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Al Arfaj AS, Khalil N. Levels of Proteinuria and Renal Pathology in Systemic Lupus Erythematosus Patients. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:154-160. [PMID: 38146725 DOI: 10.4103/1319-2442.391894] [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: 12/27/2023] Open
Abstract
According to the current guidelines, renal biopsies are performed in systemic lupus erythematosus (SLE) patients for proteinuria of 0.5 g/24 h or higher. Renal pathology may be present in patients with lower-level proteinuria (<0.5 g/24 h). We aimed to review the renal histopathology in SLE patients, with lower levels of proteinuria. In this retrospective study, we retrieved SLE patients' data, including 24-h urinary protein excretion and renal histopathology results. We compared various parameters in different lupus nephritis (LN) classes and in different levels of proteinuria (urinary protein <0.5 g, 0.5 to <1 g, and ≥1 g per 24 h). Out of 476 patients, 274 (57.6%) had proteinuria of <0.5 g, 44 (9.2%) had 0.5 to <1 g, and 158 (33.2%) had ≥1 g per 24 h. SLE patients with proteinuria of <0.5 g/24 h were found to have LN, including the proliferative classes. Of the 299 LN cases confirmed by a renal biopsy, low-level proteinuria (<0.5 g) was found in 39.8% of all LN patients, in 50% of patients with Class III LN, 33.3% of those with Class IV LN, 31.4% of those with Class V LN, and 41.4% of those with other LN classes (II/V, III/V, and IV/V). Overall, 35.9% (87/242) of patients with the proliferative LN classes (III, IV, V, II/V, III/V and IV/V) had low-level proteinuria of <0.5 g/24 h. SLE patients with low-level proteinuria had significant renal pathology. Our study suggests there is a need to perform renal biopsies at lower levels of proteinuria.
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Affiliation(s)
- Abdurhman Saud Al Arfaj
- Department of Medicine, Division of Rheumatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Najma Khalil
- College of Medicine Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Pan X, Yuan Y, Tian Y, Wang J, Li Y, Tian M. Surgical resection of lupus nephritis with pulmonary Aspergillus infection: a case report and review of the literature. J Int Med Res 2022; 50:3000605221095224. [PMID: 35481443 PMCID: PMC9087245 DOI: 10.1177/03000605221095224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a 58-year-old Asian woman who was diagnosed with systemic lupus
erythematosus (SLE) and lupus nephritis, together with a mixed pulmonary
bacterial and fungal infection including Aspergillus. The
infection did not respond well to the routine administration of anti-bacterial
and anti-fungal drugs, and the patient’s creatinine levels continued to rise and
protein remained in her urine. The patient’s SLE persisted without going into
remission. Finally, surgical resection of the pulmonary aspergilloma brought the
SLE back under control.
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Affiliation(s)
- Xiaoli Pan
- Department of Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Yuan Yuan
- School of Foreign Languages of Zunyi Medical University, Zunyi 563000, China
| | - Yu Tian
- The Zhuhai Campus of Zunyi Medical University, Zunyi 563000, China
| | - Jinjing Wang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Yida Li
- Department of Research & Development, ZheJiang TianCheng Network Technology Co., Ltd., JinHua 321000, China
| | - Mei Tian
- Department of Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
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Chedid A, Rossi GM, Peyronel F, Menez S, Atta MG, Bagnasco SM, Arend LJ, Rosenberg AZ, Fine DM. Low-Level Proteinuria in Systemic Lupus Erythematosus. Kidney Int Rep 2020; 5:2333-2340. [PMID: 33305127 PMCID: PMC7710831 DOI: 10.1016/j.ekir.2020.