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Attieh RM, Yang Y, Rosenstock JL. Updates on the Diagnosis and Management of Fibrillary Glomerulonephritis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:374-383. [PMID: 39084762 DOI: 10.1053/j.akdh.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 08/02/2024]
Abstract
Fibrillary glomerulonephritis (FGN) is a rare kidney disease typically affecting individuals in middle age, frequently presenting with advanced renal failure, proteinuria, and hypertension. FGN can be associated with autoimmune diseases, hepatitis C infection, and malignancies. Its exact pathogenesis remains elusive, and the exact role of DnaJ homolog subfamily B member 9 is yet to be determined. On renal biopsy, FGN exhibits distinctive Congo-red-negative, nonbranching fibrils, approximately 20 nm in diameter. DnaJ homolog subfamily B member 9 immunohistochemical staining has become a gold standard for diagnosis. Atypical variants exist, including congophilic, monotypic, and crescentic FGN, highlighting the disease's heterogeneity. Treatment with immunosuppression, including rituximab, has shown variable success, with no standard therapy established. FGN often leads to end-stage kidney disease, with a median progression time of 2-4 years postdiagnosis. Kidney transplantation is a viable option for FGN-related end-stage kidney disease, but recurrence in transplanted kidneys is not rare.
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Affiliation(s)
- Rose Mary Attieh
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York
| | - Yihe Yang
- Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York
| | - Jordan L Rosenstock
- Division of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY.
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Sánchez de la Nieta García MD, González López L, Castro Fernández P, Arambarri Segura M, Martínez-Calero A, Alonso Riaño M, Sánchez-Fructuoso A. Fibrillary glomerulonephritis simulating glomerular basal antimembrane antibody disease with associated thrombotic microangiopathy and ANCAp. Nefrologia 2023; 43:255-257. [PMID: 37330408 DOI: 10.1016/j.nefroe.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/01/2021] [Indexed: 06/19/2023] Open
Affiliation(s)
| | - Lucía González López
- Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Paz Castro Fernández
- Servicio de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Marina Alonso Riaño
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, Spain
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Javaugue V, Said SM, Bu L, Bridoux F, François A, Goujon JM, Fayad R, Ross D, Sastry A, Fervenza FC, Leung N, Nasr SH. Prognostic Value of Diffuse Crescentic Lesions in Fibrillary Glomerulonephritis. Am J Kidney Dis 2023; 81:368-370. [PMID: 36228825 DOI: 10.1053/j.ajkd.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Vincent Javaugue
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France.
| | - Samar M Said
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lihong Bu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Arnaud François
- Department of Pathology, Centre Hospitalier Universitaire, Rouen, France
| | - Jean-Michel Goujon
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Ramy Fayad
- Nephrology Consultants of Northwest Ohio, Toledo, Ohio
| | - Dennis Ross
- Kansas Nephrology Physicians, Wichita, Kansas
| | - Ashok Sastry
- Department of Internal Medicine, Florida State University School of Medicine, Sarasota, Florida
| | - Fernando C Fervenza
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nelson Leung
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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Sánchez de la Nieta García MD, González López L, Castro Fernández P, Arambarri Segura M, Martínez-Calero A, Alonso Riaño M, Sánchez-Fructuoso A. Fibrillary glomerulonephritis simulating glomerular basal antimembrane antibody disease with associated thrombotic microangiopathy and ANCAp. Nefrologia 2021; 43:S0211-6995(21)00132-6. [PMID: 34509321 DOI: 10.1016/j.nefro.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Lucía González López
- Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Paz Castro Fernández
- Servicio de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | | | - Marina Alonso Riaño
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
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Cheungpasitporn W, Thongprayoon C, Mao MA, Boonpheng B, Bathini T, Vallabhajosyula S, Medaura J, Chewcharat A, Kanduri SR, Kovvuru K, Salim SA, Kaewput W. The impact of race on hospitalization outcomes for goodpasture's syndrome in the United States: nationwide inpatient sample 2003-2014. Hosp Pract (1995) 2020; 49:22-26. [PMID: 32981378 DOI: 10.1080/21548331.2020.1828887] [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: 10/23/2022]
Abstract
