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Arya PVA, Marnet E, Rondla M, Tan JW, Unnikrishnan D, Buller G. Renal manifestations in adult-onset Still's disease: a systematic review. Rheumatol Int 2024; 44:1209-1218. [PMID: 38625385 DOI: 10.1007/s00296-024-05578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE We aimed to review the literature on the clinical presentation, renal pathology, treatment, and outcome of renal manifestations in adult-onset Still's disease (AOSD). METHODS We used PRISMA guidelines for our systematic review and included all English-language original articles from inception till September 15, 2023, on AOSD and kidney involvement in any form. Data on patient demographics, diagnostic criteria, clinical presentation, renal pathology, treatment employed including dialysis, outcome, cause of death were collected and analyzed. RESULTS The median age at the diagnosis of renal issues was 37, with a higher prevalence among females (58.1%). Among the cases, 28 experienced renal problems after being diagnosed with AOSD, 12 had simultaneous diagnoses of renal issues and AOSD, and in 4 cases, renal problems appeared before AOSD diagnosis. Out of the 44 cases, 36 underwent renal biopsy, revealing various pathology findings including AA amyloidosis (25%), collapsing glomerulopathy (11.4%), thrombotic microangiopathy (TMA) (11.4%), IgA nephropathy (9.1%), minimal change disease (6.8%), and others. Some cases were clinically diagnosed with TMA, proximal tubular dysfunction, or macrophage activation syndrome-related acute kidney injury. Treatment approaches varied, but glucocorticoids were commonly used. Renal involvement was associated with increased mortality and morbidity, with 6 out of 44 patients passing away, 4 progressing to end-stage renal disease (ESRD), and data on 2 cases' outcomes not available. CONCLUSION Renal manifestations in AOSD are diverse but rarely studied owing to the rarity of the disease. Studies with larger data would be essential to study further on the pathogenesis and implications.
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Affiliation(s)
- P V Akhila Arya
- Yale New Haven Health/Bridgeport Hospital, 267 Grant St, Bridgeport, CT, 06610, USA.
| | - Erica Marnet
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
| | - Madhumita Rondla
- Department of Internal Medicine, Texas Tech University, El Paso, USA
| | - Jia Wei Tan
- Department of Nephrology, Stanford School of Medicine, Stanford, USA
| | | | - Gregory Buller
- Internal Medicine/Nephrology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
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2
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Krishnamurthy H, Yang Y, Song Q, Krishna K, Jayaraman V, Wang T, Bei K, Rajasekaran JJ. Evaluation of renal markers in systemic autoimmune diseases. PLoS One 2023; 18:e0278441. [PMID: 37352246 PMCID: PMC10289317 DOI: 10.1371/journal.pone.0278441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/29/2023] [Indexed: 06/25/2023] Open
Abstract
Renal involvement is a common occurrence in subjects with systemic autoimmune diseases. The renal manifestation and its severity depend on the underlying condition and may reversely complicate the clinical course of autoimmune diseases. Renal function markers have been widely used in the assessment of normal functioning of kidneys including glomerular filtration rate and concentrating and diluting capacity of the kidney. An increase or decrease in the values of these markers may indicate kidney dysfunction. In this study, a number of critical renal markers were examined in seropositive autoimmune diseases including systemic lupus erythematosus (SLE), connective tissue disorder (CTD), and rheumatoid arthritis (RA). The data from three cohorts of subjects enrolled in renal markers and autoimmune antibody testing between January 2015 to August 2019 were retrospectively studied. The prevalence of renal markers that were out of the reference range and their average levels in female and male subgroups across SLE, CTD, and RA cohorts were compared and analyzed. The levels of renal markers are significantly affected by the presence of autoantibodies, in particular eGFR, cystatin C, and albumin. Autoantibodies were also more frequent in subjects with severe renal function damage. Close follow-up of both renal markers and autoantibodies may potentially assist in the early diagnosis of kidney diseases and improve the survival and life expectancy of autoimmune patients.
