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Roveta A, Parodi EL, Brezzi B, Tunesi F, Zanetti V, Merlotti G, Francese A, Maconi AG, Quaglia M. Lupus Nephritis from Pathogenesis to New Therapies: An Update. Int J Mol Sci 2024; 25:8981. [PMID: 39201667 PMCID: PMC11354900 DOI: 10.3390/ijms25168981] [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: 07/11/2024] [Revised: 08/03/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024] Open
Abstract
Lupus Nephritis (LN) still represents one of the most severe complications of Systemic Lupus Erythematosus (SLE) and a major risk factor for morbidity and mortality. However, over the last few years, several studies have paved the way for a deeper understanding of its pathogenetic mechanisms and more targeted treatments. This review aims to provide a comprehensive update on progress on several key aspects in this setting: pathogenetic mechanisms of LN, including new insight into the role of autoantibodies, complement, vitamin D deficiency, and interaction between infiltrating immune cells and kidney resident ones; the evolving role of renal biopsy and biomarkers, which may integrate information from renal histology; newly approved drugs such as voclosporin (VOC) and belimumab (BEL), allowing a more articulate strategy for induction therapy, and other promising phase III-immunosuppressive (IS) agents in the pipeline. Several adjunctive treatments aimed at reducing cardiovascular risk and progression of chronic renal damage, such as antiproteinuric agents, represent an important complement to IS therapy. Furthermore, non-pharmacological measures concerning general lifestyle and diet should also be adopted when managing LN. Integrating these therapeutic areas requires an effort towards a holistic and multidisciplinary approach. At the same time, the availability of an increasingly wider armamentarium may translate into improvements in patient's renal outcomes over the next decades.
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Affiliation(s)
- Annalisa Roveta
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Emanuele Luigi Parodi
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
| | - Brigida Brezzi
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
| | - Francesca Tunesi
- Nephrology and Dialysis Unit, IRCCS “San Raffaele” Scientific Institute, 20132 Milan, Italy;
| | - Valentina Zanetti
- Department of Internal Medicine, University of Genova, 16126 Genoa, Italy;
| | - Guido Merlotti
- Department of Primary Care, Azienda Socio Sanitaria Territoriale (ASST) of Pavia, 27100 Pavia, Italy;
| | - Alessia Francese
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Antonio G. Maconi
- Research and Innovation Department (DAIRI), “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (A.R.); (A.F.); (A.G.M.)
| | - Marco Quaglia
- Nephrology and Dialysis Unit, “SS Antonio e Biagio e Cesare Arrigo” University Hospital, 15121 Alessandria, Italy; (E.L.P.); (B.B.)
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100 Novara, Italy
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2
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Pană N, Ștefan G, Stancu S, Zugravu A, Ciurea O, Petre N, Mircescu G, Căpușă C. Clinicopathological Characteristics and Disease Chronicity in Glomerular Diseases: A Decade-Long Study at Romania's Largest Kidney Biopsy Reference Center. Biomedicines 2024; 12:1143. [PMID: 38927350 PMCID: PMC11200787 DOI: 10.3390/biomedicines12061143] [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: 04/16/2024] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
Glomerular diseases (GDs), significant causes of end-stage kidney disease, are better understood through epidemiological studies based on kidney biopsies (KBs), which provide important insights into their prevalence and characteristics. This study aims to analyze the clinicopathological features of GDs diagnosed from 2008 to 2017 at Romania's largest reference center. In this decade-long study, 1254 adult patients diagnosed with GDs were included. The local previously validated renal histopathological prognostic score was calculated for each KB using four histopathologic lesions: global glomerulosclerosis, tubular atrophy, interstitial fibrosis and fibrocellular/fibrous crescents. The mean patient age was 50 years, with a male predominance (57%). The primary referral reasons were nephrotic syndrome (46%), nephritic syndrome (37%), chronic kidney disease (12%), asymptomatic urinary abnormalities (4%), and acute kidney injury (1%). Immunoglobulin A nephropathy (IgAN) was the most frequently diagnosed GD (20%), aligning with frequencies reported in European registries. Diabetic glomerular nephropathy was the most common secondary GD (10%). It also presented the highest median renal histopathological prognostic score (2), indicating a poorer prognosis. Lower eGFR and higher proteinuria were independently associated with higher scores. This decade-long study highlights IgAN as the most frequent GD diagnosed by KB. Diabetic glomerular nephropathy was identified as the most common secondary GD. The renal histopathological prognostic score, notably high in diabetic glomerular nephropathy patients, was correlated with lower eGFR and higher proteinuria, underlining its clinical relevance.
