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Xiang T, Li LZ, Li JX, Chen XY, Guo F, Liu J, Wu YT, Lin L, Xu RH, Wang HP, Ma L, Fu P. Chromodomain Y-like (CDYL) inhibition ameliorates acute kidney injury in mice by regulating tubular pyroptosis. Acta Pharmacol Sin 2024:10.1038/s41401-024-01345-1. [PMID: 39043969 DOI: 10.1038/s41401-024-01345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
Acute kidney injury (AKI) is a common disease, but lacking effective drug treatments. Chromodomain Y-like (CDYL) is a kind of chromodomain protein that has been implicated in transcription regulation of autosomal dominant polycystic kidney disease. Benzo[d]oxazol-2(3H)-one derivative (compound D03) is the first potent and selective small-molecule inhibitor of CDYL (KD = 0.5 μM). In this study, we investigated the expression of CDYL in three different models of cisplatin (Cis)-, lipopolysaccharide (LPS)- and ischemia/reperfusion injury (IRI)-induced AKI mice. By conducting RNA sequencing and difference analysis of kidney samples, we found that tubular CDYL was abnormally and highly expressed in injured kidneys of AKI patients and mice. Overexpression of CDYL in cisplatin-induced AKI mice aggravated tubular injury and pyroptosis via regulating fatty acid binding protein 4 (FABP4)-mediated reactive oxygen species production. Treatment of cisplatin-induced AKI mice with compound D03 (2.5 mg·kg-1·d-1, i.p.) effectively attenuated the kidney dysfunction, pathological damages and tubular pyroptosis without side effects on liver or kidney function and other tissue injuries. Collectively, this study has, for the first time, explored a novel aspect of CDYL for tubular epithelial cell pyroptosis in kidney injury, and confirmed that inhibition of CDYL might be a promising therapeutic strategy against AKI.
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Affiliation(s)
- Ting Xiang
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
| | - Ling-Zhi Li
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
| | - Jin-Xi Li
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
| | - Xin-Yun Chen
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
| | - Fan Guo
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
| | - Jing Liu
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
| | - Yi-Ting Wu
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
| | - Lin Lin
- West-District Outpatient Department, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
| | - Rui-Han Xu
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Hui-Ping Wang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Liang Ma
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China.
| | - Ping Fu
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, and National Key Laboratory of Kidney Diseases, Chengdu, 610041, China
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Sim JJ, Shu YH, Bhandari SK, Chen Q, Harrison TN, Lee MY, Munis MA, Morrissette K, Sundar S, Pareja K, Nourbakhsh A, Willey CJ. Data driven approach to characterize rapid decline in autosomal dominant polycystic kidney disease. PLoS One 2024; 19:e0298484. [PMID: 38837988 DOI: 10.1371/journal.pone.0298484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disease with high phenotypic variability. Furthering insights into patients' ADPKD progression could lead to earlier detection, management, and alter the course to end stage kidney disease (ESKD). We sought to identify patients with rapid decline (RD) in kidney function and to determine clinical factors associated with RD using a data-driven approach. A retrospective cohort study was performed among patients with incident ADPKD (1/1/2002-12/31/2018). Latent class mixed models were used to identify RD patients using differences in eGFR trajectories over time. Predictors of RD were selected based on agreements among feature selection methods, including logistic, regularized, and random forest modeling. The final model was built on the selected predictors and clinically relevant covariates. Among 1,744 patients with incident ADPKD, 125 (7%) were identified as RD. Feature selection included 42 clinical measurements for adaptation with multiple imputations; mean (SD) eGFR was 85.2 (47.3) and 72.9 (34.4) in the RD and non-RD groups, respectively. Multiple imputed datasets identified variables as important features to distinguish RD and non-RD groups with the final prediction model determined as a balance between area under the curve (AUC) and clinical relevance which included 6 predictors: age, sex, hypertension, cerebrovascular disease, hemoglobin, and proteinuria. Results showed 72%-sensitivity, 70%-specificity, 70%-accuracy, and 0.77-AUC in identifying RD. 5-year ESKD rates were 38% and 7% among RD and non-RD groups, respectively. Using real-world routine clinical data among patients with incident ADPKD, we observed that six variables highly predicted RD in kidney function.
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Affiliation(s)
- John J Sim
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States of America
- Departments of Health Systems and Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - Yu-Hsiang Shu
- Biostatistics and Programming Clinical Affairs, Inari Medical, Irvine, CA, United States of America
| | - Simran K Bhandari
- Department of Internal Medicine, Bellflower Medical Center, Bellflower, CA, United States of America
| | - Qiaoling Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Teresa N Harrison
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Min Young Lee
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States of America
| | - Mercedes A Munis
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Kerresa Morrissette
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Shirin Sundar
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States of America
| | - Kristin Pareja
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States of America
| | - Ali Nourbakhsh
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, United States of America
| | - Cynthia J Willey
- College of Pharmacy, University of Rhode Island, Kingston, RI, United States of America
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3
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Stroescu R, Gafencu M, Steflea RM, Chisavu F. Kidney Measurement and Glomerular Filtration Rate Evolution in Children with Polycystic Kidney Disease. CHILDREN (BASEL, SWITZERLAND) 2024; 11:575. [PMID: 38790570 PMCID: PMC11119250 DOI: 10.3390/children11050575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by renal tubular cystic dilatations. The cysts can develop anywhere along the nephron, and over time the cystic dilatation leads to kidney enlargement. On the other hand, the cysts begin to reduce the number of functional nephrons as a consequence of cystic expansion that further contributes to the decline in renal function over the years. The pressure exerted by the dilated cysts leads to compensatory mechanisms that further contribute to the decline in renal function. These structural changes are responsible of glomerular hyperfiltration states, albuminuria, proteinuria, and hematuria. However, the presentation of ADPKD varies in children, from a completely asymptomatic child with incidental ultrasound detection of cysts to a rapidly progressive disease. There have been reports of early onset ADPKD in children younger than 2 years that showed a more rapid decline in renal function. ADPKD is caused by a mutation in PKD1 and PKD2 genes. Today, the PKD1 gene mutation seems to account for up to 85% of the cases worldwide, and it is associated with worse renal outcomes. Individuals with PKD2 gene mutation seem to present a milder form of the disease, with a more delayed onset of end-stage kidney disease. The cardinal sign of ADPKD is the presence of renal cysts during renal ultrasound. The current guidelines provide clinicians the recommendations for genetic testing in children with a positive family history. Given that the vast majority of children with ADPKD present with normal or supra-normal kidney function, we explored the glomerular filtration rates dynamics and the renal ultrasound-adjusted percentiles. In total, 14 out of 16 patients had kidney percentiles over 90%. The gene mutations were equally distributed among our cohort. In addition, we compared the modified Schwartz formula to the quadratic equation after adjusting the serum creatinine measurements. It seems that even though children with ADPKD have enlarged kidneys, the renal function is more likely normal or near normal when the quadratic estimation of glomerular filtration rate is used (qGFR tended to be lower, 111.95 ± 12.43 mL/min/1.73 m2 when compared to Schwartz eGFR 126.28 ± 33.07 mL/min/1.73 m2, p = 0.14). Also, when the quadratic equation was employed, not even a single patient reached the glomerular hyperfiltration threshold. The quadratic formula showed that glomerular filtration rates are linear or slightly decreasing after 1 year of follow-up (quadratic ΔeGFR = -0.32 ± 5.78 mL/min/1.73 m2), as opposed to the Schwartz formula that can falsely classify children in a hyperfiltration state (ΔeGFR = 7.51 ± 19.46 mL/min/1.73 m2), p = 0.019.
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Affiliation(s)
- Ramona Stroescu
- Department XI of Pediatrics—1st Pediatric Discipline, Center for Research on Growth and Developmental Disorders in Children, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
- 4th Pediatric Clinic, “Louis Turcanu” Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timisoara, Romania; (R.M.S.)
| | - Mihai Gafencu
- 4th Pediatric Clinic, “Louis Turcanu” Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timisoara, Romania; (R.M.S.)
- Department XI of Pediatrics—3rd Pediatric Discipline, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Ruxandra Maria Steflea
- 4th Pediatric Clinic, “Louis Turcanu” Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timisoara, Romania; (R.M.S.)
- Department XI of Pediatrics—3rd Pediatric Discipline, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Flavia Chisavu
- 4th Pediatric Clinic, “Louis Turcanu” Children’s Clinical and Emergency Hospital, Iosif Nemoianu 2, 300011 Timisoara, Romania; (R.M.S.)
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine “Victor Babes”, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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Yamazaki M, Kawano H, Miyoshi M, Kimura T, Takahashi K, Muto S, Horie S. Long-Term Effects of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease: Predictors of Treatment Response and Safety over 6 Years of Continuous Therapy. Int J Mol Sci 2024; 25:2088. [PMID: 38396765 PMCID: PMC10888637 DOI: 10.3390/ijms25042088] [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: 01/12/2024] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Tolvaptan, an oral vasopressin V2 receptor antagonist, reduces renal volume expansion and loss of renal function in patients with autosomal dominant polycystic kidney disease (ADPKD). Data for predictive factors indicating patients more likely to benefit from long-term tolvaptan are lacking. Data were retrospectively collected from 55 patients on tolvaptan for 6 years. Changes in renal function, progression of renal dysfunction (estimated glomerular filtration rate [eGFR], 1-year change in eGFR [ΔeGFR/year]), and renal volume (total kidney volume [TKV], percentage 1-year change in TKV [ΔTKV%/year]) were evaluated at 3-years pre-tolvaptan, at baseline, and at 6 years. In 76.4% of patients, ΔeGFR/year improved at 6 years. The average 6-year ΔeGFR/year (range) minus baseline ΔeGFR/year: 3.024 (-8.77-20.58 mL/min/1.73 m2). The increase in TKV was reduced for the first 3 years. A higher BMI was associated with less of an improvement in ΔeGFR (p = 0.027), and family history was associated with more of an improvement in ΔeGFR (p = 0.044). Hypernatremia was generally mild; 3 patients had moderate-to-severe hyponatremia due to prolonged, excessive water intake in response to water diuresis-a side effect of tolvaptan. Family history of ADPKD and baseline BMI were contributing factors for ΔeGFR/year improvement on tolvaptan. Hyponatremia should be monitored with long-term tolvaptan administration.
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Affiliation(s)
- Mai Yamazaki
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Haruna Kawano
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
- Department of Advanced Informatics for Genetic Diseases, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
| | - Miho Miyoshi
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Tomoki Kimura
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Keiji Takahashi
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
| | - Satoru Muto
- Department of Advanced Informatics for Genetic Diseases, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
- Department of Urology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Shigeo Horie
- Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan; (M.Y.)
- Department of Advanced Informatics for Genetic Diseases, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
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Sakoda K, Mizuno K, Seki T, Shinkawa K, Kawai Y, Hayashi A, Yoshida S, Takeuchi M, Yanagita M, Kawakami K. Treatment for patients with autosomal dominant polycystic kidney disease in the chronic kidney disease without kidney replacement therapy in real-world clinical practice: a descriptive retrospective cohort study. ANNALS OF CLINICAL EPIDEMIOLOGY 2024; 6:33-41. [PMID: 38606040 PMCID: PMC11006552 DOI: 10.37737/ace.24006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/19/2023] [Indexed: 04/13/2024]
Abstract
BACKGROUND In real-world clinical practice, treatments selected for patients with autosomal dominant polycystic kidney disease (ADPKD) in the chronic kidney disease (CKD) without kidney replacement therapy (KRT) have not been reported. This study investigated the oral treatments used in these patients and the changes in their use in recent years. Additionally, we studied the factors affecting tolvaptan dose reduction or discontinuation. METHODS This retrospective cohort study was conducted using the medical records of 160 hospitals in Japan. Patients with ADPKD or polycystic kidney disease registered on the database between January 2014 and December 2020 were selected. Changes in prescription proportions over time were assessed using the Cochran-Armitage test. We focused on patients prescribed with >15 mg of tolvaptan daily to identify the factors related to its dose reduction or discontinuation and used Multivariate Cox regression analysis to evaluate them. RESULTS Tolvaptan use in patients with ADPKD in the CKD without KRT stage has increased. As of 2020, 25% of patients were treated with tolvaptan. Overall, 3639 patients with ADPKD were enrolled in the database, of whom 156 were treated with tolvaptan. Of these, 64 patients (41%) reduced or discontinued tolvaptan during the observation period. The presence of an estimated glomerular filtration rate <60 mL/min/1.73 m2 at the beginning of the treatment was associated with a higher risk of tolvaptan dose reduction or discontinuation. CONCLUSION The proportion of patients with ADPKD treated with high-dose tolvaptan is increasing. However, patients with late-stage CKD tended to reduce or discontinue tolvaptan.
