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Uysal C, Ketenci Ertas S, Civan M, Akgun H, Kocyigit I. Pauci-immune crescentic glomerulonephritis caused to dilemma in a patient with suspected systemic lupus erythematosus: a case report. CEN Case Rep 2024; 13:174-180. [PMID: 37837535 PMCID: PMC11144177 DOI: 10.1007/s13730-023-00825-3] [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: 04/09/2023] [Accepted: 09/13/2023] [Indexed: 10/16/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease and there is a distinct differentiation of clinical manifestations. Lupus nephritis (LN) is clinically apparent in approximately half of patients. A kidney biopsy is essential to define the kidney injury, exclude other injurious causes, and determine the histopathologic subtypes. Autoantibodies are crucial to the pathogenesis and the deposition of immune complexes in glomeruli is a hallmark of LN. The histopathology of LN is quite varied. Despite pauci-immune LN being an unexpected condition in SLE, it has been observed rarely with the presence of antineutrophil cytoplasmic autoantibodies (ANCA). We present a young male who was admitted to the emergency with syncope. The brain imaging revealed small infarct areas and signs of cerebral vasculitis. Also, he had elevated inflammatory markers, moderate proteinuria, and preserved kidney function. Anti-nuclear antibodies and anti-dsDNA were positive. Pauci-immune crescentic glomerulonephritis (PICGN) was observed in a kidney biopsy, however, ANCA was negative. SLE diagnosis was established by neurological manifestation, specific antibodies, proteinuria, and kidney biopsy findings. We administered a combination induction regimen, including pulse steroid and parenteral cyclophosphamide. The proteinuria was resolved in the follow-up. Our case highlights that SLE-associated ANCA-negative PICGN can be the initial presentation in the absence of typical manifestations. LN exhibits various pathological mechanisms in the kidney. As a consequence, SLE should be considered in the differential diagnosis of all forms of kidney injury.
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Affiliation(s)
- Cihan Uysal
- Department of Nephrology, Erciyes University School of Medicine, Dede Efendi Street, Köşk District, Melikgazi, 38030, Kayseri, Turkey.
| | | | - Merve Civan
- Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hulya Akgun
- Department of Pathology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ismail Kocyigit
- Department of Nephrology, Erciyes University School of Medicine, Dede Efendi Street, Köşk District, Melikgazi, 38030, Kayseri, Turkey
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Fan Y, Kang D, Chen Z, Lu Y, Huang X, Xia X, Chen W. Clinicopathological characteristics and outcomes of lupus nephritis patients with scanty immune depositions in kidney biopsies. J Nephrol 2023; 36:2345-2354. [PMID: 37341964 DOI: 10.1007/s40620-023-01622-y] [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: 12/14/2022] [Accepted: 03/03/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The clinicopathological features, outcomes, and pathogenesis of lupus nephritis with scanty immune deposits in the kidney biopsy remain unclear. METHODS Four hundred ninety-eight biopsy-proven lupus nephritis patients were included, and clinical and pathological data were collected. The primary endpoint was mortality, while the secondary endpoint was doubling baseline serum creatinine or end-stage renal disease. Associations between scanty immune deposits lupus nephritis and adverse outcomes were analyzed by Cox regression models. RESULTS Among 498 lupus nephritis patients, 81 were diagnosed with scanty immune deposits. Patients with scanty immune deposits had significantly higher serum albumin and serum complement C4 than those with immune complex deposits. The proportion of anti-neutrophil cytoplasmic antibodies was similar between the two groups. In addition, patients with scanty immune deposits showed less proliferative features at kidney biopsy and lower activity index score, accompanied by milder mesangial cell and matrix hyperplasia, endothelial cell hyperplasia, nuclear fragmentation, and glomerular leukocyte infiltration. Patients in this group also had a milder degree of foot process fusion. Overall, renal survival and patient survival showed no significant difference between the two groups. 24-h proteinuria and chronicity index were significant risk factors for renal survival, and 24-h proteinuria and positive anti-neutrophil cytoplasmic antibodies were risk factors for patient survival in scanty immune deposits lupus nephritis patients. CONCLUSIONS Compared with other lupus nephritis patients, scanty immune deposits lupus nephritis patients had significantly lower activity features on kidney biopsy, but have similar outcomes. Positive anti-neutrophil cytoplasmic antibodies may be a risk factor for patient survival in scanty immune deposits lupus nephritis patients.
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Affiliation(s)
- Yuting Fan
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China
| | - Di Kang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China
| | - Zhiqing Chen
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China
| | - Yuewen Lu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China
| | - Xiamin Huang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China
| | - Xi Xia
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China.