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Affiliation(s)
| | - Yuanyuan Yang
- Vibrant America LLC., San Carlos, CA, United States of America
| | - Qi Song
- Vibrant America LLC., San Carlos, CA, United States of America
| | - Karthik Krishna
- Vibrant America LLC., San Carlos, CA, United States of America
| | | | - Tianhao Wang
- Vibrant America LLC., San Carlos, CA, United States of America
| | - Kang Bei
- Vibrant America LLC., San Carlos, CA, United States of America
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Kokhanchuk VA, Skvortsov AV, Shchegoleva EM, Kuznetsova EI, Novikov PI, Stoliarevich ES, Varshavsky VA, Moiseev SV, Bulanov NM. Impact of kidney biopsy on the management of patients in the rheumatology department: retrospective study. TERAPEVT ARKH 2022; 94:763-768. [DOI: 10.26442/00403660.2022.06.201565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022]
Abstract
Background. Kidney involvement is a common manifestation of the systemic autoimmune rheumatic diseases. Kidney biopsy is the gold standard for the diagnosis of kidney diseases, however this method has not yet become the standard-of-care in rheumatology practice.
Aim. To assess the diagnostic value of kidney biopsy in the management of patients of the rheumatology department.
Materials and methods. In this retrospective observational study we analyzed the medical documentation including kidney morphology findings in the patients of the Department of Rheumatology at Tareev Clinic of Internal Diseases. All patients included in the research had signs of kidney involvement and had undergone needle biopsy of the kidney or re-evaluation of the kidney tissue received previously.
Results. From June 2016 to October 2021, 3110 patients were admitted to the rheumatology department. Among them 63 (2%) underwent kidney biopsy and were included in the study. Twenty (32%) were male. Mean age was 42.513.9 years. The most common preliminary diagnoses before kidney biopsy were ANCA-associated vasculitis (n=17), systemic lupus erythematosus (n=12), and AA-amyloidosis associated with inflammatory joint diseases (n=7). In 14 (27%) patients diagnosis was unspecified at the time of biopsy. Among 49 patients with established preliminary diagnosis morphological findings were in line 38 (78%) with the pre-liminary diagnosis. However, in 11 (22%) patients morphological findings resulted in the change of the diagnosis. In all 14 patients with unspecified condition kidney biopsy helped to establish clinical diagnosis. Ultrasound evaluation demonstrated hematoma formation in 18 (31%) patients, and among them two required blood component transfusions.
Conclusion. Our study demonstrates significant value and safety of kidney biopsy in the patients with autoimmune rheumatic conditions. We suggest that kidney biopsy should be implemented in the management of this category of patients.
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4
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Potential of Polyphenols to Restore SIRT1 and NAD+ Metabolism in Renal Disease. Nutrients 2022; 14:nu14030653. [PMID: 35277012 PMCID: PMC8837945 DOI: 10.3390/nu14030653] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
SIRT1 is an NAD+-dependent class III histone deacetylase that is abundantly expressed in the kidney, where it modulates gene expression, apoptosis, energy homeostasis, autophagy, acute stress responses, and mitochondrial biogenesis. Alterations in SIRT1 activity and NAD+ metabolism are frequently observed in acute and chronic kidney diseases of diverse origins, including obesity and diabetes. Nevertheless, in vitro and in vivo studies and clinical trials with humans show that the SIRT1-activating compounds derived from natural sources, such as polyphenols found in fruits, vegetables, and plants, including resveratrol, quercetin, and isoflavones, can prevent disease and be part of treatments for a wide variety of diseases. Here, we summarize the roles of SIRT1 and NAD+ metabolism in renal pathophysiology and provide an overview of polyphenols that have the potential to restore SIRT1 and NAD+ metabolism in renal diseases.