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Affiliation(s)
- Kazunori Sakoda
- Department of Nephrology, Graduate School of Medicine, Kyoto University
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University
| | - Kayoko Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Tomotsugu Seki
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Kanna Shinkawa
- Department of Nephrology, Graduate School of Medicine, Kyoto University
| | - Yuriko Kawai
- Department of Nephrology, Graduate School of Medicine, Kyoto University
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University
| | - Ayano Hayashi
- Department of Nephrology, Graduate School of Medicine, Kyoto University
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University
- Graduate School of Public Health, Shizuoka Graduate University of Public Health
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University
- Institute for the Advanced Study of Human Biology, Kyoto University
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University
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Caroli A, Kline TL. Abdominal Imaging in ADPKD: Beyond Total Kidney Volume. J Clin Med 2023; 12:5133. [PMID: 37568535 PMCID: PMC10420262 DOI: 10.3390/jcm12155133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
In the context of autosomal dominant polycystic kidney disease (ADPKD), measurement of the total kidney volume (TKV) is crucial. It acts as a marker for tracking disease progression, and evaluating the effectiveness of treatment strategies. The TKV has also been recognized as an enrichment biomarker and a possible surrogate endpoint in clinical trials. Several imaging modalities and methods are available to calculate the TKV, and the choice depends on the purpose of use. Technological advancements have made it possible to accurately assess the cyst burden, which can be crucial to assessing the disease state and helping to identify rapid progressors. Moreover, the development of automated algorithms has increased the efficiency of total kidney and cyst volume measurements. Beyond these measurements, the quantification and characterization of non-cystic kidney tissue shows potential for stratifying ADPKD patients early on, monitoring disease progression, and possibly predicting renal function loss. A broad spectrum of radiological imaging techniques are available to characterize the kidney tissue, showing promise when it comes to non-invasively picking up the early signs of ADPKD progression. Radiomics have been used to extract textural features from ADPKD images, providing valuable information about the heterogeneity of the cystic and non-cystic components. This review provides an overview of ADPKD imaging biomarkers, focusing on the quantification methods, potential, and necessary steps toward a successful translation to clinical practice.
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Affiliation(s)
- Anna Caroli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24020 Ranica, BG, Italy
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Potretzke TA, Korfiatis P, Blezek DJ, Edwards ME, Klug JR, Cook CJ, Gregory AV, Harris PC, Chebib FT, Hogan MC, Torres VE, Bolan CW, Sandrasegaran K, Kawashima A, Collins JD, Takahashi N, Hartman RP, Williamson EE, King BF, Callstrom MR, Erickson BJ, Kline TL. Clinical Implementation of an Artificial Intelligence Algorithm for Magnetic Resonance-Derived Measurement of Total Kidney Volume. Mayo Clin Proc 2023; 98:689-700. [PMID: 36931980 PMCID: PMC10159957 DOI: 10.1016/j.mayocp.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/09/2022] [Accepted: 12/29/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To evaluate the performance of an internally developed and previously validated artificial intelligence (AI) algorithm for magnetic resonance (MR)-derived total kidney volume (TKV) in autosomal dominant polycystic kidney disease (ADPKD) when implemented in clinical practice. PATIENTS AND METHODS The study included adult patients with ADPKD seen by a nephrologist at our institution between November 2019 and January 2021 and undergoing an MR imaging examination as part of standard clinical care. Thirty-three nephrologists ordered MR imaging, requesting AI-based TKV calculation for 170 cases in these 161 unique patients. We tracked implementation and performance of the algorithm over 1 year. A radiologist and a radiology technologist reviewed all cases (N=170) for quality and accuracy. Manual editing of algorithm output occurred at radiology or radiology technologist discretion. Performance was assessed by comparing AI-based and manually edited segmentations via measures of similarity and dissimilarity to ensure expected performance. We analyzed ADPKD severity class assignment of algorithm-derived vs manually edited TKV to assess impact. RESULTS Clinical implementation was successful. Artificial intelligence algorithm-based segmentation showed high levels of agreement and was noninferior to interobserver variability and other methods for determining TKV. Of manually edited cases (n=84), the AI-algorithm TKV output showed a small mean volume difference of -3.3%. Agreement for disease class between AI-based and manually edited segmentation was high (five cases differed). CONCLUSION Performance of an AI algorithm in real-life clinical practice can be preserved if there is careful development and validation and if the implementation environment closely matches the development conditions.
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Affiliation(s)
| | | | | | | | - Jason R Klug
- Department of Radiology and Mayo Clinic, Rochester, MN, USA
| | - Cole J Cook
- Department of Radiology and Mayo Clinic, Rochester, MN, USA
| | | | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Fouad T Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - Bernard F King
- Department of Radiology and Mayo Clinic, Rochester, MN, USA
| | | | | | - Timothy L Kline
- Department of Radiology and Mayo Clinic, Rochester, MN, USA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
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Breysem L, De Keyzer F, Schellekens P, Dachy A, De Rechter S, Janssens P, Vennekens R, Bammens B, Irazabal MV, Van Ongeval C, Harris PC, Mekahli D. Risk Severity Model for Pediatric Autosomal Dominant Polycystic Kidney Disease Using 3D Ultrasound Volumetry. Clin J Am Soc Nephrol 2023; 18:581-591. [PMID: 36800517 PMCID: PMC10278786 DOI: 10.2215/cjn.0000000000000122] [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: 10/06/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Height-adjusted total kidney volume (htTKV) measured by imaging defined as Mayo Imaging Class (MIC) is a validated prognostic measure for autosomal dominant polycystic kidney disease (ADPKD) in adults to predict and stratify disease progression. However, no stratification tool is currently available in pediatric ADPKD. Because magnetic resonance imaging and computed tomography in children are difficult, we propose a novel 3D ultrasound-based pediatric Leuven Imaging Classification to complement the MIC. METHODS A prospective study cohort of 74 patients with genotyped ADPKD (37 female) was followed longitudinally with ultrasound, including 3D ultrasound, and they underwent in total 247 3D ultrasound assessments, with patients' median age (interquartile range [IQR]) at diagnosis of 3 (IQR, 0-9) years and at first 3D ultrasound evaluation of 10 (IQR, 5-14) years. First, data matching was done to the published MIC classification, followed by subsequent optimization of parameters and model type. RESULTS PKD1 was confirmed in 70 patients (95%), PKD2 in three (4%), and glucosidase IIα unit only once (1%). Over these 247 evaluations, the median height was 143 (IQR, 122-166) cm and total kidney volume was 236 (IQR, 144-344) ml, leading to an htTKV of 161 (IQR, 117-208) ml/m. Applying the adult Mayo classification in children younger than 15 years strongly underestimated ADPKD severity, even with correction for height. We therefore optimized the model with our pediatric data and eventually validated it with data of young patients from Mayo Clinic and the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease used to establish the MIC. CONCLUSIONS We proposed a five-level Leuven Imaging Classification ADPKD pediatric model as a novel classification tool on the basis of patients' age and 3D ultrasound-htTKV for reliable discrimination of childhood ADPKD severity.
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Affiliation(s)
- Luc Breysem
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Pieter Schellekens
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Angélique Dachy
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatrics, ULiège Academic Hospital, Liège, Belgium
| | - Stephanie De Rechter
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Janssens
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - Rudi Vennekens
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, VIB Center for Brain and Disease Research, KU Leuven, Leuven, Belgium
| | - Bert Bammens
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Maria V. Irazabal
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Peter C. Harris
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Djalila Mekahli
- PKD Research Group, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
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9
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Chebib FT, Perrone RD. Drug Development in Autosomal Dominant Polycystic Kidney Disease: Opportunities and Challenges. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:261-284. [PMID: 37088528 DOI: 10.1053/j.akdh.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 04/25/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disorder characterized by relentless growth of innumerable renal cysts bilaterally, associated with decline in glomerular filtration rate over the course of decades. The burden of ADPKD and its treatment is associated with a significant economic and societal cost. Despite several clinical studies conducted over the past decade, only one treatment has been approved by regulatory agencies to slow disease progression in ADPKD. Elucidating feasible endpoints and clear regulatory pathway may stimulate interest in developing and translating novel therapeutics. This review summarizes the recent progress, challenges, and opportunities in drug development for ADPKD. We discuss the traditional and accelerated regulatory approval pathways, the various clinical trials endpoints, and biomarkers in ADPKD. Furthermore, we propose strategies that could optimize the clinical trial design in ADPKD. Finally, we owe it to our ADPKD patient community to strive for international collaborative studies geared toward discovery and validation of surrogate endpoints and to rally for funded infrastructure that would allow phase 3 master protocols in ADPKD. These advances will serve to derisk and potentially accelerate the development of therapies and eventually bring hope to patients and families who endure through this devastating disease.
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Affiliation(s)
- Fouad T Chebib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL.
| | - Ronald D Perrone
- Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
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Lu J, Xu W, Gong L, Xu M, Tang W, Jiang W, Xie F, Ding L, Qian X. Efficacy and safety of tolvaptan versus placebo in the treatment of patients with autosomal dominant polycystic kidney disease: a meta-analysis. Int Urol Nephrol 2023; 55:631-640. [PMID: 36069961 PMCID: PMC9958178 DOI: 10.1007/s11255-022-03353-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this meta-analysis was to compare the efficacy and drug safety of tolvaptan with placebo for autosomal dominant polycystic kidney disease (ADPKD). METHODS The PubMed, Embase, and Cochrane Library databases were searched from inception to September 10, 2021. Eligible studies comparing tolvaptan and placebo in the treatment of patients with ADPKD were included. Data were analysed using Review Manager Version 5.3. RESULTS Thirteen studies involving 3575 patients were included in the meta-analysis. Compared with placebo, tolvaptan had a better effect on delaying eGFR decline (MD 1.27, 95% CI 1.24-1.29, P < 0.01) and TKV increase (MD - 3.01, 95% CI - 3.55 to - 2.47, P < 0.01) in ADPKD treatment. Additionally, tolvaptan reduced the incidence of complications such as renal pain (OR 0.71, 95% CI 0.58-0.87, P < 0.01), urinary tract infection (OR 0.69, 95% CI 0.54-0.89, P < 0.01), haematuria (OR 0.68, 95% CI 0.51-0.89, P < 0.01), and hypertension (OR 0.66, 95% CI 0.52-0.82, P < 0.01). However, tolvaptan was associated with a higher incidence rate of adverse events such as thirst (OR 8.48 95% CI 4.53-15.87, P < 0.01), polyuria (OR 4.71, 95% CI 2.17-10.24, P < 0.01), and hepatic injury (OR 4.56, 95% CI 2.51-8.29, P < 0.01). CONCLUSION Tolvaptan can delay eGFR decline and TKV increase and reduce complications such as renal pain, urinary tract infection, haematuria, and hypertension in the treatment of ADPKD. However, tolvaptan increases the adverse effects of thirst, polyuria and hepatic injury.
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Affiliation(s)
- Jingkui Lu
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
| | - Wei Xu
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000, Jiangsu Province, China. .,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000, Jiangsu Province, China.
| | - Lifeng Gong
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
| | - Min Xu
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
| | - Weigang Tang
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
| | - Wei Jiang
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
| | - Fengyan Xie
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
| | - Liping Ding
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
| | - Xiaoli Qian
- Department of Nephrology, Wujin Hospital Affiliated With Jiangsu University, No. 2 Yongning Road, Changzhou city, 213000 Jiangsu Province China ,Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou City, 213000 Jiangsu Province China
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Dwivedi N, Jamadar A, Mathew S, Fields TA, Rao R. Myofibroblast depletion reduces kidney cyst growth and fibrosis in autosomal dominant polycystic kidney disease. Kidney Int 2023; 103:144-155. [PMID: 36273656 PMCID: PMC9822873 DOI: 10.1016/j.kint.2022.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) involves the development and persistent growth of fluid filled kidney cysts. In a recent study, we showed that ADPKD kidney cyst epithelial cells can stimulate the proliferation and differentiation of peri-cystic myofibroblasts. Although dense myofibroblast populations are often found surrounding kidney cysts, their role in cyst enlargement or fibrosis in ADPKD is unclear. To clarify this, we examined the effect of myofibroblast depletion in the Pkd1RC/RC (RC/RC) mouse model of ADPKD. RC/RC;αSMAtk mice that use the ganciclovir-thymidine kinase system to selectively deplete α-smooth muscle actin expressing myofibroblasts were generated. Ganciclovir treatment for four weeks depleted myofibroblasts, reduced kidney fibrosis and preserved kidney function in these mice. Importantly, myofibroblast depletion significantly reduced cyst growth and cyst epithelial cell proliferation in RC/RC;αSMAtk mouse kidneys. Similar ganciclovir treatment did not alter cyst growth or fibrosis in wild-type or RC/RC littermates. In vitro, co-culture with myofibroblasts from the kidneys of patients with ADPKD increased 3D microcyst growth of human ADPKD cyst epithelial cells. Treatment with conditioned culture media from ADPKD kidney myofibroblasts increased microcyst growth and cell proliferation of ADPKD cyst epithelial cells. Further examination of ADPKD myofibroblast conditioned media showed high levels of protease inhibitors including PAI1, TIMP1 and 2, NGAL and TFPI-2, and treatment with recombinant PAI1 and TIMP1 increased ADPKD cyst epithelial cell proliferation in vitro. Thus, our findings show that myofibroblasts directly promote cyst epithelial cell proliferation, cyst growth and fibrosis in ADPKD kidneys, and their targeting could be a novel therapeutic strategy to treat PKD.
