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Cieślik A, Burban A, Gniewkiewicz M, Gozdowska J, Dęborska-Materkowska D, Perkowska-Ptasinska A, Kosieradzki M, Durlik M. The Importance of 1-Year Protocol Biopsy in the Long-Term Prognosis of Kidney Transplants-5-Years Follow-Up. Transplant Proc 2023; 55:2053-2057. [PMID: 37778932 DOI: 10.1016/j.transproceed.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/01/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Protocol biopsies are performed to detect subclinical pathologies that may lead to future graft dysfunction. However, they are not routinely performed interventions in every transplant center. There is no established regimen for performing them. PURPOSE The study aimed to evaluate if protocol biopsies can improve long-term patient outcomes after detecting early disorders and modifying treatment. MATERIAL AND METHODS Our observational study included 61 patients who underwent protocol biopsy 12 months after the transplantation. Based on the biopsy results, patients with abnormal histologic material (n = 37) were divided into 3 study groups as follows: patients with mild inflammatory lesions (n = 21), patients with interstitial fibrosis and tubular atrophy (IFTA) grade II to III (n = 12), and patients with BK virus nephropathy (n = 4). The control group (n = 24) included kidney recipients with IFTA 0 to I grade. Outcomes after 5-year follow-up were evaluated. RESULTS Five years after the biopsy, patients in the control group had stable graft function (5-year change in serum creatinine was -0.09 mg/dL). An increase in serum creatinine levels was observed in patients with IFTA II to III compared with the control group (0.14 mg/dL, P = .04). Immunosuppressive treatment was modified in the group with mild inflammatory changes and in the BKV group after the biopsy result. In the group with mild inflammatory lesions, renal function was stable (change of serum creatinine was -0.01 mg/dL, P = .51). In the BKV nephropathy group, there was a significant reduction in serum creatine levels (-0.48 mg/dL, P = .016). The analysis showed no diagnostic value for serum creatinine concentration (95% CI 0.49-0.78, P = .08). CONCLUSIONS Protocol biopsies are useful for detecting early pathologies and preventing allograft failure. They greatly benefit patients with detectable pathology that can be treated or in whom therapy modification is possible.
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Affiliation(s)
- Aleksandra Cieślik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Anna Burban
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Michał Gniewkiewicz
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Dominika Dęborska-Materkowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, The Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Gniewkiewicz M, Gozdowska J, Deborska-Materkowska D, Czerwinska K, Perkowska-Ptasinska A, Burban A, Cieslik A, Kosieradzki M, Durlik M. Potential utility of urinary chemokine CCL2 to creatinine ratio in prognosis of 5-year graft failure and mortality post 1-year protocol biopsy in kidney transplant recipients. Immun Inflamm Dis 2023; 11:e901. [PMID: 37382267 DOI: 10.1002/iid3.901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Chemokines (chemotactic cytokines) are small proteins which are engaged in many pathophysiological processes, including inflammation and homeostasis. In recent years, application of chemokines in transplant medicine was intensively studied. The aim of this study was to determine the utility of urinary chemokines CCL2 (C-C motif ligand 2) and CXCL10 (C-X-C motif chemokine ligand 10) in prognosis of 5-year graft failure and mortality post 1-year protocol biopsy in renal transplant recipients. METHODS Forty patients who had a protocol biopsy 1 year after renal transplantation were included. Concentrations of CCL2 and CXCL10 in urine with reference to urine creatinine were measured. All patients were under the supervision of one transplant center. Long-term outcomes within 5 years after 1-year posttransplant biopsy were analyzed. RESULTS Urinary CCL2:Cr at the time of biopsy was significantly increased in patients who died or had graft failure. CCL2:Cr was proven to be a significant predictor of 5-year graft failure and mortality (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.19, p = .02; OR: 1.08, 95% CI: 1.02-1.16, p = .04; respectively). CONCLUSION Chemokines are easily detected by current methods. In the era of personalized medicine, urinary CCL2:Cr can be considered as a factor providing complementary information regarding risk of graft failure or increased mortality.
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Affiliation(s)
- Michal Gniewkiewicz
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Deborska-Materkowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Czerwinska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Anna Burban
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Cieslik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Madill-Thomsen KS, Böhmig GA, Bromberg J, Einecke G, Eskandary F, Gupta G, Myslak M, Viklicky O, Perkowska-Ptasinska A, Solez K, Halloran PF. Relating Molecular T Cell-mediated Rejection Activity in Kidney Transplant Biopsies to Time and to Histologic Tubulitis and Atrophy-fibrosis. Transplantation 2023; 107:1102-1114. [PMID: 36575574 PMCID: PMC10125115 DOI: 10.1097/tp.0000000000004396] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND We studied the variation in molecular T cell-mediated rejection (TCMR) activity in kidney transplant indication biopsies and its relationship with histologic lesions (particularly tubulitis and atrophy-fibrosis) and time posttransplant. METHODS We examined 175 kidney transplant biopsies with molecular TCMR as defined by archetypal analysis in the INTERCOMEX study ( ClinicalTrials.gov #NCT01299168). TCMR activity was defined by a molecular classifier. RESULTS Archetypal analysis identified 2 TCMR classes, TCMR1 and TCMR2: TCMR1 had higher TCMR activity and more antibody-mediated rejection ("mixed") activity and arteritis but little hyalinosis, whereas TCMR2 had less TCMR activity but more atrophy-fibrosis. TCMR1 and TCMR2 had similar levels of molecular injury and tubulitis. Both TCMR1 and TCMR2 biopsies were uncommon after 2 y posttransplant and were rare after 10 y, particularly TCMR1. Within late TCMR biopsies, TCMR classifier activity and activity molecules such as IFNG fell progressively with time, but tubulitis and molecular injury were sustained. Atrophy-fibrosis was increased in TCMR biopsies, even in the first year posttransplant, and rose with time posttransplant. TCMR1 and TCMR2 both reduced graft survival, but in random forests, the strongest determinant of survival after biopsies with TCMR was molecular injury, not TCMR activity. CONCLUSIONS TCMR varies in intensity but is always strongly related to molecular injury and atrophy-fibrosis, which ultimately explains its effect on survival. We hypothesize, based on the reciprocal relationship with hyalinosis, that the TCMR1-TCMR2 gradient reflects calcineurin inhibitor drug underexposure, whereas the time-dependent decline in TCMR activity and frequency after the first year reflects T-cell exhaustion.
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Affiliation(s)
| | - Georg A. Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Gunilla Einecke
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Farsad Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA
| | - Marek Myslak
- Department of Clinical Interventions, Department of Nephrology and Kidney Transplantation SPWSZ Hospital, Pomeranian Medical University, Szczecin, Poland
| | - Ondrej Viklicky
- Department of Nephrology and Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Kim Solez
- Department of Laboratory Medicine and Pathology, Division of Anatomical Pathology, University of Alberta, Edmonton, Canada
| | - Philip F. Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Dęborska-Materkowska D, Perkowska-Ptasinska A, Sadowska-Jakubowicz A, Pazik J, Serwańska-Świętek M, Mikołajczyk N, Świder R, Nowak J, Durlik M. Antiviral prophylaxis, male sex, and killer immunoglobulin-like receptor KIR2DL3 as markers for stratifying the risk of BK polyomavirus-associated nephropathy in kidney transplant recipients. Pol Arch Intern Med 2023; 133. [PMID: 36018060 DOI: 10.20452/pamw.16331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The risk of polyomavirus‑associated nephropathy (PyVAN) currently ranges from 1% to 10%, and the risk of graft loss is 10% to 50% within 2 years post‑diagnosis. There is currently no specific antiviral therapy against BK polyomavirus (BKPyV), and no therapeutic approach has been proven superior. Natural killer cells play a key role in the defense against viral infections. OBJECTIVES A retrospective, single‑center cohort study was performed to investigate the association between the kidney transplant recipients' killer‑cell immunoglobulin‑like receptor (KIR) genotype and PyVAN. We also evaluated other possible risk factors for the occurrence of PyVAN in a population of kidney transplant recipients. PATIENTS AND METHODS DNA samples from 134 kidney transplant recipients were identified for the presence or absence of variable KIR genes and their HLA ligands using polymerase chain reaction with sequence‑specific primers. RESULTS The analysis revealed that the presence of the inhibitory KIR2DL3 (P = 0.03) was a risk factor for posttransplant PyVAN. We also found that the presence of acute rejection before PyVAN (P = 0.02), male sex (P = 0.04), and the lack of antiviral prophylaxis (P = 0.01) were additional risk factors for posttransplant PyVAN. CONCLUSIONS Our findings confirm that the KIR/HLA genotype plays a significant role in the development of PyVAN and suggest the contribution of both environmental and genetic factors to the incidence of BKPyV infection after kidney transplantation.
