470655 DOI: 10.4103/njcp.njcp_855_22] [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] [Indexed: 07/21/2023]
Abstract
Background Kidney biopsy remains the best standard for kidney tissue analysis. Although percutaneous kidney biopsy is an invasive procedure, it is an indispensable part of interventional nephrology for accurate diagnosis, selection of appropriate therapy protocol, and prognostication of kidney diseases in children. With improvement in expertise among pediatric nephrologists, data on procedure outcomes are now being documented. Aim: We aimed to describe the outcomes in a 5-year practice of kidney biopsy at the pediatric nephrology unit in a southeast Nigerian tertiary hospital. Patients and Methods An observational descriptive study conducted on the kidney biopsy performed in our facility from 2017 to 2022. The focus was on the patients' clinical profile, indications for biopsy, the adopted procedure, and the histopathologic findings. Results A total of 69 patients had kidney biopsy, 40 (58.0%) were males, while 29 (42.0%) were females. Sixty-four (92.7%) patients had the procedure at the age of >10 years, while five (7.2%) at the age of <7 years. The patients' prebiopsy mean systolic and diastolic blood pressures were 111.20 ± 16.93 and 74.64 ± 12.69 mmHg, respectively. Their estimated glomerular filtration rate (eGFR) was 119.27 ± 52.78 ml/min/1.73 m2. The most frequent indication was steroid resistance (39/69, 56.5%). Focal segmental glomerulosclerosis was the commonest histopathologic finding (38/69, 55.0%). Conclusion Outcomes of percutaneous kidney biopsy at a Nigerian tertiary hospital are adjudged successful. The histopathologic patterns highlight FSGS as the major cause of steroid resistance in childhood nephrotic syndrome in this clime.
Collapse
Affiliation(s)
- N R Mbanefo
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - O O Igbokwe
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - O N Iloh
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - U N Chikani
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - A I Bisi-Onyemaechi
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - V U Muoneke
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - H U Okafor
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - S N Uwaezuoke
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - O I Odetunde
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| |
Collapse
|
16
|
Mun-Wei L, Aiman-Mardhiyyah MY, Hayati AA, Ikram IM, Tai ELM, Shatriah I. Evaluation of Visual Acuity, Macular Thickness, and Level of Proteinuria in Children with Nephrotic Syndrome. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:42-48. [PMID: 36549302 PMCID: PMC9935067 DOI: 10.3341/kjo.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/03/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria. METHODS The comparative cross-sectional study included 66 children aged 6 to 17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map. RESULTS The mean foveal thickness was 238.15 ± 22.98 µm for children with nephrotic syndrome and 237.01 ± 22.60 µm for the control group. There was no significant difference in the mean macular thickness between the groups (p = 0.843). A significant correlation with visual acuity was observed in the superior outer macula (r = -0.41, p = 0.019), the nasal outer macula (r = -0.41, p = 0.019), and the inferior outer macula (r = -0.40, p = 0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p = 0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness. CONCLUSIONS The mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.
Collapse
Affiliation(s)
- Lam Mun-Wei
- Department of Ophthalmology, Sultanah Aminah Hospital, Johor,
Malaysia
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Mohd Yazid Aiman-Mardhiyyah
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Abdul Aziz Hayati
- Department of Ophthalmology, Sultanah Aminah Hospital, Johor,
Malaysia
| | - Ilias Mohamad Ikram
- Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Evelyn Li Min Tai
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Ismail Shatriah
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| |
Collapse
|
17
|
Deng Y, Ou YY, Mo CJ, Huang L, Qin X, Li S. Peripheral blood lymphocyte subsets in children with nephrotic syndrome: a retrospective analysis. BMC Nephrol 2023; 24:7. [PMID: 36627573 PMCID: PMC9830737 DOI: 10.1186/s12882-022-03015-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) in children is widely believed to be associated with severe changes in the immune system. Based on lymphocyte subset analysis, we examined the pathogenesis of immune deficiencies in children with NS with varying steroid sensitivity. METHODS Our study utilized flow cytometry to retrospectively analyze the ratios of lymphocyte subsets in 204 children with nephrotic syndrome and 19 healthy children. RESULTS Compared with healthy children, the ratio of CD4 + /CD8 + in onset and remission was decreased in SRNS group (p < 0.05), and CD19 + B lymphocytes were increased in onset (p < 0.05). Compared with onset, the proportion of CD19 + B lymphocytes decreased in SRNS, while the proportion of CD19 + B lymphocytes increased in SDNS, p < (0.01). The ratio of CD8 + T/CD19 + B in onset in SDNS group was significantly higher than that in SSNS and SRNS groups (p < 0.01) and healthy control group (p < 0.05). Compared with onset, the ratio of CD8 + T/CD19 + B in SDNS group decreased significantly (p < 0.01), while the ratio of CD8 + T/CD19 + B in SRNS group increased significantly (p < 0.01). The proportion of CD56 + CD16 + NK cells was significantly reduced in children with INS (p < 0.01). CONCLUSION CD8 + T lymphocytes may be involved in the mechanism of lymphocyte subsets disorder during onset of SDNS, while CD19 + B lymphocytes may be involved in the mechanism of lymphocyte subsets disorder during relapse of SDNS. The CD8 + T/CD19 + B ratio may predict the degree of frequent recurrence. There is a certain degree of lymphoid subsets disorder in children with NS.
Collapse
Affiliation(s)
- Yan Deng
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Ying-ying Ou
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Cui-Ju Mo
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Li Huang
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Xue Qin
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Shan Li
- grid.412594.f0000 0004 1757 2961Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| |
Collapse
|
18
|
Shi J, Li W, Tao R, Zhou D, Guo Y, Fu H, Sun A, Zhang J, Mao J. Association of Catalase Gene Polymorphisms with Idiopathic Nephrotic Syndrome in a Chinese Pediatric Population. Lab Med 2023; 54:35-40. [PMID: 35964233 DOI: 10.1093/labmed/lmac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Our aim was to investigate the association between gene polymorphisms in catalase (CAT), a well-known oxidative stress regulator, and susceptibility to idiopathic nephrotic syndrome (INS) or responses to steroid therapy in a Chinese pediatric population. METHODS We analyzed 3 CAT single-nucleotide polymorphisms (SNVs; rs7943316, rs769217, and rs12270780) using multi-polymerase chain reaction combined with next-generation sequencing in 183 INS patients and 100 healthy controls. RESULTS For the allele and genotype frequencies of the CAT SNVs, no significant differences were observed between INS patients and controls. Patients with C allele of CAT rs769217 had a higher risk of developing steroid-dependent nephrotic syndrome than the steroid-sensitive nephrotic syndrome patients (P = 0.018; odds ratio = 1.76). CONCLUSION Our data suggests that genetic variations in CAT were unlikely to confer susceptibility to INS in Chinese children, whereas the C allele of the CAT rs769217 polymorphism showed a strong association with steroid-dependent responses in Chinese INS children.
Collapse
Affiliation(s)
- Jianrong Shi
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Wei Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Ran Tao
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Dongming Zhou
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Yajun Guo
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Haidong Fu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Anna Sun
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Junfeng Zhang
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Jianhua Mao
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| |
Collapse
|
19
|
Teplan V. Multimorbidity in nephrotic syndrome. VNITRNI LEKARSTVI 2023; 69:156-165. [PMID: 37468310 DOI: 10.36290/vnl.2023.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Nephrotic syndrome (NS) is characterized by high proteinuria (over 3,5g/24 hrs), hypalbuminaemia, general edemas and hypercoagulation. Beside of primary glomerulonephritides this is found in secundary glomerulopaties eg. diabetes, systemic inflammatory diseases, oncology, damage by drugs and poisoning, by alergy, serious infections and in children from hereditary reasons. The most frequent reason for NS in adults patiens is diabetes and diabetes with nephropathy represents almost 40% of dialysed patiens. From this point of view, there is great interest focusing on gliflozins (SGLT2 inhibitors) with positive nephroprotecive effect. It leads do increasing of glycosuria with concomitant natriuresis and osmotic diuresis. The effect is proportional to glomerulal filtration, but the effect on natriuresis stay in all stages of renal insufficiency.
