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Gao C, Bian X, Wu L, Zhan Q, Yu F, Pan H, Han F, Wang YF, Yang Y. A nomogram predicting the histologic activity of lupus nephritis from clinical parameters. Nephrol Dial Transplant 2024; 39:520-530. [PMID: 37667508 PMCID: PMC10899760 DOI: 10.1093/ndt/gfad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The 2021 clinical guidelines of the Kidney Disease: Improving Global Outcomes emphasize the importance of the histological activity index (AI) in the management of lupus nephritis (LN). Patients with LN and a high AI have poor renal outcomes and high rates of nephritic relapse. In this study we constructed prediction models for the AI in LN. METHODS The study population comprised 337 patients diagnosed with LN using kidney biopsy. The participants were randomly divided into training and testing cohorts. They were further divided into high-activity (AI >2) and low-activity (AI ≤2) groups. This study developed two clinical prediction models using logistic regression and least absolute shrinkage and selection operator (LASSO) analyses with laboratory test results collected at the time of kidney biopsy. The performance of models was assessed using 5-fold cross-validation and validated in the testing cohort. A nomogram for individual assessment was constructed based on the preferable model. RESULTS Multivariate analysis showed that higher mean arterial pressure, lower estimated glomerular filtration rate, lower complement 3 level, higher urinary erythrocytes count and anti-double-stranded DNA seropositivity were independent risk factors for high histologic activity in LN. Both models performed well in the testing cohort regarding the discriminatory ability to identify patients with an AI >2. The average area under the curve of 5-fold cross-validation was 0.855 in the logistic model and 0.896 in the LASSO model. A webtool based on the LASSO model was created for clinicians to enter baseline clinical parameters to produce a probability score of an AI >2. CONCLUSIONS The established nomogram provides a quantitative auxiliary tool for distinguishing LN patients with a high AI and helps physicians make clinical decisions in their comprehensive assessment.
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Affiliation(s)
- Cui Gao
- Department of Nephrology, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Xueyan Bian
- Department of Nephrology, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Longlong Wu
- Department of Nephrology, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Qian Zhan
- Department of Nephrology, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Fengfei Yu
- Department of Nephrology, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Hong Pan
- Department of Nephrology, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Fei Han
- Kidney Disease Center, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yong-Fei Wang
- School of Medicine and Warshel Institute for Computational Biology, Chinese University of Hong Kong, Shenzhen, Guangdong, China
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China
| | - Yi Yang
- Department of Nephrology, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, China
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2
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Navarro D, Fonseca NM, Ferreira AC, Barata R, Góis M, Sousa H, Nolasco F. Urinary Sediment Microscopy and Correlations with Kidney Biopsy: Red Flags Not To Be Missed. KIDNEY360 2023; 4:32-40. [PMID: 36700902 PMCID: PMC10101572 DOI: 10.34067/kid.0003082022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Urinary sediment is a noninvasive laboratory test that can be performed by an automated analyzer or manually by trained personnel. Manual examination remains the diagnostic standard because it excels at differentiating isomorphic from dysmorphic red blood cells and identifying other urinary particles such as renal tubular epithelial cells (RTECs), lipids, crystals, and the composition of casts. This study aimed to investigate the prevalence of a complete profile of urinary sediment particles and its associations with histologic lesions on kidney biopsy, regardless of diagnosis. METHODS This was a single-center, observational retrospective study of 131 patients who had contemporary manual urinary sediment evaluation and kidney biopsy. A comprehensive set of urinary particles and histologic lesions were quantified, and their associations were analyzed. RESULTS In our samples, we found an elevated frequency of findings suggestive of proliferative kidney disease and a low frequency of particles evoking urologic damage. The association of histologic lesions and urinary particles was explored with a multivariate model. We identified urinary sediment characteristics that independently correlated with the presence of some histologic lesions: urinary lipids with mesangial expansion (OR=2.86; 95% confidence interval [95% CI], 1.3 to 6.3), mesangial hypercellularity (OR=2.44; 95% CI, 1.06 to 5.58), and wire loops and/or hyaline deposits (OR=2.89; 95% CI, 1.13 to 7.73); Urinary renal tubular epithelial cells with endocapillary hypercellularity (OR=3.17; 95% CI, 1.36 to 7.39), neutrophils and/or karyorrhexis (OR=4.51; 95% CI, 1.61 to 12.61), fibrinoid necrosis (OR=4.35; 95% CI, 1.48 to 12.74), cellular/fibrocellular crescents (OR=5.27; 95% CI, 1.95 to 14.26), and acute tubular necrosis (OR=2.31; 95% CI, 1.08 to 4.97). CONCLUSIONS In a population of patients submitted to kidney biopsy, we found that the presence of some urinary particles (renal tubular epithelial cells, lipids, and dysmorphic erythrocytes), which are seldom reported by automated analyzers, is associated with active proliferative histologic lesions. In this regard, manual urinary sediment evaluation may help to shape the indications for performing a kidney biopsy.