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Affiliation(s)
- Dominika Dęborska-Materkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
| | | | - Anna Sadowska-Jakubowicz
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Pazik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | | | - Natalia Mikołajczyk
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Robert Świder
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Nowak
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Halloran PF, Böhmig GA, Bromberg J, Einecke G, Eskandary FA, Gupta G, Myslak M, Viklicky O, Perkowska-Ptasinska A, Madill-Thomsen KS. Archetypal Analysis of Injury in Kidney Transplant Biopsies Identifies Two Classes of Early AKI. Front Med (Lausanne) 2022; 9:817324. [PMID: 35463013 PMCID: PMC9021747 DOI: 10.3389/fmed.2022.817324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/07/2022] [Indexed: 01/07/2023] Open
Abstract
All transplanted kidneys are subjected to some degree of injury as a result of the donation-implantation process and various post-transplant stresses such as rejection. Because transplants are frequently biopsied, they present an opportunity to explore the full spectrum of kidney response-to-wounding from all causes. Defining parenchymal damage in transplanted organs is important for clinical management because it determines function and survival. In this study, we classified the scenarios associated with parenchymal injury in genome-wide microarray results from 1,526 kidney transplant indication biopsies collected during the INTERCOMEX study. We defined injury groups by using archetypal analysis (AA) of scores for gene sets and classifiers previously identified in various injury states. Six groups and their characteristics were defined in this population: No injury, minor injury, two classes of acute kidney injury ("AKI," AKI1, and AKI2), chronic kidney disease (CKD), and CKD combined with AKI. We compared the two classes of AKI, namely, AKI1 and AKI2. AKI1 had a poor function and increased parenchymal dedifferentiation but minimal response-to-injury and inflammation, instead having increased expression of PARD3, a gene previously characterized as being related to epithelial polarity and adherens junctions. In contrast, AKI2 had a poor function and increased response-to-injury, significant inflammation, and increased macrophage activity. In random forest analysis, the most important predictors of function (estimated glomerular filtration rate) and graft loss were injury-based molecular scores, not rejection scores. AKI1 and AKI2 differed in 3-year graft survival, with better survival in the AKI2 group. Thus, injury archetype analysis of injury-induced gene expression shows new heterogeneity in kidney response-to-wounding, revealing AKI1, a class of early transplants with a poor function but minimal inflammation or response to injury, a deviant response characterized as PC3, and an increased risk of failure. Given the relationship between parenchymal injury and kidney survival, further characterization of the injury phenotypes in kidney transplants will be important for an improved understanding that could have implications for understanding native kidney diseases (ClinicalTrials.gov #NCT01299168).
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Affiliation(s)
- Philip F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada.,Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jonathan Bromberg
- Department of Surgery, University of Maryland, Baltimore, MD, United States
| | - Gunilla Einecke
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Farsad A Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA, United States
| | - Marek Myslak
- Department of Clinical Interventions, Department of Nephrology and Kidney Transplantation Samodzielny Publiczny Wojewódzki Szpital Zespolony (SPWSZ) Hospital, Pomeranian Medical University, Szczecin, Poland
| | - Ondrej Viklicky
- Department of Nephrology and Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Agnieszka Perkowska-Ptasinska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Madill-Thomsen KS, Böhmig GA, Bromberg J, Einecke G, Eskandary F, Gupta G, Hidalgo LG, Myslak M, Viklicky O, Perkowska-Ptasinska A, Halloran PF. Donor-Specific Antibody Is Associated with Increased Expression of Rejection Transcripts in Renal Transplant Biopsies Classified as No Rejection. J Am Soc Nephrol 2021; 32:2743-2758. [PMID: 34253587 PMCID: PMC8806080 DOI: 10.1681/asn.2021040433] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Donor -specific HLA antibody (DSA) is present in many kidney transplant patients whose biopsies are classified as no rejection (NR). We explored whether in some NR kidneys DSA has subtle effects not currently being recognized. METHODS We used microarrays to examine the relationship between standard-of-care DSA and rejection-related transcript increases in 1679 kidney transplant indication biopsies in the INTERCOMEX study (ClinicalTrials.gov NCT01299168), focusing on biopsies classified as NR by automatically assigned archetypal clustering. DSA testing results were available for 835 NR biopsies and were positive in 271 (32%). RESULTS DSA positivity in NR biopsies was associated with mildly increased expression of antibody-mediated rejection (ABMR)-related transcripts, particularly IFNG-inducible and NK cell transcripts. We developed a machine learning DSA probability (DSAProb) classifier based on transcript expression in biopsies from DSA-positive versus DSA-negative patients, assigning scores using 10-fold cross-validation. This DSAProb classifier was very similar to a previously described "ABMR probability" classifier trained on histologic ABMR in transcript associations and prediction of molecular or histologic ABMR. Plotting the biopsies using Uniform Manifold Approximation and Projection revealed a gradient of increasing molecular ABMR-like transcript expression in NR biopsies, associated with increased DSA (P<2 × 10-16). In biopsies with no molecular or histologic rejection, increased DSAProb or ABMR probability scores were associated with increased risk of kidney failure over 3 years. CONCLUSIONS Many biopsies currently considered to have no molecular or histologic rejection have mild increases in expression of ABMR-related transcripts, associated with increasing frequency of DSA. Thus, mild molecular ABMR-related pathology is more common than previously realized.
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Affiliation(s)
| | - Georg A. Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jonathan Bromberg
- Departments of Surgery and Microbiology and Immunology, University of Maryland, Baltimore, Maryland
| | - Gunilla Einecke
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Farsad Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia
| | - Luis G. Hidalgo
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Marek Myslak
- Pomeranian Medical University, Department of Clinical Interventions and Department of Nephrology and Kidney Transplantation, Samodzielny Publiczny Wojewodzki Szpital Zespolony, Szczecin, Poland
| | - Ondrej Viklicky
- Department of Nephrology and Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Philip F. Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada,Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, Alberta, Canada
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Halloran PF, Madill-Thomsen KS, Böhmig GA, Myslak M, Gupta G, Kumar D, Viklicky O, Perkowska-Ptasinska A, Famulski KS. A 2-fold Approach to Polyoma Virus (BK) Nephropathy in Kidney Transplants: Distinguishing Direct Virus Effects From Cognate T Cell-mediated Inflammation. Transplantation 2021; 105:2374-2384. [PMID: 34310102 DOI: 10.1097/tp.0000000000003884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND BK nephropathy (BKN) in kidney transplants diagnosed by histology is challenging because it involves damage from both virus activity and cognate T cell-mediated inflammation, directed against alloantigens (rejection) or viral antigens. The present study of indication biopsies from the Integrated Diagnostic System in the International Collaborative Microarray Study Extension study measured major capsid viral protein 2 (VP2) mRNA to assess virus activity and a T cell-mediated rejection (TCMR) classifier to assess cognate T cell-mediated inflammation. METHODS Biopsies were assessed by local standard-of-care histology and by genome-wide microarrays and Molecular Microscope Diagnostic System (MMDx) algorithms to detect rejection and injury. In a subset of 102 biopsies (50 BKN and 52 BKN-negative biopsies with various abnormalities), we measured VP2 transcripts by real-time polymerase chain reaction. RESULTS BKN was diagnosed in 55 of 1679 biopsies; 30 had cognate T cell-mediated activity assessed by by MMDx and TCMR lesions, but only 3 of 30 were histologically diagnosed as TCMR. We developed a BKN probability classifier that predicted histologic BKN (area under the curve = 0.82). Virus activity (VP2 expression) was highly selective for BKN (area under the curve = 0.94) and correlated with acute injury, atrophy-fibrosis, macrophage activation, and the BKN classifier, but not with the TCMR classifier. BKN with molecular TCMR had more tubulitis and inflammation than BKN without molecular TCMR. In 5 BKN cases with second biopsies, VP2 mRNA decreased in second biopsies, whereas in 4 of 5 TCMR classifiers, scores increased. Genes and pathways associated with BKN and VP2 mRNA were similar, reflecting injury, inflammation, and macrophage activation but none was selective for BKN. CONCLUSIONS Risk-benefit decisions in BKN may be assisted by quantitative assessment of the 2 major pathologic processes, virus activity and cognate T cell-mediated inflammation.
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Affiliation(s)
- Philip F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
- Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
| | | | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marek Myslak
- Department of Nephrology and Kidney Transplantation, SPWSZ Hospital in Szczecin, Pomeranian Medical University, Szczecin, Poland
| | - Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA
| | - Dhiren Kumar
- Division of Nephrology, Virginia Commonwealth University, Richmond, VA
| | - Ondrej Viklicky
- Department of Nephrology and Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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8
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Kowalewska J, El Moudden I, Perkowska-Ptasinska A, Kapp ME, Fogo AB, Lin MY, Mirza A, Troyer DA, Durlik M, Sandhu R, Ciszek M, Deborska-Materkowska D, Kuczynski D, McCune TR. Assessment of the Banff Working Group classification of definitive BK polyomavirus nephropathy. Transpl Int 2021; 34:2286-2296. [PMID: 34339576 DOI: 10.1111/tri.14003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 12/19/2022]
Abstract
Polyomavirus associated nephropathy (PyVAN) continues to be a burden in renal transplantation leading to allograft insufficiency or graft failure. A presumptive diagnosis of PyVAN is made based on the presence of BK polyomavirus in patients' plasma; however, kidney biopsy remains the gold standard to establish a definitive diagnosis. The Banff Working Group on PyVAN proposed a novel classification of definitive PyVAN based on polyomavirus replication/load level and the extent of interstitial fibrosis. The aim of our study was to test the newly defined classes of PyVAN using independent cohorts of 124 kidney transplant patients with PyVAN with respect to the initial presentation and outcome, and to compare our analysis to that previously reported. Detailed analysis of our cohort revealed that the proposed classification of PyVAN did not stratify or identify patients at increased risk of allograft failure. Specifically, while class 3 was associated with the worst prognosis, there was no significant difference between the outcomes in classes 1 and 2. We also found that the timing post-transplantation and inflammation in areas of interstitial fibrosis and tubular atrophy might be additional factors contributing to an unfavorable allograft outcome in patients with PyVAN.