Collapse
|
20
|
Guo S, Yang L, Zhang Q, Zhang L, Li A. Metabolomics combined with serum pharmacochemistry discovering the potential effective compounds of Fangji Huangqi Tang against nephrotic syndrome. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1214:123532. [PMID: 36462401 DOI: 10.1016/j.jchromb.2022.123532] [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: 09/27/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
Fangji Huangqi Tang (FHT) was first recorded in "Jin Gui Yao Lue," invented by the archaic Chinese medical doctor Zhongjing Zhang, and is a classic medicine that tonifies qi and expels wind, invigorates spleen for diuresis. A large number of literatures indicated that FHT showed a significant effect on Nephrotic Syndrome (NS). A comprehensive strategy was proposed to discover the potential effective compounds and therapeutic targets of FHT against NS as a case study. Serum metabolomics combined with multivariate statistical analysis was employed to analysis and screen the differential endogenous metabolites in serum samples of the control and model rats induced by Adriamycin. The correlation analysis between the efficacy biomarkers and different compounds absorbed in serum of FHT was conducted to explore the potential effective compounds of FHT against NS. With the help of network pharmacology, the therapeutic targets and the possible molecular mechanisms of FHT against NS were further investigated. Fifteen metabolites, including l-phenylalanine, 3-Hydroxybutyric acid and linolenic acid, were associated with renal damage based on the serum metabolomic results. Metabolic pathway analysis indicated that phenylalanine, tyrosine and tryptophan biosynthesis and linoleic acid metabolism were the key pathways associated with NS. Among them, 6 metabolites were defined as efficacy biomarkers such as uric acid, 2-methylbutyrylcarnitine and 10-HDA. The results of correlation analysis suggested that 14 constituents such as fanGhinoline, cycloastragenol, atractylenolide III, and glycyrrhetinic acid were recognized as potential effective compounds, whose potential protein targets participated in the MAPK signaling pathway, GnRH signaling pathway and aldoaterone-regulated sodium reabsorption. This study has clarified the potential effective compounds and therapeutic targets of FHT against NS. The results provided new evidence for the pharmacological mechanism of FHT on NS.
Collapse
Affiliation(s)
- Songjia Guo
- Nephrology Department, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Liu Yang
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, Taiyuan 030006, China; Key Laboratory of Effective Substances Research and Utilization in TCM of Shanxi Province, China; Modern Research Center for Traditional Chinese Medicine, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, China
| | - Qingyu Zhang
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, Taiyuan 030006, China; Key Laboratory of Effective Substances Research and Utilization in TCM of Shanxi Province, China; Modern Research Center for Traditional Chinese Medicine, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, China
| | - Lichao Zhang
- Institutes of Biomedical Sciences of Shanxi University, Taiyuan 030006, China.
| | - Aiping Li
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, Taiyuan 030006, China; Key Laboratory of Effective Substances Research and Utilization in TCM of Shanxi Province, China; Modern Research Center for Traditional Chinese Medicine, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, China.
| |
Collapse
|
21
|
Exome Sequencing Revealed a Novel Splice Site Variant in the CRB2 Gene Underlying Nephrotic Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121784. [PMID: 36556986 PMCID: PMC9781877 DOI: 10.3390/medicina58121784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022]
Abstract
Background and Objectives: Nephrotic syndrome (NS) is a kidney disease where the patient has a classic triad of signs and symptoms including hypercholesterolemia, hypoalbuminemia, proteinuria (>3.5 g/24 h), and peripheral edema. In case of NS, the damaged nephrons (structural and functional unit of the kidney) filter unwanted blood contents to make urine. Thus, the urine contains unwanted proteins (proteinuria) and blood cells (hematuria), while the bloodstream lacks enough protein albumin (hypoalbuminemia). Nephrotic syndrome is divided into two types, primary NS, and secondary NS. Primary NS, also known as primary glomerulonephrosis, is the result of a glomerular disease that is limited to the kidney, while secondary NS is a condition that affects the kidney and other parts of the body. The main causes of primary NS are minimal change disease, membranous glomerulonephritis, and focal segmental glomerulosclerosis. In the present study we recruited a family segregating primary NS with the aim to identify the underlying genetic etiology. Such type of study is important in children because it allows counseling of other family members who may be at risk of developing NS, predicts risk of recurrent disease phenotypes after kidney transplant, and predicts response to immunosuppressive therapy. Materials and Methods: All affected individuals were clinically evaluated. Clinical examination, results of laboratory tests, and biopsy investigations led us to the diagnosis. The next-generation sequencing technique (whole-exome sequencing) followed by Sanger sequencing identified a novel homozygous splice site variant (NM_173689.7: c.941-3C>T) in the CRB2 gene. The variant was present in a homozygous state in the affected individuals, while in a heterozygous state in phenotypically normal parents. Results: The study expanded the spectrum of the mutations in the gene CRB2 responsible for causing NS. Conclusions: In addition, the study will also help in genetic counseling, carrier testing, and prenatal and/or postnatal early diagnosis of the disease in the affected family.
Collapse
|
22
|
Forero-Delgadillo J, Ochoa V, Restrepo JM, Torres-Canchala L, Nieto-Aristizábal I, Ruiz-Ordoñez I, Sánchez A, Barrera MC, Jimenez CA, Tobón GJ. B-cell activating factor (BAFF) and its receptors' expression in pediatric nephrotic syndrome is associated with worse prognosis. PLoS One 2022; 17:e0277800. [PMID: 36399480 PMCID: PMC9674176 DOI: 10.1371/journal.pone.0277800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
AIM Immune pathogenesis of nephrotic syndrome (NS) is not completely understood. We aimed to evaluate the expression of B-cell activating factor (BAFF) and its receptors in renal samples from pediatric NS patients and its relationship with renal function survival. MATERIALS AND METHODS We conducted an ambispective study on 33 patients with pediatric NS. Immunohistochemistry for BAFF, TACI, BCMA and BR3 was performed. Markers were evaluated on podocytes and interstitial inflammatory infiltrates (III). We performed Kaplan-Meier curves to describe renal function survival according to markers' expression. RESULTS Thirty-three NS patients were included. Minimal change disease was seen in 21 (63.6%) patients, and focal segmental glomerulosclerosis in 12 (36.4%). BAFF was found in podocytes (18.2% of samples) and III (36.4% of samples), BAFF-R in one sample, TACI in 4 (podocytes and III), and BCMA in 5 samples of podocytes and 7 of III. BAFF on podocytes and III was associated with worst renal function at follow-up; those patients had 25% probability of having GFR >90 mL/min/1.73m2, versus 84.9% when absent (p = 0.0067). Patients with BAFF in III had 42.9% probability of having GFR>90 mL/min/1.73 m2, versus 94.1% when absent (p = 0.0063). CONCLUSION BAFF expression in renal biopsies could be a prognostic factor for renal function.