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Carlos CP, de Carvalho EP, Angeli Junior EV, Garcia Filho GF, Doná JPL, Batanero RPDO, Guena RDO, Agren C, Baptista MASF, Bizotto TSG, Cury PM, Chies AB. Angiotensin involvement in kidney injury induced by rheumatoid arthritis in rat. Clin Exp Pharmacol Physiol 2021; 48:1271-1279. [PMID: 34037987 DOI: 10.1111/1440-1681.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/24/2021] [Indexed: 01/11/2023]
Abstract
Renal injury induced by rheumatoid arthritis is not clear and may be related to the angiotensin II. We aim to investigate the adjuvant-induced arthritis (AIA) injury in rat kidney, focusing the angiotensin II/AT1 pathway. Male Wistar rats were allocated in to three groups: Control, AIA and AIA plus losartan. The AIA was induced by injection of 100 µL of an emulsion of dissected Mycobacterium tuberculosis (50 mg/mL) on the paw. Treatment with losartan was initiated on the first day of immunization (daily subcutaneous injection, 1 mg/kg). After 60 days post immunization, we evaluated kidney function by plasma creatinine, urea and uric acid levels and creatinine depuration; kidney injury by apoptosis analysis and inflammation markers such as macrophages, transforming growth factor beta (TGF-β) and inducible nitric oxide synthase (iNOS) expression; oxidative stress by plasma thiobarbituric acid reactive substances (TBARS); renal expression of angiotensin receptors subtype 1 (AT1 ) and 2 (AT2 ) and plasma concentration of angiotensin II. AIA rats showed elevated plasma levels of creatinine, urea, uric acid, TBARS and Ang II and reduced creatinine depuration, and enhanced kidney macrophage number, TGF-β, caspase-3, iNOS and AT1 /AT2 receptors expression. The losartan reduced plasma creatinine and its clearance, reduced macrophages and the expression of TGF-β and iNOS in renal tissues, and reduced plasma TBARS. We conclude that AIA causes kidney injury by a physiopathological mechanism that involves AT1 stimulation in renal tissue, elevating the presence of macrophages, the expression of TGF-β and iNOS, as well the local oxidative stress, which contribute to renal function deterioration.
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Affiliation(s)
- Carla Patrícia Carlos
- Laboratory of Experimental Research, FACERES School of Medicine, São José do Rio Preto, São Paulo, Brazil
| | - Enzo Prandi de Carvalho
- Laboratory of Experimental Research, FACERES School of Medicine, São José do Rio Preto, São Paulo, Brazil
| | | | | | - João Pedro Lot Doná
- Laboratory of Experimental Research, FACERES School of Medicine, São José do Rio Preto, São Paulo, Brazil
| | | | - Rafael de Oliveira Guena
- Laboratory of Experimental Research, FACERES School of Medicine, São José do Rio Preto, São Paulo, Brazil
| | - Camila Agren
- Laboratory of Experimental Research, FACERES School of Medicine, São José do Rio Preto, São Paulo, Brazil
| | | | | | - Patricia Maluf Cury
- Laboratory of Experimental Research, FACERES School of Medicine, São José do Rio Preto, São Paulo, Brazil
| | - Agnaldo Bruno Chies
- Laboratory of Pharmacology, Marília Medical School, FAMEMA, São Paulo, Marília, Brazil
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Perez-Villa F, Lafage-Proust MH, Gielen E, Ortiz A, Spasovski G, Argilés À. The renal patient seen by non-renal physicians: the kidney embedded in the 'milieu intérieur'. Clin Kidney J 2021; 14:1077-1087. [PMID: 34094517 PMCID: PMC8173597 DOI: 10.1093/ckj/sfaa234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease is defined as a decrease in renal function or evidence of kidney injury for >3 months. This represents an oversimplification that may confuse physicians. Thus kidney function is equated to glomerular filtration rate, which represents one of multiple kidney functions. Some potentially more important renal functions are lost earlier, such as the production for the anti-ageing factor Klotho. Overall, these changes modify the emergent properties of the body, altering the relationships between different organs and systems, in a manner that is difficult to predict the response to interventions based on normal physiology concepts, as there is a novel steady state of interorgan relations. In this regard we now discuss the impact of CKD on heart failure; osteomuscular and joint pain and bone fragility and fractures; and osteosarcopaenia as seen by a cardiologist, a rheumatologist and a geriatrician.