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Affiliation(s)
- Jolanta Kowalewska
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ismail El Moudden
- EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Meghan E Kapp
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mercury Y Lin
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Alamgir Mirza
- Department of Medicine, Division of Nephrology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Dean A Troyer
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Magdalena Durlik
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Rana Sandhu
- Cedars Sinai Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Michal Ciszek
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | | | - Daniel Kuczynski
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Thomas R McCune
- Department of Medicine, Division of Nephrology, Eastern Virginia Medical School, Norfolk, VA, USA
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9
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Dendooven A, Peetermans H, Helbert M, Nguyen TQ, Marcussen N, Nagata M, Gesualdo L, Perkowska-Ptasinska A, Capusa C, López-Gómez JM, Geddes C, Abdul-Hamid MA, Segelmark M, Yahya R, Garau M, Villanueva R, Dorman A, Barbour S, Cornet R, Hopfer H, Amann K, Leh S. Coding practice in national and regional kidney biopsy registries. BMC Nephrol 2021; 22:193. [PMID: 34030637 PMCID: PMC8146626 DOI: 10.1186/s12882-021-02365-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Kidney biopsy registries all over the world benefit research, teaching and health policy. Comparison, aggregation and exchange of data is however greatly dependent on how registration and coding of kidney biopsy diagnoses are performed. This paper gives an overview over kidney biopsy registries, explores how these registries code kidney disease and identifies needs for improvement of coding practice. Methods A literature search was undertaken to identify biopsy registries for medical kidney diseases. These data were supplemented with information from personal contacts and from registry websites. A questionnaire was sent to all identified registries, investigating age of registries, scope, method of coding, possible mapping to international terminologies as well as self-reported problems and suggestions for improvement. Results Sixteen regional or national kidney biopsy registries were identified, of which 11 were older than 10 years. Most registries were located either in Europe (10/16) or in Asia (4/16). Registries most often use a proprietary coding system (12/16). Only a few of these coding systems were mapped to SNOMED CT (1), older SNOMED versions (2) or ERA-EDTA PRD (3). Lack of maintenance and updates of the coding system was the most commonly reported problem. Conclusions There were large gaps in the global coverage of kidney biopsy registries. Limited use of international coding systems among existing registries hampers interoperability and exchange of data. The study underlines that the use of a common and uniform coding system is necessary to fully realize the potential of kidney biopsy registries. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02365-3.
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Affiliation(s)
- Amélie Dendooven
- Ghent University Hospital, Ghent, Belgium. .,Antwerp University, Antwerp, Belgium.
| | | | | | - Tri Q Nguyen
- University Medical Center, Utrecht, The Netherlands
| | | | | | | | | | - Cristina Capusa
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | | | | | | | | | | | - Sean Barbour
- University of British Columbia, Vancouver, Canada
| | - Ronald Cornet
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Sabine Leh
- Haukeland University Hospital, Bergen, Norway
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10
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Bellur SS, Roberts ISD, Troyanov S, Royal V, Coppo R, Cook HT, Cattran D, Arce Terroba Y, Maria Asunis A, Bajema I, Bertoni E, Bruijn JA, Cannata-Ortiz P, Casartelli D, Maria Di Palma A, Ferrario F, Fortunato M, Furci L, Gakiopoulou H, Galesic Ljubanovic D, Giannakakis K, Gomà M, Gröne HJ, Gutiérrez E, Haider SA, Honsova E, Ioachim E, Karkoszka H, Kipgen D, Maldyk J, Mazzucco G, Orhan D, Ozluk Y, Pantzaki A, Perkowska-Ptasinska A, Riispere Z, Soderberg MP, Steenbergen E, Stoppacciaro A, Sundelin Von Feilitzen B, Tardanico R. Reproducibility of the Oxford classification of immunoglobulin A nephropathy, impact of biopsy scoring on treatment allocation and clinical relevance of disagreements: evidence from the VALidation of IGA study cohort. Nephrol Dial Transplant 2020; 35:1453. [DOI: 10.1093/ndt/gfz001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Gniewkiewicz M, Paszkowska I, Gozdowska J, Czerwinska K, Sadowska-Jakubowicz A, Deborska-Materkowska D, Perkowska-Ptasinska A, Kosieradzki M, Durlik M. P1687ASSOCIATION OF URINARY MICRORNA-21-5P WITH INTERSTITIAL FIBROSIS AND TUBULAR ATROPHY (IFTA) IN RENAL TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
One of the most limiting factors of long-term graft survival is chronic renal allograft dysfunction (CAD). The major hallmarks of CAD are interstitial fibrosis and tubular atrophy (IFTA).
MicroRNAs (miRNAs) are 19-25 nucleotides, small, noncoding molecules involved in the regulation of gene expression. MiRNAs have a role in various immunological processes, including inflammation and fibrosis. Particularly, microRNA-21-5p (miR-21) is reported to be strongly associated with pathogenesis regarding tubulointerstitium.
The aim of this study was to analyse expression levels of urinary miR-21 in the renal transplant recipients and evaluate their application in the assessment of IFTA and kidney allograft function.
Method
The expression levels of urinary miR-21 were measured in 31 renal transplant recipients with biopsy-evaluated IFTA (IFTA 0+I: n=17; IFTA II+III: n=14) by quantitative PCR. Protocolar biopsies were performed 1 or 2 years after renal transplantation. Urine samples were collected at the time of biopsy procedure. MicroRNA-191-5p was used as reference gene. Correlations between the clinicopathological parameters and the level of expression of miR-21 were assessed.
Results
Relative expression level of miR-21 was significantly increased in IFTA II+III group compared to IFTA 0+I group. MiR-21 correlated positively with serum concentration of creatinine and negatively with eGFR. ROC analysis showed diagnostic value of miR-21 with an area under curve (AUC) of 0.80, high sensitivity and specificity.
Conclusion
MiR-21 is associated with IFTA and dysfunction of kidney allograft. It may be considered as potential non-invasive biomarker of renal allograft function.
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Affiliation(s)
- Michal Gniewkiewicz
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
| | - Izabela Paszkowska
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
| | - Jolanta Gozdowska
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
| | - Katarzyna Czerwinska
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
| | - Anna Sadowska-Jakubowicz
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
| | - Dominika Deborska-Materkowska
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
| | - Agnieszka Perkowska-Ptasinska
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
| | - Maciej Kosieradzki
- Medical University of Warsaw, Department of General and Transplantation Surgery, Warsaw, Poland
| | - Magdalena Durlik
- Medical University of Warsaw, Department of Transplantation Medicine, Nephrology and Internal Medicine, Warsaw, Poland
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12
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Moszczuk B, Krata N, Cysewski D, Perkowska-Ptasinska A, Pączek L, Foroncewicz B, Zagożdżon R, Mucha K. P0489URINARY PROTEOMIC MARKERS OF MEMBRANOUS NEPHROPATHY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Membranous nephropathy (MN) is considered one of the major conditions causing nephrotic-range proteinuria. Last years brought a huge progress in the field of non-invasive diagnostics, mainly due to the PLA2R antibody use in diagnostics and follow-up of primary MN. However, our understanding of MN is far from complete, especially that PLA2R-antibodies are found only in approximately 60-70% of all cases. Urinary proteomics is a promising tool that can help us to improve diagnostics, monitoring and understanding of MN. Our previous studies (Patent No. WO/2017/212463) suggested that specific urinary proteins can be used in the diagnostics of IgA nephropathy, lupus nephritis and ADPKD. The aim of this study was to evaluate with Mass Spectrometry (MS) patients diagnosed with MN in comparison to healthy controls.
Method
This study included patients with biopsy-proven MN (25) and healthy controls (7). Urine samples were obtained from a midstream of the second- or third-morning (SPOT) sample. The samples were processed up to 2 h after collection and stored at -80°C for further measurements with MS. The results were related to demographic data, standard laboratory tests and GFR estimated with use of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Results
The signal intensity of urine protein A, B and C (patent pending and the name of proteins disclosed until the date of ERA-EDTA Congress) was found to be significantly higher (p < 0.05) in MN patients compared to healthy controls (Fig. 1). Mass spectrometry, according to the specific amino-acids fragments of each tested protein, confirmed the differences between tested and control group. Additionally, statistically significant differences exist between patients with different types of glomerulonephritides (comparative MS in progress).
Conclusion
The signal intensity of urine proteins A, B, C is elevated in MN and according to our study, vary depending on types of nephropathies. This observation might suggests their differential roles in the pathophysiology of MN and its’ possible application as a non-invasive diagnostic and prognostic marker. Further studies are desired to establish the role of these urinary proteins.