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Affiliation(s)
- David Navarro
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
| | - Nuno Moreira Fonseca
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ana Carina Ferreira
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Rui Barata
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
| | - Mário Góis
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Helena Sousa
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Fernando Nolasco
- Nephrology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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3
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Saha MK, Massicotte-Azarniouch D, Reynolds ML, Mottl AK, Falk RJ, Jennette JC, Derebail VK. Glomerular Hematuria and the Utility of Urine Microscopy: A Review. Am J Kidney Dis 2022; 80:383-392. [PMID: 35777984 DOI: 10.1053/j.ajkd.2022.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/16/2022] [Indexed: 01/27/2023]
Abstract
Evaluation of hematuria and microscopic examination of urine sediment are commonly used tools by nephrologists in their assessment of glomerular diseases. Certain morphological aspects of urine red blood cells (RBCs) seen by microscopy may help in identifying the source of hematuria as glomerular or not. Recognized signs of glomerular injury are RBC casts or dysmorphic RBCs, in particular acanthocytes (ring-shaped RBCs with protruding blebs). Despite being a highly operator-dependent test, urine sediment examination revealing these signs of glomerular hematuria has demonstrated specificities and positive predictive values ranging between 90%-100% for diagnosing glomerular disease, although sensitivity can be quite variable. Hematuria is a commonly used tool for diagnosing patients with proliferative glomerulonephritis such as IgA nephropathy, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and lupus nephritis, sometimes even as a surrogate for kidney involvement. Studies examining the role for hematuria in monitoring and predicting adverse outcomes in these diseases have shown inconsistent results, possibly due to inconsistent definitions that often fail to consider specific markers of glomerular hematuria such as dysmorphic RBCs, acanthocytes, or RBC casts. A consensus definition of what constitutes glomerular hematuria would help standardize use in future studies and likely improve the diagnostic and prognostic value of hematuria as a marker of glomerulonephritis.
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Affiliation(s)
- Manish K Saha
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
| | - David Massicotte-Azarniouch
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Monica L Reynolds
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Amy K Mottl
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Ronald J Falk
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Vimal K Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Gamaleldin SM, Alghazaly GM, Saad MA, Shareef MM, Elnagar GF. Urinary Sediments as Predictors of the Histopathology of Lupus Nephritis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:617-626. [PMID: 37955454 DOI: 10.4103/1319-2442.389422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Lupus nephritis (LN) is a major risk factor for morbidity and mortality in systemic lupus erythematosus (SLE). Urinalysis has an invaluable role in the diagnosis of various renal and urological diseases. Examinations of the urinary sediment using phase contrast microscopy (PCM) may add more information to help earlier diagnoses of LN. This cross-sectional study aimed to assess the possible role of the components of urinary sediment examined using PCM in discriminating the proliferative classes of LN (III and IV ± V) from the non-proliferative classes (I, II, and V), and to detect the correlation between the components of urinary sediment and indices of both activity and chronicity found by the renal biopsy. The study was conducted on 40 SLE patients for whom a renal biopsy was indicated. Clinical, demographic, and laboratory data and the results of the histopathological renal biopsy were collected. The morning before the renal biopsy; urine samples were collected from every patient and examined by PCM. Receiver operating characteristic curves were used to detect the area under the curve to predict proliferative LN. The correlations of counts of leukocytes, erythrocytes, all dysmorphic erythrocytes, acanthocytes, and stomatocytes with the indices of activity and chronicity were significant (activity: P = 0.027, P = 0.015, P = 0.033, P = 0.040, and P <0.001*; chronicity: P = 0.035, P = 0.009, P = 0.027, P = 0.010, and P <0.001, respectively). For patients with SLE, urinary sediment examinations can suggest a renal biopsy for the histopathology of LN.