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Affiliation(s)
- Nicolae Pană
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Diaverum Morarilor” Nephrology and Dialysis Medical Center, 022452 Bucharest, Romania
| | - Gabriel Ștefan
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Simona Stancu
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Adrian Zugravu
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Otilia Ciurea
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Nicoleta Petre
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Gabriel Mircescu
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Cristina Căpușă
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (N.P.); (S.S.); (A.Z.); (O.C.); (N.P.); (G.M.); (C.C.)
- “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
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3
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Gauckler P, Zitt E, Regele H, Eller K, Säemann MD, Lhotta K, Neumann I, Rudnicki M, Odler B, Kronbichler A, Zschocke J, Windpessl M. [Diagnosis and treatment of focal-segmental glomerulosclerosis-2023]. Wien Klin Wochenschr 2023; 135:638-647. [PMID: 37728649 PMCID: PMC10511576 DOI: 10.1007/s00508-023-02260-x] [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] [Accepted: 07/24/2023] [Indexed: 09/21/2023]
Abstract
The histopathological term focal-segmental glomerulosclerosis comprises different pathogenic processes with the unifying features of a high proteinuria and the name-giving glomerular lesion pattern seen on light microscopy. A differentiation according to the underlying cause into primary, secondary and genetic forms is therefore of utmost importance. The pathogenesis of primary focal-segmental glomerulosclerosis remains unknown but, like minimal-change disease, an autoimmune-mediated process leading to podocyte damage is assumed. Consequently, the unifying term "podocytopathy" is increasingly being used for both entities. Supportive treatment measures to preserve kidney function are important in all subtypes. In contrast, immunosuppressive treatment is only indicated in primary focal-segmental glomerulosclerosis. Steroid-dependence, steroid-resistance and frequently relapsing disease often complicate disease management and necessitate alternative treatment strategies. Here, the Austrian Society of Nephrology (ÖGN) provides consensus recommendations on how to best diagnose and manage patients with focal-segmental glomerulosclerosis.
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Affiliation(s)
- Philipp Gauckler
- Department Innere Medizin IV (Nephrologie und Hypertensiologie), Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Emanuel Zitt
- Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Heinz Regele
- Klinisches Institut für Pathologie, Medizinische Universität Wien, Wien, Österreich
| | - Kathrin Eller
- Klinische Abteilung für Nephrologie, Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Medizinische Universität Graz, Graz, Österreich
| | - Marcus D. Säemann
- 6.Medizinische Abteilung mit Nephrologie & Dialyse, Klinik Ottakring, Wien, Österreich
- Medizinische Fakultät, SFU, Wien, Österreich
| | - Karl Lhotta
- Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Irmgard Neumann
- Vasculitis.at, Wien, Österreich
- Immunologiezentrum Zürich (IZZ), Zürich, Schweiz
| | - Michael Rudnicki
- Department Innere Medizin IV (Nephrologie und Hypertensiologie), Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Balazs Odler
- Klinische Abteilung für Nephrologie, Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Medizinische Universität Graz, Graz, Österreich
| | - Andreas Kronbichler
- Department Innere Medizin 4 (Nephrologie und Hypertensiologie), Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Johannes Zschocke
- Institut für Humangenetik, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Martin Windpessl
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Österreich
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Kanjanabuch T, Isaranuwatchai S, Nopsopon T, Thammathiwat T, Pooprasert T, Puapatanakul P, Pongpirul K, Chawanasuntorapoj R, Kittiskulnam P, Eiam-Ong S, Tungsanga K, Chusil S, Ophascharoensuk V, Vanichakarn S, Sitprija V, Boonpucknavig V. Exploring hospital practice types and their impact on glomerular pathologic patterns: Insights from the largest kidney biopsy cohort in Thailand. Nephrology (Carlton) 2023; 28 Suppl 1:24-34. [PMID: 37534843 DOI: 10.1111/nep.