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Affiliation(s)
- Barbara Moszczuk
- Medical University of Warsaw, Immunology, Transplantology and Internal Medicine, Warsaw, Poland
| | - Natalia Krata
- Medical University of Warsaw, Department of Immunology, Transplantology and Internal Medicine, Warsaw, Poland
| | - Dominik Cysewski
- Polish Academy of Sciences, Institute of Biochemistry and Biophysics, Warsaw, Poland
| | | | - Leszek Pączek
- Medical University of Warsaw, Department of Immunology, Transplantology and Internal Medicine, Warsaw, Poland
- Polish Academy of Sciences, Institute of Biochemistry and Biophysics, Warsaw, Poland
| | - Bartosz Foroncewicz
- Medical University of Warsaw, Department of Immunology, Transplantology and Internal Medicine, Warsaw, Poland
- Polish Academy of Sciences, Institute of Biochemistry and Biophysics, Warsaw, Poland
| | - Radosław Zagożdżon
- Medical University of Warsaw, Department of Immunology, Transplantology and Internal Medicine, Warsaw, Poland
- Polish Academy of Sciences, Institute of Biochemistry and Biophysics, Warsaw, Poland
- Medical University of Warsaw, Department of Clinical Immunology, Warszawa, Poland
| | - Krzysztof Mucha
- Medical University of Warsaw, Department of Immunology, Transplantology and Internal Medicine, Warsaw, Poland
- Polish Academy of Sciences, Institute of Biochemistry and Biophysics, Warsaw, Poland
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13
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Bellur SS, Roberts ISD, Troyanov S, Royal V, Coppo R, Cook HT, Cattran D, Arce Terroba Y, Asunis AM, Bajema I, Bertoni E, Bruijn JA, Cannata-Ortiz P, Casartelli D, Maria Di Palma A, Ferrario F, Fortunato M, Furci L, Gakiopoulou H, Galesic Ljubanovic D, Giannakakis K, Gomà M, Gröne HJ, Gutiérrez E, Asma Haider S, Honsova E, Ioachim E, Karkoszka H, Kipgen D, Maldyk J, Mazzucco G, Orhan D, Ozluk Y, Pantzaki A, Perkowska-Ptasinska A, Riispere Z, Soderberg MP, Steenbergen E, Stoppacciaro A, Sundelin Von Feilitzen B, Tardanico R. Reproducibility of the Oxford classification of immunoglobulin A nephropathy, impact of biopsy scoring on treatment allocation and clinical relevance of disagreements: evidence from the VALidation of IGA study cohort. Nephrol Dial Transplant 2020; 34:1681-1690. [PMID: 30561721 DOI: 10.1093/ndt/gfy337] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/18/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The VALidation of IGA (VALIGA) study investigated the utility of the Oxford Classification of immunoglobulin A nephropathy (IgAN) in 1147 patients from 13 European countries. Methods. Biopsies were scored by local pathologists followed by central review in Oxford. We had two distinct objectives: to assess how closely pathology findings were associated with the decision to give corticosteroid/immunosuppressive (CS/IS) treatments, and to determine the impact of differences in MEST-C scoring between central and local pathologists on the clinical value of the Oxford Classification. We tested for each lesion the associations between the type of agreement (local and central pathologists scoring absent, local present and central absent, local absent and central present, both scoring present) with the initial clinical assessment, as well as long-term outcomes in those patients who did not receive CS/IS. RESULTS All glomerular lesions (M, E, C and S) assessed by local pathologists were independently associated with the decision to administer CS/IS therapy, while the severity of tubulointerstitial lesions was not. Reproducibility between local and central pathologists was moderate for S (segmental sclerosis) and T (tubular atrophy/interstitial fibrosis), and poor for M (mesangial hypercellularity), E (endocapillary hypercellularity) and C (crescents). Local pathologists found statistically more of each lesion, except for the S lesion, which was more frequent with central review. Disagreements were more likely to occur when the proportion of glomeruli affected was low. The M lesion, assessed by central pathologists, correlated better with the severity of the disease at presentation and discriminated better with outcomes. In contrast, the E lesion, evaluated by local pathologists, correlated better with the clinical presentation and outcomes when compared with central review. Both C and S lesions, when discordant between local and central pathologists, had a clinical phenotype intermediate to double absent lesions (milder disease) and double present (more severe). CONCLUSION We conclude that differences in the scoring of MEST-C criteria between local pathologists and a central reviewer have a significant impact on the prognostic value of the Oxford Classification. Since the decision to offer immunosuppressive therapy in this cohort was intimately associated with the MEST-C score, this study indicates a need for a more detailed guidance for pathologists in the scoring of IgAN biopsies.
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Affiliation(s)
| | | | | | | | - Rosanna Coppo
- City of the Health and the Science of Turin Health Agency, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Daniel Cattran
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | | | | | | | | | - Jan A Bruijn
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | - Luciana Furci
- Pathology, Policlinic of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | | | - Eduardo Gutiérrez
- Nephrology Department, University Hospital October 12, Madrid, Spain
| | - S Asma Haider
- Pathology, Leicester General Hospital, Leicester, UK
| | - Eva Honsova
- Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Elli Ioachim
- Nephrology, Medical School University of Ioannina, Ioannina, Greece
| | | | - David Kipgen
- Pathology, Western Infirmary Glasgow, Glasgow, UK
| | | | | | - Diclehan Orhan
- Hacettepe University Institute of Children's Health, Ankara, Turkey
| | | | - Afroditi Pantzaki
- Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Magnus P Soderberg
- Pathology, Drug Safety and Metabolism, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Eric Steenbergen
- Nephropathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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14
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Wszola M, Domagala P, Serwanska-Swietek M, Ostaszewska A, Perkowska-Ptasinska A, Piatek T, Gozdowska J, Durlik M, Chmura A, Kwiatkowski A. Should Immunosuppression After Kidney Transplant Be Adjusted Based on Renal Resistance During Pretransplant Hypothermic Machine Perfusion? Transplant Proc 2019; 51:2676-2682. [PMID: 31477422 DOI: 10.1016/j.transproceed.2019.01.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The hypothermic machine perfusion reduces delayed graft function after kidney transplant and allows, to some extent, predicting early graft function. However, it is difficult to identify exact perfusion criteria with which to exclude kidneys from transplant or modify post-transplant care. The aim of this study was to analyze whether renal resistance during the fourth hour of hypothermic machine perfusion is useful in the prediction of graft survival and acute rejection. PATIENTS AND METHODS Data on pretransplant hypothermic machine perfusion parameters of 407 transplanted kidneys were available. Receiver operating characteristic curve analysis was performed to find an optimal cutoff value of ratio for predicting a higher risk class of considered group of patients. According to this, patients were divided into 2 groups: those who received kidneys with renal resistance lower than 0.19 mm Hg/mL/min (R1; n = 187) and those who received kidneys with renal resistance equal to or higher than 0.19 mm Hg/mL/min (R2; n = 220). Within R2, we additionally analyzed 2 subgroups: patients who received induction therapy (R2-Ind+; n = 124) and those who did not received induction therapy (R2-Ind-; n = 96). RESULTS Acute rejection in R1 within 1 month post transplant was 2-fold lower compared with R2 and was 6.4% vs 13.1% (P = .03), respectively. One-year graft survival was higher in R1 compared with R2 and was 94.6% vs 88.5% (P = .03), respectively. Acute rejection in the R2-Ind+ subgroup within 1 month post transplant was 2.46-fold lower compared with the R2-Ind- subgroup and was 8% vs 19.7% (P = .01), respectively. CONCLUSION Immunosuppression treatment after transplant should be adjusted to perfusion parameters.
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Affiliation(s)
- Michal Wszola
- Foundation of Research and Science Development, Otwock, Poland
| | - Piotr Domagala
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland.
| | | | - Agata Ostaszewska
- Foundation of Research and Science Development, Otwock, Poland; Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | | | - Tomasz Piatek
- Department of Surgical & Transplant Nursing, Medical University of Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplant Medicine and Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplant Medicine and Nephrology and Internal Diseases, Medical University of Warsaw, Poland
| | - Andrzej Chmura
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | - Artur Kwiatkowski
- Foundation of Research and Science Development, Otwock, Poland; Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
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15
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Domagala P, Wszola M, Perkowska-Ptasinska A, Gorski L, Kwiatkowski A, Durlik M, Kosieradzki M. Predictors of Acute Kidney Injury in Deceased Kidney Donors After Brain Death. Transplant Proc 2019; 51:2598-2601. [PMID: 31474453 DOI: 10.1016/j.transproceed.2019.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Donors with acute kidney injury (AKI) are generally accepted as a valuable source of kidneys for transplant. The aim of this study was to assess the risk of developing AKI based on deceased kidney donor parameters. MATERIALS AND METHODS The data of 162 kidneys procured from deceased donors after brain death were collected. These included clinical characteristics of donors and histologic assessment in organ biopsy specimens. The donors' kidney terminal function was classified according to the Acute Kidney Injury Network criteria. All biopsies were performed with the use of a 16G automatic needle, and the 20-mm tissue specimen was available in all cases. Biopsy specimens were secured and prepared in a routine way with hematoxylin and eosin. The presence of chronic changes was analyzed according to the Banff 2009 classification by 1 experienced nephropathologist. The logistic regression model was used to assess the risk of AKI regarding donor characteristics and histologic findings. RESULTS There were 50 kidneys (30.9%) with AKI identified. The risk of AKI increased with donor age (P = .002; odds ratio [OR], 1.02; 95% CI, 1.01-1.03), body mass index (P = .003; OR, 1.05; 95% CI, 1.01-1.09), and male sex (P = .001; OR, 1.79; 95% CI, 1.31-2.27). Regarding the histologic findings, the interstitial fibrosis presence was a risk factor of AKI (P = .004; OR, 1.04; 95% CI, 1.01-1.06). CONCLUSIONS Older donor age, male sex, higher body mass index, and presence of interstitial fibrosis in kidney graft biopsy specimen are risk factors of AKI.