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Affiliation(s)
- Nidhi Dwivedi
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Abeda Jamadar
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sijo Mathew
- Department of Pharmaceutical Sciences, School of Pharmacy, North Dakota State University, Fargo, North Dakota, USA
| | - Timothy A Fields
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA; Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Reena Rao
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA; Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
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Polycystic Kidney Disease Drug Development: A Conference Report. Kidney Med 2022; 5:100596. [PMID: 36698747 PMCID: PMC9867973 DOI: 10.1016/j.xkme.2022.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is part of a spectrum of inherited diseases that also includes autosomal recessive polycystic kidney disease, autosomal dominant polycystic liver disease, and an expanding group of recessively inherited disorders collectively termed hepatorenal fibrocystic disorders. ADPKD is the most common monogenic disorder frequently leading to chronic kidney failure with an estimated prevalence of 12 million people worldwide. Currently, only one drug (tolvaptan) has been approved by regulatory agencies as disease-modifying therapy for ADPKD, but, given its mechanism of action and side effect profile, the need for an improved therapy for ADPKD remains a priority. Although significant regulatory progress has been made, with qualification of total kidney volume as a prognostic enrichment biomarker and its later designation as a reasonably likely surrogate endpoint for progression of ADPKD within clinical trials, further work is needed to accelerate drug development efforts for all forms of PKD. In May 2021, the PKD Outcomes Consortium at the Critical Path Institute and the PKD Foundation organized a PKD Regulatory Summit to spur conversations among patients, industry, academic, and regulatory stakeholders regarding future development of tools and drugs for ADPKD and autosomal recessive polycystic kidney disease. This Special Report reviews the key points discussed during the summit and provides future direction related to PKD drug development tools.
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Gansevoort RT, Hariri A, Minini P, Ahn C, Chapman AB, Horie S, Knebelmann B, Mrug M, Ong ACM, Pei YPC, Torres VE, Modur V, Antonshchuk I, Perrone RD. Venglustat, a Novel Glucosylceramide Synthase Inhibitor, in Patients at Risk of Rapidly Progressing ADPKD: Primary Results of a Double-Blind, Placebo-Controlled, Phase 2/3 Randomized Clinical Trial. Am J Kidney Dis 2022; 81:517-527.e1. [PMID: 36535535 DOI: 10.1053/j.ajkd.2022.10.016] [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: 06/24/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
RATIONALE & OBJECTIVE Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the formation of multiple kidney cysts that leads to growth in total kidney volume (TKV) and progression to kidney failure. Venglustat is a glucosylceramide synthase inhibitor that has been shown to inhibit cyst growth and reduce kidney failure in preclinical models of ADPKD. STUDY DESIGN STAGED-PKD was a 2-stage, multicenter, double-blind, randomized, placebo-controlled phase 2/3 study in adults with ADPKD at risk of rapidly progressive disease, who were selected based on Mayo Clinic imaging classification of ADPKD class 1C, 1D, or 1E and an estimated glomerular filtration rate (eGFR) of 30-89.9mL/min/1.73m2. SETTING & PARTICIPANTS Enrollment included 236 and 242 patients in stages 1 and 2, respectively. INTERVENTIONS In trial stage 1, the patients were randomized 1:1:1 to venglustat, 8mg; venglustat, 15mg; or placebo. In stage 2, the patients were randomized 1:1 to venglustat, 15mg (highest dose identified as safe and well tolerated in stage 1), or placebo. OUTCOMES Primary end points were rate of change in TKV over 18 months in stage 1 and eGFR slope over 24 months in stage 2. Secondary end points were eGFR slope over 18 months (stage 1), rate of change in TKV (stage 2), and safety/tolerability, pain, and fatigue (stages 1 and 2). RESULTS A prespecified interim futility analysis showed that venglustat treatment had no effect on the annualized rate of change in TKV over 18 months (stage 1) and had a faster rate of decline in eGFR slope over 24 months (stage 2). Due to this lack of efficacy, the study was terminated early. LIMITATIONS The short follow-up period after the end of treatment and limited generalizability of the findings. CONCLUSIONS In patients with rapidly progressing ADPKD, treatment with venglustat at either 8mg or 15mg showed no change in the rate of change in TKV and a faster rate of eGFR decline in STAGED-PKD despite a dose-dependent decrease in plasma glucosylceramide levels. FUNDING This study was funded by Sanofi. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT03523728.
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Affiliation(s)
- Ronald T Gansevoort
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ali Hariri
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | | | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Arlene B Chapman
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Bertrand Knebelmann
- Université Paris Cité, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Michal Mrug
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Veterans Affairs Medical Center, Birmingham, Alabama
| | - Albert C M Ong
- Academic Nephrology Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - York P C Pei
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Vijay Modur
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | | | - Ronald D Perrone
- Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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Adebayo OC, Nkoy AB, van den Heuvel LP, Labarque V, Levtchenko E, Delanaye P, Pottel H. Glomerular hyperfiltration: part 2-clinical significance in children. Pediatr Nephrol 2022:10.1007/s00467-022-05826-5. [PMID: 36472656 DOI: 10.1007/s00467-022-05826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/27/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
Glomerular hyperfiltration (GHF) is a phenomenon that can occur in various clinical conditions affecting the kidneys such as sickle cell disease, diabetes mellitus, autosomal dominant polycystic kidney disease, and solitary functioning kidney. Yet, the pathophysiological mechanisms vary from one disease to another and are not well understood. More so, it has been demonstrated that GHF may occur at the single-nephron in some clinical conditions while in others at the whole-kidney level. In this review, we explore the pathophysiological mechanisms of GHF in relation to various clinical conditions in the pediatric population. In addition, we discuss the role and mechanism of action of important factors such as gender, low birth weight, and race in the pathogenesis of GHF. Finally, in this current review, we further highlight the consequences of GHF in the progression of kidney disease.
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Affiliation(s)
- Oyindamola C Adebayo
- Center of Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
| | - Agathe B Nkoy
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lambertus P van den Heuvel
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Nephrology, Radboud University Medical Centre, 6500 Nijmegen, The Netherlands
| | - Veerle Labarque
- Center of Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Elena Levtchenko
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Campus Kulak, 8500 Kortrijk, Belgium.
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Park H, Paek JH, Kim Y, Park WY, Han S, Jin K. Clinical characteristics and risk factors for kidney failure in patients with autosomal dominant polycystic kidney disease: A retrospective study. Medicine (Baltimore) 2022; 101:e31838. [PMID: 36451428 PMCID: PMC9704897 DOI: 10.1097/md.0000000000031838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary and progressive renal disease. By the age of 65 years, 45% to 70% of patients with ADPKD reach end-stage renal disease (ESRD). Although there are various treatments for this condition, no standard therapy exists to delay the progression of ADPKD. Hence, understanding the factors that affect disease progression may be helpful for the treatment of ADPKD. The medical records of 288 patients with ADPKD at Keimyung University Dongsan Medical Center between January 1989 and August 2018 were analyzed retrospectively. Furthermore, we inspected the risk factors involved in the progression of ADPKD and the kidney survival rates of patients using the Cox proportional hazards model and Kaplan-Meier survival analysis. The mean age at the time of diagnosis was 43.1 ± 14.1 years, and there were 146 males (50.7%). In total, 197 patients (68.4%) had hypertension and 11 patients (3.8%) had cerebral aneurysm. Stroke occurred in 35 patients (12.1%), including 11 cases of cerebral hemorrhage and 24 cases of cerebral infarction. Twenty-eight patients (9.7%) died during the follow-up period (117.1 ± 102.1 months). Infection (42.9%) was the most common cause of mortality, followed by sudden cardiac death (25.0%). Overall, 132 patients (45.8%) progressed to ESRD and 104 patients (36.1%) required renal replacement therapy (RRT). The mean duration from diagnosis to RRT was 110.8 ± 93.9 months. Age at diagnosis after 30 years (odd's ratio [OR], 2.737; 95% confidence interval [CI], 1.320-5.675; P = .007), baseline serum creatinine levels (OR, 1.326; 95% CI, 1.259-1.396; P < .001), and cyst infection (OR, 2.065; 95% CI, 1.242-3.433; P = .005) were the independent risk factors for kidney failure in multivariable analysis. To delay the advance of ADPKD to ESRD, early diagnosis and close observation for the onset of cyst infection are crucial.
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Affiliation(s)
- Hanil Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Keimyung University Kidney Institute, Daegu, Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Keimyung University Kidney Institute, Daegu, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Keimyung University Kidney Institute, Daegu, Korea
| | - Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Keimyung University Kidney Institute, Daegu, Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Keimyung University Kidney Institute, Daegu, Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Keimyung University Kidney Institute, Daegu, Korea
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Perrone RD, Hariri A, Minini P, Ahn C, Chapman AB, Horie S, Knebelmann B, Mrug M, Ong AC, Pei YP, Torres VE, Modur V, Gansevoort RT. The STAGED-PKD 2-Stage Adaptive Study With a Patient Enrichment Strategy and Treatment Effect Modeling for Improved Study Design Efficiency in Patients With ADPKD. Kidney Med 2022; 4:100538. [PMID: 36204243 PMCID: PMC9529969 DOI: 10.1016/j.xkme.2022.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rationale & Objective Venglustat, a glucosylceramide synthase inhibitor, inhibits cyst growth and reduces kidney failure in mouse models of autosomal dominant polycystic kidney disease (ADPKD). STAGED-PKD aims to determine the safety and efficacy of venglustat and was designed using patient enrichment for progression to end-stage kidney disease and modeling from prior ADPKD trials. Study Design STAGED-PKD is a 2-stage, international, double-blind, randomized, placebo-controlled trial in adults with ADPKD (Mayo Class 1C-1E) and estimated glomerular filtration rate (eGFR) 45-<90 mL/min/1.73 m2 at risk of rapidly progressive disease. Enrichment for rapidly progressing patients was identified based on retrospective analysis of total kidney volume (TKV) and eGFR slope from the combined Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease and HALT Progression of Polycystic Kidney Disease A studies. Setting & Participants Target enrollment in stages 1 and 2 was 240 and 320 patients, respectively. Interventions Stage 1 randomizes patients 1:1:1 to venglustat 8 mg or 15 mg once daily or placebo. Stage 2 randomizes patients 1:1 to placebo or venglustat, with the preferred dose based on stage 1 safety data. Outcomes Primary endpoints are TKV growth rate over 18 months in stage 1 and eGFR slope over 24 months in stage 2. Secondary endpoints include: annualized rate of change in eGFR from baseline to 18 months (stage 1); annualized rate of change in TKV based on magnetic resonance imaging from baseline to 18 months (stage 2); and safety, tolerability, pain, and fatigue (stages 1 and 2). Limitations If stage 1 is unsuccessful, patients enrolled in the trial may develop drug-related adverse events that can have long-lasting effects. Conclusions Modeling allows the design and powering of a 2-stage combined study to assess venglustat’s impact on TKV growth and eGFR slope. Stage 1 TKV assessment via a nested approach allows early evaluation of efficacy and increased efficiency of the trial design by reducing patient numbers and trial duration. Funding This study was funded by Sanofi. Trial registration STAGED-PKD has been registered at ClinicalTrials.gov with study number NCT03523728.
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Affiliation(s)
- Ronald D. Perrone
- Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Ali Hariri
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | | | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | | | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Bertrand Knebelmann
- Université de Paris, AP-HP, Service de Néphrologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Michal Mrug
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama and Department of Veterans Affairs Medical Center, Birmingham, Alabama
| | - Albert C.M. Ong
- Academic Nephrology Unit, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - York P.C. Pei
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Vicente E. Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Vijay Modur
- Eloxx Pharmaceuticals, Watertown, Massachusetts
| | - Ronald T. Gansevoort
- Department of Nephrology, University Medical Center Groningen, The Netherlands
- Address for Correspondence: Ronald T. Gansevoort, MD, PhD, Department of Nephrology, University Medical Center Groningen, The Netherlands.
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Dekker SEI, Verhoeven A, Frey D, Soonawala D, Peters DJM, Mayboroda OA, de Fijter JW. Change in Urinary Myoinositol/Citrate Ratio Associates with Progressive Loss of Renal Function in ADPKD Patients. Am J Nephrol 2022; 53:470-480. [PMID: 35613556 PMCID: PMC9393825 DOI: 10.1159/000524851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In autosomal dominant polycystic kidney disease (ADPKD) patients, predicting renal disease progression is important to make a prognosis and to support the clinical decision whether to initiate renoprotective therapy. Conventional markers all have their limitations. Metabolic profiling is a promising strategy for risk stratification. We determined the prognostic performance to identify patients with a fast progressive disease course and evaluated time-dependent changes in urinary metabolites. METHODS Targeted, quantitative metabolomics analysis (1H NMR-spectroscopy) was performed on spot urinary samples at two time points, baseline (n = 324, 61% female; mean age 45 years, SD 11; median eGFR 61 mL/min/1.73 m2, IQR 42-88; mean years of creatinine follow-up 3.7, SD 1.3) and a sample obtained after 3 years of follow-up (n = 112). Patients were stratified by their eGFR slope into fast and slow progressors based on an annualized change of > -3.0 or ≤ -3.0 mL/min/1.73 m2/year, respectively. Fifty-five urinary metabolites and ratios were quantified, and the significant ones were selected. Logistic regression was used to determine prognostic performance in identifying those with a fast progressive course using baseline urine samples. Repeated-measures ANOVA was used to analyze whether changes in urinary metabolites over a 3-year follow-up period differed between fast and slow progressors. RESULTS In a single urinary sample, the prognostic performance of urinary metabolites was comparable to that of a model including height-adjusted total kidney volume (htTKV, AUC = 0.67). Combined with htTKV, the predictive value of the metabolite model increased (AUC = 0.75). Longitudinal analyses showed an increase in the myoinositol/citrate ratio (p < 0.001) in fast progressors, while no significant change was found in those with slow progression, which is in-line with an overall increase in the myoinositol/citrate ratio as GFR declines. CONCLUSION A metabolic profile, measured at a single time point, showed at least equivalent prognostic performance to an imaging-based risk marker in ADPKD. Changes in urinary metabolites over a 3-year follow-up period were associated with a fast progressive disease course.