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction In patients with systemic lupus erythematosus (SLE) without concurrent active urinary sediment or unexplained acute kidney injury (AKI), current guidelines recommend performing a kidney biopsy in those with at least 500 mg/24-hour (European League Against Rheumatism/European Renal Association-European Dialysis and Transplant Association [EULAR/ERA-EDTA]) or 1000 mg/24-hour (American College of Rheumatology [ACR]) proteinuria. To evaluate the relevance of these indications, we studied histopathologic findings in patients with SLE with proteinuria below these cutoffs. Methods We retrospectively reviewed the clinical, laboratory and histological characteristics of patients with SLE with <1000 mg/24-hour proteinuria (or mg/g urinary protein-to-creatinine ratio [UPCR]) who underwent their first kidney biopsy between 2003 and 2018. Results We identified 87 patients with SLE with proteinuria less than 1000 mg/24-hour (or mg/g UPCR); 52 of 87 (60%) with isolated proteinuria, that is, without AKI or active urinary sediment (hematuria). Histologic evidence of lupus nephritis (LN) was present in 40 of 52 (76%). Of the 40 patients with LN, 12 had class I or II, 14 had class III or IV, 8 had class V, 6 had a combined proliferative and membranous LN. Non-lupus diagnoses included focal segmental glomerulosclerosis, acute interstitial nephritis, and others. Patient’s age, low C3, low C4, and positivity for anti-double-stranded DNA (anti-dsDNA) antibodies predicted the histological diagnosis of LN on univariate logistic regression; however, a multivariate model including these parameters as independent covariates failed to predict LN. Conclusions Patients with SLE with low-level proteinuria may have significant lupus- or non–lupus-related kidney disease with management implications. There was a significant burden of severe forms of LN. The presence of LN was not predicted by laboratory abnormalities. Based on our findings, we suggest current guidelines be revised to expand kidney biopsy indications to include isolated proteinuria of any grade.
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Affiliation(s)
- Alice Chedid
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Giovanni M Rossi
- UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
- Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Francesco Peyronel
- UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
| | - Steven Menez
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamed G Atta
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Serena M Bagnasco
- Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Lois J Arend
- Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Avi Z Rosenberg
- Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Derek M Fine
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Aringer M. Inflammatory markers in systemic lupus erythematosus. J Autoimmun 2019; 110:102374. [PMID: 31812331 DOI: 10.1016/j.jaut.2019.102374] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 01/04/2023]
Abstract
While systemic lupus erythematosus (SLE) is an autoantibody and immune complex disease by nature, most of its organ manifestations are in fact inflammatory. SLE activity scores thus heavily rely on assessing inflammation in the various organs. This focus on clinical items demonstrates that routine laboratory markers of inflammation are still limited in their impact. The erythrocyte sedimentation rate (ESR) is used, but represents a rather crude overall measure. Anemia and diminished serum albumin play a role in estimating inflammatory activity, but both are reflecting more than one mechanism, and the association with inflammation is complex. C-reactive protein (CRP) is a better marker for infections than for SLE activity, where there is only a limited association, and procalcitonin (PCT) is also mainly used for detecting severe bacterial infection. Of the cytokines directly induced by immune complexes, type I interferons, interleukin-18 (IL-18) and tumor necrosis factor (TNF) are correlated with inflammatory disease activity. Still, precise and timely measurement is an issue, which is why they are not currently used for routine purposes. While somewhat more robust in the assays, IL-18 binding protein (IL-18BP) and soluble TNF-receptor 2 (TNF-R2), which are related to the respective cytokines, have not yet made it into clinical routine. The same is true for several chemokines that are increased with activity and relatively easy to measure, but still experimental parameters. In the urine, proteinuria leads and is essential for assessing kidney involvement, but may also result from damage. Similar to the situation in serum and plasma, several cytokines and chemokines perform reasonably well in scientific studies, but are not routine parameters. Cellular elements in the urine are more difficult to assess in the routine laboratory, where sufficient routine is not always available. Therefore, the analysis of urinary T cells may have potential for better monitoring renal inflammation.