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Affiliation(s)
- Piotr Domagala
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Michal Wszola
- Foundation of Research and Science Development, Otwock, Poland
| | | | - Lukasz Gorski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland; Foundation of Research and Science Development, Otwock, Poland
| | - Artur Kwiatkowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplant Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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16
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Kiewisz J, Skowronska A, Winiarska A, Pawlowska A, Kiezun J, Rozicka A, Perkowska-Ptasinska A, Kmiec Z, Stompor T. WNT4 Expression in Primary and Secondary Kidney Diseases: Dependence on Staging. Kidney Blood Press Res 2019; 44:200-210. [PMID: 31067548 DOI: 10.1159/000498989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS WNT4 protein is important for kidney development. Its expression was found to be altered in experimental models of chronic kidney disease (CKD). However, the expression of the WNT4 gene has yet not been studied in human renal biopsy samples from patients with broad spectrum of glomerular disease and at different stages of CKD. Thus, the aim of the study was to assess the WNT4 gene expression in renal biopsies of 98 patients using the real-time PCR technique. MATERIALS In order to assess the relative amounts of mRNA, in samples of patients with manifestation of different renal diseases and separately at different stages of CKD, by QPCR, total RNA was isolated from human kidney tissues collected during renal biopsies. Results of blood and urine samples assessment were used to calculate the correlations of biochemical parameters with WNT4 gene expression in both studied groups. RESULTS After pathomorphological evaluation, 49 patients were selected as presenting the most common cases in the studied group. Among the patients who developed focal segmental glomerulosclerosis (FSGS; n = 13), IgA nephropathy (IgAN; n = 10), IgAN with morphological presentation of focal segmental glomerulosclerosis (IgAN/FSGS; n = 8), membranous nephropathy (MN; n = 12), and lupus nephritis (LN; n = 6) were included in the analysis. We found that the level of WNT4 mRNA was higher in kidney specimens obtained from patients with MN as compared to those diagnosed with LN or IgAN. A correlation between WNT4 gene expression and serum albumin and cholesterol levels was observed in patients with FSGS, while WNT4 mRNA levels correlated with plasma sodium in patients diagnosed with LN. After consideration of 98 patients, based on the KDIGO classification of CKD, 20 patients were classified as CKD1 stage, 23 as stage 2, 13 as stage 3a, 11 as stage 3b, 13 as stage 4, and 18 as stage 5. WNT4 gene expression was lower in the CKD patients in stage 2 as compared to CKD 3a. Correlations of WNT4 mRNA level at different stages of CKD with indices of kidney function and lipid metabolism such as serum levels of HDL and LDL cholesterol, TG, urea, creatinine, sodium, and potassium were also found. CONCLUSIONS Our results suggest that altered WNT4 gene expression in patients with different types of glomerular diseases and patients at different stages of CKD may play a role in kidney tissue disorganization as well as disease development and progression.
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Affiliation(s)
- Jolanta Kiewisz
- Department of Human Histology and Embryology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Agnieszka Skowronska
- Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Agata Winiarska
- Department of Nephrology, Hypertension and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Pawlowska
- Department of Nephrology, Hypertension and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Jacek Kiezun
- Department of Human Histology and Embryology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Anna Rozicka
- Department of Pathomorphology, The Regional Specialist Hospital, Olsztyn, Poland
| | | | - Zbigniew Kmiec
- Department of Human Histology and Embryology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.,Department of Histology, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Stompor
- Department of Nephrology, Hypertension and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland,
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17
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Coppo R, D'Arrigo G, Tripepi G, Russo ML, Roberts ISD, Bellur S, Cattran D, Cook TH, Feehally J, Tesar V, Maixnerova D, Peruzzi L, Amore A, Lundberg S, Di Palma AM, Gesualdo L, Emma F, Rollino C, Praga M, Biancone L, Pani A, Feriozzi S, Polci R, Barratt J, Del Vecchio L, Locatelli F, Pierucci A, Caliskan Y, Perkowska-Ptasinska A, Durlik M, Moggia E, Ballarin JC, Wetzels JFM, Goumenos D, Papasotiriou M, Galesic K, Toric L, Papagianni A, Stangou M, Benozzi L, Cusinato S, Berg U, Topaloglu R, Maggio M, Ots-Rosenberg M, D’Amico M, Geddes C, Balafa O, Quaglia M, Cravero R, Lino Cirami C, Fellstrom B, Floege J, Egido J, Mallamaci F, Zoccali C, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, Coppo R, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, Feehally J, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels JFM, Peters H, Berg U, Carvalho F, da Costa Ferreira AC, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Papastirou M, Galesic K, Toric L, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Rauen T, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders MEJ, Boria Grinyo JM, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Roszkowska-Blaim M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma AM, Ferrario F, Gutiérrez E, Asunis AM, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, GalesicLjubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene HJ, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E. Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update. Nephrol Dial Transplant 2018; 35:1002-1009. [DOI: 10.1093/ndt/gfy302] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up.
Methods
In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)].
Results
In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%).
Conclusion
Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.
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Affiliation(s)
- Rosanna Coppo
- Fondazione Ricerca Molinette, Turin, Piemonte, Italy
| | | | | | | | | | - Shubha Bellur
- Cellular Pathology, Oxford University Hospital, Oxford, UK
| | | | | | - John Feehally
- Department of Nephrology, Leicester General Hospital, Leicester, UK
| | - Vladimir Tesar
- Nephrology, General University Hospital, Prague, Czech Republic
| | - Dita Maixnerova
- Nephrology, General University Hospital, Prague, Czech Republic
| | - Licia Peruzzi
- Nephrology, Regina Margherita Hospital, Turin, Italy
| | | | - Sigrid Lundberg
- Department of Nephrology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Francesco Emma
- Department of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy
| | | | - Manuel Praga
- Department of Nephrology, H12Octubre, Madrid, Spain
| | | | | | | | - Rosaria Polci
- Department of Nephrology, Belcolle Hospital, Viterbo, Italy
| | - Jonathan Barratt
- Department of Nephrology, Leicester General Hospital, Leicester, UK
| | | | | | | | | | | | - Magdalena Durlik
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Jack F M Wetzels
- Department of Nephrology and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dimitris Goumenos
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | - Marios Papasotiriou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | | | - Luka Toric
- Department of Nephrology, Dubrava University, Zagreb, Croatia
| | - Aikaterini Papagianni
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Stangou
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Ulla Berg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Huddinge, Sweden
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Milena Maggio
- Department of Nephrology, Hospital Maggiore di Lodi, Lodi, Italy
| | | | | | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Olga Balafa
- Department of Nephrology, Medical School University of Ioannina, Ioannina, Greece
| | - Marco Quaglia
- Department of Nephrology, Maggiore della Carità Hospital, Piem, Onte Orientale University, Novara, Italy
| | | | | | | | - Jürgen Floege
- Division of Nephrology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jesus Egido
- Department of Nephrology, Fundacion Jimenez Diaz, CIBERDEM, Madrid, Spain
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Deborska-Materkowska D, Perkowska-Ptasinska A, Sadowska A, Gozdowska J, Ciszek M, Serwanska-Swietek M, Domagala P, Miszewska-Szyszkowska D, Sitarek E, Jozwik A, Kwiatkowski A, Durlik M. Diagnostic utility of monitoring cytomegalovirus-specific immunity by QuantiFERON-cytomegalovirus assay in kidney transplant recipients. BMC Infect Dis 2018; 18:179. [PMID: 29661141 PMCID: PMC5902940 DOI: 10.1186/s12879-018-3075-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/03/2018] [Indexed: 12/18/2022] Open
Abstract
Background Despite universal prophylaxis, late cytomegalovirus (CMV) infection occurs in a high proportion of kidney transplant recipients. We evaluated whether a specific viral T-cell response allows for the better identification of recipients who are at high risk of CMV infection after prophylaxis withdrawal. Methods We conducted a prospective study in 19 pretransplant anti-CMV seronegative kidney graft recipients R- (18 from seropositive donors [D+] and one from a seronegative donor [D-]) and 67 seropositive recipients R(+) (59 from seropositive donors and eight from seronegative donors) who received antiviral prophylaxis with valganciclovir. The QuantiFERON-CMV (QF-CMV) assay was performed within the first and third months after transplantation. Blood samples were monitored for CMV DNAemia using a commercial quantitative nucleic acid amplification test (QNAT) that was calibrated to the World Health Organization International Standard. Results Twenty-one of the 86 patients (24%) developed CMV viremia after prophylaxis withdrawal within 12 months posttransplantation. In the CMV R(+) group, the QF-CMV assay yielded reactive results (QF-CMV[+]) in 51 of 67 patients (76%) compared with 7 of 19 patients (37%) in the CMV R(−) group (p = 0.001). In the CMV R(+) group, infection occurred in seven of 16 recipients (44%) who were QF-CMV(−) and eight of 51 recipients (16%) who were QF-CMV(+). In the CMV R(−) group, infection evolved in five of 12 recipients (42%) who were QF-CMV(−) and one of 7 recipients (14%) who were QF-CMV(+). No difference was found in the incidence of CMV infection stratified according to the QF-CMV results with regard to the recipients’ pretransplant CMV IgG serology (p = 0.985). Cytomegalovirus infection occurred in 15 of 36 patients (42%) with hypogammaglobulinemia (HGG) 90 days posttransplantation compared with two of 34 patients (6%) without HGG (p = 0.0004). Cytomegalovirus infection occurred in seven of 13 patients (54%) with lymphocytopenia compared with 14 of 70 patients (20%) without lymphocytopenia (p = 0.015). The multivariate analysis revealed that the nonreactive QuantiFERON-CMV assay was an independent risk factor for postprophylaxis CMV infection. Conclusions In kidney transplant recipients who received posttransplantation prophylaxis, negative QF-CMV results better defined the risk of CMV infection than initial CMV IgG status after prophylaxis withdrawal. Hypogammaglobulinemia and lymphocytopenia were risk factors for CMV infection.