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Affiliation(s)
- Shosha E I Dekker
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands,
| | - Aswin Verhoeven
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Daria Frey
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
- Laboratory of Clinical Metabolomics, Tomsk State University, Tomsk, Russian Federation
| | - Darius Soonawala
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Dorien J M Peters
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Oleg A Mayboroda
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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18
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Li X, Liu Q, Xu J, Huang C, Hua Q, Wang H, Ma T, Huang Z. A MRI-based radiomics nomogram for evaluation of renal function in ADPKD. Abdom Radiol (NY) 2022; 47:1385-1395. [PMID: 35152314 PMCID: PMC8930797 DOI: 10.1007/s00261-022-03433-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study is aimed to establish a fusion model of radiomics-based nomogram to predict the renal function of autosomal dominant polycystic kidney disease (ADPKD). METHODS One hundred patients with ADPKD were randomly divided into training group (n = 69) and test group (n = 31). The radiomics features were extracted from T1-weighted fat suppression images (FS-T1WI) and T2-weighted fat suppression images (FS-T2WI). Decision tree algorithm was employed to build radiomics model to get radiomics signature. Then multivariate logistic regression analysis was used to establish the radiomics nomogram based on independent clinical factors, conventional MR imaging variables and radiomics signature. The receiver operating characteristic (ROC) analysis and Delong test were used to compare the performance of radiomics model and radiomics nomogram model, and the decision curve to evaluate the clinical application value of radiomics nomogram model in the evaluation of renal function in patients with ADPKD. RESULTS Fourteen radiomics features were selected to establish radiomics model. Based on FS-T1WI and FS-T2WI sequences, the radiomics model showed good discrimination ability in training group and test group [training group: (AUC) = 0.7542, test group (AUC) = 0.7417]. The performance of radiomics nomogram model was significantly better than that of radiomics model in all data sets [radiomics model (AUC) = 0.7505, radiomics nomogram model (AUC) = 0.8435, p value = 0.005]. The analysis of calibration curve and decision curve showed that radiomics nomogram model had more clinical application value. CONCLUSION radiomics analysis of MRI can be used for the preliminary evaluation and prediction of renal function in patients with ADPKD. The radiomics nomogram model shows better prediction effect in renal function evaluation, and can be used as a non-invasive renal function prediction tool to assist clinical decision-making. Trial registration ChiCTR, ChiCTR2100046739. Registered 27 May 2021-retrospectively registered, http://www.ChiCTR.org.cn/showproj.aspx?proj=125955.
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Affiliation(s)
- Xiaojiao Li
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324, jingwuweiqi Road, Jinan, 250021, Shandong, China
| | - Qingwei Liu
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324, jingwuweiqi Road, Jinan, 250021, Shandong, China
| | - Jingxu Xu
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of, PHD Technology Co.Ltd, Beijing, China
| | - Chencui Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of, PHD Technology Co.Ltd, Beijing, China
| | - Qianqian Hua
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324, jingwuweiqi Road, Jinan, 250021, Shandong, China
| | - Haili Wang
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324, jingwuweiqi Road, Jinan, 250021, Shandong, China
| | - Teng Ma
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324, jingwuweiqi Road, Jinan, 250021, Shandong, China.
| | - Zhaoqin Huang
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324, jingwuweiqi Road, Jinan, 250021, Shandong, China.
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19
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Abstract
Circulating blood is filtered across the glomerular barrier to form an ultrafiltrate of plasma in the Bowman's space. The volume of glomerular filtration adjusted by time is defined as the glomerular filtration rate (GFR), and the total GFR is the sum of all single-nephron GFRs. Thus, when the single-nephron GFR is increased in the context of a normal number of functioning nephrons, single glomerular hyperfiltration results in 'absolute' hyperfiltration in the kidney. 'Absolute' hyperfiltration can occur in healthy people after high protein intake, during pregnancy and in patients with diabetes, obesity or autosomal-dominant polycystic kidney disease. When the number of functioning nephrons is reduced, single-nephron glomerular hyperfiltration can result in a GFR that is within or below the normal range. This 'relative' hyperfiltration can occur in patients with a congenitally reduced nephron number or with an acquired reduction in nephron mass consequent to surgery or kidney disease. Improved understanding of the mechanisms that underlie 'absolute' and 'relative' glomerular hyperfiltration in different clinical settings, and of whether and how the single-nephron haemodynamic and related biomechanical forces that underlie glomerular hyperfiltration promote glomerular injury, will pave the way toward the development of novel therapeutic interventions that attenuate glomerular hyperfiltration and potentially prevent or limit consequent progressive kidney injury and loss of function.
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20
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Goel A, Shih G, Riyahi S, Jeph S, Dev H, Hu R, Romano D, Teichman K, Blumenfeld JD, Barash I, Chicos I, Rennert H, Prince MR. Deployed Deep Learning Kidney Segmentation for Polycystic Kidney Disease MRI. Radiol Artif Intell 2022; 4:e210205. [PMID: 35391774 PMCID: PMC8980881 DOI: 10.1148/ryai.210205] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/18/2022]
Abstract
This study develops, validates, and deploys deep learning for automated total kidney volume (TKV) measurement (a marker of disease severity) on T2-weighted MRI studies of autosomal dominant polycystic kidney disease (ADPKD). The model was based on the U-Net architecture with an EfficientNet encoder, developed using 213 abdominal MRI studies in 129 patients with ADPKD. Patients were randomly divided into 70% training, 15% validation, and 15% test sets for model development. Model performance was assessed using Dice similarity coefficient (DSC) and Bland-Altman analysis. External validation in 20 patients from outside institutions demonstrated a DSC of 0.98 (IQR, 0.97-0.99) and a Bland-Altman difference of 2.6% (95% CI: 1.0%, 4.1%). Prospective validation in 53 patients demonstrated a DSC of 0.97 (IQR, 0.94-0.98) and a Bland-Altman difference of 3.6% (95% CI: 2.0%, 5.2%). Last, the efficiency of model-assisted annotation was evaluated on the first 50% of prospective cases (n = 28), with a 51% mean reduction in contouring time (P < .001), from 1724 seconds (95% CI: 1373, 2075) to 723 seconds (95% CI: 555, 892). In conclusion, our deployed artificial intelligence pipeline accurately performs automated segmentation for TKV estimation of polycystic kidneys and reduces expert contouring time. Keywords: Convolutional Neural Network (CNN), Segmentation, Kidney ClinicalTrials.gov identification no.: NCT00792155 Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Akshay Goel
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - George Shih
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Sadjad Riyahi
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Sunil Jeph
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Hreedi Dev
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Rejoice Hu
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Dominick Romano
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Kurt Teichman
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Jon D. Blumenfeld
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Irina Barash
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Ines Chicos
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Hanna Rennert
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
| | - Martin R. Prince
- From the Departments of Radiology (A.G., G.S., S.R., S.J., H.D.,
R.H., D.R., K.T., M.R.P.), Internal Medicine (J.D.B., I.B., I.C.), and Pathology
and Laboratory Medicine (H.R.), Weill Cornell Medicine, 525 E 68th St, New York,
NY 10021
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21
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El-Damanawi R, Lee M, Harris T, Cowley LB, Scholtes I, Bond S, Sandford RN, Wilkinson IB, Casteleijn NF, Hogan MC, Karet Frankl FE, Hiemstra TF. Developing a patient-centred tool for pain measurement and evaluation in autosomal dominant polycystic kidney disease. Clin Kidney J 2021; 14:2338-2348. [PMID: 34754429 PMCID: PMC8573025 DOI: 10.1093/ckj/sfaa259] [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] [Received: 09/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pain affects 60% of the autosomal dominant polycystic kidney disease (ADPKD) population. Despite being an early and debilitating symptom, it is poorly characterized and management is suboptimal. This study aimed to develop an ADPKD-specific pain assessment tool (APAT) to facilitate pain research. METHODS Following a systematic review of PATs used in ADPKD studies and against international recommendations for pain trials, our multi-disciplinary team of clinical experts and patients constructed an ADPKD-pain conceptual framework of key pain evaluation themes. We compiled a new APAT covering domains prioritized within our framework using components of questionnaires validated in other chronic pain disorders. The APAT was administered longitudinally within a randomized high-water intake trial (NCT02933268) to ascertain feasibility and provide pilot data on ADPKD pain. RESULTS Thirty-nine ADPKD participants with chronic kidney disease Stages 1-4 provided 129 APAT responses. Each participant completed a median of 3 (range 1-10) assessments. Respondents' mean ± standard deviation age was 47 ± 13 years; 59% (23) were female; and 69% (27) had enlarged kidneys with median time from diagnosis 14.2 (interquartile range 7.0-25.9) years. Pain (52%) and associated analgesic use (29%) were common. Pain severity was associated with increasing age [odds ratio (OR) = 1.07, P = 0.009], female gender (OR = 4.34, P = 0.018), estimated glomerular filtration rate <60 mL/min/1.73 m2 (OR = 5.45, P = 0.021) and hypertension (OR = 12.11, P = 0.007), but not with kidney size (P = 0.23). The APAT achieved good internal consistency (Cronbach's alpha coefficient = 0.91) and test-retest reliability (domain intra-class correlation coefficients ranging from 0.62 to 0.90). CONCLUSIONS The APAT demonstrated good acceptability and reliability, and following further validation in a larger cohort could represent an invaluable tool for future ADPKD pain studies.
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Affiliation(s)
- Ragada El-Damanawi
- Department of Medicine, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Michael Lee
- Department of Medicine, Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | | | - Laura B Cowley
- Cambridge Clinical Trials Unit, Cambridge, UK
- Patient Led Research Hub, Cambridge Clinical Trials Unit, Cambridge, UK
| | - Ingrid Scholtes
- Department of Medicine, Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge, UK
| | | | - Ian B Wilkinson
- Department of Medicine, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Niek F Casteleijn
- Department of Nephrology, University of Groningen, Groningen, The Netherlands
- Department of Urology, University of Groningen, Groningen, The Netherlands
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, NY, USA
| | | | - Thomas F Hiemstra
- Department of Medicine, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge, UK
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22
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Borrego Utiel FJ, Esteban de la Rosa RJ, Merino García E, Medina Benítez A, Polo Moyano A, Moriana Domínguez C, Morales García AI, Bravo Soto JA. Predicting Future Renal Function Decline in Patients with Autosomal Dominant Polycystic Kidney Disease Using Mayo Clinic Classification. Am J Nephrol 2021; 52:630-641. [PMID: 34518464 DOI: 10.1159/000518255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/29/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Mayo clinic classification (MCC) has been proposed in patients with autosomal dominant polycystic kidney disease (ADPKD) to identify who may experience a rapid decline of renal function. Our aim was to validate this predictive model in a population from southern Spain. METHODS ADPKD patients with measurements of height-adjusted total kidney volume (HtTKV) and baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m2 were selected. Last eGFR was estimated with Mayo Clinic (MC) equation and bias and accuracy were studied. We also analyzed predictive capacity of MCC classes using survival analysis and Cox regression models. RESULTS We included 134 patients with a mean follow-up of 82 months. While baseline eGFR was not different between classes, last eGFR decreased significantly with them. eGFR variation rate was different according to the MCC class with a more rapid decline in 1C, 1D, and 1E classes. Final eGFR predicted was not significantly different from the real one, with an absolute bias of 0.6 ± 17.0 mL/min/1.73 m2. P10 accuracy was low ranging from 37.5 to 59.5% in classes 1C, 1D, and 1E. Using MC equation, the rate of eGFR decline was underestimated in 1C, 1D, and 1E classes. Cox regression analysis showed that MCC class is a predictor of renal survival after adjusting with baseline eGFR, age, sex, and HtTKV, with 1D and 1E classes having the worst prognosis. CONCLUSION MCC classification is able to identify patients who will undergo a more rapid decline of renal function in a Spanish population. Prediction of future eGFR with MC equation is acceptable as a group, although it shows a loss of accuracy considering individual values. The rate of eGFR decline calculated using MC equation can underestimate the real rate presented by patients of 1C, 1D, and 1E classes.