Collapse
Affiliation(s)
| | - Vanessa Ochoa
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Jaime M Restrepo
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Servicio de Nefrología Pediátrica, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Ingrid Ruiz-Ordoñez
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Aura Sánchez
- Servicio de Patología, Fundación Valle del Lili, Cali, Colombia
| | - María Claudia Barrera
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
| | | | - Gabriel J Tobón
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Laboratorio de Inmunología, Fundación Valle del Lili, Cali, Colombia
| |
Collapse
|
23
|
Utility of muscle ultrasound in nutritional assessment of children with nephrotic syndrome. Pediatr Nephrol 2022; 38:1821-1829. [PMID: 36357636 PMCID: PMC10154282 DOI: 10.1007/s00467-022-05776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/09/2022] [Accepted: 09/25/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nutritional status assessment in children with nephrotic syndrome (NS) is critical for identifying patients who are at risk of protein-energy wasting (PEW) and for determining their nutritional needs and monitoring nutritional intervention outcomes. METHODS In a case-control study, we enrolled 40 children (age range: 2-16 years) with NS and 40 apparently healthy children (age and sex-matched) as a control group. Anthropometric data, as well as demographic, clinical, and laboratory data, were collected. A dietary intake assessment using a 3-day food intake record was done, and the quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) were assessed using B-mode ultrasound and compared between both groups. RESULTS Children with NS had lower QRFT and QVIT measurements than control groups (p < 0.001). Inadequacy in protein intake occurred in 62.5% and 27.5% of the NS and control groups, respectively (p = 0.002). The thickness of the rectus and vastus muscles by ultrasound was significantly associated with the percentage of protein intake (p < 0.001). The ROC curve revealed that the best cutoff value of QRFT for the prediction of the patient at risk of malnutrition was ≤ 1.195 with an area under curve of 0.907, with p < 0.001. CONCLUSION In children with NS, skeletal muscle ultrasound is a simple and easy-to-use bedside technique for the identification of patients at risk of malnutrition. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
|
24
|
Zhang X, Jin Y, Li Q, Xie Y, Liu F, Huang G, Chen J, Fu H, Wang J, Shen H, Mao J. Successful Treatment of New-Onset Pediatric Nephrotic Syndrome With Rituximab as a First-Line Therapy. Kidney Int Rep 2022; 7:2750-2751. [PMID: 36506238 PMCID: PMC9727513 DOI: 10.1016/j.ekir.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Xiaojing Zhang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yanyan Jin
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiuyu Li
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yi Xie
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Liu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guoping Huang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junyi Chen
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Haidong Fu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Wang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Huijun Shen
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianhua Mao
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China,Correspondence: Jianhua Mao, Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, No. 3333, Binsheng Road, Binjiang District, Hangzhou 310052, Zhejiang, China.
| |
Collapse
|
25
|
Assessment of Brain-Derived Neurotrophic Factor (BDNF) Concentration in Children with Idiopathic Nephrotic Syndrome. Int J Mol Sci 2022; 23:ijms232012312. [PMID: 36293164 PMCID: PMC9603999 DOI: 10.3390/ijms232012312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Idiopathic nephrotic syndrome (INS) is a chronic disease affecting children in early childhood. It is characterized by proteinuria, hypoalbuminemia, edema and hyperlipidemia. To date, the diagnosis is usually established at an advanced stage of proteinuria. Therefore, new methods of early INS detection are desired. This study was designed to assess brain-derived neurotrophic factor (BDNF) as a potential marker in the early diagnosis of INS. The study group included patients with a diagnosis of idiopathic nephrotic syndrome (n = 30) hospitalized in Clinical Hospital No. 1 in Zabrze, from December 2019 to December 2021. Our study shows that serum BDNF concentration decreased and urine BDNF concentration increased in a group of patients with INS, compared with healthy controls. Such outcomes might be related to loss of the BDNF contribution in podocyte structure maintenance. Moreover, we anticipate the role of BDNF in urine protein concentration increase, which could be used as a direct predictor of urine protein fluctuations in clinical practice. Moreover, the ROC curve has also shown that serum BDNF and urine BDNF levels might be useful as an INS marker.
Collapse
|
26
|
Zion E, Borovitz Y, Alfandary H, Haskin O, Levi S, Shoham S, Davidovits M, Dagan A. A Clinical Response-Adjusted Steroid Treatment Protocol for Children With Newly Diagnosed Idiopathic Nephrotic Syndrome. Am J Kidney Dis 2022; 80:473-482.e1. [PMID: 35659571 DOI: 10.1053/j.ajkd.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/08/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Prednisone protocols for children with idiopathic nephrotic syndrome (INS) are generally similar in dose and duration, despite wide variations in time to response. We assessed the feasibility of a novel clinical treatment protocol characterized by a shorter duration and lower cumulative dose for children with early clinical response. STUDY DESIGN Nonrandomized pilot clinical trial. SETTING & PARTICIPANTS The study population included 59 children with newly diagnosed INS treated between 2014 and 2019 who responded to treatment within 8 days. INTERVENTION The intervention group (n = 27) was treated with a response-adjusted protocol during which responders received an 8-week course of tapering doses of prednisone. The usual care group (n =32) was treated with the standard protocol (prednisone, 60 mg/m2/24 hours for 6 weeks, followed by 40 mg/m2/48 hours for 4 weeks, followed by a slow taper for a total of 24 weeks). OUTCOME Consent rate, cumulative prednisone dose, the development of frequently relapsing or steroid-dependent nephrotic syndrome (FRNS or SDNS, respectively), relapses per year, treatment with steroid-sparing therapies, and adverse effects of steroid therapy over 3 years of follow-up observation. RESULTS The consent rate was 88%. The mean cumulative steroid dose for the initial treatment was 70 mg/kg and 141 mg/kg (P < 0.001) in the intervention and usual care groups, respectively. None of the patients in the intervention group relapsed while on faster steroid taper down. The occurrence of FRNS and SDNS in the intervention group was not statistically different than in the usual care group, hazard ratios were 0.80 (95% CI, 0.37-1.73) and 0.61 (95% CI, 0.30-1.27), respectively. The proportions of relapse-free patients were similar (P = 0.5), and adverse steroid events did not differ between the groups. LIMITATIONS Lack of randomization and small sample size. CONCLUSIONS These findings demonstrate the feasibility of a shortened duration of steroid dosing for INS when patients demonstrate an initial clinical response to treatment. A larger study is needed to characterize the relative efficacy and toxicity of this novel treatment regimen. FUNDING This study received no funding. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCTO2649413.
Collapse
Affiliation(s)
- Elena Zion
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Department A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
| | - Yael Borovitz
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Hadas Alfandary
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Orly Haskin
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Levi
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Shoval Shoham
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Dagan
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
27
|
Circulating Permeability Factors in Focal Segmental Glomerulosclerosis: In V itro Detection. Kidney Int Rep 2022; 7:2691-2703. [PMID: 36506233 PMCID: PMC9727530 DOI: 10.1016/j.ekir.2022.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The recurrence of proteinuria after kidney transplantation in patients with focal segmental glomerulosclerosis (FSGS) is considered proof of the presence of circulating permeability factors (CPFs). The aim of this study is to demonstrate the presence of plasma CPFs using series of in vitro assays. Methods Podocytes and endothelial cells (glomerular microvascular endothelial cells [GMVECs]) were incubated with plasma from FSGS patients with presumed CPFs in relapse and remission and from steroid-resistant nephrotic syndrome (SRNS), steroid-sensitive nephrotic syndrome (SSNS), membranous nephropathy (MN), and healthy controls (hCtrls). Cell viability, podocyte actin cytoskeleton architecture, and reactive oxygen species (ROS) formation with or without ROS scavenger were investigated by Cell Counting Kit-8 assay, immunofluorescence staining, and CM-H2DCFDA probing, respectively. Results Presumed CPF-containing plasma causes a series of events in podocytes but not in GMVECs. These events include actin cytoskeleton rearrangement and excessive formation of ROS, which results in podocyte loss. These effects were solely observed in response to CPF plasma collected during relapse, but not in response to plasma of hCtrls, or patients with SRNS, SSNS, and MN. The copresence of dimethylthiourea, a scavenger of ROS, abolished the aforementioned effects of CPF plasma. Conclusion We provide a panel of in vitro bioassays to measure podocyte injury and predict the presence of CPFs in plasma of patients with nephrotic syndrome (NS), providing a new framework for monitoring CPF activity that may contribute to future NS diagnostics or used for disease monitoring purposes. Moreover, our findings suggest that the inhibition of ROS formation or facilitating rapid ROS scavenging may exert beneficial effects in patients with CPFs.