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China.
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China.
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China.
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Pfister H. Neutrophil Extracellular Traps and Neutrophil-Derived Extracellular Vesicles: Common Players in Neutrophil Effector Functions. Diagnostics (Basel) 2022; 12:diagnostics12071715. [PMID: 35885618 PMCID: PMC9323717 DOI: 10.3390/diagnostics12071715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 02/06/2023] Open
Abstract
Neutrophil granulocytes are a central component of the innate immune system. In recent years, they have gained considerable attention due to newly discovered biological effector functions and their involvement in various pathological conditions. They have been shown to trigger mechanisms that can either promote or inhibit the development of autoimmunity, thrombosis, and cancer. One mechanism for their modulatory effect is the release of extracellular vesicles (EVs), that trigger appropriate signaling pathways in immune cells and other target cells. In addition, activated neutrophils can release bactericidal DNA fibers decorated with proteins from neutrophil granules (neutrophil extracellular traps, NETs). While NETs are very effective in limiting pathogens, they can also cause severe damage if released in excess or cleared inefficiently. Since NETs and EVs share a variety of neutrophil molecules and initially act in the same microenvironment, differential biochemical and functional analysis is particularly challenging. This review focuses on the biochemical and functional parallels and the extent to which the overlapping spectrum of effector molecules has an impact on biological and pathological effects.
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Affiliation(s)
- Heiko Pfister
- Munich Biomarker Research Center, Institute of Laboratory Medicine, German Heart Center Munich, Technical University Munich, D-80636 Munich, Germany
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Rong C, Xu H, Yan C, Wei F, Zhou H, Guan X. Linc8986 and linc0597 in plasma are novel biomarkers for systemic lupus erythematosus. Exp Ther Med 2021; 22:1210. [PMID: 34584555 PMCID: PMC8422381 DOI: 10.3892/etm.2021.10644] [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: 11/27/2020] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
Despite increasing evidence that large intergenic non-coding RNAs (lincRNAs) are widely involved in human disease, the role of lincRNAs in the development of systemic lupus erythematosus (SLE) has remained largely elusive. The purpose of the present study was to investigate the expression of three lincRNAs (linc0597, linc8986 and linc7190) in the plasma of patients with SLE and their potential use as biomarkers for the diagnosis and treatment of SLE. Plasma samples were obtained from 54 patients with SLE, 24 patients with rheumatoid arthritis (RA), 24 patients with Sjogren's syndrome (SS) and 22 healthy controls. LincRNA expression levels were measured by reverse transcription-quantitative PCR. Compared with those in the healthy controls, the plasma levels of linc0597 and linc8986 were significantly increased in the patients with SLE (P<0.001), while the difference in the level of linc7190 was not significant (P=0.052). In addition, there was no significant difference in the levels of linc0597 and linc8986 among patients with RA, patients with SS and the healthy controls (P>0.05). Compared with patients with SLE without lupus nephritis (LN), the levels of linc0597 were significantly higher in patients with LN (P=0.044). For linc7190 and linc8986, there was no significant difference between patients with and without LN (P>0.05). Furthermore, complement component 3 (C3) levels were used to evaluate whether the expression of linc8986 and linc0597 is related to the activity of SLE. The results indicated that the levels of linc8986 and linc0597 were negatively correlated with the level of C3 (P<0.001 and P=0.004, respectively). Further analysis suggested that linc0597 and linc8986 were able to specifically identify patients with SLE and that a combination of linc0597 and linc8986 may improve the diagnostic accuracy. Therefore, the plasma levels of linc0597 and linc8986 may be suitable biomarkers for diagnosing SLE.