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND This study aims to investigate the influence of different kidney biopsy practices on the prevalence of glomerular pathologic patterns in the largest kidney biopsy registry in Thailand. METHODS We conducted a retrospective review of kidney biopsy records from the period between 2000 and 2014. The records were obtained from 2 major institutions: King Chulalongkorn Memorial Hospital, a large university-based hospital, and the Kidney Center Bangkok Hospital, which provides pathology services to hospitals throughout Thailand. The study included native kidney biopsies from all provinces in Thailand, excluding paediatric patients, kidney transplant recipients, and cases of inadequate and repeated biopsies. Patient demographics, indications for biopsy, and final glomerular diagnoses were compared across different hospital practice settings: university (UVH), private (PVH) and public (PBH). RESULTS A total of 5893 eligible native kidney biopsies were identified from a pool of 7005 biopsies conducted over a 15-year period in 25 provinces throughout Thailand. The 3 most common indications for biopsy were suspected kidney involvement in systemic lupus erythematosus (SLE) (29%), nephrotic syndrome (NS) (29%), and acute glomerulonephritis (AGN)/rapidly progressive glomerulonephritis (RPGN) (13%). The leading indication for biopsy differed across practice types, with suspected kidney involvement in SLE being the primary indication in UVH, while NS took precedence in both PBH and PVH practices. Notably, UVH performed fewer kidney biopsies for asymptomatic urinary abnormalities and diabetes-related indications compared with PVH and PBH. The leading glomerular diagnoses correlated with the biopsy indications, with lupus nephritis (LN) being the most common diagnosis in UVH and PBH practices, whiles immunoglobulin A nephropathy was the predominant diagnosis in PVH practice. CONCLUSION Hospital practice types significantly impact the prevalence of glomerular pathologic diagnosis patterns in kidney biopsy data, highlighting the importance of considering this influence in epidemiological comparisons.
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Affiliation(s)
- Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suramath Isaranuwatchai
- Division of Nephrology, Department of Medicine, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Theerachai Thammathiwat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Thitipong Pooprasert
- Department of Internal medicine department, Uttaradit Hospital, Uttaradit, Thailand
| | - Pongpratch Puapatanakul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Ratana Chawanasuntorapoj
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kring Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saowaluck Chusil
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vuddhidej Ophascharoensuk
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Visith Sitprija
- Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok, Thailand
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5
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Bobart SA, Portalatin G, Sawaf H, Shettigar S, Carrion-Rodriguez A, Liang H, Herlitz L, Gebreselassie SK. The Cleveland Clinic Kidney Biopsy Epidemiological Project. KIDNEY360 2022; 3:2077-2085. [PMID: 36591368 PMCID: PMC9802556 DOI: 10.34067/kid.0005882022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The kidney biopsy is the gold standard for diagnosing glomerular diseases. Large-scale, epidemiologic studies describing the prevalence of kidney diseases are lacking, especially in the United States. We aimed to determine the spectrum of biopsy-proven kidney disease across the Cleveland Clinic enterprise. METHODS We identified all patients with a native kidney biopsy performed or reviewed at the Cleveland Clinic from January 2015 to September 2021. Retrospective chart review was performed to obtain clinical and demographic characteristics. Results were stratified by age, sex, race, and location to determine epidemiologic trends. RESULTS Of >9600 patients, we excluded transplant and donor biopsies and unavailable records, and included 4128 patients with native kidney biopsy data. The median age was 60 years, with 46% female patients. Self-reported racial demographics included 73% White, 22% Black, 3% multiracial, and 2% Asian background, with 5% Hispanic. Common diagnoses were: FSGS (n=633, 15%), diabetic kidney disease (DKD) (n=602, 15%), IgA nephropathy (n=319, 8%), lupus nephritis (LN) (n=289, 7%), pauci-immune glomerulonephritis (n=275, 7%), membranous nephropathy (n=211, 5%), and amyloidosis (n=110, 3%). There were 3322 patients in Ohio, with 361 patients in Florida. Using multivariate analysis, those aged >70 years were more likely to have FSGS, whereas those <45 years were more likely to have IgA nephropathy or LN. Males were more likely to have FSGS or IgAN, and less likely to have LN. Black patients were more likely to have FSGS, DKD, or LN. Hispanic patients were more likely to have DKD. Finally, patients in Florida were more likely to have LN. There was no change in the disease spectrum before and during the COVID-19 pandemic. CONCLUSION Our study catalogs the spectrum of biopsy-proven kidney disease across the Cleveland Clinic enterprise. This lays the foundation for glomerular disease clinical trials, and highlights the need for a standardized national kidney biopsy registry to bolster glomerular and kidney disease research in the United States.