Collapse
|
28
|
Assessment of hearing levels in children with nephrotic syndrome. Int J Pediatr Otorhinolaryngol 2022; 160:111230. [PMID: 35835030 DOI: 10.1016/j.ijporl.2022.111230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/12/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Due to the similarities in the physiological mechanisms and antigenicity of the kidney and cochlea, they are simultaneously affected by certain diseases and drugs. Therefore, the purpose of this study was to investigate whether the hearing functions of patients with nephrotic syndrome (NS) were affected by the severity of the disease and the cyclosporine treatment. METHODS The sample of this study consisted of 87 participants, including 65 patients (130 ears) with NS and 22 age- and sex-matched normal hearing children (44 ears). Based on the severity of the disease, the patients were divided into two groups: infrequently relapsing nephrotic syndrome (IRNS) and steroid-dependent or frequently relapsing nephrotic syndrome (SD/FRNS). Their audiologic tests, including Pure-tone Audiometry and Distortion-Product Otoacoustic Emission (DPOAE), were compared with the tests of the control group. In addition, the audiologic tests of the NS patients who received cyclosporine were compared with those who did not. RESULTS In the pure-tone audiometry, there were statistically significant differences between the IRNS, SD/FRNS, and control groups at 2000, 4000 Hz, and pure-tone average (PTA). Hearing levels of the SD/FRNS group at 2000, 4000 Hz, and PTA were higher than those of the control group. At 6000 Hz in pure-tone audiometry, there was a very weak positive correlation between the hearing level and the number of relapses. At 250 Hz and PTA, hearing levels of the group that received cyclosporine were higher compared to the group that did not receive it. In DPOAE, there was no significant difference between the groups according to the severity of the disease and the use of cyclosporine. CONCLUSION During the follow-up of the patients with NS, their hearing functions should be questioned, especially in patients with SD/FRNS and receiving cyclosporine treatment.
Collapse
|
29
|
Potential Molecular Mechanisms of Ephedra Herb in the Treatment of Nephrotic Syndrome Based on Network Pharmacology and Molecular Docking. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9214589. [PMID: 35837376 PMCID: PMC9276517 DOI: 10.1155/2022/9214589] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/30/2022] [Accepted: 06/11/2022] [Indexed: 01/17/2023]
Abstract
Objective To explore the possible mechanisms of Ephedra herb (EH) in the treatment of nephrotic syndrome (NS) by using network pharmacology and molecular docking in this study. Methods Active ingredients and related targets of EH were obtained from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database, and the gene names corresponding to the proteins were found through the UniProt database. Then, target genes related to NS were screened out from GeneCards, PharmGKB, and OMIM databases. Next, the intersection targets were obtained successfully through Venn diagram, which were also seen as key target genes of EH and NS. Cytoscape 3.9.0 software was used to construct the effective “active ingredient-target” network diagram, and “drug-ingredient-target-disease (D-I-T-D)” network diagram. After that, the STRING database was used to construct a protein-protein interaction (PPI) network. Furthermore, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment involved in the targets were performed by the DAVID database and ClueGO plugin in Cytoscape. Finally, AutoDockTools software was used for molecular docking to verify the binding strength between main active ingredients and key target proteins. Results A total of 22 main active ingredients such as quercetin, kaempferol, luteolin, and naringenin were obtained, which could act on 105 targets related to NS. Through PPI network, 53 core targets such as AKT1, TNF, IL6, VEGFA, and IL1B were found, which might play a crucial role in the treatment of NS. Meanwhile, these targets were significantly involved in PI3K-Akt signaling pathway, TNF signaling pathway, AGE-RAGE signaling pathway, hepatitis B, and pathways in cancer through GO and KEGG enrichment analysis. The docking results indicated that active ingredients such as kaempferol, luteolin, quercetin, and naringenin all had good binding to the target protein AKT1 or TNF. Among them, luteolin and naringenin binding with AKT1 showed the best binding energy (-6.2 kcal/mol). Conclusion This study indicated that the potential mechanism of EH in treating NS may be related to PI3K-Akt signaling pathway, TNF signaling pathway, and AGE-RAGE signaling pathway, which provided better approaches for exploring the mechanism in treating NS and new ideas for further in vivo and in vitro experimental verifications.
Collapse
|
30
|
Network Pharmacology and In Vivo Experimental Validation to Uncover the Renoprotective Mechanisms of Fangji Huangqi Decoction on Nephrotic Syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4223729. [PMID: 35722158 PMCID: PMC9200505 DOI: 10.1155/2022/4223729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022]
Abstract
Background Fangji Huangqi decoction (FHD) is a traditional Chinese medicine formula that has the potential efficacy for nephrotic syndrome (NS) treatment. This study aims to explore the effects and underlying mechanisms of FHD against NS via network pharmacology and in vivo experiments. Methods The bioactive compounds and targets of FHD were retrieved from the TCMSP database. NS-related targets were collected from GeneCards and DisGeNET databases. The compound-target and protein-protein interaction networks were constructed by Cytoscape 3.8 and BisoGenet, respectively. GO and KEGG analyses were performed by the DAVID online tool. The interactions between active compounds and hub genes were revealed by molecular docking. An NS rat model was established to validate the renoprotective effects and molecular mechanisms of FHD against NS in vivo. Results A total of 32 hub genes were predicted to play essential roles in FHD treating NS. Eight main bioactive compounds of FHD had the good affinity with 9 hub targets (CCL2, IL-10, PTGS2, TNF, MAPK1, IL-6, CXCL8, TP53, and VEGFA). The therapeutic effect of FHD on NS was closely involved in the regulation of inflammation and PI3K-Akt pathway. In vivo experiments confirmed the renoprotective effect of FHD on NS, evidenced by reducing the levels of proteinuria, serum creatinine, blood urea nitrogen, and inflammatory factors in NS rats. The PI3K activator 740Y-P weakened the effects of FHD against NS. Furthermore, FHD downregulated the levels of PTGS2, MAPK1, IL-6, and p-Akt in NS rats. Conclusions FHD alleviates kidney injury and inflammation in NS by targeting PTGS2, MAPK1, IL-6, and PI3K-Akt pathway.
Collapse
|
31
|
HDL and Kidney Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1377:163-170. [PMID: 35575929 DOI: 10.1007/978-981-19-1592-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Serum lipid profiles, as well as HDL can be altered in patients with kidney diseases. There are various types of kidney diseases, including nephrotic syndrome and chronic kidney disease. In patients with nephrotic syndrome, plasma levels of HDL cholesterol and ApoA-I were within or below the normal limits. The HDL cholesterol: total cholesterol ratio decreased compared to healthy individuals. In patients with chronic kidney disease (CKD), reverse cholesterol transport function of HDL is impaired, and CKD also affects the composition and function of HDL. Cardiovascular disease (CVD) is the severe complication of CKD. Furthermore, HDL might also be a potential target for the prevention of cardiovascular complications associated with CKD.
Collapse
|
32
|
Yang YQ, Chen H, Qiu LR, Zhu RF. Case Report: The Application of Dupilumab in Atopic Dermatitis Children Complicated With Nephrotic Syndrome. Front Med (Lausanne) 2022; 9:813313. [PMID: 35573014 PMCID: PMC9099359 DOI: 10.3389/fmed.2022.813313] [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: 11/18/2021] [Accepted: 04/13/2022] [Indexed: 12/01/2022] Open
Abstract
Nephrotic syndrome (NS) tends to be more common in patients with history of allergies. Atopic dermatitis (AD) is one of the most common allergic diseases in children. Dupilumab, a dual IL-4 and IL-13 inhibitor, has been widely used to treat AD patients. However, the efficacy and safety of Dupilumab in NS is unclear. We reported two AD patients with NS comorbidities treated with Dupilumab. The outcomes showed the good control of NS and less systemic steroids and/or immunosuppressive agents use during the Dupilumab treatment period, accompanied by significant relief of AD symptoms. We suggest prospective pilot studies and randomized controlled trials could be carried out to validate the efficacy and safety of Dupilumab in the treatment of NS patients.
