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ElSharkawy M, Emara A, Ahmed MM, Ghonamy E, Teama NM. Clinical value of adding Dapagliflozin in patients with nephrotic syndrome. Int Urol Nephrol 2024; 56:3617-3625. [PMID: 38862701 DOI: 10.1007/s11255-024-04099-1] [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: 04/28/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors in nephrotic patients on immunosuppression are underexplored. We evaluated dapagliflozin's impact in non-diabetic primary nephrotic syndrome. METHODS Randomized controlled clinical trial was conducted on 60 non-diabetic primary nephrotic syndrome patients, equally assigned to dapagliflozin and control groups. All patients received the standard of care medication and the Dapagliflozin group received 10 mg dapagliflozin in addition. Demographic data, nephrotic syndrome etiology, proteinuria levels, eGFR, and immunosuppression doses, were well-matched. After 6 months of follow up primary outcomes included changes in and eGFR. RESULTS Both groups exhibited significant reductions in proteinuria after 6 months, with the dapagliflozin group achieving a mean UPCR reduction of - 94.7%, and the control group - 86.7% (p < 0.001). However, the comparative change in proteinuria between both groups did not reach statistical significance (p = 0.158). Dapagliflozin initially led to a transient eGFR decline. Dapagliflozin also resulted in a significant mean body weight reduction (p < 0.001) and notable improvements in triglyceride levels compared to the control group (p = 0.045). CONCLUSION In primary nephrotic syndrome patients, adjunct dapagliflozin may enhance the standard of care. While notable, the reduction in proteinuria was comparable to that of the control group by the study's end. Furthermore, after 6 months, eGFR remained stable in both groups. However, significant weight loss and serum triglyceride reduction were particularly pronounced in the dapagliflozin group. Further long-term investigations are necessary to address potential immunosuppression-related confounding effects in patients with primary glomerular disease.
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Affiliation(s)
- Magdy ElSharkawy
- Faculty of Medicine, Internal Medicine and Nephrology Department, Ain Shams University, Ramsis Street 38, Abbasia, Cairo, Postal Code: 11566, Egypt
| | - Ahmed Emara
- Faculty of Medicine, Internal Medicine and Nephrology Department, Ain Shams University, Ramsis Street 38, Abbasia, Cairo, Postal Code: 11566, Egypt
| | - Mohamed Mohyeldin Ahmed
- Faculty of Medicine, Internal Medicine and Nephrology Department, Ain Shams University, Ramsis Street 38, Abbasia, Cairo, Postal Code: 11566, Egypt
| | - ElSayed Ghonamy
- Faculty of Medicine, Medical Physiology Department, Ain Shams University, Cairo, Egypt
| | - Nahla Mohamed Teama
- Faculty of Medicine, Internal Medicine and Nephrology Department, Ain Shams University, Ramsis Street 38, Abbasia, Cairo, Postal Code: 11566, Egypt.
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Veličković D, Shapiro JP, Parikh SV, Rovin B, Toto RD, Vazquez MA, Poggio ED, O'Toole JF, Sedor JR, Alexandrov T, Jain S, Bitzer M, Hodgin J, Veličković M, Sharma K, Anderton CR. Protein N-glycans in Healthy and Sclerotic Glomeruli in Diabetic Kidney Disease. J Am Soc Nephrol 2024; 35:00001751-990000000-00327. [PMID: 38771634 PMCID: PMC11387035 DOI: 10.1681/asn.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Diabetes is expected to directly impact renal glycosylation, yet to date, there has not been a comprehensive evaluation of alterations in N-glycan composition in the glomeruli of patients with diabetic kidney disease (DKD). METHODS We used untargeted mass spectrometry imaging to identify N-glycan structures in healthy and sclerotic glomeruli in FFPE sections from needle biopsies of five patients with DKD and three healthy kidney samples. Regional proteomics was performed on glomeruli from additional biopsies from the same patients to compare the abundances of enzymes involved in glycosylation. Secondary analysis of single nuclei transcriptomics (snRNAseq) data was used to inform on transcript levels of glycosylation machinery in different cell types and states. RESULTS We detected 120 N-glycans, and among them identified twelve of these protein post-translated modifications that were significantly increased in glomeruli. All glomeruli-specific N-glycans contained an N-acetyllactosamine (LacNAc) epitope. Five N-glycan structures were highly discriminant between sclerotic and healthy glomeruli. Sclerotic glomeruli had an additional set of glycans lacking fucose linked to their core, and they did not show tetra-antennary structures that are common in healthy glomeruli. Orthogonal omics analyses revealed lower protein abundance and lower gene expression involved in synthesizing fucosylated and branched N-glycans in sclerotic podocytes. In snRNAseq and regional proteomics analyses, we observed that genes and/or proteins involved in sialylation and LacNAc synthesis were also downregulated in DKD glomeruli, but this alteration remained undetectable by our spatial N-glycomics assay. CONCLUSIONS Integrative spatial glycomics, proteomics, and transcriptomics revealed protein N-glycosylation characteristic of sclerotic glomeruli in DKD.
