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Suetsugu R, Sakuma H, Maruyama K, Matsuki M, Ogawa Y, Nakagawa N. Successful treatment of coexisting membranous nephropathy and immune thrombocytopenia by eradicating gastric Helicobacter pylori infection: a case report. CEN Case Rep 2024; 13:98-103. [PMID: 37421572 PMCID: PMC10982251 DOI: 10.1007/s13730-023-00805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome in middle-aged and older adults. MN etiology is mainly primary or idiopathic; however, it may also be secondary to infections, drugs, neoplasms, and autoimmune diseases. We present the case of a 52-year-old Japanese man with coexisting nephrotic MN and immune thrombocytopenic purpura (ITP). Renal biopsy revealed glomerular basement membrane thickening with immunoglobulin (Ig) G and complement component 3 deposition. Glomerular IgG subclass analysis revealed predominant IgG4 deposition with weak IgG1 and IgG2 deposition. IgG3 and phospholipase A2 receptor deposits were negative. Upper endoscopy revealed no ulcers, but histological examination demonstrated Helicobacter pylori infection in the gastric mucosa with elevated IgG antibodies. After gastric Helicobacter pylori eradication, the nephrotic-range proteinuria and thrombocytopenia of the patient were markedly improved without initiation of immunosuppressive treatment. Therefore, clinicians should consider the possibility of Helicobacter pylori infection in patients with coexisting MN and ITP. Further studies are required to demonstrate the associated pathophysiological aspects.
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Affiliation(s)
- Reina Suetsugu
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Hirofumi Sakuma
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Keisuke Maruyama
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Motoki Matsuki
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Pulmonology, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Japan.
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Furuto Y, Hashimoto H, Namikawa A, Morikawa T, Shibuya Y. Remission Induction of IgG4-related Membranous Nephropathy with Multitarget Therapy. Intern Med 2023; 62:3175-3181. [PMID: 36927975 PMCID: PMC10686725 DOI: 10.2169/internalmedicine.1023-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/06/2023] [Indexed: 03/15/2023] Open
Abstract
IgG4-related membranous nephropathy (MN) is often refractory to glucocorticoid (GC) therapy, and treatment remains unclear. We herein report a 67-year-old Japanese man with IgG4-related MN and tubulointerstitial nephritis. A post-gastroscopy antibody test revealed Helicobacter pylori infection. After eradication, his proteinuria decreased indefinitely. We started prednisolone (30 mg/day), long-term GCs, and immunosuppressant therapy. However, remission proved challenging to achieve, with persistent proteinuria present at 1.0-2.0 g/gCr. We performed multitarget therapy for refractory IgG4-related MN, achieving proteinuria remission (<0.3 g/gCr). Multitarget therapy with low-dose GCs can resolve refractory IgG4-related MN through remission induction of proteinuria and minimize the risks associated with GC therapy.
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Affiliation(s)
- Yoshitaka Furuto
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, Japan
| | | | - Akio Namikawa
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, Japan
| | - Yuko Shibuya
- Department of Hypertension and Nephrology, NTT Medical Center Tokyo, Japan
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Farrokhnia F, Derakhshan A, Fallahzade M, Basiratnia M. Relationship between H. pylori infection and some other risk factors in the incidence and recurrence of idiopathic nephrotic syndrome in children. CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:454-459. [PMID: 37520862 PMCID: PMC10379807 DOI: 10.22088/cjim.14.3.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 08/17/2022] [Accepted: 09/10/2022] [Indexed: 08/01/2023]
Abstract
Background Idiopathic nephrotic syndrome (INS) is one of the chronic diseases in children and it is important to identify its related factors. The present study aimed at investigating the relationship between H. pylori infection and the incidence and recurrence of idiopathic nephrotic syndrome in children. Methods The total number of case participants was 40 and the total number of control participants was 41. Based on the number of cases of nephrotic syndrome (NS), the same number of healthy children of the same age and gender were selected as the control group. The information and data collected include demographic characteristics of patients, duration of disease, number of recurrences, blood pressure and blood excretion in urine, height, and weight, and presence of gastrointestinal symptoms on the checklist. The data were entered into SPSS and analyzed at a significance level of 05. Results From 81 participants in the study, 11 (13.75%) cases were H. pylori positive, of whom 7 (17.5%) cases were in the control group and 4 (10%) cases were in the patients' group. There was no significant difference between the two groups in terms of H. pylori infection rate (P = 0.863). Moreover, there were no significant differences between the patients suffering from the nephrotic syndrome in terms of height, weight, blood pressure, hematuria, duration and recurrence of the disease (p>0.05). Conclusion According to the evaluations performed in the present study, there was no relationship between low birth weight, blood pressure, disease duration, and disease recurrence with NS.