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Affiliation(s)
- Martin Aringer
- University Medical Center and Faculty of Medicine Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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Xue L, Shuyan T, Xiaoli L, Zilong L, Qiuling F, Lining W, Yanqiu L, Li Y. Glomerular Proteomic Profiles in the NZB/W F1 Hybrid Mouse Model of Lupus Nephritis. Med Sci Monit 2019; 25:2122-2131. [PMID: 30900683 PMCID: PMC6698093 DOI: 10.12659/msm.914365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE) and is associated with patient mortality. This study aimed to investigate the proteomic profiles of the glomerulus in the NZB/W F1 hybrid mouse model of mild and severe lupus nephritis using two-dimensional fluorescence difference gel electrophoresis (2D-DIGE) combined with matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF-MS). Material/Methods Female NZB/WF1 mice (n=60) at 28 weeks of age were divided into the mild proteinuria group (+1), the moderate proteinuria group (+2), and the severe proteinuria group (+3) using paper strip urine testing, and then later divided into a mild (≤1+) and severe (≥3+) proteinuria group to allow comparison of upregulation and down-regulation of proteins between the two groups. Renal glomeruli were isolated following renal perfusion with magnetic beads. Protein expression was determined by Western blot, immunohistochemistry, 2D-DIGE, and MALDI-TOF-MS. Results A total of 56 differentially expressed proteins were identified from 133 protein spots, of which 18 were upregulated and 23 were down-regulated between groups 1 and 2. Expression of the proteins Ras-related GTP-binding protein B (RRAGB), serine/threonine-protein kinase 1 (SMG1), angiopoietin 2 (ANGP2), methylmalonate semialdehyde (MMSA), and ATP beta chain (ATPB) were identified by Western blot and SMG1, ANGP2, and MMSA were identified by immunohistochemistry. Conclusions In a mouse model of lupus nephritis, expression of SMG1, MMSA, and ATPB were down-regulated, and RRAGB and ANGP2 were upregulated.
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Affiliation(s)
- Liu Xue
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Tian Shuyan
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Li Xiaoli
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Li Zilong
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Fan Qiuling
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Wang Lining
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Li Yanqiu
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yao Li
- Department of Nephrology, The First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
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Meng Y, Jiang Z, Li N, Zhao Z, Cheng T, Yao Y, Wang L, Liu Y, Deng X. Protective Effects of Methane-Rich Saline on Renal Ischemic-Reperfusion Injury in a Mouse Model. Med Sci Monit 2018; 24:7794-7801. [PMID: 30379804 PMCID: PMC6223098 DOI: 10.12659/msm.911156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Renal ischemic-reperfusion (RIR) injury remains a major cause of acute kidney injury, with increased in-hospital mortality and risks for chronic kidney disease. Previous studies have proposed that oxidative stress, inflammation, and renal apoptosis are the most common causes of injury, whereas recent research proved that methane, the simplest alkane generated by an enteric microorganism or accompanying the production of reactive oxygen species (ROS), can alleviate inflammation and oxidative stress and reduce apoptosis in different organs. MATERIAL AND METHODS In the present study, we analyzed the possible effects of methane-rich saline in RIR injury in a mouse model and analyzed its possible protective effects on inflammation, oxidative stress, and apoptosis. RESULTS The results showed that treatment with methane significantly improved blood creatinine and blood urea nitrogen (BUN) levels and improved renal histology in RIR injury. Further experimentation proved that this protective effect was primarily manifested in decreased oxidative stress, less apoptosis, and reduced inflammation in renal tissues, as well as improved general responses. CONCLUSIONS Our present study proved the protective effects of methane in RIR injury and, together with previous research, confirmed the multi-organ protective effects. This may help to translate methane application and develop its use in organ ischemic-reperfusion injury.
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Affiliation(s)
- Yan Meng
- Faculty of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Zhengyu Jiang
- Faculty of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Na Li
- Faculty of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Zhenzhen Zhao
- Faculty of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Tingting Cheng
- Department of Anesthesiology, Ruijin Hospital North Affiliated to Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Ying Yao
- Faculty of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Liping Wang
- Department of Anesthesiology, Fuzhou General Hospital of People's Liberation Army (PLA), Fuzhou, Fujian, China (mainland)
| | - Yi Liu
- Faculty of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Xiaoming Deng
- Faculty of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
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