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Affiliation(s)
- Dušan Veličković
- Earth and Biological Sciences Directorate, Pacific Northwest National Laboratory, Richland, Washington
| | - John P Shapiro
- Department of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Samir V Parikh
- Department of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Brad Rovin
- Department of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert D Toto
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Miguel A Vazquez
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emilio D Poggio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
| | - John F O'Toole
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
| | - John R Sedor
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
| | - Theodore Alexandrov
- Structural and Computational Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
- BioStudio, BioInnovation Institute, Copenhagen, Denmark
| | - Sanjay Jain
- Department of Medicine, Washington University School of Medicine, St. Louis
| | - Markus Bitzer
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey Hodgin
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Marija Veličković
- Earth and Biological Sciences Directorate, Pacific Northwest National Laboratory, Richland, Washington
| | - Kumar Sharma
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Christopher R Anderton
- Earth and Biological Sciences Directorate, Pacific Northwest National Laboratory, Richland, Washington
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
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Esposito P, Picciotto D, Cappadona F, Costigliolo F, Russo E, Macciò L, Viazzi F. Multifaceted relationship between diabetes and kidney diseases: Beyond diabetes. World J Diabetes 2023; 14:1450-1462. [PMID: 37970131 PMCID: PMC10642421 DOI: 10.4239/wjd.v14.i10.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023] Open
Abstract
Diabetes mellitus is one of the most common causes of chronic kidney disease. Kidney involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney failure. The development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments, such as the vascular system and glomeruli. Glomerular alterations include thickening of the glomerular basement membrane, loss of podocytes, and segmental mesangiolysis, which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson nodules. Beyond lesions directly related to diabetes, awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is increasing. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, and other primary or secondary renal disorders. Differential diagnosis of these conditions is crucial in guiding clinical management and therapeutic approaches. However, the relationship between diabetes and the kidney is bidirectional; thus, new-onset diabetes may also occur as a complication of the treatment in patients with renal diseases. Here, we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course, differential diagnosis, and therapeutic oppor-tunities offered by novel drugs.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Daniela Picciotto
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Francesca Cappadona
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Francesca Costigliolo
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Elisa Russo
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Lucia Macciò
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
| | - Francesca Viazzi
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa 16132, Italy
- Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
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Kim YH, Saha MK, Hu Y, Kumar S, Poulton CJ, Hogan SL, Nachman P, Jennette JC, Nast CC, Mottl AK. Impact of Diabetic Lesions on Pathology, Treatment, and Outcomes of Glomerular Diseases. KIDNEY360 2023; 4:1445-1453. [PMID: 37642555 PMCID: PMC10615380 DOI: 10.34067/kid.0000000000000247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
Key Points People with glomerular disease (GD) and comorbid diabetes have similar baseline characteristics irrespective of superimposed diabetic lesions. Immunosuppression for GD with comorbid diabetes is the same regardless of superimposed diabetic glomerular lesions. ESKD or death is more rapid in GD and comorbid diabetes only in the presence of moderate-severe diabetic glomerular lesions. Background We aimed to evaluate whether concomitant diabetic glomerulosclerosis (DGS) and its severity affect the treatment and outcomes of primary glomerular diseases (GDs) with comorbid diabetes. Methods We conducted a retrospective review of people with diabetes and GD. We searched the GD Collaborative Network for biopsies from 2008 to 2015 among persons with diabetes and any of the following diagnoses: FSGS, IgA nephropathy, minimal change disease, membranous nephropathy, or antineutrophil cytoplasmic autoantibody GN. Data were abstracted from health records and