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Affiliation(s)
- Farrokh Farrokhnia
- Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Derakhshan
- Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mitra Basiratnia
- Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Nesheiwat Z, Daboul J, Merugu GP, Adapa S, Balla M. Membranous nephropathy and autoimmune hepatitis in the setting of acute Helicobacter pylori infection: a case report. J Med Case Rep 2021; 15:308. [PMID: 34051825 PMCID: PMC8164793 DOI: 10.1186/s13256-021-02874-7] [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: 12/16/2020] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults worldwide. A growing body of evidence indicates a pathogenic and autoimmune correlation between Helicobacter pylori infection, MN, and autoimmune liver disease. Case presentation A 47-year-old African American woman presented to our institution with epigastric pain and vomiting. In-patient hospital workup included a thorough abdominal evaluation including esophagogastroduodenoscopy and liver biopsy, which revealed active H. pylori infection and autoimmune hepatitis. The patient was incidentally also found to have nephrotic-range proteinuria. Renal workup including kidney biopsy established the diagnosis of MN. Proteinuria improved after initiation of triple therapy for H. pylori infection. Conclusion This case adds to the growing evidence of a correlation between H. pylori infection, MN, and autoimmune liver disease. This report demonstrates a unique case of a patient with MN, autoimmune hepatitis (AIH)/primary biliary cholangitis (PBC), and HP who underwent triple-eradication antibiotic treatment that resulted in an ultimate resolution of all these conditions.
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Affiliation(s)
- Zeid Nesheiwat
- Department of Internal Medicine, The University of Toledo College of Medicine, 2100 Central Avenue 2nd floor, Toledo, Ohio, 43606, USA. .,Department of Internal Medicine, The University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, Ohio, 42614, USA.
| | - Judy Daboul
- Department of Internal Medicine, The University of Toledo College of Medicine, 2100 Central Avenue 2nd floor, Toledo, Ohio, 43606, USA
| | - Ganesh Prasad Merugu
- Division Chief and Geriatric Medicine Fellowship Director, Division of Geriatric Medicine, Department of Family Medicine, The University of Toledo College of Medicine, 3000 Arlington Avenue, Toledo, Ohio, 43614, USA
| | - Sreedhar Adapa
- Department of Internal Medicine, Division of Nephrology, Adventist Medical Center, 115 Mall Drive, Hanford, CA, 93230, USA
| | - Mamtha Balla
- Department of Internal Medicine, The University of Toledo College of Medicine, 2100 Central Avenue 2nd floor, Toledo, Ohio, 43606, USA.,The University of Toledo College of Medicine, ProMedica Physician Hospitalist, ProMedica Toledo Hospital, 2142 N Cove Blvd, Toledo, Ohio, 43606, USA
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Bazmamoun H, Isapour D, Sanaei Z, Amiri R. Evaluation of Helicobacter pylori eradication on the course of childhood nephrotic syndrome and its response to treatment. Med J Islam Repub Iran 2021; 35:52. [PMID: 34268240 PMCID: PMC8271273 DOI: 10.47176/mjiri.35.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Idiopathic nephrotic syndrome is one of the most common glomerular diseases, which may be secondary to infections or systemic diseases. The aim of this study was to evaluate the effect of Helicobacter pylori (H. pylori) eradication on childhood nephrotic syndrome.