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Affiliation(s)
| | | | | | - Antonio Medina Benítez
- UGC de Radiología del Hospital Regional Universitario "Virgen de las Nieves" de Granada, Granada, Spain
| | - Aurora Polo Moyano
- UGC de Nefrología del Hospital Regional Universitario "Virgen de las Nieves" de Granada, Granada, Spain
| | | | - Ana Isabel Morales García
- UGC de Nefrología del Hospital Regional Universitario "Virgen de las Nieves" de Granada, Granada, Spain
| | - Juan Antonio Bravo Soto
- UGC de Nefrología del Hospital Regional Universitario "Virgen de las Nieves" de Granada, Granada, Spain
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Mahendran R, Lim SK, Ong KC, Chua KH, Chai HC. Natural-derived compounds and their mechanisms in potential autosomal dominant polycystic kidney disease (ADPKD) treatment. Clin Exp Nephrol 2021; 25:1163-1172. [PMID: 34254206 DOI: 10.1007/s10157-021-02111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a monogenic kidney disorder that impairs renal functions progressively leading to kidney failure. The disease affects between 1:400 and 1:1000 ratio of the people worldwide. It is caused by the mutated PKD1 and PKD2 genes which encode for the defective polycystins. Polycystins mimic the receptor protein or protein channel and mediate aberrant cell signaling that causes cystic development in the renal parenchyma. The cystic development is driven by the increased cyclic AMP stimulating fluid secretion and infinite cell growth. In recent years, natural product-derived small molecules or drugs targeting specific signaling pathways have caught attention in the drug discovery discipline. The advantages of natural products over synthetic drugs enthusiast researchers to utilize the medicinal benefits in various diseases including ADPKD. CONCLUSION Overall, this review discusses some of the previously studied and reported natural products and their mechanisms of action which may potentially be redirected into ADPKD.
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Affiliation(s)
- Rhubaniya Mahendran
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Renal Division, Department of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kien Chai Ong
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kek Heng Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hwa Chia Chai
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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24
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PKD1-Associated Arachnoid Cysts in Autosomal Dominant Polycystic Kidney Disease. J Stroke Cerebrovasc Dis 2021; 30:105943. [PMID: 34175641 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES the prevalence of intracranial aneurysms and arachnoid cysts is higher in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. A genotype correlation was reported for intracranial aneurysms, but it is unclear for arachnoid cysts. Therefore, the genotype correlation with intracranial aneurysms and arachnoid cysts was investigated in ADPKD. MATERIALS AND METHODS intracranial aneurysms and arachnoid cysts were screened by magnetic resonance imaging (MRI), and PKD genotypes were examined using next-generation sequencing for 169 patients with ADPKD. RESULTS PKD1-, PKD2- and no-mutation were identified in 137, 24 and 8 patients, respectively. Intracranial aneurysms and arachnoid cysts were found in 34 and 25 patients, respectively, with no significant difference in frequency. Genotype, sex, estimated glomerular filtration rate and age at ADPKD diagnosis significantly affected the age at brain MRI. The proportional hazard risk analyzed using the age at brain MRI adjusted by these four variables was 5.0-times higher in the PKD1 group than in the PKD2 group for arachnoid cysts (P = 0.0357), but it was not different for intracranial aneurysms (P = 0.1605). Arachnoid cysts were diagnosed earlier in the PKD1 group than in the PKD2 group (54.8 vs 67.7 years, P = 0.0231), but no difference was found for intracranial aneurysms (P = 0.4738) by Kaplan-Meier analysis. CONCLUSIONS this study demonstrated the correlation between arachnoid cysts and PKD1 mutation. The reported association of arachnoid cysts with advanced renal disease may be due to the common correlation of these factors with PKD1 mutation.
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25
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Phakdeekitcharoen B, Treesinchai W, Wibulpolprasert P, Boongird S, Klytrayong P. The correlation between kidney volume and measured glomerular filtration rate in an Asian ADPKD population: a prospective cohort study. BMC Nephrol 2021; 22:178. [PMID: 33992075 PMCID: PMC8126117 DOI: 10.1186/s12882-021-02392-0] [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: 01/12/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder that leads to end stage renal disease (ESRD). Cyst expansion in ADPKD is strongly associated with the decline in renal function. However, the correlation between total kidney volume (TKV) and glomerular filtration rate (GFR) at an early stage has not been well demonstrated. There is growing evidence that utilization of estimated GFR (eGFR) may induce misleading information in a population with near normal renal function. Therefore, a more accurate method is essential. Methods A prospective cohort of ADPKD patients was conducted with clinical data and laboratory collection. Measured GFR (mGFR) was assessed by iohexol plasma clearance method using ultra performance liquid chromatography. eGFR was calculated using the CKD-EPI equation. Kidney volumes were evaluated using MRI imaging protocol. Results Thirty two patients completed the study. The mean age was 56 years old. The mean initial mGFR was 83.8 mL/min/1.73m2. The mean change in mGFR per year was –2.99 mL/min/1.73m2/year. The mean initial height-adjusted TKV (htTKV) was 681.0 mL/m. The mean percentage change in htTKV per year (%ΔhtTKV/y) was 4.77 %/year. mGFR had a better association with clinical parameters than eGFR. Initial mGFR was significantly and inversely correlated with initial htTKV and age. The percentage change in mGFR per year was significantly and inversely correlated with the %ΔhtTKV/y and 24-hr urine albumin. The %ΔhtTKV/y was significantly correlated with initial htTKV. Conclusions Our studies demonstrated that mGFR using iohexol is a more reliable and accurate method than eGFR for evaluating GFR changes in the early stages of ADPKD patients. There is a strong inverse correlation between kidney volume and mGFR in an Asian ADPKD population. The initial htTKV is a good predictor of kidney volume progression. The %ΔhtTKV/y is a good early surrogate marker for the decline in renal function. 24-hr urine albumin is also a good indicator for renal progression.
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Affiliation(s)
- Bunyong Phakdeekitcharoen
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand.
| | - Watcharapong Treesinchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand
| | - Pornphan Wibulpolprasert
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarinya Boongird
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand
| | - Pinkael Klytrayong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand
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Epithelial proliferation and cell cycle dysregulation in kidney injury and disease. Kidney Int 2021; 100:67-78. [PMID: 33831367 DOI: 10.1016/j.kint.2021.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 02/08/2023]
Abstract
Various cellular insults and injury to renal epithelial cells stimulate repair mechanisms to adapt and restore the organ homeostasis. Renal tubular epithelial cells are endowed with regenerative capacity, which allows for a restoration of nephron function after acute kidney injury. However, recent evidence indicates that the repair is often incomplete, leading to maladaptive responses that promote the progression to chronic kidney disease. The dysregulated cell cycle and proliferation is also a key feature of renal tubular epithelial cells in polycystic kidney disease and HIV-associated nephropathy. Therefore, in this review, we provide an overview of cell cycle regulation and the consequences of dysregulated cell proliferation in acute kidney injury, polycystic kidney disease, and HIV-associated nephropathy. An increased understanding of these processes may help define better targets for kidney repair and combat chronic kidney disease progression.
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27
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Automatic semantic segmentation of kidney cysts in MR images of patients affected by autosomal-dominant polycystic kidney disease. Abdom Radiol (NY) 2021; 46:1053-1061. [PMID: 32940759 PMCID: PMC7940295 DOI: 10.1007/s00261-020-02748-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE For patients affected by autosomal-dominant polycystic kidney disease (ADPKD), successful differentiation of cysts is useful for automatic classification of patient phenotypes, clinical decision-making, and disease progression. The objective was to develop and evaluate a fully automated semantic segmentation method to differentiate and analyze renal cysts in patients with ADPKD. METHODS An automated deep learning approach using a convolutional neural network was trained, validated, and tested on a set of 60 MR T2-weighted images. A three-fold cross-validation approach was used to train three models on distinct training and validation sets (n = 40). An ensemble model was then built and tested on the hold out cases (n = 20), with each of the cases compared to manual segmentations performed by two readers. Segmentation agreement between readers and the automated method was assessed. RESULTS The automated approach was found to perform at the level of interobserver variability. The automated approach had a Dice coefficient (mean ± standard deviation) of 0.86 ± 0.10 vs Reader-1 and 0.84 ± 0.11 vs. Reader-2. Interobserver Dice was 0.86 ± 0.08. In terms of total cyst volume (TCV), the automated approach had a percent difference of 3.9 ± 19.1% vs Reader-1 and 8.0 ± 24.1% vs Reader-2, whereas interobserver variability was - 2.0 ± 16.4%. CONCLUSION This study developed and validated a fully automated approach for performing semantic segmentation of kidney cysts in MR images of patients affected by ADPKD. This approach will be useful for exploring additional imaging biomarkers of ADPKD and automatically classifying phenotypes.
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Horie S, Muto S, Kawano H, Okada T, Shibasaki Y, Nakajima K, Ibuki T. Preservation of kidney function irrelevant of total kidney volume growth rate with tolvaptan treatment in patients with autosomal dominant polycystic kidney disease. Clin Exp Nephrol 2021; 25:467-478. [PMID: 33471240 PMCID: PMC8038960 DOI: 10.1007/s10157-020-02009-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
Background Tolvaptan slowed the rates of total kidney volume (TKV) growth and renal function decline over a 3-year period in patients with autosomal dominant polycystic kidney disease (ADPKD) enrolled in the Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes (TEMPO) 3:4 trial (NCT00428948). In this post hoc analysis of Japanese patients from TEMPO 3:4, we evaluated whether the effects of tolvaptan on TKV and on renal function are interrelated. Methods One hundred and forty-seven Japanese patients from TEMPO 3:4 were included in this analysis (placebo, n = 55; tolvaptan, n = 92). Tolvaptan-treated patients were stratified into the responder group (n = 37), defined as tolvaptan-treated patients with a net decrease in TKV from baseline to year 3, and the non-responder group (n = 55), defined as tolvaptan-treated patients with a net increase in TKV. Results Mean changes during follow-up in the placebo, responder, and non-responder groups were 16.99%, − 8.33%, and 13.95%, respectively, for TKV and − 12.61, − 8.47, and − 8.58 mL/min/1.73 m2, respectively, for estimated glomerular filtration rate (eGFR). Compared with the placebo group, eGFR decline was significantly slowed in both the responder and non-responder groups (P < 0.05). Conclusion Tolvaptan was effective in slowing eGFR decline, regardless of TKV response, over 3 years in patients with ADPKD in Japan. Treatment with tolvaptan may have beneficial effects on slowing of renal function decline even in patients who have not experienced a reduction in the rate of TKV growth by treatment with tolvaptan. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-020-02009-0.
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Affiliation(s)
- Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Satoru Muto
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Informatics for Genetic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tadashi Okada
- Department of Clinical Development, Otsuka Pharmaceutical Co., Ltd, Osaka, Japan
| | | | - Koji Nakajima
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Tatsuki Ibuki
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
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Saini AK, Saini R, Singh S. Autosomal dominant polycystic kidney disease and pioglitazone for its therapy: a comprehensive review with an emphasis on the molecular pathogenesis and pharmacological aspects. Mol Med 2020; 26:128. [PMID: 33308138 PMCID: PMC7731470 DOI: 10.1186/s10020-020-00246-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited chronic kidney disorder (CKD) that is characterized by the development of numerous fluid-filled cysts in kidneys. It is caused either due to the mutations in the PKD1 or PKD2 gene that encodes polycystin-1 and polycystin-2, respectively. This condition progresses into end-stage renal disorder if the renal or extra-renal clinical manifestations remain untreated. Several clinical trials with a variety of drugs have failed, and the only Food and Drugs Administration (FDA) approved drug to treat ADPKD to date is tolvaptan that works by antagonizing the vasopressin-2 receptor (V2R). The pathology of ADPKD is complex and involves the malfunction of different signaling pathways like cAMP, Hedgehog, and MAPK/ERK pathway owing to the mutated product that is polycystin-1 or 2. A measured yet substantial number of preclinical studies have found pioglitazone to decrease the cystic burden and improve the renal function in ADPKD. The peroxisome proliferator-activated receptor-gamma is found on the epithelial cells of renal collecting tubule and when it gets agonized by pioglitazone, confers efficacy in ADPKD treatment through multiple mechanisms. There is only one clinical trial (ongoing) wherein it is being assessed for its benefits and risk in patients with ADPKD, and is expected to get approval from the regulatory body owing to its promising therapeutic effects. This article would encompass the updated information on the epidemiology, pathophysiology of ADPKD, different mechanisms of action of pioglitazone in the treatment of ADPKD with preclinical and clinical shreds of evidence, and related safety updates.