histologic diabetic glomerular class scored. The primary composite end point was ESKD or death. Multivariable Cox regression models tested whether any or the severity of diabetes histopathology affected the primary end point. Results Data from 134 cases were available for analysis (78 DGS+GD and 56 GD alone). Diabetes duration and glycemic control were similar between the two groups (P = 0.2; P = 0.09, respectively). Use of immunosuppression did not differ between the two groups (P = 0.3). The composite end point was significantly higher in DGS+GD (22.5 cases per 100 person-years [95% confidence interval (CI), 16.6 to 30.5]) versus GD alone (10.2 cases per 100 person-years [95% CI, 6.4 to 16.2]). Regression analyses demonstrated that compared with the GD-alone group, the risk for the composite end point was similar in the group with mild DGS+GD (DGS class 1, 2a) (hazard ratio, 1.15 [95% CI, 0.54 to 2.43]) while the group with severe DGS+GD (DGS class 2b, 3, 4) had a greater risk (hazard ratio, 3.60 [1.79 to 7.22]). Conclusions Among people with diabetes and GD, mild diabetic glomerular lesions on biopsy do not affect outcomes, but moderate-severe lesions increase the risk for ESKD and death. Whether use of immunosuppression, particularly glucocorticoids, is less successful in inducing GD remission in people with moderate-severe diabetic lesions will be a focus of future study in a larger population.
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Affiliation(s)
- Young Ho Kim
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | - Manish K. Saha
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | - Yichun Hu
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | - Srikar Kumar
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | - Caroline J. Poulton
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | - Susan L. Hogan
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | - Patrick Nachman
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
- University of Minnesota Division of Nephrology and Hypertension, UM School of Medicine, Minneapolis, Minnesota
| | - J. Charles Jennette
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
| | - Cynthia C. Nast
- Division of Nephropathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Amy K. Mottl
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, North Carolina
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Mottl AK, Bomback AS, Mariani LH, Coppock G, Jennette JC, Almaani S, Gipson DS, Kelley S, Kidd J, Laurin LP, Mucha K, Oliverio A, Palmer M, Rizk D, Sanghani N, Stokes MB, Susztak K, Wadhwani S, Nast CC. CureGN-Diabetes Study: Rationale, Design, and Methods of a Prospective Observational Study of Glomerular Disease Patients with Diabetes. GLOMERULAR DISEASES 2023; 3:155-164. [PMID: 37901700 PMCID: PMC10601908 DOI: 10.1159/000531679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/15/2023] [Indexed: 10/31/2023]
Abstract
Glomerular diseases (GDs) represent the third leading cause of end-stage kidney disease (ESKD) in the US Diabetes was excluded from the CureGN Study, an NIH/NIDDK-sponsored observational cohort study of four leading primary GDs: IgA nephropathy (IgAN), membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), and minimal change disease (MCD). CureGN-Diabetes, an ancillary study to CureGN, seeks to understand how diabetes influences the diagnosis, treatment, and outcomes of GD. It is a multicenter, prospective cohort study, targeting an enrollment of 300 adults with prevalent type 1 or type 2 diabetes and MCD, FSGS, MN, or IgAN, with first kidney biopsy obtained within 5 years of enrollment in 80% (20% allowed if biopsy after 2010). CureGN and Transformative Research in DiabEtic NephropaThy (TRIDENT) provide comparator cohorts. Retrospective and prospective clinical data and patient-reported outcomes are obtained. Blood and urine specimens are collected at study visits annually. Kidney biopsy reports and digital images are obtained, and standardized pathologic evaluations performed. Light microscopy images are uploaded to the NIH pathology repository. Outcomes include relapse and remission rates, changes in proteinuria and estimated glomerular filtration rate, infections, cardiovascular events, malignancy, ESKD, and death. Multiple analytical approaches will be used leveraging the baseline and longitudinal data to compare disease presentation and progression across subgroups of interest. With 300 patients and an average of 3 years of follow-up, the study has 80% power to detect a HR of 1.4-1.8 for time to complete remission of proteinuria, a rate ratio for hospitalizations of 1.18-1.56 and difference in eGFR slope of 6.0-8.6 mL/min/year between two groups of 300 participants each. CureGN-Diabetes will enhance our understanding of diabetes as a modifying factor of the pathology and outcomes of GDs and support studies to identify disease mechanisms and improve patient outcomes in this understudied patient population.