Methods: In this randomized controlled clinical trial study, 38 children with concomitant idiopathic nephrotic syndrome and H. pylori infection were divided into 2 equal groups; the intervention group received a cotreatment for both diseases and the control group received only nephrotic syndrome treatment. Patients were followed for 6 months. Data were analyzed using SPSS 21 software. Chi square test, Fisher exact test, and student t test were used. P value <0.05 was considered statistically significant.
Results: The mean interval time from treatment to the recovery of nephrotic syndrome was 48.36±14.48 days in the intervention group and 51.68± 17.32 days in control groups, which was shorter in the intervention group, but not statistically significant. The recurrence of nephrotic syndrome and the mean number of recurrences in the intervention group were lower than the control group, but were not statistically significant. The frequency of diarrhea in the intervention group was significantly higher than the control group (p=0.003).
Conclusion: In children with concomitant idiopathic nephrotic syndrome and H. pylori infection, the treatment of both diseases may accelerate the recovery and decrease the recurrence of nephrotic syndrome.
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Affiliation(s)
- Hassan Bazmamoun
- Department of Pediatric Gastroenterology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Danyal Isapour
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Sanaei
- Department of Community Medicine, Education Development Office, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rahimpour Amiri
- Department of Pediatric Nephrology, Hamadan University of Medical Sciences, Hamadan, Iran
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Liu XZ, Zhang YM, Jia NY, Zhang H. Helicobacter pylori infection is associated with elevated galactose-deficient IgA1 in IgA nephropathy. Ren Fail 2021; 42:539-546. [PMID: 32524871 PMCID: PMC7946026 DOI: 10.1080/0886022x.2020.1772295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Mucosal immunity plays an important role in the pathogenesis of IgA nephropathy (IgAN). This study aimed to investigate if infection of Helicobacter pylori (H. pylori), a common bacteria in the gastrointestinal tract, associated with IgAN. Methods This study included 261 patients with IgAN and 46 healthy controls. Clinical information and plasma samples were collected from patients and healthy controls. H. pylori infection was confirmed by western blot. Plasma IgA1 and galactose-deficient IgA1 (Gd-IgA1) levels were detected by specific enzyme-linked immunosorbent assay. Results Total H. pylori infection rates showed no statistical differences between IgAN patients and healthy controls, but the infection rates of type I H. pylori in IgAN patients were significantly higher than those in healthy controls (44.4 vs. 28.3%, p = 0.040). Compared with uninfected patients, the systolic blood pressure, 24-h proteinuria, and blood urea nitrogen levels were significantly higher in patients with H. pylori infection (126.0 ± 15.5 vs. 119.6 ± 14.5 mmHg, p = 0.010; 1.8 ± 2.7 vs. 1.2 ± 1.4 g/24h, p = 0.013; 7.9 ± 5.4 vs. 6.7 ± 3.9 μmol/L, p = 0.042), especially in patients with type I infection (126.5 ± 15.4 vs. 119.6 ± 14.5 mmHg, p = 0.002; 1.9 ± 2.9 vs. 1.2 ± 1.4 g/24 h, p = 0.033; 8.1 ± 5.6 vs. 6.7 ± 3.9 μmol/L, p = 0.041). Similarly, patients with IgAN and type I H. pylori infection showed higher plasma Gd-IgA1 levels than uninfected patients (5.5 ± 2.2 vs. 4.5 ± 2.2 μg/mL, p = 0.037). Conclusions Virulent type I H. pylori infection is more common in patients with IgAN. Patients with IgAN and type I H. pylori infection showed lower renal function and higher underglycosylation of plasma IgA1.