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Affiliation(s)
| | | | - Eveline Gielen
- Department of Geriatrics and Centre for Metabolic Bone Diseases, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Alberto Ortiz
- Departamento de Nefrologia e Hipertensión, Laura BaderInstituto de Investigación Sanitaria de la-Fundación Jimenez Diaz Universidad Autónoma de Madrid, Madrid, Spain
| | - Goce Spasovski
- Department of Nephrology, University Hospital, Skopje, Macedonia
| | - Àngel Argilés
- RD-Néphrologie, Montpellier, France
- Bio-Communication Cardio-Métabolique EA7288, Université de Montpellier, Montpellier, France
- Néphrologie Dialyse St Guilhem, Sète, France
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7
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Oweis AO, Alawneh KM, Alshelleh SA, Alnaimat F, Alawneh D, Zahran DJ. Renal dysfunction among rheumatoid arthritis patients: A retrospective cohort study. Ann Med Surg (Lond) 2020; 60:280-284. [PMID: 33204418 PMCID: PMC7649584 DOI: 10.1016/j.amsu.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a common rheumatological disease which can involve a variety of different renal manifestations. This may be explained by disease effect itself or by medications used for treatment that may lead to renal dysfunction and its complications. We aimed to identify the prevalence and factors that played a role in renal dysfunction among RA Jordanian patients. Method 285 patients with RA visiting outpatient clinic between March 2016 and March 2017 were included in a retrospective study design. Age, gender, comorbidities, duration of the disease, medications and laboratory results were gathered and scoring of RA activity was done. Results Data gathered from the 285 patients showed a female predominance with 88.4% female and 11.6% male. The average disease duration was 6.7 years. Age, DM, HTN, and serum CRP were associated with worse renal function on univariate analysis. 44 patients (18.8%) presented with microscopic hematuria, 16 (6.9%) with proteinuria and only 5 (2.1%) patients presented with both microscopic hematuria and proteinuria. Patients with eGFR <60 ml/min had longer disease duration with a mean of 11 years (±7.7) in comparison to 6.4 years (±6.1) for those with eGFR>90 ml/min (P = 0.001). Conclusion Renal dysfunction is not common in RA Jordanian population and has variable presentations. Age and the duration of illness play a major role in the progression of CKD if present. Future prospective studies evaluating renal biopsies in RA patients are needed. First study in the country to discuss the prevalence of renal involvement in rheumatoid arthritis. Renal involvement is rare in rheumatoid arthritis patients. Different drugs can affect renal outcome in a different ways.
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Affiliation(s)
- Ashraf O Oweis
- Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaldoon M Alawneh
- Division of Rheumatology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sameeha A Alshelleh
- Division of Nephrology, Department of Medicine, The University of Jordan, Amman, Jordan
| | - Fatima Alnaimat
- Division of Rheumatology, Department of Medicine, The University of Jordan, Amman, Jordan
| | - Diala Alawneh
- Department of Medicine, University of Missouri, Kansas City, MO, USA
| | - Deeb Jamil Zahran
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
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8
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Wang C, Wei X, Wu Y, Tang H, Wang B, Wang Y, Sun W, Asenso J, Xiao F, Wei W. CP-25 improves nephropathy in collagen-induced arthritis rats by inhibiting the renal inflammatory response. Int Immunopharmacol 2020; 88:106997. [PMID: 33182042 DOI: 10.1016/j.intimp.2020.106997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
Abstract
Paeoniflorin-6'-O-benzene sulfonate (CP-25) is a derivative of paeoniflorin. We previously confirmed that CP-25 inhibits inflammatory responses in several arthritis animal models. The aim of the present study was to investigate the beneficial effects of CP-25 on renal damage in rats with collagen-induced arthritis (CIA). CIA was induced in rats, which were orally administered CP-25 (25, 50 and 100 mg/kg/day) for 24 days. The levels of plasma blood urea nitrogen (BUN) and urine protein in CIA rats were measured. Pathological changes in renal tissues and joints were observed, and inflammatory cell infiltration was evaluated by immunohistochemistry. Moreover, renal inflammatory mediators and transporters were measured by western blotting. We found that CP-25 not only inhibited arthritis manifestations but also improved renal pathological manifestations and kidney injury by decreasing serum BUN and urine protein levels. Further study revealed that CP-25 treatment reduced the number of renal CD68+ cells and downregulated the levels of MCP-1, TNF-α and IL-6 in CIA rats. On the other hand, we noted that CP-25 decreased the ratios of phosphorylated NF-κB p65 (p-p65) to total p65 and p-IκBα to total IκBα in CIA rats, suggesting that CP-25 blocked NF-κB activation. Finally, we observed that CP-25 restored the abnormal expression of OAT1 and OCT1 in the renal tissues of CIA rat. Our data indicate that CP-25 ameliorates kidney damage in CIA rats, and this beneficial effect is closely related to inhibiting renal inflammation and the abnormal expression of transporters.