BACKGROUND Goodpasture's syndrome is a rare and life-threatening autoimmune disease. While Goodpasture's syndrome is well described in Caucasian and Asian populations, its prevalence and outcomes among African American and Hispanic populations are unclear. We conducted this study to assess the impacts of race on hospital outcomes among patients with Goodpasture's syndrome. METHODS The National Inpatient Sample database was used to identify hospitalized patients with a principal diagnosis of Goodpasture's syndrome from 2003 to 2014. Goodpasture's syndrome patients were grouped based on their race. The differences in-hospital supportive care for organ failure and outcomes between Caucasian, African American, and Hispanic Goodpasture's syndrome patients were assessed using logistic regression analysis. RESULTS Nine hundred and sixty-four patients were hospitalized with a primary diagnosis of Goodpasture's syndrome. Of these, 786 were included in the analysis: 622 (79%) were Caucasian, 73 (9%) were African American, and 91 (12%) were Hispanic. Hispanics had significantly lower use of plasmapheresis. The use for mechanical ventilation, noninvasive ventilation support, and renal replacement therapy in African Americans and Hispanics were comparable to Caucasians. There was no significant difference in organ failure, sepsis, and in-hospital mortality between African Americans and Caucasians. In contrast, Hispanics had higher in-hospital mortality than Caucasians but similar risk of organ failure and sepsis. CONCLUSION African American and Hispanic populations account for 9% and 12% of hospitalizations for Goodpasture's syndrome, respectively. While there is no significant difference in in-hospital mortality between African Americans and Caucasians, Hispanics with Goodpasture's syndrome carry a higher in-hospital mortality compared to Caucasians.
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Affiliation(s)
- Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Michael A Mao
- Department of Medicine, Mayo Clinic , Jacksonville, FL, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California , Los Angeles, CA, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona , Tucson, AZ, USA
| | | | - Juan Medaura
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, MN, USA
| | - Swetha R Kanduri
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
| | - Karthik Kovvuru
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
| | - Sohail Abdul Salim
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center , Jackson, MS, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine , Bangkok, Thailand
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Klomjit N, Alexander MP, Zand L. Fibrillary Glomerulonephritis and DnaJ Homolog Subfamily B Member 9 (DNAJB9). ACTA ACUST UNITED AC 2020; 1:1002-1013. [DOI: 10.34067/kid.0002532020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
Fibrillary GN (FGN) is a rare glomerular disease that is diagnosed based on the presence of fibrils in glomeruli. The fibrils are typically noncongophilic, randomly oriented, and measure 12–24 nm. Traditionally, electron microscopy (EM) has been an important tool to aid in the diagnosis of FGN by identifying the fibrils and to distinguish it from other entities that could mimic FGN. However, recently DnaJ homolog subfamily B member 9 (DNAJB9) has emerged as both a specific and sensitive biomarker in patients with FGN. It allows prompt diagnosis and alleviates reliance on EM. DNAJB9 is a cochaperone of heat shock protein 70 and is involved in endoplasmic reticulum protein-folding pathways. But its role in the pathogenesis of FGN remains elusive. DNAJB9 may act as a putative antigen or alternatively it may secondarily bind to misfolded IgG in the glomeruli. These hypotheses need future studies to elucidate the role of DNAJB9 in the pathogenesis of FGN. The treatment regimen for FGN has been limited due to paucity of studies. Most patients receive combination immunosuppressive regimens. Rituximab has been studied the most in FGN and it may delay disease progression. Prognosis of FGN remains poor and 50% require dialysis within 2 years of diagnosis. Despite its poor prognosis in native kidneys, the rate of recurrence post-transplantation is low (20%) and patient as well as allograft outcomes are similar to patients without FGN.
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Impact of ANCA-Associated Vasculitis on Outcomes of Hospitalizations for Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014. ACTA ACUST UNITED AC 2020; 56:medicina56030103. [PMID: 32121573 PMCID: PMC7142422 DOI: 10.3390/medicina56030103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 12/27/2022]
Abstract
Background and objectives: Goodpasture’s syndrome (GS) is a rare, life-threatening autoimmune disease. Although the coexistence of anti-neutrophil cytoplasmic antibody (ANCA) with Goodpasture’s syndrome has been recognized, the impacts of ANCA vasculitis on mortality and resource utilization among patients with GS are unclear. Materials and Methods: We used the National Inpatient Sample to identify hospitalized patients with a principal diagnosis of GS from 2003 to 2014 in the database. The predictor of interest was the presence of ANCA-associated vasculitis. We tested the differences concerning in-hospital treatment and outcomes between GS patients with and without ANCA-associated vasculitis using logistic regression analysis with adjustment for other clinical characteristics. Results: A total of 964 patients were primarily admitted to hospital for GS. Of these, 84 (8.7%) had a concurrent diagnosis of ANCA-associated vasculitis. Hemoptysis was more prevalent in GS patients with ANCA-associated vasculitis. During hospitalization, GS patients with ANCA-associated required non-significantly more mechanical ventilation and non-invasive ventilation support, but non-significantly less renal replacement therapy and plasmapheresis than those with GS alone. There was no significant difference in in-hospital outcomes, including organ failure and mortality, between GS patients with and without ANCA-associated vasculitis. Conclusions: Our study demonstrated no significant differences between resource utilization and in-hospital mortality among hospitalized patients with coexistence of ANCA vasculitis and GS, compared to those with GS alone.