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Affiliation(s)
- Xing-Zi Liu
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Yue-Miao Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Ni-Ya Jia
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
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Mahmoud A, Bakr A, Elsaid A, Wahba Y. Prevalence of Helicobacter pylori infection among children with primary nephrotic syndrome: a cross-sectional study. Afr Health Sci 2020; 20:1624-1631. [PMID: 34394223 PMCID: PMC8351824 DOI: 10.4314/ahs.v20i4.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Limited data are available about the prevalence of helicobacter pylori (H.pylori) infection among primary NS children. Objectives To assess the frequency and risk factors of H.pylori infection among children with primary NS. Methods A cross-sectional study was carried out in Mansoura University Children's Hospital, Egypt during the period from 2017 to 2019 including 100 NS children (NS group) and 100 healthy controls. NS group included 88 steroid sensitive (SSNS) and 12 steroid resistant (SRNS) cases. All patients were assessed for H.pylori infection using H.pylori stool antigen (HpSA) test. Statistical analysis was done using chi-square, fisher exact and Mann-Whitney tests. Results With regard to HpSA test results, no significant differences were detected between control and NS groups (p = 0.193) and between SSNS and SRNS groups (p = 0.286). Concerning total biopsied cases and MCD (proven plus presumed) cases, no significant differences were found between those with positive and negative HpSA test (p = 0.648 and 0.126, respectively). The high dose of steroid therapy was associated with a higher risk of H.pylori infection among NS group (Odds ratio = 3.8; 95% confidence interval = 1.3–11.3). Conclusion The current study negates the increased risk of H.pylori infection in children with primary NS.
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Affiliation(s)
- Ahmed Mahmoud
- Mansoura University, Faculty of Medicine, Department of Pediatrics
| | - Ashraf Bakr
- Mansoura University, Faculty of Medicine, Department of Pediatrics
| | - Afaf Elsaid
- Mansoura University Children's Hospital, Biochemistry Section
| | - Yahya Wahba
- Mansoura University, Faculty of Medicine, Department of Pediatrics
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Rasane RK, Horn CB, Coleoglou Centeno AA, Fiore NB, Torres Barboza M, Zhang Q, Bochicchio KM, Punch LJ, Bochicchio GV, Ilahi ON. Are Patients with Perforated Peptic Ulcers Who are Negative for Helicobacter pylori at a Greater Risk? Surg Infect (Larchmt) 2019; 20:444-448. [PMID: 30939075 DOI: 10.1089/sur.2018.249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: The link between Helicobacter pylori infection and peptic ulceration is well established. Recent studies have reported a decrease of H. pylori-related peptic ulcer disease; Helicobacter pylori eradication is likely the cause of this decrease. We hypothesized that patients with H. pylori-positive perforated peptic ulcer disease (PPUD) requiring surgical intervention had worse outcomes than patients with H. pylori-negative PPUD. Patients and Methods: A prospectively collected Acute and Critical Care Surgery registry spanning the years 2008 to 2015 was searched for patients with PPUD and tested for H. pylori serum immunoglobulin G (IgG) test. Patients were divided into two cohorts: H. pylori positive (HPP) and H. pylori negative (HPN). Demographics, laboratory values, medication history, social history, and esophagogastroduodenoscopy were collected. Student t-test was used for continuous variables and χ2 test was used for categorical variables. Linear regression was applied as appropriate. Results: We identified 107 patients diagnosed with PPUD, of whom 79 (74%) patients had H. pylori serum IgG testing. Forty-two (53.2%) tested positive and 37 (46.8%) tested negative. Helicobacter pylori-negative PPUD was more frequent in females (70.27%, p = 0.004), whites (83.78%, p = 0.001) and patients with higher body mass index (BMI) 28.81 ± 8.8 (p = 0.033). The HPN group had a lower serum albumin