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Affiliation(s)
- Aryendu Kumar Saini
- Department of Pharmacy, Chaudhary Sughar Singh College of Pharmacy, Etawah, Uttar Pradesh, India.
| | - Rakesh Saini
- Department of Pharmacy, Chaudhary Sughar Singh College of Pharmacy, Etawah, Uttar Pradesh, India
| | - Shubham Singh
- Department of Pharmacy, Shri Ram Lakhan Tiwari College of Pharmacy, Etawah, Uttar Pradesh, India
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Higashihara E, Horie S, Muto S, Kawano H, Tambo M, Yamaguchi T, Taguchi S, Kaname S, Yokoyama K, Yoshioka T, Furukawa T, Fukuhara H. Imaging Identification of Rapidly Progressing Autosomal Dominant Polycystic Kidney Disease: Simple Eligibility Criterion for Tolvaptan. Am J Nephrol 2020; 51:881-890. [PMID: 33227802 DOI: 10.1159/000511797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tolvaptan was approved for the treatment of autosomal dominant polycystic kidney disease (ADPKD). However, the official indication of "rapidly progressive disease" is described differently in the clinical guidelines. We aim to define "rapidly progressive disease" by risk of ESRD, which is evaluated using estimated height-adjusted total kidney volume (HtTKV) growth rate. METHODS The risk of ESRD was retrospectively analyzed in 617 initially non-ESRD adults with ADPKD and observed with standard of care between 2007 and 2018. The estimated annual growth rate of the HtTKV, termed as eHTKV-α (%/year), is derived from the following equation: [HtTKV at age t] = K(1 + eHTKV-α/100)t, where K = 150 mL/m is used in Mayo Imaging Classification and K = 130 mL/m is proposed for individually stable eHTKV-α value from baseline. The accuracy of eHTKV-α to predict ESRD for censored ages was analyzed using time-dependent receiver-operating characteristic curves (ROC). The cutoff point of initially measured eHTKV-α to predict ESRD was assessed using Kaplan-Meier and Cox's proportional hazards models. Performance characteristics of the cutoff point for censored ages were calculated using time-dependent ROC and validated by the bootstrap method. RESULTS The area under the time-dependent ROC of eHTKV-α to predict ESRD at age 65 was 0.89 ± 0.04 (K = 130). The mean renal survival was less than 70 years at eHTKV-α ≥4.0%/year (K = 130). Mean renal survival was approximately 12 years shorter, and hazard ratio of ESRD was more than 5-time higher at this cutoff point than at lower point. Time-dependent sensitivity for age 65 and cutoff point of 4.0%/year (K = 130) was 93.4 ± 0.3%. Between cutoff points ≥4.0%/year (K = 130) and ≥3.5%/year (K = 150), there was no significant difference in performance characteristics and accuracy to predict ESRD. CONCLUSION eHTKV-α well predicts ESRD. Initially, measured eHTKV-α ≥4.0%/year (K = 130) defines high-risk ESRD. Without additional conditions, a single eHTKV-α cutoff point identifies subjects that are most likely to benefit from tolvaptan.
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Affiliation(s)
- Eiji Higashihara
- Department of Hereditary Kidney Disease Research, Kyorin University School of Medicine, Tokyo, Japan,
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan,
| | - Shigeo Horie
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Tambo
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Yamaguchi
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Satoru Taguchi
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenich Yokoyama
- Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tatsuya Yoshioka
- Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Hiroshi Fukuhara
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
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Kalatharan V, Welk B, Nash DM, McArthur E, Slater J, Sarma S, Pei Y, Garg AX. Complications in Patients With Autosomal Dominant Polycystic Kidney Disease Undergoing Ureteroscopy: A Cohort Study. Can J Kidney Health Dis 2020; 7:2054358120972830. [PMID: 33282326 PMCID: PMC7691941 DOI: 10.1177/2054358120972830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ureteroscopy is a minimally invasive treatment option for upper tract stones. The distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may place them at higher risk for ureteroscopic complications. OBJECTIVE To compare the 30-day risk of ureteroscopic complications between patients with and without ADPKD. DESIGN Retrospective cohort study. SETTING Ontario, Canada. PATIENTS Seventy three patients with ADPKD and 81 445 patients without ADPKD who underwent ureteroscopy for upper urinary tract stones between April 1, 2002, and March 1, 2018. MEASUREMENTS A 30-day risk of (1) hospital presentation with ureteroscopic complications (which was a composite outcome of either emergency department visit or hospital admission with acute kidney injury, urinary tract infection, or sepsis); (2) all-cause hospital presentation; (3) all-cause hospital admission; and (4) all-cause emergency department visit. METHODS We regressed outcomes on demographic variables, health care use in the prior 1-year, various procedures and comorbidities related to the outcome in the prior 5 years, and prescribed medications filled in the past 120 days using modified Poisson regression to compare the risk ratio (RR) of each outcome between patients with and without ADPKD. RESULTS The median (interquartile, IQR) age was 44 (38-60 years) in the ADPKD group and 53 (42-64) in the control group. About 40% were women in both groups. The risk of ureteroscopic complications was not significantly different in patients with versus without ADPKD (8.2% vs 4.3%; adjusted RR = 1.5, 95% confidence interval [CI] = 0.7-3.2). Patients with versus without ADPKD were more likely to present to hospital after their procedure (35.6% vs. 20.0%; adjusted RR = 1.6, 95% CI = 1.2-2.2), which included a statistically significant increase in the risk of presenting to the emergency department (32.9% vs. 19.0%; adjusted RR = 1.6, 95% CI = 1.1-2.2) but not hospital admissions (10.9% vs. 5.0%; adjusted RR = 1.8, 95% CI = 0.9-3.4). LIMITATIONS The low numbers of events led to imprecision around the estimates. CONCLUSION Patients with ADPKD have a higher risk of return to the hospital within 30 days of ureteroscopy for stone disease. TRIAL REGISTRATION We did not register this study.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - Blayne Welk
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
- Department of Surgery, Western
University, London, ON, Canada
| | | | | | | | - Sisira Sarma
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - York Pei
- University Health Network, University of
Toronto, ON, Canada
| | - Amit X. Garg
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
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Shi H, Niu W, Liu Y, Jin H, Song W, Shi S, Yao G, Xu J, Sun Y. A novel monogenic preimplantation genetic testing strategy for sporadic polycystic kidney caused by de novo PKD1 mutation. Clin Genet 2020; 99:250-258. [PMID: 33111320 DOI: 10.1111/cge.13871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022]
Abstract
Autosomal dominant hereditary polycystic kidney disease (ADPKD) is the most common inherited kidney disease that causes end-stage renal disease and kidney failure. Preimplantation genetic testing for monogenic (PGT-M) can effectively prevent the transmission of genetic diseases from parents to the offspring before pregnancy. However, PGT-M currently adopts the single nucleotide polymorphism (SNP) linkage analysis for embryo's pathogenic gene carrying status and linkage analysis requires proband of the family. Here we report a new PGT-M strategy using single sperm SNP linkage analysis for male patient with sporadic ADPKD caused by de novo PKD1 mutation. We recruited five couples with male patient with ADPKD caused by de novo PKD1 mutation, and 39 embryos from six PGT-M cycles were detected. The five couples had at least one embryo that does not carry the PKD1 mutation. Within these five couples, the accuracy of carrier status of embryos was confirmed by amniotic fluid gene detection of two couples and two couples successfully delivered healthy fetuses. Therefore, the new PGT-M strategy of using single sperm SNP linkage analysis was proved to be feasible and effective for male patient with ADPKD caused by de novo PKD1 mutation.
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Affiliation(s)
- Hao Shi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenbin Niu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yidong Liu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haixia Jin
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenyan Song
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Senlin Shi
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guidong Yao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiawei Xu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Higashihara E, Fukuhara H, Ouyang J, Lee J, Nutahara K, Tanbo M, Yamaguchi T, Taguchi S, Muto S, Kaname S, Miyazaki I, Horie S. Estimation of Changes in Kidney Volume Growth Rate in ADPKD. Kidney Int Rep 2020; 5:1459-1471. [PMID: 32954070 PMCID: PMC7486344 DOI: 10.1016/j.ekir.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/24/2020] [Accepted: 06/10/2020] [Indexed: 10/30/2022] Open
Abstract
Introduction In the Mayo Imaging Classification (MIC) for autosomal dominant polycystic kidney disease (ADPKD), the height-adjusted total kidney volume (HtTKV) growth rate is estimated for classification. Estimated HtTKV slope, termed as eHTKV-α, is calculated by the equation [HtTKV at age t] = K(1+α/100)(t-A), where K = 150 and A = 0 are used in MIC. If eHTKV-α is nearly stable during a standard-of-care period, the change in eHTKV-α from baseline can be used for estimation of the treatment effect on the HtTKV slope. Methods The constancy of eHTKV-α (A = 0 and K = 150) was evaluated using 453 placebo-assigned subjects in the Tolvaptan Efficacy and Safety in Management of ADPKD and Its Outcomes (TEMPO) 3:4 trial. A and K were sought out respectively by a converged pattern of regression lines of log10(HtTKV) plotted against age for subgroups divided according to MIC, and by change in eHTKV-α from baseline. A total of 239 standard-of-care patients from the Kyorin University Cohort (KUC) served as validation. Changes in eHTKV-α from baseline were evaluated in 809 tolvaptan-treated subjects in TEMPO 3:4. Results In placebo-assigned subjects, eHTKV-α (A = 0 and K = 150) changed significantly from baseline at the third year. As regression lines of placebo-assigned subgroups converged around age 0, A was set as 0, which was confirmed by KUC. K = 130 was selected because of minimal change in eHTKV-α from baseline. The KUC validated the constancy of eHTKV-α (A = 0 and K = 130) but not that of eHTKV-α (A=0 and K=150). In tolvaptan-treated subjects, eHTKV-α remained significantly lower than baseline for 3 years. Conclusions eHTKV-α (A = 0 and K = 130) was nearly stable from baseline through follow-up in standard-of-care adults. Treatment effects on the HtTKV slope can be estimated by changes in eHTKV-α from baseline.
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Affiliation(s)
- Eiji Higashihara
- Department of Hereditary Kidney Disease Research, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - John Ouyang
- Otsuka Pharmaceutical Development and Commercialization, Rockville, Maryland, USA
| | - Jennifer Lee
- Otsuka Pharmaceutical Development and Commercialization, Rockville, Maryland, USA
| | - Kikuo Nutahara
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mistuhiro Tanbo
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Yamaguchi
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Satoru Taguchi
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Isao Miyazaki
- Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
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Narita I. Estimating Growth Rate by a Single Measurement of Kidney Volume in ADPKD. Kidney Int Rep 2020; 5:1383-1384. [PMID: 32955522 PMCID: PMC7486328 DOI: 10.1016/j.ekir.2020.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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35
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Joly D, Quinn J, Mokiou S, O'Reilly K, Sánchez-Covisa J, Wang-Silvanto J, Doll H. Rationale and study protocol of ACQUIRE, a prospective, observational study measuring quality of life, treatment preference and treatment satisfaction of autosomal dominant polycystic kidney disease (ADPKD) patients in Europe. BMC Nephrol 2020; 21:298. [PMID: 32709218 PMCID: PMC7379359 DOI: 10.1186/s12882-020-01927-1] [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: 07/22/2019] [Accepted: 07/05/2020] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is considered the most common inherited renal disease. Patient-Reported Outcomes (PROs) and patient experience in ADPKD are difficult to quantify and have not been well studied, particularly in the early stages of the disease. There is evidence to suggest that early-stage ADPKD patients have a lower Health-Related Quality of Life (HRQoL) than the general population due to the signs and symptoms of early-stage ADPKD. However, no research has been carried out on the HRQoL of early-stage ADPKD patients using validated ADPKD-specific PRO measures. Additionally, a new disease progression delaying treatment option has recently emerged for ADPKD. Patient preference for this treatment and unmet treatment needs have not yet been investigated. METHODS The ACQUIRE study is a prospective, observational study investigating the influence of early-stage ADPKD-related symptoms and treatments on PROs. It aims to collect real-world data on patient demographics, treatment patterns, clinical outcomes, and PROs such as HRQoL, treatment satisfaction and treatment preference in early-stage ADPKD. Adult ADPKD patients in stages 1-3 of chronic kidney disease (CKD) with evidence of rapidly progressing disease are being recruited from seven European countries. At baseline and every 3 months, for a follow-up period of 18 months, general and disease-specific questionnaires are completed remotely to capture patients' own assessment of their overall and ADPKD-related HRQoL. A Discrete Choice Experiment (DCE) is also used to investigate the value patients place on different attributes of hypothetical treatment options (e.g. treatment outcomes, side effects) and the role each attribute plays in determining overall patient treatment preference. DISCUSSION The results of this study will highlight the real-world effects of ADPKD-related challenges on PROs including HRQoL, treatment experience and satisfaction; and help physicians gain greater insight into likely disease outcomes based on early-stage patient symptoms and patients' experience with treatment. Data captured by the DCE may inform ADPKD treatment decision-making from a patient perspective. The DCE will also provide insights into which patients are more likely to perceive benefit from treatments based on the value and trade-offs they place on specific treatment attributes. TRIAL REGISTRATION NCT02848521 . Protocol Number/Version: 156-303-00096/Final.