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Affiliation(s)
- Dominika Deborska-Materkowska
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland.
| | - Agnieszka Perkowska-Ptasinska
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Anna Sadowska
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Michał Ciszek
- Department of Immunology, Transplantology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Marta Serwanska-Swietek
- Department of General and Transplant Surgery, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Piotr Domagala
- Department of General and Transplant Surgery, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Dorota Miszewska-Szyszkowska
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Elzbieta Sitarek
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Agnieszka Jozwik
- Department of General and Transplant Surgery, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Artur Kwiatkowski
- Department of General and Transplant Surgery, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation Medical University of Warsaw, 59 Nowogrodzka Street, 02-006, Warsaw, Poland
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Wazna E, Pazik J, Perkowska-Ptasinska A, Durlik M. Does Histopathology of Implanted Kidney According to Banff 07 Help Predict Long-term Transplantation Outcome? Transplant Proc 2018; 50:1765-1768. [PMID: 30056897 DOI: 10.1016/j.transproceed.2018.02.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/19/2018] [Indexed: 11/27/2022]
Abstract
Analyses of peritransplant biopsies of deceased-donor kidneys show high incidence of chronic abnormalities. The question arises whether chronic abnormalities present at implantation determine engrafted kidney fate regardless of other concomitant variables. The aim of this study was to identify risk factors of graft loss considering histopathological changes present at implantation scored according to Banff 07 criteria. PATIENTS AND METHODS Inclusion criteria (n = 300) was engraftment between years 2000 and 2008 and availability of implantation biopsy. Analyzed abnormalities present in donor biopsy were arteriolar hyalinization, interstitial fibrosis, intimal sclerotization, tubular atrophy, total inflammation, and percentage of sclerotic glomeruli (Banff classification). Allograft function was estimated by abbreviated Modification of Diet in Renal Disease formula and proteinuria semi-quantitatively by standard dip-stick test. Kaplan-Meier estimate was used to assess graft survival. Searching for independent risk factors of graft survival was performed by means of Cox proportional hazards models (SAS System, SAS Institute Inc, Cary, NC, United States). RESULTS In one-factor analyses, predictors of kidney allograft loss were donor age, donor history of diabetes, kidney allograft dysfunction within first posttransplant year, and recipient chronic hepatitis C. In terms of chronic abnormalities, arteriolar hyalinization of any intensity nearly doubled the risk of allograft loss. Independent risk factors of kidney allograft loss in multivariate analysis were donor age, posttransplant diabetes mellitus, proteinuria after engraftment, and recipient hepatitis C. CONCLUSION The effect of arteriolar hyalinization on renal transplant survival is probably interwoven with other predictors of graft loss. Recognizing the negative impact of recipient chronic hepatitis C on graft survival, hepatitis C virus treatment should be provided to patients with advanced chronic kidney disease, patients on wait lists, or patients already transplanted.
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Affiliation(s)
- E Wazna
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - J Pazik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - A Perkowska-Ptasinska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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20
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Bujnowska A, Michon M, Konopelski P, Hryniewiecka E, Jalbrzykowska A, Perkowska-Ptasinska A, Cieciura T, Zagozdzon R, Paczek L, Ciszek M. Outcomes of Prolonged Treatment With Intravenous Immunoglobulin Infusions for Acute Antibody-mediated Rejection in Kidney Transplant Recipients. Transplant Proc 2018; 50:1720-1725. [PMID: 29961551 DOI: 10.1016/j.transproceed.2018.02.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/06/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Treatment of antibody-mediated rejection (AMR) is one of the main problems after kidney transplantation (KTx). The results of intensive AMR treatment with plasmapheresis (PF) and repeated infusions of intravenous immunoglobulin (IVIg) are presented. METHODS Diagnosis of AMR was based on graft biopsy and the presence of donor-specific antibodies (DSAs). AMR therapy consisted of 5 PF and IVIg infusions given after the last PF. Subsequent IVIg doses were given every 4 weeks for 6 months. Graft biopsy and DSA assessment were repeated at the end of the treatment (ET). RESULTS Four women and 10 men were included in our study; mean time from KTx to AMR was 79 (range, 3-193) months. During the treatment, 4 patients had graft failure. Graft function at baseline was significantly worse (P = .02) in this group compared with patients who completed the therapy. At baseline, mean flourescence intensity (MFI) was 6574 (range, 852-15,917) in the whole group, 7088 (range, 1054-15,917) in patients who completed treatment, and 4828 (range, 852-11,797) in patients who restarted hemodialysis. At ET, DSA MFI decreased in 8 of 10 patients (80%) who completed the therapy. The MFI decrease was 3946 (range, 959-11,203). Control graft biopsies revealed decreased intensity of C4d deposits in peritubular capillaries in 7 patients (78%) and decreased peritubular capillaritis in 2 patients (22%). CONCLUSION Intensive, prolonged AMR therapy with PF and IVIg resulted in a decrease in DSA titer and intensity of C4d deposits, but was not associated with reduction of microcirculation inflammation. Treatment was ineffective in patients with baseline advanced graft insufficiency.
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Affiliation(s)
- A Bujnowska
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - M Michon
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - P Konopelski
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - E Hryniewiecka
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland; Department of Clinical Nursing, Medical University of Warsaw, Warsaw, Poland
| | - A Jalbrzykowska
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | - A Perkowska-Ptasinska
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - T Cieciura
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - R Zagozdzon
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | - L Paczek
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland; Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - M Ciszek
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
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21
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Perkowska-Ptasinska A, Bartczak A, Wagrowska-Danilewicz M, Halon A, Okon K, Wozniak A, Danilewicz M, Karkoszka H, Marszalek A, Kowalewska J, Mroz A, Korolczuk A, Oko A, Debska-Slizien A, Naumnik B, Hruby Z, Klinger M, Ciechanowski K, Myslak M, Sulowicz W, Rydzewski A, Wiecek A, Manitius J, Gregorczyk T, Niemczyk S, Nowicki M, Gellert R, Stompor T, Wieliczko M, Marczewski K, Paczek L, Rostkowska O, Deborska-Materkowska D, Bogdanowicz G, Milkowski A, Durlik M. Clinicopathologic correlations of renal pathology in the adult population of Poland. Nephrol Dial Transplant 2017; 32:ii209-ii218. [PMID: 28339709 DOI: 10.1093/ndt/gfw365] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/13/2016] [Indexed: 01/28/2023] Open
Abstract
Background This is the first report on the epidemiology of biopsy-proven kidney diseases in Poland. Methods The Polish Registry of Renal Biopsies has collected information on all (n = 9394) native renal biopsies performed in Poland from 2009 to 2014. Patients' clinical data collected at the time of biopsy, and histopathological diagnoses were used for epidemiological and clinicopathologic analysis. Results There was a gradual increase in the number of native renal biopsies performed per million people (PMP) per year in Poland in 2009-14, starting from 36 PMP in 2009 to 44 PMP in 2014. A considerable variability between provinces in the mean number of biopsies performed in the period covered was found, ranging from 5 to 77 PMP/year. The most common renal biopsy diagnoses in adults were immunoglobulin A nephropathy (IgAN) (20%), focal segmental glomerulosclerosis (FSGS) (15%) and membranous glomerulonephritis (MGN) (11%), whereas in children, minimal change disease (22%), IgAN (20%) and FSGS (10%) were dominant. Due to insufficient data on the paediatric population, the clinicopathologic analysis was limited to patients ≥18 years of age. At the time of renal biopsy, the majority of adult patients presented nephrotic-range proteinuria (45.2%), followed by urinary abnormalities (38.3%), nephritic syndrome (13.8%) and isolated haematuria (1.7%). Among nephrotic patients, primary glomerulopathies dominated (67.6% in those 18-64 years of age and 62.4% in elderly patients) with leading diagnoses being MGN (17.1%), FSGS (16.2%) and IgAN (13.0%) in the younger cohort and MGN (23.5%), amyloidosis (18.8%) and FSGS (16.8%) in the elderly cohort. Among nephritic patients 18-64 years of age, the majority (55.9%) suffered from primary glomerulopathies, with a predominance of IgAN (31.3%), FSGS (12.7%) and crescentic GN (CGN) (11.1%). Among elderly nephritic patients, primary and secondary glomerulopathies were equally common (41.9% each) and pauci-immune GN (24.7%), CGN (20.4%) and IgAN (14.0%) were predominant. In both adult cohorts, urinary abnormalities were mostly related to primary glomerulopathies (66.8% in younger and 50% in elderly patients) and the leading diagnoses were IgAN (31.4%), FSGS (15.9%), lupus nephritis (10.7%) and FSGS (19.2%), MGN (15.1%) and pauci-immune GN (12.3%), respectively. There were significant differences in clinical characteristics and renal biopsy findings between male and female adult patients. Conclusions The registry data focused new light on the epidemiology of kidney diseases in Poland. These data should be used in future follow-up and prospective studies.