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Affiliation(s)
- Sally M Gamaleldin
- Department of Internal Medicine, Nephrology Unit, Tanta University, Tanta, Egypt
| | - Ghada M Alghazaly
- Department of Internal Medicine, Nephrology Unit, Tanta University, Tanta, Egypt
| | - Mohammed A Saad
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed M Shareef
- Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Gamal F Elnagar
- Department of Internal Medicine, Nephrology Unit, Tanta University, Tanta, Egypt
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5
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Lupus nephritis diagnosis using enhanced moth flame algorithm with support vector machines. Comput Biol Med 2022; 145:105435. [PMID: 35397339 DOI: 10.1016/j.compbiomed.2022.105435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/02/2022] [Accepted: 03/20/2022] [Indexed: 12/24/2022]
Abstract
Systemic lupus erythematosus is a chronic autoimmune disease that affects the kidney in most patients. Lupus nephritis (LN) is divided into six categories by the International Society of Nephrology/Renal Pathology Society (ISN/RPS). The purpose of this research is to build a framework for discriminating between ISN/RPS pure class V(MLN) and classes III ± V or IV ± V (PLN) using real clinical data. The framework is developed by merging a hybrid stochastic optimizer, moth-flame algorithm (HMFO), with a support vector machine (SVM), dubbed HMFO-SVM. The HMFO is constructed by enhancing the original moth-flame algorithm (MFO) with a bee-foraging learning operator, which guarantees that the algorithm speeds convergence and departs from the local optimum. The HMFO is used to optimize parameters and select features simultaneously for SVM on clinical SLE data. On 23 benchmark tests, the suggested HMFO method is validated. Finally, clinical data from LN patients are analyzed to determine the efficacy of HMFO-SVM over other SVM rivals. The statistical findings indicate that all measures have predictive capabilities and that the suggested HMFO-SVM is more stable for analyzing systemic LN. HMFO-SVM may be used to analyze LN as a feasible computer-assisted technique.
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6
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Zhang C, Ge C, Wang J, Sun D. Fish oil enhanced the efficacy of low-dose cyclophosphamide regimen for proliferative lupus nephritis: a randomized controlled double-blind trial. Food Nutr Res 2021; 65:7842. [PMID: 34393696 PMCID: PMC8344404 DOI: 10.29219/fnr.v65.7842] [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: 04/24/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background Lupus nephritis (LN) is one of the most severe organ that damages the systemic lupus erythematosus (SLE). Cyclophosphamide is one of the main drugs used in the treatment of LN. Fish oil is a general term of all the oily substances in fish, whose main component is omega-3 fatty acid. This study aimed to investigate whether fish oil could be used as an adjunct to low-dose cyclophosphamide in proliferative LN treatment. Methods A total of 237 patients with proliferative LN were recruited and randomized into two groups: cyclophosphamide + placebo group and cyclophosphamide + fish oil group. In the cyclophosphamide + placebo group, participants received prednisone + cyclophosphamide + placebo. In the cyclophosphamide + fish oil group, participants received prednisone + cyclophosphamide + fish oil. Before and after treatment, the clinical parameters of the patients in both groups were evaluated. Results In the cyclophosphamide + fish oil group, the number of patients achieving complete remission (n = 45, 46.9%) was significantly higher than the cyclophosphamide + placebo group (n = 31, 32.6%). The number of patients achieving no response in the cyclophosphamide + fish oil group (n = 8, 8.3%) was significantly lower than the cyclophosphamide + placebo group (n = 22, 23.2%). Hematuria (P = 0.036), urine protein-creatinine ratio (uPCR) (P = 0.014), estimated glomerular filtration rate (eGFR) (P = 0.027), and renal SLE disease activity index (SLEDAI) (P = 0.009) improved more significantly in the cyclophosphamide + fish oil group. The number of patients with infection (P = 0.04) or urinary tract infection (P = 0.04) in the cyclophosphamide + fish oil group was lower than the cyclophosphamide + placebo group. Conclusion In conclusion, the treatment of fish oil in LN patients enhances the efficiency of cyclophosphamide, alleviates nephritis-related parameters, and inhibits infection and urinary tract infection during the treatment. Thus, fish oil may serve as a potential adjuvant drug in the treatment of LN.