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Affiliation(s)
- Dominique Joly
- Nephrology Department, Necker Hospital, 149 Rue de Sèvres, 75015, Paris, France.
| | | | | | | | | | | | - Helen Doll
- Clinical Outcomes Solutions, Folkestone, UK
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Kalatharan V, Jandoc R, Grewal G, Nash DM, Welk B, Sarma S, Pei Y, Garg AX. Efficacy and Safety of Surgical Kidney Stone Interventions in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review. Can J Kidney Health Dis 2020; 7:2054358120940433. [PMID: 32754344 PMCID: PMC7378961 DOI: 10.1177/2054358120940433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reduced kidney function and distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may complicate stone interventions more compared with the general population. OBJECTIVES To review studies describing the safety and efficacy of the 3 main stone interventions in adults with ADPKD: shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL). DESIGN Systematic review. SETTING Any country of origin. PATIENTS Adults with ADPKD who underwent SWL, ureteroscopy, or PCNL. MEASUREMENTS Being stone free after the intervention and postoperative complications as reported by each study, which included pain, bleeding, and fever. METHODS Relevant studies published until February 2019 were identified through a comprehensive search of MEDLINE, EMBASE, Web of Science, BIOSIS PREVIEW, and CINAHL. Studies were eligible for review if they reported at least one outcome following SWL, ureteroscopy, and/or PCNL in adults with ADPKD. We then abstracted information on study characteristics, patient characteristics, intervention details, and postintervention outcomes and assessed the methodological quality of each study using a modified Downs and Black checklist. RESULTS We screened 221 citations from which we identified 24 studies that met our review criteria. We identified an additional article when manually reviewing the reference list of an included article, yielding a total of 25 studies describing 311 patients (32 SWL, 42 ureteroscopy, and 237 PCNL). The percentage of patients who were stone free after 1 session ranged from 0% to 69% after SWL, 73% to 100% after ureteroscopy, and 45% to 100% after PCNL. The percentage of patients with ADPKD that experienced at least one postoperative complication ranged from 0% to 33% for SWL, 0% to 27% for ureteroscopy, and 0% to 100% for PCNL. LIMITATIONS The number and quality of studies published to date are limited. CONCLUSIONS The efficacy and safety of stone interventions in patients with ADPKD remains uncertain, with wide-ranging estimates reported in the literature. TRIAL REGISTRATION We did not register the protocol of this systematic review.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | | | - Gary Grewal
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
| | - Danielle M. Nash
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - Blayne Welk
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - York Pei
- Division of Nephrology, University
Health Network and University of Toronto, ON, Canada
| | - Amit X. Garg
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
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Jouret F, Devuyst O. Targeting chloride transport in autosomal dominant polycystic kidney disease. Cell Signal 2020; 73:109703. [PMID: 32619563 DOI: 10.1016/j.cellsig.2020.109703] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent inherited kidney disease. Transepithelial fluid secretion is one of the key factors of cystogenesis in ADPKD. Multiple studies have suggested that fluid secretion across ADPKD cyst-lining cells is driven by the secretion of chloride, essentially mediated by the CFTR channel and stimulated by increased intracellular levels of 3',5'-cyclic adenosine monophosphate. This review focuses on the pathophysiology of fluid secretion in ADPKD based on the pioneering studies of Jared Grantham and colleagues, and on the follow-up investigations from the molecular level to the potential applications in ADPKD patients. Altogether, the studies of fluid and chloride transport in ADPKD paved the way for innovative therapeutic targets to prevent cyst volume expansion and thus, kidney disease progression.
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Affiliation(s)
- François Jouret
- Division of Nephrology, Department of Internal Medicine, ULiège Academic Hospital, Liège, Belgium,; Groupe Interdisciplinaire de Géno-protéomique Appliquée, Cardiovascular Sciences, ULiège Medical School, Liège, Belgium
| | - Olivier Devuyst
- Division of Nephrology, UCLouvain Medical School, B-1200, Brussels, Belgium,; Mechanisms of Inherited Kidney Disorders, University of Zurich, CH-8057 Zurich, Switzerland.
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Nakatani S, Ishimura E, Machiba Y, Fujimoto K, Uedono H, Tsuda A, Mori K, Emoto M, Inaba M. Long-Term Effects of High-Dose Tolvaptan for Autosomal Dominant Polycystic Kidney Disease Patients. Case Rep Nephrol Dial 2020; 10:9-17. [PMID: 32232055 PMCID: PMC7098338 DOI: 10.1159/000506118] [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: 10/16/2019] [Accepted: 01/24/2020] [Indexed: 12/04/2022] Open
Abstract
Tolvaptan, a vasopressin V<sub>2</sub> receptor antagonist, was initially approved in Japan for treatment of autosomal dominant polycystic kidney disease (ADPKD). Recently, a retrospective study showed that the effect of tolvaptan on kidney function could be sustained for a long period. However, the long-term efficacy and safety of high-dose tolvaptan (120 mg/day) in individual cases remain unknown. We report here 2 Japanese ADPKD patients (males, 36 and 29 years old) treated with tolvaptan (120 mg/day) for 9 years, during which time determinations of estimated glomerular filtration rate (eGFR) and total kidney volume (TKV) were performed. In these 2 patients, eGFR prior to therapy was 57.3 and 76.3 mL/min/1.73 m<sup>2</sup>, respectively, and 30.2 and 43.5 mL/min/1.73 m<sup>2</sup>, respectively, after 9 years of tolvaptan treatment, for a relatively constant annual decline of −3.01 and −3.64 mL/min/1.73 m<sup>2</sup>, respectively. As compared to the predicted (calculated) eGFR without tolvaptan treatment, eGFR actually measured was higher by 15.3 and 12.6 mL/min/1.73 m<sup>2</sup>, respectively, after the 9-year therapy period. In addition, the rate of TKV increase was gradual, 2.4 and 4.7%, respectively, per year during the initial 3-year period, to 6.5 and 12.5%, respectively, per year in the following 6-year period. During the 9 years of treatment, neither patient showed tolvaptan-related adverse events. Our findings suggest that long-term administration of tolvaptan at a high dose is both safe and effective to preserve kidney function, though a gradual increase in TKV was seen in both of the present cases, particularly during the later phase.
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Affiliation(s)
- Shinya Nakatani
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Eiji Ishimura
- Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuri Machiba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenta Fujimoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hideki Uedono
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Tsuda
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Renal Volume in ADPKD Patient Evaluation. Int J Nephrol 2020; 2020:9286728. [PMID: 32158561 PMCID: PMC7060877 DOI: 10.1155/2020/9286728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 01/18/2023] Open
Abstract
The clinical manifestations of ADPKD are related to the growth of renal cysts. Renal volume has been recognised as the biomarker that is able to identify those patients at risk of complications (hypertension and haematuria) and at risk of progression to End Stage Renal Disease (ESRD). Recently, several scores have been introduced to predict the evolution of ADPKD. The Mayo Clinic Group developed a classification based on renal volume as measured by CT or MRI and corrected for age and height (Ht-TKV); this allowed predicting the evolution of the disease, but it has not been fully validated so far. In addition, it is used to identify patients labelled as “fast progressors” and eligible for Tolvaptan therapy according to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) recommendations. We studied 80 patients who underwent MRI and had been classified as ADPKD typical form (class 1A-1E). A significant correlation between renal volume, hypertension, and low GFR was found (p < 0.005). A progressive increase in disease severity has been found across the different Mayo classes; 41.2% were eligible for Tolvaptan therapy. The results demonstrate that the Mayo method is easy to perform and provides valid information in order to identify with rapidly progressing disease.
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40
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The positive effect of selective prostaglandin E2 receptor EP2 and EP4 blockade on cystogenesis in vitro is counteracted by increased kidney inflammation in vivo. Kidney Int 2020; 98:404-419. [PMID: 32622526 DOI: 10.1016/j.kint.2020.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/16/2020] [Accepted: 02/07/2020] [Indexed: 01/15/2023]
Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a major cause of end-stage kidney disease in man. The central role of cyclic adenosine monophosphate (cAMP) in ADPKD pathogenesis has been confirmed by numerous studies including positive clinical trial data. Here, we investigated the potential role of another major regulator of renal cAMP, prostaglandin E2 (PGE2), in modifying disease progression in ADPKD models using selective receptor modulators to all four PGE2 receptor subtypes (EP1-4). In 3D-culture model systems utilizing dog (MDCK) and patient-derived (UCL93, OX161-C1) kidney cell lines, PGE2 strikingly promoted cystogenesis and inhibited tubulogenesis by stimulating proliferation while reducing apoptosis. The effect of PGE2 on tubulogenesis and cystogenesis in 3D-culture was mimicked or abolished by selective EP2 and EP4 agonists or antagonists but not those specific to EP1 or EP3. In a Pkd1 mouse model (Pkd1nl/nl), kidney PGE2 and COX-2 expression were increased by two-fold at the peak of disease (week four). However, Pkd1nl/nl mice treated with selective EP2 (PF-04418948) or EP4 (ONO-AE3-208) antagonists from birth for three weeks had more severe cystic disease and fibrosis associated with increased cell proliferation and macrophage infiltration. A similar effect was observed for the EP4 antagonist ONO-AE3-208 in a second Pkd1 model (Pax8rtTA-TetO-Cre-Pkd1f/f). Thus, despite the positive effects of slowing cyst growth in vitro, the more complex effects of inhibiting EP2 or EP4 in vivo resulted in a worse outcome, possibly related to unexpected pro-inflammatory effects.
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Nobakht N, Hanna RM, Al-Baghdadi M, Ameen KM, Arman F, Nobahkt E, Kamgar M, Rastogi A. Advances in Autosomal Dominant Polycystic Kidney Disease: A Clinical Review. Kidney Med 2020; 2:196-208. [PMID: 32734239 PMCID: PMC7380379 DOI: 10.1016/j.xkme.2019.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Polycystic kidney disease (PKD) is a multiorgan disorder resulting in fluid-filled cyst formation in the kidneys and other systems. The replacement of kidney parenchyma with an ever-increasing volume of cysts eventually leads to kidney failure. Recently, increased understanding of the pathophysiology of PKD and genetic advances have led to new approaches of treatment targeting physiologic pathways, which has been proven to slow the progression of certain types of the disease. We review the pathophysiologic patterns and recent advances in the clinical pharmacotherapy of autosomal dominant PKD. A multipronged approach with pharmacologic and nonpharmacologic treatments can be successfully used to slow down the rate of progression of autosomal dominant PKD to kidney failure.
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Affiliation(s)
- Niloofar Nobakht
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ramy M. Hanna
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Nephrology, Department of Medicine, University of California Irvine, Orange, CA
| | - Maha Al-Baghdadi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Medicine, University of Alabama Birmingham Huntsville Regional Campus, Huntsville, AL
| | - Khalid Mohammed Ameen
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Farid Arman
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Ehsan Nobahkt
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC
| | - Mohammad Kamgar
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Anjay Rastogi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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42
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Kalatharan V, Grewal G, Nash DM, Welk B, Sarma S, Pei Y, Garg AX. Stone Prevalence in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2020; 7:2054358120934628. [PMID: 35186303 PMCID: PMC8851145 DOI: 10.1177/2054358120934628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022] Open
Abstract
Background: It is uncertain how often patients with autosomal dominant polycystic kidney disease (ADPKD) develop kidney stones. Objective: To review English-language studies reporting the incidence and prevalence of stones and stone interventions in adults with ADPKD. Design: Systematic review and meta-analysis. Setting: Any country of origin. Patients: Adult patients with ADPKD. Measurements: Incidence or prevalence of kidney stones and stone interventions. Methods: We reviewed 1812 citations from bibliographic databases, abstracted data from 49 eligible studies, and assessed methodological quality in duplicate. In some studies, the proportion of adults with ADPKD with the outcome were compared to adults without ADPKD; for these studies, prevalence risk ratios were calculated and pooled using a random effects model. Results: We identified 49 articles that met our review criteria. The methodological quality of many studies was limited (scores ranging from 2 to 14 out of 22, with a higher score indicating higher quality). No study clearly reported stone incidence, and in the cross-sectional studies, the definition of stones was often unclear. The prevalence of stones ranged from 3% to 59%, and a prevalence of stone interventions ranged from 1% to 8%; the average patient age at the time of assessment ranged from 26 to 61 years across the studies. Two studies reported a nonstatistically significant higher stone prevalence in patients with ADPKD compared to unaffected family members. Compared to unaffected family members, patients with ADPKD had a higher prevalence of kidney stones (6 cross-sectional studies; unadjusted prevalence ratio: 1.8; 95% confidence interval: 1.3 to 2.6; P = .0007; test for heterogeneity: I2 = 0%, P = .8). Limitations: Studies were limited to articles published in English. Conclusions: The prevalence of kidney stones and stone interventions in adults with ADPKD remains uncertain. Future studies of higher methodological quality are needed to better characterize the incidence and prevalence of kidney stones in patients with ADPKD. Trial registration: We did not register the protocol for this systematic review.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Gary Grewal
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Danielle M Nash
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
| | - York Pei
- University Health Network, University of Toronto, ON, Canada
| | - Amit X. Garg
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES, ON, Canada
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
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The role of DNA damage as a therapeutic target in autosomal dominant polycystic kidney disease. Expert Rev Mol Med 2019; 21:e6. [PMID: 31767049 DOI: 10.1017/erm.2019.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic kidney disease and is caused by heterozygous germ-line mutations in either PKD1 (85%) or PKD2 (15%). It is characterised by the formation of numerous fluid-filled renal cysts and leads to adult-onset kidney failure in ~50% of patients by 60 years. Kidney cysts in ADPKD are focal and sporadic, arising from the clonal proliferation of collecting-duct principal cells, but in only 1-2% of nephrons for reasons that are not clear. Previous studies have demonstrated that further postnatal reductions in PKD1 (or PKD2) dose are required for kidney cyst formation, but the exact triggering factors are not clear. A growing body of evidence suggests that DNA damage, and activation of the DNA damage response pathway, are altered in ciliopathies. The aims of this review are to: (i) analyse the evidence linking DNA damage and renal cyst formation in ADPKD; (ii) evaluate the advantages and disadvantages of biomarkers to assess DNA damage in ADPKD and finally, (iii) evaluate the potential effects of current clinical treatments on modifying DNA damage in ADPKD. These studies will address the significance of DNA damage and may lead to a new therapeutic approach in ADPKD.