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Affiliation(s)
| | - Artur Bartczak
- Department of Pathology, Medical Center of Postgraduate Education, Warsaw, Poland
| | | | - Agnieszka Halon
- Department of Pathomorphology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Okon
- Department of Clinical and Experimental Pathology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Aldona Wozniak
- Biopsy Diagnostics Laboratory, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Henryk Karkoszka
- Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Katowice, Poland
| | - Andrzej Marszalek
- Department of Pathomorphology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jolanta Kowalewska
- Department of Pathology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Andrzej Mroz
- Department of Pathology, Medical Center of Postgraduate Education, Warsaw, Poland
| | | | - Andrzej Oko
- Department of Nephrology, Transplantology, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Alicja Debska-Slizien
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Beata Naumnik
- Department of Nephrology and Transplantology with Dialysis Unit, Medical University Bialystok, Bialystok, Poland
| | - Zbigniew Hruby
- Department of Nephrology, with subdivision of Diabetology and Transplantology, District Specialist Hospital in Wroclaw, Wroclaw, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Kazimierz Ciechanowski
- Clinic of Nephrology, Transplantology and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Marek Myslak
- Department of Nephrology and Kidney Transplantation, District Hospital in Szczecin, Szczecin, Poland
| | | | - Andrzej Rydzewski
- Department of Internal Diseases, Nephrology and Transplantology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Andrzej Wiecek
- Department of Nephrology, Silesian School of Medicine, Katowice, Poland
| | - Jacek Manitius
- Department of Nephrology, Hypertension and Internal Medicine, Collegium Medicum UMK, Bydgoszcz, Poland
| | | | - Stanislaw Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Michal Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland.,Nephrology and Dialysis, Polish Mother's Memorial Hospital, Lodz, Poland
| | - Ryszard Gellert
- Department of Nephrology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Tomasz Stompor
- PD Unit, Chair and Department of Nephrology, Jagiellonian University, Cracow, Poland
| | - Monika Wieliczko
- Department of Nephrology, Dialysis, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Marczewski
- Zaklad Etyki i Filozofii Czlowieka, Uniwersytet Medyczny w Lublinie, Lublinie, Poland
| | - Leszek Paczek
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Olga Rostkowska
- Department of Transplantology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Magdalena Durlik
- Department of Transplantology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Abstract
Chronic kidney disease (CKD), diabetes and cardiovascular disease constitute three interrelated conditions of strong public health relevance. Elderly individuals account for the largest and the most rapidly growing age segment of the end-stage renal disease population. The elderly are affected by the same types of kidney diseases as younger individuals, but aging itself is associated with a gradual reduction in estimated glomerular filtration rate, which leads to the diminishment of the functional reserve and makes an individual more vulnerable to injurious effects of hypertension, cardiovascular disease, diabetes, and drugs' toxicity. Although the spectrum of diseases affecting people aged ≥65 is the same as in younger population, there are some distinct differences in the frequency of certain nephropathies between these two age groups. The superimposition of aging-related lesions on other kidney diseases evolving in the elderly population makes the clinical picture more complex and reaching diagnosis more challenging. In elderly CKD patients the high prevalence of comorbidities and the often aberrant metabolism of medications have to be considered in individually tailored treatment strategies.
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Affiliation(s)
| | | | - Magdalena Durlik
- Department of Transplantology, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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23
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Coppo R, D'Arrigo G, Tripepi G, Russo ML, Roberts I, Bellur S, Cattran D, Cook TH, Feehally J, Tesar V, Maixnerova D, Lundberg S, Di Palma AM, Emma F, Rollino C, Praga M, Biancone L, Pani A, Barratt J, Del Vecchio L, Locatelli F, Pierucci A, Caliskan Y, Perkowska-Ptasinska A, Ballarin J. SP104IS THERE LONG-TERM VALUE OF PATHOLOGY SCORING IN IGA NEPHROPATHY? A VALIGA UPDATE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx141.sp104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Coppo R, Lofaro D, Camilla RR, Bellur S, Cattran D, Cook HT, Roberts ISD, Peruzzi L, Amore A, Emma F, Fuiano L, Berg U, Topaloglu R, Bilginer Y, Gesualdo L, Polci R, Mizerska-Wasiak M, Caliskan Y, Lundberg S, Cancarini G, Geddes C, Wetzels J, Wiecek A, Durlik M, Cusinato S, Rollino C, Maggio M, Praga M, K Smerud H, Tesar V, Maixnerova D, Barratt J, Papalia T, Bonofiglio R, Mazzucco G, Giannakakis C, Soderberg M, Orhan D, Di Palma AM, Maldyk J, Ozluk Y, Sudelin B, Tardanico R, Kipgen D, Steenbergen E, Karkoszka H, Perkowska-Ptasinska A, Ferrario F, Gutierrez E, Honsova E. Risk factors for progression in children and young adults with IgA nephropathy: an analysis of 261 cases from the VALIGA European cohort. Pediatr Nephrol 2017; 32:139-150. [PMID: 27557557 DOI: 10.1007/s00467-016-3469-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/03/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is a need for early identification of children with immunoglobulin A nephropathy (IgAN) at risk of progression of kidney disease. METHODS Data on 261 young patients [age <23 years; mean follow-up of 4.9 (range 2.5-8.1) years] enrolled in VALIGA, a study designed to validate the Oxford Classification of IgAN, were assessed. Renal biopsies were scored for the presence of mesangial hypercellularity (M1), endocapillary hypercellularity (E1), segmental glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis (T1-2) (MEST score) and crescents (C1). Progression was assessed as end stage renal disease and/or a 50 % loss of estimated glomerular filtration rate (eGFR) (combined endpoint) as well as the rate of renal function decline (slope of eGFR). Cox regression and tree classification binary models were used and compared. RESULTS In this cohort of 261 subjects aged <23 years, Cox analysis validated the MEST M, S and T scores for predicting survival to the combined endpoint but failed to prove that these scores had predictive value in the sub-group of 174 children aged <18 years. The regression tree classification indicated that patients with M1 were at risk of developing higher time-averaged proteinuria (p < 0.0001) and the combined endpoint (p < 0.001). An initial proteinuria of ≥0.4 g/day/1.73 m2 and an eGFR of <90 ml/min/1.73 m2 were determined to be risk factors in subjects with M0. Children aged <16 years with M0 and well-preserved eGFR (>90 ml/min/1.73 m2) at presentation had a significantly high probability of proteinuria remission during follow-up and a higher remission rate following treatment with corticosteroid and/or immunosuppressive therapy. CONCLUSION This new statistical approach has identified clinical and histological risk factors associated with outcome in children and young adults with IgAN.
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Affiliation(s)
- Rosanna Coppo
- Fondazione Ricerca Molinette, Nephrology, Dialysis and Transplantation, Regina Margherita Hospital, Turin, Italy.