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Affiliation(s)
- Chi Zhang
- Department of Nephrology, The Affiliated Suqian Hospital of Xuzhou Medical University, Jiangsu, China.,Xuzhou Medical University, Jiangsu, China
| | - Chang Ge
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Junsheng Wang
- Department of Nephrology, The Affiliated Suqian Hospital of Xuzhou Medical University, Jiangsu, China
| | - Dong Sun
- Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China.,Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Jiangsu, China
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7
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Evolving fuzzy k-nearest neighbors using an enhanced sine cosine algorithm: Case study of lupus nephritis. Comput Biol Med 2021; 135:104582. [PMID: 34214940 DOI: 10.1016/j.compbiomed.2021.104582] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 02/05/2023]
Abstract
Because of its simplicity and effectiveness, fuzzy K-nearest neighbors (FKNN) is widely used in literature. The parameters have an essential impact on the performance of FKNN. Hence, the parameters need to be attuned to suit different problems. Also, choosing more representative features can enhance the performance of FKNN. This research proposes an improved optimization technique based on the sine cosine algorithm (LSCA), which introduces a linear population size reduction mechanism for enhancing the original algorithm's performance. Moreover, we developed an FKNN model based on the LSCA, it simultaneously performs feature selection and parameter optimization. Firstly, the search performance of LSCA is verified on the IEEE CEC2017 benchmark test function compared to the classical and improved algorithms. Secondly, the validity of the LSCA-FKNN model is verified on three medical datasets. Finally, we used the proposed LSCA-FKNN to predict lupus nephritis classes, and the model showed competitive results. The paper will be supported by an online web service for any question at https://aliasgharheidari.com.
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8
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Mizuno G, Hoshi M, Nakamoto K, Sakurai M, Nagashima K, Fujita T, Ito H, Hata T. Evaluation of red blood cell parameters provided by the UF-5000 urine auto-analyzer in patients with glomerulonephritis. Clin Chem Lab Med 2021; 59:1547-1553. [PMID: 33908221 DOI: 10.1515/cclm-2021-0287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The microscopic examination of hematuria, a cardinal symptom of glomerulonephritis (GN), is time-consuming and labor-intensive. As an alternative, the fully automated urine particle analyzer UF-5000 can interpret the morphological information of the glomerular red blood cells (RBCs) using parameters such as UF-5000 small RBCs (UF-%sRBCs) and Lysed-RBCs. METHODS Hematuria samples from 203 patients were analyzed using the UF-5000 and blood and urine chemistries to determine the cut-off values of RBC parameters for GN and non-glomerulonephritis (NGN) classification and confirm their sensitivity to the IgA nephropathy and non-IgA nephropathy groups. RESULTS The UF-%sRBCs and Lysed-RBCs values differed significantly between the GN and NGN groups. The cut-off value of UF-%sRBCs was >56.8% (area under the curve, 0.649; sensitivity, 94.1%; specificity, 38.1%; positive predictive value, 68.3%; and negative predictive value, 82.1%), while that for Lysed-RBC was >4.6/μL (area under the curve, 0.708; sensitivity, 82.4%; specificity, 56.0%; positive predictive value, 72.6%; and negative predictive value, 69.1%). Moreover, there was no significant difference in the sensitivity between the IgA nephropathy and non-IgA nephropathy groups (87.1 and 89.8% for UF-%sRBCs and 83.9 and 78.4% for Lysed-RBCs, respectively). In the NGN group, the cut-off values showed low sensitivity (56.0% for UF-%sRBCs and 44.0% for Lysed-RBCs). CONCLUSIONS The RBC parameters of the UF-5000, specifically UF-%sRBCs and Lysed-RBCs, showed good cut-off values for the diagnosis of GN.