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Affiliation(s)
- Shane A. Bobart
- Department of Kidney Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Gilda Portalatin
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Hanny Sawaf
- Department of Kidney Medicine, Cleveland Clinic Ohio, Cleveland, Ohio
| | - Shruti Shettigar
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | | | - Hong Liang
- Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Leal Herlitz
- Department of Anatomic Pathology, Cleveland Clinic Ohio, Cleveland, Ohio
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Deleersnijder D, Knops N, Trouet D, Van Hoeck K, Karamaria S, Vande Walle J, Mauel R, Cools L, Meeus G, Dendooven A, De Meester J, Laurens W, Sprangers B. Epidemiology and clinicopathological characteristics of native kidney disease in children in Flanders, Belgium. Pediatr Nephrol 2022; 38:1533-1545. [PMID: 36227435 DOI: 10.1007/s00467-022-05719-7] [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: 04/26/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Flemish Collaborative Glomerulonephritis Group (FCGG) registry is a population-based kidney biopsy registry that has been including all native kidney biopsies performed in children in Flanders (Belgium), since 2017. METHODS From 2017 to 2020, 148 pediatric (< 18 years) native kidney biopsies were included. Each biopsy received a histopathological and final nephrological diagnosis, and concordance between both was assessed. Disease chronicity, summarized by the Mayo Clinic Chronicity Score, was determined on 122 biopsies with > 5 glomeruli. RESULTS Kidney biopsy rate was high (29.0 biopsies per million children per year), median age was 10.0 years (IQR 5.8-14.7), and boys predominated (56.1% males). A total of 140 biopsies (94.6%) showed a representative pathology result. Glomerular disease was most prevalent, with IgA nephropathy/IgA vasculitis (43 biopsies, 29.1%) and minimal change disease (MCD) (29 biopsies, 19.6%) being the overall most frequent diagnoses. In general, diagnostic concordance was high (80.7%). In Alport syndrome and focal segmental glomerulosclerosis (FSGS), concordance was lower, as the nephrological diagnosis was often determined by results of genetic analysis. Nephrotic syndrome was the most frequent indication for kidney biopsy (31.8%) and was mainly caused by MCD and FSGS. The degree of disease chronicity on kidney biopsies was generally low, although 27.3% of biopsies with a diagnosis of FSGS showed moderate-to-severe chronic damage. CONCLUSIONS The presented epidemiological findings validate data from previous European registry studies and may inspire kidney biopsy registries worldwide to implement novel features such as clinicopathological concordance and chronicity grading. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Dries Deleersnijder
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Louvain, Belgium. .,Division of Nephrology, University Hospitals Leuven, Louvain, Belgium.
| | - Noël Knops
- Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Louvain, Belgium.,Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Dominique Trouet
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Wilrijk, Belgium.,Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Koen Van Hoeck
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Sevasti Karamaria
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Reiner Mauel
- Department of Pediatrics, University Hospital Brussels, Brussels, Belgium
| | - Louise Cools
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Louvain, Belgium
| | - Gert Meeus
- Department of Nephrology, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Amélie Dendooven
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Wilrijk, Belgium.,Division of Pathology, University Hospital Ghent, Ghent, Belgium
| | - Johan De Meester
- Department of Nephrology and Dialysis, VITAZ Hospital, Sint-Niklaas, Belgium
| | - Wim Laurens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Nephrology and Dialysis, VITAZ Hospital, Sint-Niklaas, Belgium
| | - Ben Sprangers
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Louvain, Belgium. .,Division of Nephrology, University Hospitals Leuven, Louvain, Belgium.