Collapse
Affiliation(s)
- Ya-Qi Yang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li-Ru Qiu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Li-Ru Qiu
| | - Rong-Fei Zhu
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Rong-Fei Zhu
| |
Collapse
|
33
|
Ndongo A, Ranchin B, Cartier R, Bertholet-Thomas A, Bacchetta J, Cochat P. Are plasma proteins a valid alternative for assessing nephrotic syndrome in children from low-income countries? Arch Pediatr 2022; 29:263-266. [DOI: 10.1016/j.arcped.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 12/23/2022]
|
34
|
Jin J, Li Y, Zhu Y, Ni J. A single center, retrospective chart review of associations between cessation of second-line therapies and relapse rates of childhood refractory minimal change nephrotic syndrome. Curr Ther Res Clin Exp 2022; 96:100671. [PMID: 35574245 PMCID: PMC9092853 DOI: 10.1016/j.curtheres.2022.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Yufeng Li
- Address correspondence to: Yu-Feng Li, MD, PhD, Department of Pediatric Nephrology, Rheumatology, and Immunology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665, Kongjiang Rd, Yangpu District, Shanghai 200092, China.
| | | | | |
Collapse
|
35
|
Maghrabi K, Aldhaheri R, Aljunaid N, Alzahrani AS, Alsayyad HM, Kalakattawi N, Safdar O. Postoperative Intracardiac Thrombus in a Child with Nephrotic Syndrome. Int Med Case Rep J 2022; 15:91-96. [PMID: 35300123 PMCID: PMC8922339 DOI: 10.2147/imcrj.s349740] [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: 11/27/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Thromboembolic events are a known complication of nephrotic syndrome in children. Intracardiac thrombi are a rare location for thrombus formation but can lead to severe clinical consequences. Case Presentation We report an intracardiac left atrial thrombus in a child with new onset steroid-resistant nephrotic syndrome and recently repaired atrial septal defect and cor triatriatum. The thrombus was successfully treated with surgical excision. Conclusion Intracardiac thrombus is a rare but serious complication of nephrotic syndrome in children, especially in children with risk factors for potentially increased intracardiac thrombogenicity such as history of recent intervention.
Collapse
Affiliation(s)
- Khadijah Maghrabi
- Abdullah Bakhsh Children’s Heart Center, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Khadijah Maghrabi, Abdullah Bakhsh Children’s Heart Center, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Saudi Arabia, Tel +996 2 6401000 Ext. 20208, Email
| | - Ruba Aldhaheri
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nora Aljunaid
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amal Saeed Alzahrani
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hanan Mohammad Alsayyad
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nada Kalakattawi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Safdar
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
36
|
El-Halaby H, Bakr A, Eid R, Abdalla HA, Hamdy N, Shamekh N, Adel A, El-Husseiny A. Edema in childhood nephrotic syndrome: possible genes-hormones interplay. J Genet Eng Biotechnol 2022; 20:30. [PMID: 35181806 PMCID: PMC8857332 DOI: 10.1186/s43141-022-00310-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Abstract
Background The role of atrial natriuretic peptide (ANP) in edema formation in idiopathic nephrotic syndrome (INS) was studied before with conflicting results reported; however, the possible contribution of genes regulating ANP expression and receptors was never explored. Methods One hundred children (60 with active INS and 40 in remission) were studied for plasma atrial natriuretic peptide (ANP), urinary sodium, ANP gene A2843G and ScaI polymorphisms, and natriuretic peptide receptor clearance C (-55) A polymorphism. For comparative purposes, 20 healthy controls were studied for ANP levels. Results ANP was higher in active compared to remission patients (p<0.001). ANP in the healthy control group was significantly lower than the ANP level of active INS (during edema) group (p=0.009) but did not show significant differences when compared to ANP levels of either active INS group after resolution of edema or remission group (p= 0.42 and 0.56, respectively). Urinary sodium levels in edematous patients were significantly lower while ANP levels were significantly higher during edema than after resolution (p< 0.001 for both). Genotypes’ frequencies of studied polymorphisms did not differ between active and remission groups. Patients with the A1A1 genotype of ScaI polymorphism had higher ANP levels compared to other genotypes (p =0.01). Conclusions During edema, ANP levels are elevated in INS children however this increment is not associated with natriuresis suggesting a blunted renal response to ANP. Polymorphisms of genes regulating ANP levels and receptors don’t seem to be implicated in edema formation except for the A1A1 genotype of ScaI polymorphism however, its possible role needs further evaluation.
Collapse
Affiliation(s)
- Hanan El-Halaby
- Pediatric Intensive Care Unit, Pediatrics Department, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf Bakr
- Pediatric Nephrology Unit, Pediatrics Department, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Riham Eid
- Pediatric Nephrology Unit, Pediatrics Department, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | | | - Nashwa Hamdy
- Pediatric Nephrology Unit, Pediatrics Department, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nora Shamekh
- Pediatrics Department, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amira Adel
- Pediatrics Department, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Husseiny
- Pediatric Intensive Care Unit, Pediatrics Department, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
37
|
Abstract
Nephrotic syndrome (NS) encompasses a variety of disease processes leading to heavy proteinuria and edema. Minimal change disease (MCD) remains the most common primary cause of NS, as well as the most responsive to pharmacologic treatment with often minimal to no chronic kidney disease. Other causes of NS include focal segmental glomerulosclerosis, which follows MCD, and secondary causes, including extrarenal or systemic diseases, infections, and drugs. Although initial diagnosis relies on clinical findings as well as urine and blood chemistries, renal biopsy and genetic testing are important diagnostic tools, especially when considering non-MCD NS. Moreover, biomarkers in urine and serum have become important areas for research in this disease. NS progression and prognosis are variable and depend on etiology, with corticosteroids being the mainstay of treatment. Other alternative therapies found to be successful in inducing and maintaining remission include calcineurin inhibitors and rituximab. Disease course can range from recurrent disease relapse with or without acute kidney injury to end-stage renal disease in some cases. Given the complex pathogenesis of NS, which remains incompletely understood, complications are numerous and diverse and include infections, electrolyte abnormalities, acute kidney injury, and thrombosis. Pediatricians must be aware of the presentation, complications, and overall long-term implications of NS and its treatment.
Collapse
|
38
|
Li W, Shou X, Xiang W, He L, Li L, Fu H, Mao J. Urinary Sediment mRNA Level of CREBBP and CYBA in Children With Steroid-Resistant Nephrotic Syndrome. Front Immunol 2022; 12:801313. [PMID: 35173708 PMCID: PMC8841695 DOI: 10.3389/fimmu.2021.801313] [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: 10/25/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study aimed to evaluate gene expression patterns in urinary sediment samples of children with steroid-resistant nephrotic syndrome (SRNS).MethodsThe messenger RNA (mRNA) levels of 770 immune-related genes were detected using a NanoString nCounter platform. To verify the NanoString results, quantitative analysis of nine gene mRNAs was performed using real-time RT-PCR in more samples.ResultsFirstly, compared with the steroid-sensitive nephrotic syndrome (SSNS) group (n=3), significant changes were observed in the mRNA level of 70 genes, including MAP3K14, CYBA, SLC3A2, CREB-binding protein (CREBBP), CD68, forkhead box P1 (FOXP1), CD74, ITGB2, IFI30, and so forth, in the SRNS group (n=3). A total of 129 children with idiopathic nephrotic syndrome (INS), 15 with acute glomerulonephritis, and 6 with immunoglobulin A nephropathy (IgAN) were enrolled to verify the NanoString results. Compared with patients with IgAN, those with INS had significantly lower levels of FOXP1 (P=0.047) and higher levels of CREBBP (P=0.023). Among SSNS, the mRNA level of ITGB2 was significantly lower in the non-relapse group than in the non-frequent relapse and frequent-relapse groups (P=0.006). Compared with the SSNS group, CREBBP was significantly elevated in the SRNS group (P=0.02). Further, CYBA significantly decreased in the SRNS group (P=0.01). The area under the curve (AUC) for CREBBP and CYBA was 0.655 and 0.669, respectively. CREBBP had a sensitivity of 83.3% and a specificity of 49.4% and CYBA had a sensitivity of 58.3% and a specificity of 83.1% to rule out SSNS and SRNS. The diagnosis value was better for CREBBP+CYBA than for CREBBP or CYBA alone, indicating that the combination of CREBBP and CYBA was a more effective biomarker in predicting steroid resistance (AUC=0.666; sensitivity=63.9%; specificity=76.4%).ConclusionsThis study was novel in investigating the urinary sediment mRNA level in children with INS using high-throughput NanoString nCounter technology, and 70 genes that may relate to SRNS were found. The results revealed that the urinary sediment mRNA level of ITGB2 was significantly lower in the non-relapse group than in the non-frequent relapse and frequent-relapse groups. Meanwhile, CREBBP was significantly elevated and CYBA was significantly lowered in the SRNS group compared with the SSNS group.