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Affiliation(s)
- Genki Mizuno
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan
| | - Masato Hoshi
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan.,Department of Biochemical and Analytical Science, Fujita Health University, Kutsukakecho, Toyoake, Aichi, Japan
| | - Kentaro Nakamoto
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan.,Department of Disease Control and Prevention, Fujita Health University, Kutsukakecho, Toyoake, Aichi, Japan
| | - Masayo Sakurai
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan
| | - Kazuko Nagashima
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan
| | - Takashi Fujita
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan
| | - Hiroyasu Ito
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan
| | - Tadayoshi Hata
- Department of Clinical Laboratory, Fujita Health University Hospital, Kutsukakecho, Toyoake, Aichi, Japan
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9
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Yuan M, Tan Y, Li J, Yu X, Zhang H, Zhao M. Urinary sediments could differentiate endocapillary proliferative lupus nephritis and endocapillary proliferative IgA nephropathy. Int Immunopharmacol 2020; 90:107122. [PMID: 33199236 DOI: 10.1016/j.intimp.2020.107122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study investigated the differences in urinary sediment findings between patients with endocapillary proliferative lupus nephritis (LN) and patients with endocapillary proliferative IgA nephropathy (IgAN) and further evaluated the associations of leukocyturia with disease activity, pathological features and prognosis. METHODS The urinary sediments of 126 patients, including 92 with LN and 34 with IgAN, with renal-biopsy-proven endocapillary proliferative glomerulonephritis (EPGN) were examined by a standardized method. The urinary elements investigated included various cells, casts and crystals. The associations of leukocyturia with disease activity, pathological features and prognosis were further analyzed. RESULTS In the patients with EPGN, normal to mild leukocyturia (≤12/HPF) and moderate to severe leukocyturia (>12/HPF) were found in 52 (41.27%) and 74 (58.73%) patients, respectively. The proportion of moderate to severe leukocyturia and the frequencies of urinary white blood cell casts and waxy casts were significantly higher in endocapillary proliferative LN than those in endocapillary proliferative IgAN (P < 0.001, P = 0.020, P = 0.010, respectively). In the endocapillary proliferative LN group, the levels of leukocyturia were significantly correlated with serum creatinine (r = 0.288, P = 0.005), eGFR (r = -0.284, P = 0.006), serum C3 (r = -0.275, P = 0.009), SLEDAI scores (r = 0.383, P ≤ 0.001) and glomerular leukocyte infiltration (r = 0.285, P = 0.002). A multivariate analysis showed that leukocyturia was an independent risk factor for renal outcomes in endocapillary proliferative LN (HR: 1.456, 95% CI: 1.083-1.957, P = 0.013) but not in IgAN. CONCLUSIONS Urinary sediments of LN with EPGN and IgAN with EPGN differed in many aspects. Leukocyturia could reflect the disease activity and prognosis of EPGN, especially in endocapillary proliferative LN.
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Affiliation(s)
- Mo Yuan
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, PR China
| | - Ying Tan
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, PR China.
| | - Jingzi Li
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, PR China
| | - Xiaojuan Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, PR China
| | - Hong Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, PR China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, PR China; Peking-Tsinghua Center for Life Sciences, Beijing 100084, PR China
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10
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Luimstra JJ, Koçer RG, Jerman A, Klein Gunnewiek J, Gijzen K, Jacobs LHJ, Demir AY. Current state of the morphological assessment of urinary erythrocytes in The Netherlands: a nation-wide questionnaire. Clin Chem Lab Med 2020; 58:1891-1900. [PMID: 32335538 DOI: 10.1515/cclm-2020-0236] [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: 03/02/2020] [Accepted: 03/28/2020] [Indexed: 01/03/2023]
Abstract
Background The morphological assessment of urinary erythrocytes (uRBC) is a convenient screening tool for the differentiation of nephrological (dysmorphic) and urological (isomorphic) causes of hematuria. Considering the morphological heterogeneity, this analysis is often perceived as difficult. There is no clear (inter)national consensus and there is a lack of external quality assessment programs. To gain insight into the heterogeneity within and between laboratories, we scrutinized the current state of this analysis in Dutch medical laboratories. Methods The laboratories, affiliated with the Dutch Foundation for Quality Assessment in Medical Laboratories, were invited to participate in a web-based survey, consisting of two questionnaires. The first one provided information about the institution and laboratory organization, and the second explored the variability in the morphological analysis of uRBC on the basis of categorization of 160 uRBC images. Statistical analysis was premised on binomial significance testing and principal component analysis. Results Nearly one third of the Dutch medical laboratories (65/191) with 167 staff members participated in the survey. Most of these laboratories (83%) were an integral part of secondary care. The statistical analysis of the evaluations of the participants in comparison to the consensus (three experts from two different medical laboratories) suggested a great degree of heterogeneity in the agreement. Nearly half of the participants consciously disagreed with the consensus, whereas one fifth demonstrated a random relationship with it. Conclusions In Dutch medical laboratories, results from morphological analysis of uRBC are heterogeneous, which point out the necessity for standardization and harmonization.