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Affiliation(s)
- Chun Wang
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - Xiao Wei
- Blood Purification Center, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yijin Wu
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - Hao Tang
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - Bin Wang
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - Yong Wang
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - Wei Sun
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - James Asenso
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - Feng Xiao
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China
| | - Wei Wei
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China; Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Hefei 230032, China; Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei 230032, China.
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Karasawa K, Iwabuchi Y, Kyoda M, Akihisa T, Yamaguchi E, Suzuki S, Ogura S, Takabe T, Miyabe Y, Kamiyama T, Nakano M, Manabe S, Kamiyama M, Akiyama K, Sato M, Uchida K, Nitta K, Moriyama T. Primary IgA Vasculitis with Nephritis in a Patient with Rheumatoid Arthritis Diagnosed by Anti-galactose-deficient IgA1 Immunostaining. Intern Med 2019; 58:2551-2554. [PMID: 31178497 PMCID: PMC6761328 DOI: 10.2169/internalmedicine.2640-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Renal disease is a common complication of rheumatoid arthritis (RA) and can occur secondary to RA or be induced by therapeutic agents. Recently, glomerular deposition of galactose-deficient IgA1 (Gd-IgA1) was identified as a feature of primary IgA vasculitis with nephritis (IgA-VN). We herein report a case of IgA-VN in an RA patient whose disease activity was controlled by treatment with etanercept. To distinguish between primary IgA-VN and secondary IgA-VN caused by RA or etanercept, we performed immunostaining of renal biopsy sections with the Gd-IgA1-specific antibody KM55. Positive KM55 staining confirmed the diagnosis of primary IgA-VN in a patient with RA.