Collapse
Affiliation(s)
- Wei Li
- Department of Clinical Laboratory, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xinyi Shou
- Department of Nephrology, The Children’ s Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Wenqing Xiang
- Department of Clinical Laboratory, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lin He
- Department of Clinical Laboratory, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lin Li
- Department of Clinical Laboratory, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Haidong Fu
- Department of Nephrology, The Children’ s Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Jianhua Mao
- Department of Nephrology, The Children’ s Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
- *Correspondence: Jianhua Mao,
| |
Collapse
|
39
|
Tahir N, Hashim RK, Bohan A, Mahmood L. Assessment of Cystatin-C level in Newly Diagnosed Iraqi Children with Nephritic Syndrome. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Nephritic syndrome (NS) is a common kidney disease in children that causes protein leakage from the blood into the urine due to glomerular injury.
AIM: The aim of this research was to determine the level of Cystatin-C (CysC) and other biochemical parameters in newly diagnosed NS children in Iraq.
PATIENTS AND METHODS: Ninety Iraqi children divided into: 50 children with newly diagnosed NS (28 boys and 22 girls) aged between (4 and 16) years, and 40 healthy control children (20 boys and 20 girls) aged between (5 and 16) years, who were attending Al-Yarmouk Teaching Hospital, Baghdad.
RESULTS: There was a significant increase in blood urea, serum total cholesterol (S.TC), and serum low density lipoprotein (S.LDL) and a significant decreased of serum creatinine (S. creatinine), protein/creatinine ratio, serum total bilirubin, serum albumin, and serum high density lipoprotein, while a highly significant increased (p < 0.001) of CysC levels in children with newly diagnosed NS when compared with control group. A significant positive correlation between CysC level versus systolic blood pressure, body mass index, diastolic blood pressure, S.TC, S. LDL cholesterol (S.LDL-C), S. Total Bilirubin, S. Albumin, S. Total protein, and B. urea, while a significant negative correlation was found between CysC level versus serum low density lipoprotein cholesterol and estimated glomerular filtration rate in children with newly diagnosed NS.
CONCLUSION: It may come to the conclusion that CysC can be the best predictor of overall efficacy than creatinine and in the diagnosis of any damage to the kidney in children with NS.
Collapse
|
40
|
An evaluation of kidney dysfunction as a common symptom of typhoid infection in an endemic country: A rare case study. IDCases 2022; 29:e01580. [PMID: 35942255 PMCID: PMC9356191 DOI: 10.1016/j.idcr.2022.e01580] [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: 04/12/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Nephrotic syndrome and encephalopathy are uncommon complications that occurred in typhoid fever. The diagnosis is based on proteinuria finding with nephrotic range value, edema, and hypoalbuminemia. In this study, a 10-year-old boy was diagnosed with encephalopathy typhoid and nephrotic syndrome. The physical examination and urinalysis were conducted with methylprednisolone 60 mg/body surface area and captopril to reduce proteinuria.
Collapse
|
41
|
Sachdeva S, Khan S, Davalos C, Avanthika C, Jhaveri S, Babu A, Patterson D, Yamani AJ. Management of Steroid-Resistant Nephrotic Syndrome in Children. Cureus 2021; 13:e19363. [PMID: 34925975 PMCID: PMC8654081 DOI: 10.7759/cureus.19363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Nephrotic syndrome (NS) affects 115-169 children per 100,000, with rates varying by ethnicity and location. Immune dysregulation, systemic circulating substances, or hereditary structural abnormalities of the podocyte are considered to have a role in the etiology of idiopathic NS. Following daily therapy with corticosteroids, more than 85% of children and adolescents (often aged 1 to 12 years) with idiopathic nephrotic syndrome have full proteinuria remission. Patients with steroid-resistant nephrotic syndrome (SRNS) do not demonstrate remission after four weeks of daily prednisolone therapy. The incidence of steroid-resistant nephrotic syndrome in children varies between 35 and 92 percent. A third of SRNS patients have mutations in one of the important podocyte genes. An unidentified circulating factor is most likely to blame for the remaining instances of SRNS. The aim of this article is to explore and review the genetic factors and management of steroid-resistant nephrotic syndrome. An all language literature search was conducted on MEDLINE, COCHRANE, EMBASE, and Google Scholar till September 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: “Steroid resistance”, “nephrotic syndrome”, “nephrosis” and “hypoalbuminemia”. We comprehensively reviewed the literature on the epidemiology, genetics, current treatment protocols, and management of steroid-resistant nephrotic syndrome. We found that for individuals with non-genetic SRNS, calcineurin inhibitors (cyclosporine and tacrolimus) constitute the current mainstay of treatment, with around 70% of patients achieving full or partial remission and an acceptable long-term prognosis. Patients with SRNS who do not react to calcineurin inhibitors or other immunosuppressive medications may have deterioration in kidney function and may develop end-stage renal failure. Nonspecific renal protective medicines, such as angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers, and anti-lipid medications, slow the course of the illness. Recurrent focal segmental glomerulosclerosis in the allograft affects around a third of individuals who get a kidney transplant, and it frequently responds to a combination of plasma exchange, rituximab, and increased immunosuppression. Despite the fact that these results show a considerable improvement in outcome, further multicenter controlled studies are required to determine the optimum drugs and regimens to be used.
Collapse
Affiliation(s)
| | - Syeda Khan
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | | | - Chaithanya Avanthika
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND.,Pediatrics, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Sharan Jhaveri
- Internal Medicine, Smt. NHL Municipal Medical College (MMC), Ahmedabad, IND
| | - Athira Babu
- Pediatrics, Saudi German Hospital, Dubai, ARE
| | | | - Abdullah J Yamani
- Pediatric Medicine, Coast General Teaching and Referral Hospital, Mombasa, KEN
| |
Collapse
|
42
|
Lv J, Luo S, Zhang Y, Dai E. The effectiveness of cyclosporine A for patients with steroid-resistant nephrotic syndrome: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28186. [PMID: 34889296 PMCID: PMC8663857 DOI: 10.1097/md.0000000000028186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The purpose of this study is to determine the efficacy and safety of Cyclosporine A (CsA) for patients with steroid-resistant nephrotic syndrome (SRNS). METHODS This study will be designed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement guidelines. Studies are identified through systematic searches in November 2021 with no restrictions on date and time, and publication status using the following bibliographic databases: Embase, Medline, PubMed, Web of Science, Science Direct, and the Cochrane Library. The risk of bias of included studies is estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting, and other bias by Cochrane Collaboration's tool. Data synthesis and analyses are performed using Stata version 10.0 software. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION CsA may be an effective and safe therapy for SRNS. However, additional randomized controlled studies are needed to thoroughly assess the role of CsA in the treatment of SRNS. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER 10.17605/OSF.IO/P6YB9.