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Affiliation(s)
- Jolien J Luimstra
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Rüya G Koçer
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Alexander Jerman
- Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia
| | - Jacqueline Klein Gunnewiek
- Section General Chemistry, Dutch Foundation for External Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands
| | - Karlijn Gijzen
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Leo H J Jacobs
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Ayşe Y Demir
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
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11
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Weiner SM, Waldherr R. Stellenwert der Nierenbiopsie bei Lupusnephritis. AKTUEL RHEUMATOL 2020. [DOI: 10.1055/a-1121-8852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungBei systemischem Lupus erythematodes (SLE) findet sich häufig eine renale Mitbeteiligung, der verschiedene pathogenetische Mechanismen zugrunde liegen. Die Nierenbeteiligung hat einen negativen Einfluss auf die Prognose des SLE, insbesondere bei progredienter Niereninsuffizienz. Eine Nierenbiopsie ist aufgrund der Heterogenität der Nierenbeteiligung und der damit verbundenen therapeutischen Konsequenzen unabdingbar. Sie kann durch nicht-invasive Untersuchungen wie die Urindiagnostik oder Serologie nicht ersetzt werden, da das Ausmaß der Proteinurie oder der Mikrohämaturie keine sicheren Rückschlüsse auf den Schweregrad, die Pathogenese und die Prognose der Nierenbeteiligung erlauben. Die Nierenbiopsie gibt neben der korrekten Klassifikation der Lupusnephritis (LN) Informationen über die Mitbeteiligung des Niereninterstitium, der intrarenalen Gefäße und der Aktivität sowie Chronizität der Nephritis. Auch kann der Pathologe die Frage beantworten, inwieweit mit einer Besserung der Nierenfunktion unter Therapie gerechnet werden kann. Der folgende Beitrag gibt einen Überblick über den Stellenwert der Nierenbiopsie bei SLE, der revidierten Klassifikation der LN von 2018 einschließlich Sonderformen der LN und über die Implikationen des Biopsie-Ergebnisses für die Therapie.
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Affiliation(s)
- Stefan Markus Weiner
- 2. Medizinische Abteilung, Krankenhaus der Barmherzigen Brüder, Trier
- KfH Nierenzentrum Nordallee, KfH Kuratorium für Dialyse und Nierentransplantation e. V., Trier
| | - Rüdiger Waldherr
- Pathologisches Institut, Ruprecht Karls Universität Heidelberg, Heidelberg
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Cobbaert CM, Arslan F, Caballé Martín I, Serra AA, Picó-Plana E, Sánchez-Margalet V, Carmona-Fernández A, Burden J, Ziegler A, Bechel W. Automated urinalysis combining physicochemical analysis, on-board centrifugation, and digital imaging in one system: A multicenter performance evaluation of the cobas 6500 urine work area. Pract Lab Med 2019; 17:e00139. [PMID: 31649991 PMCID: PMC6804654 DOI: 10.1016/j.plabm.2019.e00139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND We evaluated the analytical performance of the fully automated cobas® 6500 urine work area and its automated components-cobas u 601 and cobas u 701. DESIGN AND METHODS The study was conducted at three European centers using un-centrifuged surplus routine urine samples; all measurements were performed within 2 h of sample collection. Precision, sample carry-over, and method comparisons were evaluated per Clinical and Laboratory Standards Institute guidelines. Method comparisons: cobas u 601 versus Urisys 2400 and cobas u 411 urine test strips; and cobas u 701 versus KOVA® visual microscopy and iQ200 analyzer. Operability and functionality were assessed using questionnaires. RESULTS Precision of the entire cobas 6500 system was within predefined acceptance limits and no significant carry-over was observed. Erythrocytes, leukocytes, nitrites, and protein were in good agreement (≥93%) with cobas u 411 reflectometry. High correlation was shown between the cobas u 701 analyzer and KOVA visual microscopy for red blood cells (RBC; slope, 0.89; Pearson's r, 0.95) and white blood cells (WBC; slope, 0.96; Pearson's r, 0.96), demonstrating equivalence of test results. The 97.5% percentile reference values on the cobas u 701 analyzer were 5.3 cells/μL (RBC) and 6.2 cells/μL (WBC). The cobas 6500 system showed good sensitivity for small bacteria (>1 μm) and pathological casts, and the user interface, maintenance wizards, and system design were highly rated by operators. CONCLUSIONS The fully automated workflow, high precision, and high throughput of the cobas 6500 system have the potential to facilitate standardization of urine screening.