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Affiliation(s)
| | - Yuko Iwabuchi
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Mizuki Kyoda
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Erika Yamaguchi
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Shunji Suzuki
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Shota Ogura
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Tomo Takabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Yoei Miyabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | | | - Marie Nakano
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | | | - Kenichi Akiyama
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Masayo Sato
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Keiko Uchida
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Japan
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Lee SW. Risk Factors Associated with Estimated Glomerular Filtration Rate in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis after Treatment with Biological Disease Modifying Anti-Rheumatic Drugs. J Korean Med Sci 2018; 33:e214. [PMID: 30034307 PMCID: PMC6052327 DOI: 10.3346/jkms.2018.33.e214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sung Won Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
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11
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Rathi M, Sharma A. Mycophenolate or Cyclophosphamide in Lupus Nephritis: Which One to Use in Indian Patients? Indian J Nephrol 2018; 28:99-100. [PMID: 29861558 PMCID: PMC5952465 DOI: 10.4103/ijn.ijn_376_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Hotfiel T, Carl HD, Eibenberger T, Gelse K, Weiß J, Jendrissek A, Swoboda B. Cementless femoral components in bicondylar hybrid knee arthroplasty in patients with rheumatoid arthritis: A 10-year survivorship analysis. J Orthop Surg (Hong Kong) 2018; 25:2309499017716252. [PMID: 28656874 DOI: 10.1177/2309499017716252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) has been established as a successful surgical treatment in the late stages of rheumatoid joint destruction. The purpose of this study was to review the clinical outcome and survivorship in rheumatoid arthritis (RA) patients undergoing TKA in hybrid technique with a cementless fixation of the femoral component. METHODS We analysed retrospectively 66 RA patients who underwent 72 TKAs (P.F.C. Sigma®). Mean follow-up time was 124 ± 41 months. To evaluate postoperative clinical outcome, knee injury and osteoarthritis outcome score (KOOS) and Oxford knee score (OKS) were assessed. Kaplan-Meier analysis was used to calculate survivorship. The primary outcome was revision for any reason. RESULTS Thirty-four patients (36 knees) died and two patients (2 knees) were lost to follow-up. Three patients (four knees) did not agree to participate. Twenty-seven patients (30 knees) were available for assessing clinical scores. The average scores were 85 ± 14 for KOOS and 34 ± 10 for OKS. In three patients (three knees), revision was necessary, including restricted range of motion ( n = 1), instability ( n = 1), and infection ( n = 1). There were no cases of loosening in this cohort study. The survival rates were 100% at 5 years, 97.1% at 10 years (95% CI 89.0-99.2%) and 95.6% at 15 years (95% CI 86.9-98.5%). CONCLUSIONS This study confirms that excellent clinical results and a good 10-year survivorship can be obtained with hybrid fixation technique in TKA in the unique population of RA patients.
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Affiliation(s)
- Thilo Hotfiel
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hans-Dieter Carl
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Teresa Eibenberger
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Kolja Gelse
- 2 Department of Orthopedic and Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Julian Weiß
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Jendrissek
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bernd Swoboda
- 1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Djakovic I, Butorac D, Vucicevic Z, Kosec V, Kuna AT, Lugović-Mihić L. Henoch-Schönlein purpura in the third trimester of pregnancy. Biochem Med (Zagreb) 2018; 28:010801. [PMID: 29472804 PMCID: PMC5806616 DOI: 10.11613/bm.2018.010801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is an IgA-mediated small vessels’ vasculitis that affects the skin, intestines and kidneys. Pregnancy has been reported as an exacerbating factor. We present the case of a 24-year-old primigravida with HSP that occurred in the third trimester and lasted up to the end of the successful delivery. She had pruritic maculopapular exanthema on her legs. Biopsy of a cutaneous lesion was performed for histopathologic features and direct immunofluorescence (DIF) for the presence of perivascular IgA deposition. Histopathology of the cutaneous lesion confirmed leukocytoclastic vasculitis. A DIF examination of the skin lesion confirmed deposits of fibrinogen in the small blood vessel walls. Six weeks following delivery, the skin lesions almost completely disappeared. Control laboratory findings were normal. This case of HSP might have been primarily associated with a preceding respiratory infection but this should first be carefully investigated due to a possible severe immunological disease in the patient’s background requiring special attention since nephrotic symptoms may occur.