Collapse
Affiliation(s)
- Juan Lv
- College of Integrated Traditional Chinese and Western Medicine, Gansu University of Traditional Chinese Medicine, Gansu, China
- Department of Emergency, Gansu Hospital of Traditional Chinese Medicine, Gansu, China
| | - Shizhi Luo
- Department of Song's Orthopedics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Gansu, China
| | - Yunxia Zhang
- Department of Neurology, Gansu Hospital of Traditional Chinese Medicine, Gansu, China
| | - Enlai Dai
- Integrated Traditional Chinese and Western Medicine College, Gansu University of Traditional Chinese Medicine, Gansu, China
| |
Collapse
|
43
|
Haddad M, Kale A, Butani L. Intravenous cyclophosphamide induces remission in children with difficult to treat steroid resistant nephrotic syndrome from minimal change disease. BMC Nephrol 2021; 22:395. [PMID: 34839817 PMCID: PMC8628458 DOI: 10.1186/s12882-021-02605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Steroid resistant nephrotic syndrome (SRNS), while uncommon in children, is associated with significant morbidity. Calcineurin inhibitors (CNIs) remain the first line recommended therapy for children with non-genetic forms of SRNS, but some children fail to respond to them. Intravenous (IV) cyclophosphamide (CTX) has been shown to be effective in Asian-Indian children with difficult to treat SRNS (SRNS-DTT). Our study evaluated the outcome of IV CTX treatment in North American children with SRNS-DTT. Methods Retrospective review of the medical records of children with SRNS-DTT treated with IV CTX from January 2000 to July 2019 at our center. Data abstracted included demographics, histopathology on renal biopsy, prior and concomitant use of other immunosuppressive agents and serial clinical/laboratory data. Primary outcome measure was attainment of complete remission (CR). Results Eight children with SRNS-DTT received monthly doses (median 6; range 4–6) of IV CTX. Four (50%) went into CR, 1 achieved partial remission and 3 did not respond. Three of the 4 responders had minimal change disease (MCD). Excluding the 1 child who responded after the 4th infusion, the median time to CR was 6.5 (range 0.5–8) months after completion of IV CTX infusions. Three remain in CR at a median of 8.5 years (range: 3.7–10.5 years) after completion of CTX; one child relapsed and became steroid-dependent. No infections or life-threatening complications related to IV CTX were observed. Conclusions IV CXT can induce long term remission in North-American children with MCD who have SRNS-DTT.
Collapse
Affiliation(s)
- Maha Haddad
- Section of Pediatric Nephrology, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Arundhati Kale
- Section of Pediatric Nephrology, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Lavjay Butani
- Section of Pediatric Nephrology, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA.
| |
Collapse
|
44
|
Yahia S, Hammad A, El-Gilany AH, El-Assmy M, El-Tanbouly R, Elsaid AM, Elmoursi LZ, Elshazli RM, Shoaib RM. Genetic variant in the 5' untranslated region of endothelin1 (EDN1) gene in children with primary nephrotic syndrome. J Biochem Mol Toxicol 2021; 36:e22963. [PMID: 34783119 DOI: 10.1002/jbt.22963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022]
Abstract
Endothelin-1 plays a crucial role in the pathophysiology of nephrotic syndrome (NS) in children. The primary purpose of this study is to evaluate the contribution of the EDN1 (3A/4A; rs1800997) variant to the risk of nephrotic syndrome. This study involves 200 participants (100 healthy controls, 50 steroid-sensitive nephrotic syndromes [SSNS] patients, and 50 steroid-resistant nephrotic syndromes [SRNS] patients]. Genomic DNA has been characterized using the PCR-RFLP technique. The predominant genotype that is common in this study population was the EDN1 3A/3A genotype (NS [75%] and healthy controls [88%]). The prevalence of EDN1 3A/4A genotype and EDN1 4A allele was significantly increased among NS patients compared with healthy subjects (p-value < 0.05). Furthermore, the frequency of the EDN1 (3A/4A; rs1800997) variant was statistically significant among SRNS patients (p-value < 0.05). The EDN1 3A/4A genotype and the EDN1 4A allele were identified as independent risk factors of the nephrotic syndrome among children.
Collapse
Affiliation(s)
- Sohier Yahia
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ayman Hammad
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abdel-Hady El-Gilany
- Department of Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed El-Assmy
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha El-Tanbouly
- Resident of Pediatrics and Neonatology, Aga Central Hospital, Aga, Egypt
| | - Afaf M Elsaid
- Department of Biochemistry, Genetics Unit, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Lamiaa Z Elmoursi
- Department of Clinical Pathology, Student Hospital, Mansoura University, Mansoura, Egypt
| | - Rami M Elshazli
- Department of Basic Sciences, Biochemistry and Molecular Genetics Unit, Faculty of Physical Therapy, Horus University - Egypt, New Damietta, Egypt
| | - Rasha Ms Shoaib
- Department of Biochemistry, Faculty of Science, Damietta University, Damietta, Egypt
| |
Collapse
|
45
|
Polderman N, Cushing M, McFadyen K, Catapang M, Humphreys R, Mammen C, Matsell DG. Dietary intakes of children with nephrotic syndrome. Pediatr Nephrol 2021; 36:2819-2826. [PMID: 33783623 DOI: 10.1007/s00467-021-05055-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/06/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Our multidisciplinary clinical pathway for treatment of childhood nephrotic syndrome (NS) was established with the goal of standardizing local clinical practice. This descriptive study aimed to assess nutrient intakes of children with newly diagnosed NS compared with nutrition goals defined by our pathway. METHODS Our pathway includes evidence-based recommendations that target daily intakes during corticosteroid induction therapy: energy (Estimated Energy Requirements (EER) × Sedentary Physical Activity (PA)), sodium (1 mg/kcal), calcium (Dietary Reference Intake (DRI) + 500 mg elemental calcium), and vitamin D (DRI +800-1000 IU). After dietitian-led education at initial diagnosis, 3-day food records were completed at 4 weeks post-diagnosis. Daily nutrient intakes were compared to pathway targets and DRIs. RESULTS Thirty-six children (median age 4.8 years, 44% female) with newly diagnosed NS submitted food records. Mean energy and sodium intakes were 103±22% and 99±53% of pathway targets, respectively. Fourteen (39%) children exceeded pathway sodium recommendations, with four (11%) exceeding them by greater than 50%. Seven (19%) children met DRI for calcium, while six (17 %) met pathway targets for calcium. No children met DRI for vitamin D from diet alone; and only one met the target with supplementation. CONCLUSIONS This is the first study to describe dietary intakes of children with newly diagnosed NS. Our clinical pathway targets for energy and sodium were achievable; however, calcium and vitamin D intakes fell short of pathway guidelines and DRIs. Prescription of supplemental calcium and vitamin D may be needed to achieve target intakes of calcium and vitamin D.
Collapse
Affiliation(s)
- Nonnie Polderman
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada. .,British Columbia Children's Hospital, 4480 Oak Street, Room K4-169, Vancouver, BC, V6H 2V2, Canada.
| | - Meredith Cushing
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten McFadyen
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Marisa Catapang
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robert Humphreys
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cherry Mammen
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Douglas G Matsell
- Division of Nephrology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
46
|
Novel insights in the genetics of steroid-sensitive nephrotic syndrome in childhood. Pediatr Nephrol 2021; 36:2165-2175. [PMID: 33084934 DOI: 10.1007/s00467-020-04780-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Steroid-sensitive nephrotic syndrome (SSNS) is the most common form of nephrotic syndrome in childhood and there is growing evidence that genetics play a role in the susceptibility for the disease. Familial clustering has been observed and has led to several studies on familial SSNS trying to identify a monogenic cause of the disease. Until now, however, none of these have provided convincing evidence for Mendelian inheritance. This and the phenotypic variability within SSNS suggest a complex inheritance pattern, where multiple variants and interactions between those and the environment play roles in disease development. Genome-wide association studies (GWASs) have been used to investigate this complex disease. We herein highlight new insights in the genetics of the disease provided by GWAS and identify how these insights fit into our understanding of the pathogenesis of SSNS.