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7
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Deleersnijder D, Laurens W, De Meester J, Cleenders E, Dendooven A, Lerut E, De Vriese AS, Dejagere T, Helbert M, Hellemans R, Koshy P, Maes B, Pipeleers L, Van Craenenbroeck AH, Van Laecke S, Vande Walle J, Couttenye MM, Meeus G, Sprangers B, De Rycke A, Bogaert AM, Woestenburg A, Denys B, Maes B, Peeters D, Vanbelleghem H, Donck J, Scharpé J, De Clippeleir N, Colson A, Meyvis K, Vandepitte K, Reyns LM, Peeters J, Decupere M, Helbert M, Zeegers M, Neirynck N, Bernaert P, Dejagere T, Lemahieu W, Sprangers B, Pipeleers L, Hellemans R, Van Laecke S, Knops N, Levtchenko E, Walle JV, Karamaria S, Van Hoeck K, Trouet D, Mauel R, Dendooven A, Hoorens A, Van Dorpe J, Praet M, Geers C, Lerut E, Koshy P, Roskams T, Aydin S, Siozopoulou V, Schelfhout AM, De Raeve H, Steenkiste E, Dedeurwaerdere F, Dalle I, Cokelaere K, Deloose S, De Paepe P, Van Eyken P. Clinicopathological characteristics and disease chronicity in native kidney biopsies in Flanders. Clin Kidney J 2022; 16:125-137. [PMID: 36726429 PMCID: PMC9871845 DOI: 10.1093/ckj/sfac208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background The Flemish Collaborative Glomerulonephritis Group (FCGG) registry provides complete population data on kidney disease epidemiology in the region of Flanders (Belgium), as it captures all native kidney biopsies performed in its population of 6.5 million inhabitants. Methods From 2017 until 2019, 2054 adult kidney biopsies were included from 26 nephrology centers (one biopsy per patient). Data on nephrotic and nephritic syndrome were available in 1992 and 2026 biopsies, respectively. In a subgroup of 898 biopsies containing ≥10 glomeruli from 2018 to 2019, disease chronicity was graded using the Mayo Clinic Chronicity Score (MCCS). The association between clinical variables and MCCS was determined using simple and multiple linear regression models. Results Nephrotic syndrome (present in 378 patients, 19.0%) was most frequently caused by minimal change disease in younger patients (18-44 years), membranous nephropathy in older patients (45-74 years) and amyloidosis in the elderly (>75 years). Nephritic syndrome (present in 421 patients, 20.8%) was most frequently caused by immunoglobulin A nephropathy (IgAN) in younger patients (18-64 years) and ANCA-associated vasculitis (AAV) in older patients (>64 years). AAV and IgAN were the most frequent underlying diagnoses in biopsies in which crescents were identified. In multivariable analysis, acute and chronic kidney disease and diagnoses of diabetic kidney disease, nephrosclerosis and hyperoxaluria/hypercalcemic nephropathy were associated with the highest MCCS increases. Conclusions The FCGG registry validates data from previous Western European registries and provides a snapshot of disease chronicity in the whole biopsied Flemish population.
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Affiliation(s)
| | | | - Johan De Meester
- Department of Nephrology and Dialysis, VITAZ Hospital, Sint-Niklaas, Belgium
| | - Evert Cleenders
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Amélie Dendooven
- Division of Pathology, University Hospital Ghent, Ghent, Belgium,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - An S De Vriese
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium,Department of Nephrology and Infectious Diseases, AZ Sint-Jan, Brugge, Belgium
| | - Tom Dejagere
- Department of Nephrology, Jessa Hospital, Hasselt, Belgium
| | - Mark Helbert
- Department of Nephrology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Rachel Hellemans
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium,Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Priyanka Koshy
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Maes
- Department of Nephrology, AZ Delta, Roeselare, Belgium
| | - Lissa Pipeleers
- Department of Nephrology, University Hospital Brussels, Brussels, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium,Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Steven Van Laecke
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Marie M Couttenye
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium,Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Gert Meeus
- Department of Nephrology, AZ Groeninge Hospital, Kortrijk, Belgium
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