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Affiliation(s)
- Ivka Djakovic
- Department of Gynaecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Drazan Butorac
- Department of Gynaecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Zeljko Vucicevic
- Department of Internal Medicine, Intensive Care Unit, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vesna Kosec
- Department of Gynaecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Andrea Tesija Kuna
- University Department of Chemistry, Medical School Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Liborija Lugović-Mihić
- Clinical Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Bramlage CP, Kröplin J, Wallbach M, Minguet J, Smith KH, Lüders S, Schrader J, Patschan S, Gross O, Deutsch C, Bramlage P, Müller GA, Koziolek M. Management of cardiovascular risk factors in patients with ANCA-associated vasculitis. J Eval Clin Pract 2017; 23:747-754. [PMID: 28205311 DOI: 10.1111/jep.12709] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is accompanied by increased cardiovascular (CV) risk. Treatment of AAV patients includes the management of conventional CV risk factors, primarily hypertension and hypercholesterolemia, while lipoprotein(a) (LP(a)) is an emerging potential target. METHODS We performed a multicenter, retrospective study in Germany. Patients were considered if they were between 18 and 90 years old and presented with AAV. Patients with arterial hypertension but no autoimmune disease were used as a control group (HTN reference group). RESULTS Compared to the reference group (n = 52), CV disease burden was significantly greater in patients with AAV (n = 53). Hypercholesterolemia was also more common in the AAV patients (71.7% vs 46.2% for the HTN; P = .008). Lipoprotein(a) levels were elevated in both groups, with 11.3% and 17.3% of the AAV and HTN groups, respectively, displaying a level above 0.6 g/l (P = .083). Guideline-recommended targets for low-density lipoprotein cholesterol and blood pressure levels were rarely met. According to Kidney Disease: Improving Global Outcomes guidelines, 72.5% of the patients with AAV should have been taking statins and/or ezetimibe for treatment of hyperlipidemia; however, only 24.3% of them were receiving such treatment. Blood pressure below ≤140/90 mmHg was reached in 78.6% of the patients with chronic kidney disease. However, for patients with chronic kidney disease and an albumin excretion rate of >30 mg/day, the recommended blood pressure is ≤130/80 mmHg, a value that was not reached in 65% of the AAV patients. CONCLUSION Patients with AAV are at high CV risk, but management of the associated risk factors is poor. In addition to improving the treatment of hypercholesterolemia and hypertension, lipoprotein(a) is a further potential target for reducing CV risk in individuals with AAV.
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Affiliation(s)
- Carsten Paul Bramlage
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.,Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Juliane Kröplin
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Joan Minguet
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.,Institute for Research and Medicine Advancement (IRM), Terrassa, Spain
| | | | - Stephan Lüders
- Department of Internal Medicine, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany
| | - Joachim Schrader
- Department of Internal Medicine, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany
| | - Susan Patschan
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Oliver Gross
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Gerhard Anton Müller
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Michael Koziolek
- Department of Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
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15
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Distinct Patterns of Dietary Intake in Different Functional Classes of Patients With Rheumatoid Arthritis. TOP CLIN NUTR 2017. [DOI: 10.1097/tin.0000000000000099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Affiliation(s)
- Seon-Ho Ahn
- Division of Nephrology, Department of Internal Medicine, Wonkwang University School of Medicine and Hospital, Iksan, Korea
| | - Jong Hwan Jung
- Division of Nephrology, Department of Internal Medicine, Wonkwang University School of Medicine and Hospital, Iksan, Korea
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17
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Sharma A, Nada R, Naidu GSRSNK, Minz RW, Kohli HS, Sakhuja V, Gupta KL, Rathi M. Pauci-immune glomerulonephritis: does negativity of anti-neutrophilic cytoplasmic antibodies matters? Int J Rheum Dis 2015; 19:74-81. [DOI: 10.1111/1756-185x.12729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Aman Sharma
- Department of Internal Medicine; Postgraduate Institute of Medical Education & Research; Chandigarh India
| | - Ritambra Nada
- Department of Histopathology; Postgraduate Institute of Medical Education & Research; Chandigarh India
| | | | - Ranjana W. Minz
- Department of Immunopathology; Postgraduate Institute of Medical Education & Research; Chandigarh India
| | - Harbir Singh Kohli
- Department of Nephrology; Postgraduate Institute of Medical Education & Research; Chandigarh India
| | - Vinay Sakhuja
- Department of Nephrology; Postgraduate Institute of Medical Education & Research; Chandigarh India
| | - Krishan Lal Gupta
- Department of Nephrology; Postgraduate Institute of Medical Education & Research; Chandigarh India
| | - Manish Rathi
- Department of Nephrology; Postgraduate Institute of Medical Education & Research; Chandigarh India
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