Collapse
|
47
|
Ruslie RH, Darmadi D, Pakpahan C. Health-Related Quality of Life Difference between Early Diagnosed and Finished Therapy of Nephrotic Syndrome in Children. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Nephrotic syndrome is the most common glomerular disease in children with high economic burden. The management of nephrotic syndrome at present is not only focusing in outcomes of disease but also the burden related to health-related quality of life (HRQOL). HRQOL of children with nephrotic syndrome is influenced by steroid dependence, steroid resistance, cytotoxic therapy, frequency of relapse, disease severity, socioeconomic status, and duration of illness.
AIM: The objective of the study is to determine the difference of HRQOL in children between early diagnosed nephrotic syndrome and finished therapy of nephrotic syndrome.
METHODS: A cross-sectional study was conducted between January and December 2018. Subjects were children aged 1–18 years with nephrotic syndrome and then divided into 2 groups based on either in the 1st week of full dose corticosteroid treatment or in the 1st week after finishing therapy equally. Demographical data, nutritional status, and laboratory results were obtained. HRQOL was measured using PedsQL 4.0 questionnaire in the Indonesian language. The difference of HRQOL was analyzed using independent T-test.
RESULTS: A total of 100 subjects enrolled in this study and divided into two groups. Male-to-female ratio was 4:1 in early diagnosed group and 7.3:1 in finished therapy group. Mean age of subjects for the early diagnosed group was 4.6 years and finished therapy group was 5.3 years. Total HRQOL was improved after treatment administration in children with nephrotic syndrome (p < 0.001). The improvement was most significant in physical domain (p = 0.002).
CONCLUSION: HRQOL in children with early diagnosed nephrotic syndrome was lower compared to children with finished therapy of nephrotic syndrome.
Collapse
|
48
|
Huang YC, Tsai MC, Tsai CR, Fu LS. Frasier Syndrome: A Rare Cause of Refractory Steroid-Resistant Nephrotic Syndrome. CHILDREN-BASEL 2021; 8:children8080617. [PMID: 34438508 PMCID: PMC8394468 DOI: 10.3390/children8080617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022]
Abstract
Frasier syndrome is a rare disease that affects the kidneys and genitalia. Patients who have Frasier syndrome develop nephrotic syndrome (NS) featuring focal segmental glomerulosclerosis (FSGS) that is resistant to steroid treatment in early childhood. Male patients can have female external genitalia (pseudo-hermaphroditism) at birth and develop gonado-blastoma in their adolescence. Frasier syndrome is caused by mutations in the splice donor site at intron 9 of the Wilms’ tumor WT1 gene; these mutations result in an imbalanced ratio of WT1 protein isoforms and affect the development of the urogenital tract, podocyte function, and tumor suppression. Here, we report on a patient with long-term refractory NS who developed a malignant mixed germ cell tumor arising in a gonado-blastoma of the ovary 8 years after the onset of proteinuria.
Collapse
Affiliation(s)
- Yung-Chieh Huang
- Department of Pediatrics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; (Y.-C.H.); (M.-C.T.); (C.-R.T.)
| | - Ming-Chin Tsai
- Department of Pediatrics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; (Y.-C.H.); (M.-C.T.); (C.-R.T.)
| | - Chi-Ren Tsai
- Department of Pediatrics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; (Y.-C.H.); (M.-C.T.); (C.-R.T.)
- Institute of Molecular Biology, National Chung Hsing University, Taichung 40227, Taiwan
| | - Lin-Shien Fu
- Department of Pediatrics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; (Y.-C.H.); (M.-C.T.); (C.-R.T.)
- Institute of Molecular Biology, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Pediatrics, National Yang-Ming University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-4-23592525 (ext. 5909); Fax: +886-4-23741359
| |
Collapse
|
49
|
Li L, Zhu M, Li DY, Guo HL, Hu YH, Xu ZY, Jing X, Chen F, Zhao F, Li YM, Xu J, Jiao Z. Dose tailoring of tacrolimus based on a non-linear pharmacokinetic model in children with refractory nephrotic syndrome. Int Immunopharmacol 2021; 98:107827. [PMID: 34284341 DOI: 10.1016/j.intimp.2021.107827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
The population pharmacokinetics (PPK) of tacrolimus (TAC) in children with refractory nephrotic syndrome (RNS) have not been well-characterized. This study aimed to investigate the significant factors affecting the TAC PPK characteristics of children with RNS and to optimize the dosing regimen. A total of 494 concentrations from 108 children were obtained from routine therapeutic drug monitoring between 2016 and 2018. Information regarding the demographic features, laboratory test results, genetic polymorphisms of CYP3A5 (rs776746) and co-therapy medications were collected. PPK analysis was performed using the nonlinear mixed-effects modelling (NONMEM) software and two modelling strategies (the linear one-compartment model and nonlinear Michaelis-Menten model) were evaluated and compared. CYP3A5 genotype, weight, daily dose of TAC and daily dose of diltiazem were retained in the final linear model. The absorption rate constant (Ka) was set at 4.48 h-1 in the linear model, and the apparent clearance (CL/F) and volume of distribution (V/F) in the final linear model were 14.2 L/h and 172 L, respectively. CYP3A5 genotype, weight and daily dose of diltiazem were the significant factors retained in the final nonlinear model. The maximal dose rate (Vmax) and the average steady-state concentration at half-Vmax (Km) in the final nonlinear model were 2.15 mg/day and 0.845 ng/ml, respectively. The nonlinear model described the pharmacokinetic data of TAC better than the linear model in children with RNS. A dosing regimen was proposed based on weight, CYP3A5 genotype and daily dose of diltiazem according to the final nonlinear PK model, which may facilitate individualized drug therapy with TAC.
Collapse
Affiliation(s)
- Ling Li
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Min Zhu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Pharmacy, Shanghai Chest Hospital, Shanghai, China
| | - De-Yi Li
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hong-Li Guo
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ze-Yue Xu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xia Jing
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Fei Zhao
- Department of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yun-Man Li
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jing Xu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Zheng Jiao
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai, China.
| |
Collapse
|
50
|
Renal Involvement in Congenital Cytomegalovirus Infection: A Systematic Review. Microorganisms 2021; 9:microorganisms9061304. [PMID: 34203932 PMCID: PMC8232607 DOI: 10.3390/microorganisms9061304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/03/2021] [Accepted: 06/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Congenital cytomegalovirus (cCMV) infection is the most frequent mother-to-child transmitted infection worldwide and a prevalent cause of neonatal disease and long-term morbidity. The kidney is a target organ for CMV, which replicates in renal tubules and is excreted in large quantities in urine for years in children with cCMV infection. Nonetheless, kidney disease has rarely been reported in cCMV-infected patients. Objective: We aimed to describe the available data on renal involvement in patients with cCMV infection at the pathologic, functional, anatomical, and/or clinical levels. Methods: A systematic search was performed in the MEDLINE/PubMed, SCOPUS, and Cochrane databases. Studies describing any renal involvement in fetuses or neonates aged ≤3 weeks at diagnosis of microbiologically confirmed cCMV infection were eligible. Results: Twenty-four articles were included, with a very low level of evidence. Pathologic findings in autopsy studies universally described CMV typical inclusion bodies in tubular cells. No functional studies were identified. cCMV infection was not associated with an increased risk of kidney malformations. Congenital nephrotic syndrome was the most common clinical condition associated with cCMV, but a causal relationship cannot be established. Conclusions: Typical pathological features of cCMV infection are very common in renal tissue, but they do not seem to entail significant consequences at the anatomical or clinical levels.
Collapse
|