level (2.97 ± 0.96 vs. 3.86 ± 0.91 p = 0.0001), higher American Society of Anesthesiologists (ASA; 3.11 ± 0.85 vs. 2.60 ± 0.73; p = 0.005), and Charlson comorbidity index (4.81 ± 2.74 vs. 2.98 ± 2.71; p = 0.004). On unadjusted analysis the HPN cohort had a longer hospital length of stay (LOS; 20.20 ± 13.82 vs. 8.48 ± 7.24; p = 0.0001), intensive care unit (ICU) LOS (10.97 ± 11.60 vs. 1.95 ± 4.59; p = 0.0001), increased ventilator days (4.54 ± 6.74 vs. 0.98 ± 2.85; p = 0.004), and higher rates of 30-day re-admission (11; 29.73% vs. 5; 11.91%; p = 0.049). Regression models showed that HPN PPUD patients had longer hospital and ICU LOS by 11 days (p = 0.002) and 8 days (p = 0.002), respectively, compared with HPP PPUD. Conclusion: In contrast to our hypothesis, HPN patients had clinically worse outcomes than HPP patients. These findings may represent a difference in the baseline pathophysiology of the peptic ulcer disease process. Further investigation is warranted.
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Affiliation(s)
- Rohit K Rasane
- 1Department of Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | | | | | - Nicholas B Fiore
- 1Department of Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | | | - Qiao Zhang
- 1Department of Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Kelly M Bochicchio
- 1Department of Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Laurie J Punch
- 1Department of Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Grant V Bochicchio
- 1Department of Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Obeid N Ilahi
- 1Department of Surgery, Washington University in Saint Louis, Saint Louis, Missouri
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Shi Y, Duan JY, Liu DW, Qiao YJ, Han QX, Pan SK, Tang L, Cai GY, Chen XM, Liu ZS, Zhu HY. Helicobacter pylori Infection is Associated with Occurrence of Proteinuria in Type 2 Diabetes Patients: A Systemic Review and Meta-Analysis. Chin Med J (Engl) 2018; 131:2734-2740. [PMID: 30425200 PMCID: PMC6247588 DOI: 10.4103/0366-6999.245269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2DM) patients are susceptible to Helicobacter pylori (HP), and it has been reported that the occurrence of proteinuria is associated with HP infection in T2DM patients; however, this view remains controversial. This meta-analysis aimed to explore the association between HP infection and the occurrence of proteinuria in T2DM patients. In addition, we hope to provide some recommendations to readers in clinical or related fields. METHODS Our meta-analysis was conducted with the methodology of the Cochrane Collaboration. Search strategies were formulated by relevant professionals. Case-control studies that compared the occurrence of proteinuria in T2DM patients with and without HP infection were involved in our meta-analysis. Relevant English or Chinese studies were searched on online databases before 2018, including PubMed, the Cochrane library, Medline, Google Scholar, the China National Infrastructure, and Wanfang database. The search strategies were "diabetic proteinuria, diabetic microalbuminuria, diabetic albuminuria, diabetic kidney disease, diabetic renal dysfunction, diabetic renal disease, diabetic nephropathy, diabetic complications, and diabetic mellitus, combined with HP." The quality of these involved articles was separately assessed by two investigators using the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and associated 95% confidence intervals (CIs) were extracted and pooled using fixed-effects models. RESULTS Seven studies involving 1029 participants were included. The quality of these seven articles was all above five stars as assessed by NOS, and there was no significant publication bias in our meta-analysis. We found that T2DM patients with HP infection had a 2.00 times higher risk of the occurrence of proteinuria than patients without HP infection (OR: 2.00, 95% CI: 1.48-2.69). CONCLUSIONS Our analysis showed that HP infection was associated with the occurrence of proteinuria in T2DM patients. HP radical surgery might be a therapeutic option for protecting kidney function in patients with T2DM.