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Affiliation(s)
- Amy K Mottl
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Andrew S Bomback
- Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Laura H Mariani
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Gaia Coppock
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - J Charles Jennette
- Division of Nephropathology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Salem Almaani
- Division of Nephrology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Debbie S Gipson
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Sara Kelley
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jason Kidd
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA, USA
| | - Louis-Philippe Laurin
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Faculté de Médecine, Centre affilié à l'Université de Montréal, Montréal, QC, Canada
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Oliverio
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Palmer
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dana Rizk
- Division of Nephrology, University of Alabama, Birmingham, AL, USA
| | - Neil Sanghani
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Barry Stokes
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Katalin Susztak
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Shikha Wadhwani
- Division of Nephrology and Hypertension, Northwestern University, Chicago, IL, USA
| | - Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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A Case of Oxalate Nephropathy in a Known Diabetic Patient following Acute Alcoholic Pancreatitis. Case Rep Nephrol 2022; 2022:6284693. [PMID: 35910258 PMCID: PMC9325594 DOI: 10.1155/2022/6284693] [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] [Received: 12/01/2021] [Revised: 05/11/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
This was a case of a 39-year-old gentleman known to have diabetes mellitus since February 2021 on insulin glargine (Lantus) 16 units nocte and sitagliptin/metformin 50/500 mg once a day who presented to a tertiary teaching hospital in Kenya in May 2021 with a three-week history of vomiting and diarrhea. He had been previously admitted to a different facility with acute alcoholic pancreatitis. His examination was nonremarkable except for mild dehydration and pallor. He had moderate metabolic acidosis and deranged renal function. Prior to this, his creatinine was normal. As part of the evaluation for the rapid deterioration of renal function, a kidney biopsy performed revealed oxalate nephropathy. He was started on renal replacement therapy with hemodialysis.
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Perspectives on the Role of Magnetic Resonance Imaging (MRI) for Noninvasive Evaluation of Diabetic Kidney Disease. J Clin Med 2021; 10:jcm10112461. [PMID: 34199385 PMCID: PMC8199575 DOI: 10.3390/jcm10112461] [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: 04/29/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/09/2023] Open
Abstract
Renal magnetic resonance imaging (MRI) techniques are currently in vogue, as they provide in vivo information on renal volume, function, metabolism, perfusion, oxygenation, and microstructural alterations, without the need for exogenous contrast media. New imaging biomarkers can be identified using these tools, which represent a major advance in the understanding and study of the different pathologies affecting the kidney. Diabetic kidney disease (DKD) is one of the most important diseases worldwide due to its high prevalence and impact on public health. However, its multifactorial etiology poses a challenge for both basic and clinical research. Therefore, the use of novel renal MRI techniques is an attractive step forward in the comprehension of DKD, both in its pathogenesis and in its detection and surveillance in the clinical practice. This review article outlines the most promising MRI techniques in the study of DKD, with the purpose of stimulating their clinical translation as possible tools for the diagnosis, follow-up, and monitoring of the clinical impacts of new DKD treatments.
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