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Kaewput W, Thongprayoon C, Boonpheng B, Ungprasert P, Bathini T, Chewcharat A, Srivali N, Vallabhajosyula S, Cheungpasitporn W. Inpatient Burden and Mortality of Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014. J Clin Med 2020; 9:jcm9020455. [PMID: 32041346 PMCID: PMC7074028 DOI: 10.3390/jcm9020455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Goodpasture’s syndrome is a rare, life-threatening, small vessel vasculitis. Given its rarity, data on its inpatient burden and resource utilization are lacking. We conducted this study aiming to assess inpatient prevalence, mortality, and resource utilization of Goodpasture’s syndrome in the United States. Methods: The 2003–2014 National Inpatient Sample was used to identify patients with a principal diagnosis of Goodpasture’s syndrome. The inpatient prevalence, clinical characteristics, in-hospital treatment, end-organ failure, mortality, length of hospital stay, and hospitalization cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. Results: A total of 964 patients were admitted in hospital with Goodpasture’s syndrome as the principal diagnosis, accounting for an overall inpatient prevalence of Goodpasture’s syndrome among hospitalized patients in the United States of 10.3 cases per 1,000,000 admissions. The mean age of patients was 54 ± 21 years, and 47% were female; 52% required renal replacement therapy, whereas 39% received plasmapheresis during hospitalization. Furthermore, 78% had end-organ failure, with renal failure and respiratory failure being the two most common end-organ failures. The in-hospital mortality rate was 7.7 per 100 admissions. The factors associated with increased in-hospital mortality were age older than 70 years, sepsis, the development of respiratory failure, circulatory failure, renal failure, and liver failure, whereas the factors associated with decreased in-hospital mortality were more recent year of hospitalization and the use of therapeutic plasmapheresis. The median length of hospital stay was 10 days. The median hospitalization cost was $75,831. Conclusion: The inpatient prevalence of Goodpasture’s syndrome in the United States is 10.3 cases per 1,000,000 admissions. Hospitalization of patients with Goodpasture’s syndrome was associated with high hospital inpatient utilization and costs.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Correspondence: ; Tel.: +66-235-4760093613; Fax: +6623547733
| | - Charat Thongprayoon
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (C.T.); (A.C.)
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA;
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA;
| | - Api Chewcharat
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (C.T.); (A.C.)
| | - Narat Srivali
- Department of Internal Medicine, St. Agnes Hospital, Baltimore, MD 21229, USA;
| | | | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA;
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Abstract
Acute kidney injury (AKI) and chronic kidney disease (CKD) are worldwide public health problems affecting millions of people and have rapidly increased in prevalence in recent years. Due to the multiple causes of renal failure, many animal models have been developed to advance our understanding of human nephropathy. Among these experimental models, rodents have been extensively used to enable mechanistic understanding of kidney disease induction and progression, as well as to identify potential targets for therapy. In this review, we discuss AKI models induced by surgical operation and drugs or toxins, as well as a variety of CKD models (mainly genetically modified mouse models). Results from recent and ongoing clinical trials and conceptual advances derived from animal models are also explored.
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Affiliation(s)
- Yin-Wu Bao
- Kidney Disease Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou Zhejiang 310058, China. .,Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou Zhejiang 310058, China
| | - Yuan Yuan
- Kidney Disease Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou Zhejiang 310058, China. .,Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou Zhejiang 310058, China
| | - Jiang-Hua Chen
- Kidney Disease Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou Zhejiang 310058, China.
| | - Wei-Qiang Lin
- Kidney Disease Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou Zhejiang 310058, China. .,Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou Zhejiang 310058, China
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