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Affiliation(s)
- Yan Shi
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
- Department of Nephrology, Zhengzhou University; The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Key Laboratory of Accurate Diagnosis and Treatment of Chronic Kidney Diseases in Henan Province, Core Unit of National Kidney Disease Clinical Medical Research Center, Zhengzhou, Henan 450052, China
| | - Jia-Yu Duan
- Department of Nephrology, Zhengzhou University; The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Key Laboratory of Accurate Diagnosis and Treatment of Chronic Kidney Diseases in Henan Province, Core Unit of National Kidney Disease Clinical Medical Research Center, Zhengzhou, Henan 450052, China
| | - Dong-Wei Liu
- Department of Nephrology, Zhengzhou University; The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Key Laboratory of Accurate Diagnosis and Treatment of Chronic Kidney Diseases in Henan Province, Core Unit of National Kidney Disease Clinical Medical Research Center, Zhengzhou, Henan 450052, China
| | - Ying-Jin Qiao
- Department of Nephrology, Zhengzhou University; The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Key Laboratory of Accurate Diagnosis and Treatment of Chronic Kidney Diseases in Henan Province, Core Unit of National Kidney Disease Clinical Medical Research Center, Zhengzhou, Henan 450052, China
| | - Qiu-Xia Han
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
- Department of Nephrology, Zhengzhou University; The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Key Laboratory of Accurate Diagnosis and Treatment of Chronic Kidney Diseases in Henan Province, Core Unit of National Kidney Disease Clinical Medical Research Center, Zhengzhou, Henan 450052, China
| | - Shao-Kang Pan
- Department of Nephrology, Zhengzhou University; The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Key Laboratory of Accurate Diagnosis and Treatment of Chronic Kidney Diseases in Henan Province, Core Unit of National Kidney Disease Clinical Medical Research Center, Zhengzhou, Henan 450052, China
| | - Li Tang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Zhang-Suo Liu
- Department of Nephrology, Zhengzhou University; The First Affiliated Hospital of Zhengzhou University, Research Institute of Nephrology, Key Laboratory of Accurate Diagnosis and Treatment of Chronic Kidney Diseases in Henan Province, Core Unit of National Kidney Disease Clinical Medical Research Center, Zhengzhou, Henan 450052, China
| | - Han-Yu Zhu
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
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Lai WL, Yeh TH, Chen PM, Chan CK, Chiang WC, Chen YM, Wu KD, Tsai TJ. Membranous nephropathy: a review on the pathogenesis, diagnosis, and treatment. J Formos Med Assoc 2015; 114:102-11. [PMID: 25558821 DOI: 10.1016/j.jfma.2014.11.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 11/07/2014] [Accepted: 11/12/2014] [Indexed: 11/25/2022] Open
Abstract
In adults, membranous nephropathy (MN) is a major cause of nephrotic syndrome. However, the etiology of approximately 75% of MN cases is idiopathic. Secondary causes of MN are autoimmune diseases, infection, drugs, and malignancy. The pathogenesis of MN involves formation of immune complex in subepithelial sites, but the definite mechanism is still unknown. There are three hypotheses about the formation of immune complex, including preformed immune complex, in situ immune-complex formation, and autoantibody against podocyte membrane antigen. The formation of immune complex initiates complement activation, which subsequently leads to glomerular damage. Recently, the antiphospholipase A2 receptor antibody was found to be associated with idiopathic MN. This finding may be useful in the diagnosis and prognosis of MN. The current treatment includes best supportive care, which consists of the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, lipid-lowering agents, and optimal control of blood pressure. Immunosuppressive agents should be used for patients who suffer from refractory proteinuria or complications associated with nephrotic syndrome. Existing evidence supports the use of a combination of steroid and alkylating agents. This article reviews the epidemiology, pathogenesis, diagnosis, and the treatment of MN.
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Affiliation(s)
- Wei Ling Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting Hao Yeh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping Min Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen Chih Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yung Ming Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kwan Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tun Jun Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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