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Affiliation(s)
- Christa M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, ZA, 2333, the Netherlands
| | - Figen Arslan
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, ZA, 2333, the Netherlands
| | - Imma Caballé Martín
- CatLab, Vial St Jordi S/n, Pol.Ind. Can Mitjans, 08232, Viladecavalls, Spain
| | - Antoni Alsius Serra
- CatLab, Vial St Jordi S/n, Pol.Ind. Can Mitjans, 08232, Viladecavalls, Spain
| | - Ester Picó-Plana
- CatLab, Vial St Jordi S/n, Pol.Ind. Can Mitjans, 08232, Viladecavalls, Spain
| | - Víctor Sánchez-Margalet
- Virgen Macarena University Hospital, University of Seville, Calle Dr. Fedriani, 3, 41009, Seville, Spain
| | - Antonio Carmona-Fernández
- Virgen Macarena University Hospital, University of Seville, Calle Dr. Fedriani, 3, 41009, Seville, Spain
| | - John Burden
- Roche Diagnostics International Ltd., Forrenstrasse 2, CH-6343, Rotkreuz, Switzerland
| | - André Ziegler
- Roche Diagnostics International Ltd., Forrenstrasse 2, CH-6343, Rotkreuz, Switzerland
| | - Walter Bechel
- Roche Diagnostics International Ltd., Forrenstrasse 2, CH-6343, Rotkreuz, Switzerland
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Jesus D, Matos A, Henriques C, Zen M, Doria A, Inês LS. Response to: 'SLE-DAS: ready for routine use' by Mathew et al. Ann Rheum Dis 2019; 79:e117. [PMID: 31201172 DOI: 10.1136/annrheumdis-2019-215794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Diogo Jesus
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Ana Matos
- School of Technology and Management, Polytechnic Institute of Viseu, Viseu, Portugal.,Centre for the Study of Education, Technologies and Health, Viseu, Portugal
| | - Carla Henriques
- School of Technology and Management, Polytechnic Institute of Viseu, Viseu, Portugal.,Centre for the Study of Education, Technologies and Health, Viseu, Portugal.,Centre for Mathematics, University of Coimbra, Coimbra, Portugal
| | - Margherita Zen
- Rheumatology Unit, Department of Rheumatology, University of Padova, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Rheumatology, University of Padova, Padova, Italy
| | - Luís Sousa Inês
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal .,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
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Class IV Lupus Nephritis in the Setting of Serologically Quiescent Disease and Normal Urine Sediment in a Patient with Late-Onset Systemic Lupus Erythematosus. Case Rep Rheumatol 2019; 2019:1219529. [PMID: 30911427 PMCID: PMC6398080 DOI: 10.1155/2019/1219529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/31/2019] [Indexed: 12/27/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that may affect any organ of the body. Lupus nephritis (LN) is a frequent and serious complication of SLE. We report a case of an 80-year-old woman who was initially diagnosed with late-onset SLE and eventually developed LN in the setting of normal complements, double-stranded DNA, C-reactive protein, erythrocyte sedimentation rate, and urine sediment. She developed abnormal renal function (creatinine of 1.7 mg/dl) and mild proteinuria (1-2+) without hematuria. Renal biopsy showed class IV lupus glomerulonephritis, active and chronic. The patient was started on mycophenolate mofetil which led to improvement of proteinuria and stabilization of creatinine. The suspicion for LN in a patient with late-onset SLE should remain high when there is development of suspicious renal or urinary abnormalities even if laboratory values do not suggest high disease activity and urinary sediment is normal. To our knowledge, this is one of the oldest patients with biopsy-proven LN and late-onset SLE.
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Hamadah AM, Gharaibeh K, Mara KC, Thompson KA, Lieske JC, Said S, Nasr SH, Leung N. Urinalysis for the diagnosis of glomerulonephritis: role of dysmorphic red blood cells. Nephrol Dial Transplant 2017; 33:1397-1403. [DOI: 10.1093/ndt/gfx274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Kamel Gharaibeh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Katherine A Thompson
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Samar Said
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samih H Nasr
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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