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44
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Brosnahan G. Quest for the Cure: Testing the Old and New to Prevent Progression of Autosomal Dominant Polycystic Kidney Disease. Kidney Med 2019; 1:329-331. [PMID: 33015606 PMCID: PMC7525136 DOI: 10.1016/j.xkme.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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45
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Messchendorp AL, Meijer E, Visser FW, Engels GE, Kappert P, Losekoot M, Peters DJM, Gansevoort RT. Rapid Progression of Autosomal Dominant Polycystic Kidney Disease: Urinary Biomarkers as Predictors. Am J Nephrol 2019; 50:375-385. [PMID: 31600749 DOI: 10.1159/000502999] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Markers currently used to predict the likelihood of rapid disease progression in patients with autosomal dominant polycystic kidney disease (ADPKD) are expensive and time consuming to assess and often have limited sensitivity. New, easy-to-measure markers are therefore needed that alone or in combination with conventional risk markers can predict the rate of disease progression. In the present study, we investigated the ability of tubular damage and inflammation markers to predict kidney function decline. METHODS At baseline, albumin, immunoglobulin G, kidney injury molecule 1, β2 microglobulin (β2MG), heart-type fatty acid-binding protein, neutrophil gelatinase-associated lipocalin, and monocyte chemotactic protein-1 -(MCP-1) were measured in 24-h urine samples of patients participating in a study investigating the therapeutic efficacy of lanreotide in ADPKD. Individual change in estimated glomerular filtration rate (eGFR) during follow-up was calculated using mixed-model analysis taking into account 13 -eGFRs (chronic kidney disease EPIdemiology) per patient. Logistic regression analysis was used to select urinary biomarkers that had the best association with rapidly progressive disease. The predictive value of these selected urinary biomarkers was compared to other risk scores using C-statistics. RESULTS Included were 302 patients of whom 53.3% were female, with an average age of 48 ± 7 years, eGFR of 52 ± 12 mL/min/1.73 m2, and a height-adjusted total kidney volume (htTKV) of 1,082 (736-1,669) mL/m. At baseline, all urinary damage and inflammation markers were associated with baseline eGFR, also after adjustment for age, sex and baseline htTKV. For longitudinal analyses only patients randomized to standard care were considered (n = 152). A stepwise backward analysis revealed that β2MG and MCP-1 showed the strongest association with rapidly progressive disease. A urinary biomarker score was created by summing the ranking of tertiles of β2MG and MCP-1 excretion. The predictive value of this urinary biomarker score was higher compared to that of the Mayo htTKV classification (area under the curve [AUC] 0.73 [0.64-0.82] vs. 0.61 [0.51-0.71], p = 0.04) and comparable to that of the predicting renal outcomes in -ADPKD score (AUC 0.73 [0.64-0.82] vs. 0.65 [0.55-0.75], p = 0.18). In a second independent cohort with better kidney function, similar results were found for the urinary biomarker score. CONCLUSION Measurement of urinary β2MG and MCP-1 excretion allows selection of ADPKD patients with rapidly progressive disease, with a predictive value comparable to or even higher than that of TKV or PKD mutation. Easy and inexpensive to measure urinary markers therefore hold promise to help predict prognosis in ADPKD.
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Affiliation(s)
- A Lianne Messchendorp
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
| | - Esther Meijer
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Visser
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Peter Kappert
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Monique Losekoot
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorien J M Peters
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rastogi A, Ameen KM, Al-Baghdadi M, Shaffer K, Nobakht N, Kamgar M, Lerma EV. Autosomal dominant polycystic kidney disease: updated perspectives. Ther Clin Risk Manag 2019; 15:1041-1052. [PMID: 31692482 PMCID: PMC6716585 DOI: 10.2147/tcrm.s196244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited multisystem disorder, characterized by renal and extra-renal fluid-filled cyst formation and increased kidney volume that eventually leads to end-stage renal disease. ADPKD is considered the fourth leading cause of end-stage renal disease in the United States and globally. Care of patients with ADPKD was, for a long time, limited to supportive lifestyle measures, due to the lack of therapeutic strategies targeting the main pathways involved in the pathophysiology of ADPKD. As the first FDA approved treatment of ADPKD, Vasopressin (V2) receptor blocking agent, tolvaptan, is an urgently awaited advance for ADPKD patients. In our review, we also shed some lights on what is beyond Tolvaptan as there are other medications in the pipeline and many medications have been or are currently being studied in clinical trials such as Tesevatinib, Metformin and Pravastatin, with the goal of slowing the rate of progression of ADPKD by reducing the increase in total kidney volume or maintaining eGFR. Here, we review updates in the perspectives and management of ADPKD.
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Affiliation(s)
- Anjay Rastogi
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Khalid Mohammed Ameen
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Maha Al-Baghdadi
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kelly Shaffer
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Niloofar Nobakht
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mohammad Kamgar
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Edgar V Lerma
- Department of Medicine, Divison of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Section of Nephrology, Oak Lawn, IL, USA
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47
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Mattei C, Pelander L, Hansson K, Uhlhorn M, Olsson U, Häggström J, Ljungvall I, Ley CJ. Renal ultrasonographic abnormalities are associated with low glomerular filtration rate calculated by scintigraphy in dogs. Vet Radiol Ultrasound 2019; 60:432-446. [PMID: 31050102 DOI: 10.1111/vru.12755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/13/2019] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Abstract
Ultrasound provides information on kidney morphology, but studies relating structural and functional abnormalities in chronic kidney disease (CKD) are lacking. The aim of this descriptive cross-sectional study was to compare individual kidney (IK) B-mode ultrasound abnormalities to IK glomerular filtration rate (GFR) estimated by scintigraphy normalized to plasma volume (PV) in dogs, to evaluate if ultrasonographic findings were associated with low IKGFR/PV. Eighty privately owned dogs with and without clinical suspicion of CKD were prospectively enrolled, and kidney ultrasound and IKGFR/PV were evaluated independently. Ultrasound images were assessed retrospectively for subjective abnormalities (shape, cortical, and medullary hyperechogenicity), and kidney size was measured. The normal IKGFR/PV cutoff was derived from dogs in the study group with no history and clinical signs of kidney disease and normal blood and urine results (n = 28) and was 16.84 mL/min/L. Kidneys were categorized into normal, mild, moderate, and severe ultrasound changes according to subjective ultrasound grades. Associations were found between low IKGFR/PV and abnormal kidney shape (P = .0004), cortical hyperechogenicity (P = .0008), medullary hyperechogenicity (P < .0001), and low kidney volume (P = .0092). Apart from the moderate and severe category comparison, IKGFR/PV value significantly decreased with increasing severity of category. The combination of ultrasonographic subjective abnormalities had a high sensitivity (93.8%) and moderate specificity (65.7%) for detecting low IKGFR/PV. Kidneys with normal IKGFR/PV had a low frequency of mild ultrasound changes. Findings indicate kidneys with increasing number and grade of subjective ultrasound abnormalities are more likely to have a lower IKGFR/PV.
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Affiliation(s)
- Chiara Mattei
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Lena Pelander
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Kerstin Hansson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Margareta Uhlhorn
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ulf Olsson
- Unit of Applied Statistics and Mathematics, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Charles J Ley
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Ozkurt S, Dogan I, Ozcan O, Fidan N, Bozaci I, Yilmaz B, Bilgin M. Correlation of serum galectin-3 level with renal volume and function in adult polycystic kidney disease. Int Urol Nephrol 2019; 51:1191-1197. [PMID: 31012038 DOI: 10.1007/s11255-019-02156-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The decrease in kidney functions in autosomal dominant polycystic kidney disease (ADPKD) is strongly correlated with the severity and growth of kidney cysts. Total kidney volume (TKV) was shown to be an early marker of the severity of the disease and a predictor of reduction in kidney functions. New treatment approaches for ADPKD have led to a need for easily applicable strong biomarkers predicting progression of the disease. The profibrotic mediator of galectin-3 (Gal-3) is linked to development of renal fibrosis. METHODS The study included 74 patients with ADPKD diagnosis and 40 healthy controls. The TKV of patients was calculated using the manual tracing method on MR images. The serum Gal-3 levels of patient and healthy control groups were measured with the ELISA method. The correlations between serum Gal-3 value with TKV and kidney function were assessed in patients. RESULTS As the stage of chronic kidney disease (CKD) increased, serum Gal-3 and TKV values increased (p < 0.001, p = 0.049, respectively). Correlation analysis found a negative relationship between serum Gal-3 levels and eGFR (r: - 0.515, p < 0.001); however, there was no relationship between serum Gal-3 and TKV (r = 0.112, p = 0.344). Linear regression analysis showed the major parameter affecting Gal-3 was eGFR (p = 0.016). CONCLUSIONS In our study, we showed that renal impairment is an important determinant of Gal-3, and there is no correlation of Gal-3 and TKV in ADPKD. As a result, there is an urgent clinical need for new biomarkers to identify individuals with the chance of treatment in the early stage among ADPKD patients.
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Affiliation(s)
- Sultan Ozkurt
- Department of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Büyükdere, 26040, Odunpazarı, Eskisehir, Turkey.
| | - Ibrahim Dogan
- Department of Nephrology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Oguzhan Ozcan
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Nurdan Fidan
- Department of Radiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Ilter Bozaci
- Department of Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Büyükdere, 26040, Odunpazarı, Eskisehir, Turkey
| | - Behice Yilmaz
- Department of Radiology, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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49
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Urinary Tissue Inhibitor of Metalloproteinases-2 and Insulin-Like Growth Factor-Binding Protein 7 Do Not Correlate With Disease Severity in ADPKD Patients. Kidney Int Rep 2019; 4:833-841. [PMID: 31194166 PMCID: PMC6551510 DOI: 10.1016/j.ekir.2019.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst formation and variable renal function decline that frequently leads to end-stage renal failure. With the advent of renoprotective treatment, there is renewed interest in noninvasive biomarkers to help identify patients at risk of rapid disease progression at early stages. Urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been validated as early markers of acute kidney injury. Because these markers are associated with tubular damage, we studied the performance of both markers in a cohort with chronic tubular pathology. We investigated whether these biomarkers may be useful to evaluate disease severity in ADPKD. Methods In a cross-sectional analysis, we measured TIMP-2 and IGFBP7 in stored spot urine samples of patients with ADPKD with various stages of chronic kidney disease (CKD) and healthy controls by enzyme-linked immunosorbent assay. Renal function was estimated using the CKD-Epidemiology Collaboration equation. Patients were stratified according to the Kidney Disease Outcomes Quality Initiative classification for CKD. In a subset of patients, total kidney volume (TKV; using magnetic resonance imaging [MRI]) was measured. Results In 296 patients with ADPKD (45.5 ± 11.5 years, 51.0% female, serum creatinine 106 [85-147] μmol/l), urine levels of TIMP-2 and IGFBP7 were not increased or tended to be lower as compared with 71 healthy controls (46.5 ± 18.5 years, 72.6% female). The levels did not differ across CKD stages, which remained so after correcting for urine creatinine or osmolality, and for age, sex, and urine protein in multivariable analyses. Conclusions Urinary levels of TIMP-2 and IGFBP7 were not higher in patients with ADPKD, and did not correlate with disease severity.
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Cornec-Le Gall E, Alam A, Perrone RD. Autosomal dominant polycystic kidney disease. Lancet 2019; 393:919-935. [PMID: 30819518 DOI: 10.1016/s0140-6736(18)32782-x] [Citation(s) in RCA: 308] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 12/15/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease and one of the most common causes of end-stage kidney disease. Multiple clinical manifestations, such as enlarged kidneys filled with growing cysts, hypertension, and multiple extrarenal complications, including liver cysts, intracranial aneurysms, and cardiac valvular disease, show that ADPKD is a systemic disorder. New information derived from clinical research using molecular genetics and advanced imaging techniques has provided enhanced tools for assessing the diagnosis and prognosis for individual patients and their families. Phase 3 randomised, placebo-controlled clinical trials have clarified aspects of disease management and a disease-modifying therapeutic drug is now available for patients with high risk of rapid disease progression. These developments provide a strong basis on which to make clear recommendations about the management of affected patients and families. Implementation of these advances has the potential to delay kidney failure, reduce the symptom burden, lessen the risk of cardiovascular complications, and prolong life.
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Affiliation(s)
- Emilie Cornec-Le Gall
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalier Universitaire, Brest, France; UMR1078 Génétique, Génomique Fonctionnelle et Biotechnologies, INSERM, Université de Brest, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Ahsan Alam
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Ronald D Perrone
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA.
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