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Affiliation(s)
- Chunli Rong
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Huafeng Xu
- Department of Radio-Immunity, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Changxin Yan
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Feng Wei
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Haizhou Zhou
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Xiuru Guan
- Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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Doğantan Ş, Günay N, Taşkın SN, Balaban AG, Kısaarslan AP, Yel S, Akgün H, Dursun İ, Poyrazoğlu MH. Two faces of lupus nephritis? Answers. Pediatr Nephrol 2021; 36:2109-2111. [PMID: 33770284 DOI: 10.1007/s00467-021-04962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Şeyda Doğantan
- Department of Pediatric Rheumatology, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - Neslihan Günay
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Sema Nur Taşkın
- Department of Pediatric Rheumatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Aynur Gencer Balaban
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hülya Akgün
- Department of Pathology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Muammer Hakan Poyrazoğlu
- Department of Pediatric Rheumatology, Erciyes University Medical Faculty, Kayseri, Turkey.,Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
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Ronsin C, Georges M, Chapelet-Debout A, Augusto JF, Audard V, Lebourg L, Rubin S, Quemeneur T, Bataille P, Karras A, Daugas E, Titeca-Beauport D, Boffa JJ, Vigneau C, Halimi JM, Isnard-Bagnis C, Durault S, Renaudineau E, Bridoux F, Testa A, Le Quintrec M, Renaudin K, Fakhouri F. ANCA-Negative Pauci-Immune Necrotizing Glomerulonephritis: A Case Series and a New Clinical Classification. Am J Kidney Dis 2021; 79:56-68.e1. [PMID: 34119564 DOI: 10.1053/j.ajkd.2021.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/29/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Pauci-immune necrotizing glomerulonephritis (PING) is usually associated with the presence of antineutrophil cytoplasmic antibodies (ANCA). However, a minority (2%-3%) of patients with PING do not have detectable ANCA. We assessed the clinical spectrum and outcome of patients with ANCA-negative PING. STUDY DESIGN Case series. SETTING & PARTICIPANTS 74 patients with ANCA-negative PING diagnosed in 19 French nephrology centers between August 2006 and December 2018 were included in the series. Patients' medical files were reviewed, and kidney biopsies were centrally reexamined by pathologists who were masked to the diagnosis. FINDINGS Median age at diagnosis was 69 (IQR, 61-76) years. The clinical and pathological features were remarkable for a high frequency of extrarenal manifestations (54%), nephrotic syndrome (32%), and endocapillary hypercellularity (31%). Three main subtypes of ANCA-negative PING were observed: infection-associated (n=9[12%]), malignancy-associated (n=6[8%]), and primary (n=57[77%]). For patients with primary PING, induction treatment included mainly corticosteroids (n=56[98%]), cyclophosphamide (n=37[65%]), and rituximab (n=5[9%]). Maintenance treatment consisted mainly of corticosteroids (n=42[74%]), azathioprine (n=18[32%]), and mycophenolate mofetil (n=11[19%]). After a median follow-up period of 28 months, 28 (38%) patients had died and 20 (27%) developed kidney failure (estimated glomerular filtration rate<15mL/min/1.73m2). Eleven (21%) patients (9 with primary and 2 with malignancy-associated PING) relapsed. LIMITATIONS Retrospective study and limited number of patients; electron microscopy was not performed to confirm the absence of glomerular immune deposits. CONCLUSIONS Within the spectrum of ANCA-negative PING, infection and malignancy-associated forms represent a distinct clinical subset. This new clinical classification may inform the management of ANCA-negative PING, which remains a severe form of vasculitis with high morbidity and mortality rates despite immunosuppressive treatments.
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Affiliation(s)
- Charles Ronsin
- Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France
| | - Marie Georges
- Department of Pathology, Center Hospitalier Universitaire de Nantes, Nantes, France
| | - Agnès Chapelet-Debout
- Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France; Centre de Recherche en Transplantation et en Immunologie, UMR 1064, INSERM, Université de Nantes, France
| | | | - Vincent Audard
- Department of Nephrology and Renal Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, INSERM U955, Université Paris Est Créteil, Paris, France
| | | | | | - Thomas Quemeneur
- Department of Nephrology and Internal Medicine, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Pierre Bataille
- Department of Nephrology, Centre Hospitalier de Boulogne-sur-Mer, Boulogne sur Mer, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, Université Paris Descartes, Paris, France
| | - Eric Daugas
- Department of Nephrology, CHU Bichat, Paris, France
| | | | - Jean-Jacques Boffa
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | | | | | - Corinne Isnard-Bagnis
- Department of Nephrology, Groupe Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
| | - Sandrine Durault
- Department of Nephrology, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Eric Renaudineau
- Department of Nephrology, Centre Hospitalier de Saint Malo, Saint Malo, France
| | - Frank Bridoux
- Department of Nephrology, CHU Poitiers, Poitiers, France
| | - Angelo Testa
- Centre ECHO, Site Confluent-Rezé, Nantes, France
| | | | - Karine Renaudin
- Department of Pathology, Center Hospitalier Universitaire de Nantes, Nantes, France; Centre de Recherche en Transplantation et en Immunologie, UMR 1064, INSERM, Université de Nantes, France.
| | - Fadi Fakhouri
- Department of Nephrology and Immunology, Center Hospitalier Universitaire de Nantes, Nantes, France; Centre de Recherche en Transplantation et en Immunologie, UMR 1064, INSERM, Université de Nantes, France.
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