| | | | - Roberta R Camilla
- Fondazione Ricerca Molinette, Nephrology, Dialysis and Transplantation, Regina Margherita Hospital, Turin, Italy
| | | | - Daniel Cattran
- Toronto General Hospital, University Health Network, Toronto, Canada
| | | | | | - Licia Peruzzi
- Fondazione Ricerca Molinette, Nephrology, Dialysis and Transplantation, Regina Margherita Hospital, Turin, Italy
| | - Alessandro Amore
- Fondazione Ricerca Molinette, Nephrology, Dialysis and Transplantation, Regina Margherita Hospital, Turin, Italy
| | | | | | - Ulla Berg
- Karolinska University Hospital, Huddinge, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eva Honsova
- General University Hospital, Prague, Czech Republic
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Haas M, Verhave JC, Liu ZH, Alpers CE, Barratt J, Becker JU, Cattran D, Cook HT, Coppo R, Feehally J, Pani A, Perkowska-Ptasinska A, Roberts ISD, Soares MF, Trimarchi H, Wang S, Yuzawa Y, Zhang H, Troyanov S, Katafuchi R. A Multicenter Study of the Predictive Value of Crescents in IgA Nephropathy. J Am Soc Nephrol 2016; 28:691-701. [PMID: 27612994 DOI: 10.1681/asn.2016040433] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/14/2016] [Indexed: 11/03/2022] Open
Abstract
The Oxford Classification of IgA nephropathy does not account for glomerular crescents. However, studies that reported no independent predictive role of crescents on renal outcomes excluded individuals with severe renal insufficiency. In a large IgA nephropathy cohort pooled from four retrospective studies, we addressed crescents as a predictor of renal outcomes and determined whether the fraction of crescent-containing glomeruli associates with survival from either a ≥50% decline in eGFR or ESRD (combined event) adjusting for covariates used in the original Oxford study. The 3096 subjects studied had an initial mean±SD eGFR of 78±29 ml/min per 1.73 m2 and median (interquartile range) proteinuria of 1.2 (0.7-2.3) g/d, and 36% of subjects had cellular or fibrocellular crescents. Overall, crescents predicted a higher risk of a combined event, although this remained significant only in patients not receiving immunosuppression. Having crescents in at least one sixth or one fourth of glomeruli associated with a hazard ratio (95% confidence interval) for a combined event of 1.63 (1.10 to 2.43) or 2.29 (1.35 to 3.91), respectively, in all individuals. Furthermore, having crescents in at least one fourth of glomeruli independently associated with a combined event in patients receiving and not receiving immunosuppression. We propose adding the following crescent scores to the Oxford Classification: C0 (no crescents); C1 (crescents in less than one fourth of glomeruli), identifying patients at increased risk of poor outcome without immunosuppression; and C2 (crescents in one fourth or more of glomeruli), identifying patients at even greater risk of progression, even with immunosuppression.
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Affiliation(s)
- Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California;
| | - Jacobien C Verhave
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zhi-Hong Liu
- Department of Nephrology, National Clinical Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Charles E Alpers
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan Barratt
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Jan U Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Daniel Cattran
- Department of Medicine and Toronto General Research Institute, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - H Terence Cook
- Centre for Complement and Inflammation Research, Department of Medicine, Imperial College, London, United Kingdom
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Nephrology, Dialysis, and Transplantation, Regina Margherita Hospital, Turin, Italy
| | - John Feehally
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Antonello Pani
- Department of Nephrology and Dialysis, G. Brotzu Hospital, Cagliari, Italy
| | - Agnieszka Perkowska-Ptasinska
- Department of Nephrology, Transplantation Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ian S D Roberts
- Department of Cellular Pathology, Oxford University Hospitals, Oxford, United Kingdom
| | | | - Hernan Trimarchi
- Department of Nephrology, Nephrology Service and Kidney Transplant Unit, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Suxia Wang
- Department of Pathology, Laboratory of Electron Microscopy, Pathological Centre and
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake Aichi, Japan
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Stéphan Troyanov
- Division of Nephrology, Department of Medicine, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada; and
| | - Ritsuko Katafuchi
- Kidney Unit, National Fukuoka Higashi Medical Center, Fukuoka, Japan
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Moresco RN, Speeckaert MM, Zmonarski SC, Krajewska M, Komuda-Leszek E, Perkowska-Ptasinska A, Gesualdo L, Rocchetti MT, Delanghe SE, Vanholder R, Van Biesen W, Delanghe JR. Urinary myeloid IgA Fc alpha receptor (CD89) and transglutaminase-2 as new biomarkers for active IgA nephropathy and henoch-Schönlein purpura nephritis. BBA Clin 2016; 5:79-84. [PMID: 27051593 PMCID: PMC4802400 DOI: 10.1016/j.bbacli.2016.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/06/2016] [Accepted: 02/16/2016] [Indexed: 10/25/2022]
Abstract
BACKGROUND IgA nephropathy (IgAN) and Henoch-Schönlein purpura nephritis (HSPN) are glomerular diseases that share a common and central pathogenic mechanism. The formation of immune complexes containing IgA1, myeloid IgA Fc alpha receptor (FcαRI/CD89) and transglutaminase-2 (TG2) is observed in both conditions. Therefore, urinary CD89 and TG2 could be potential biomarkers to identify active IgAN/HSPN. METHODS In this multicenter study, 160 patients with IgAN or HSPN were enrolled. Urinary concentrations of CD89 and TG2, as well as some other biochemical parameters, were measured. RESULTS Urinary CD89 and TG2 were lower in patients with active IgAN/HSPN compared to IgAN/HSPN patients in complete remission (P < 0.001). The CD89xTG2 formula had a high ability to discriminate active from inactive IgAN/HSPN in both situations: CD89xTG2/proteinuria ratio (AUC: 0.84, P < 0.001, sensitivity: 76%, specificity: 74%) and CD89xTG2/urinary creatinine ratio (AUC: 0.82, P < 0.001, sensitivity: 75%, specificity: 74%). Significant correlations between urinary CD89 and TG2 (r = 0.711, P < 0.001), proteinuria and urinary CD89 (r = - 0.585, P < 0.001), and proteinuria and urinary TG2 (r = - 0.620, P < 0.001) were observed. CONCLUSIONS Determination of CD89 and TG2 in urine samples can be useful to identify patients with active IgAN/HSPN.
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Affiliation(s)
- Rafael N. Moresco
- Department of Clinical and Toxicological Analysis, Federal University of Santa Maria, Santa Maria, Brazil
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
| | | | - Slawomir C. Zmonarski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Komuda-Leszek
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | | | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, Section of Nephrology, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria T. Rocchetti
- Department of Emergency and Organ Transplantation, Section of Nephrology, University of Bari “Aldo Moro”, Bari, Italy
| | | | | | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Gent, Belgium
| | - Joris R. Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
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Barbour SJ, Espino-Hernandez G, Reich HN, Coppo R, Roberts IS, Feehally J, Herzenberg AM, Cattran DC, Bavbek N, Cook T, Troyanov S, Alpers C, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn J, D’Agati V, D’Amico G, Emancipator S, Emmal F, Ferrario F, Fervenza F, Florquin S, Fogo A, Geddes C, Groene H, Haas M, Hill P, Hogg R, Hsu S, Hunley T, Hladunewich M, Jennette C, Joh K, Julian B, Kawamura T, Lai F, Leung C, Li L, Li P, Liu Z, Massat A, Mackinnon B, Mezzano S, Schena F, Tomino Y, Walker P, Wang H, Weening J, Yoshikawa N, Zhang H, Coppo R, Troyanov S, Cattran D, Cook H, Feehally J, Roberts I, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, RC, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, JF, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels J, Peters H, Berg U, Carvalho F, da Costa Ferreira A, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Kalliakmani P, Gerolymos M, Galesic K, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders M, Boria Grinyo J, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Bellur S, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma A, Ferrario F, Gutiérrez E, Asunis A, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, Galesic Ljubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene H, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E. The MEST score provides earlier risk prediction in lgA nephropathy. Kidney Int 2016; 89:167-75. [DOI: 10.1038/ki.2015.322] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 01/12/2023]
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Perkowska-Ptasinska A, Bartczak A, Wagrowska-Danilewicz M, Danilewicz M, Halon A, Okon K, Wozniak A, Korolczuk A, Marszalek A, Mroz A, Klinger M, Durlik M. SP375EPIDEMIOLOGY OF RENAL DISEASES IN POLAND: A 5 YEARS REVIEW OF POLISH REGISTRY OF KIDNEY BIOPSIES IN ADULTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv192.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Coppo R, Troyanov S, Bellur S, Cattran D, Cook HT, Feehally J, Roberts ISD, Morando L, Camilla R, Tesar V, Lunberg S, Gesualdo L, Emma F, Rollino C, Amore A, Praga M, Feriozzi S, Segoloni G, Pani A, Cancarini G, Durlik M, Moggia E, Mazzucco G, Giannakakis C, Honsova E, Sundelin BB, Di Palma AM, Ferrario F, Gutierrez E, Asunis AM, Barratt J, Tardanico R, Perkowska-Ptasinska A. Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. Kidney Int 2014; 86:828-36. [PMID: 24694989 PMCID: PMC4184028 DOI: 10.1038/ki.2014.63] [Citation(s) in RCA: 315] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/03/2013] [Accepted: 01/02/2014] [Indexed: 12/16/2022]
Abstract
The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from the original study and how therapy influences the predictive value of pathology remain uncertain. The VALIGA study examined 1147 patients from 13 European countries that encompassed the whole spectrum of IgAN. Over a median follow-up of 4.7 years, 86% received renin-angiotensin system blockade and 42% glucocorticoid/immunosuppressive drugs. M, S, and T lesions independently predicted the loss of estimated glomerular filtration rate (eGFR) and a lower renal survival. Their value was also assessed in patients not represented in the Oxford cohort. In individuals with eGFR less than 30 ml/min per 1.73 m(2), the M and T lesions independently predicted a poor survival. In those with proteinuria under 0.5 g/day, both M and E lesions were associated with a rise in proteinuria to 1 or 2 g/day or more. The addition of M, S, and T lesions to clinical variables significantly enhanced the ability to predict progression only in those who did not receive immunosuppression (net reclassification index 11.5%). The VALIGA study provides a validation of the Oxford classification in a large European cohort of IgAN patients across the whole spectrum of the disease. The independent predictive value of pathology MEST score is reduced by glucocorticoid/immunosuppressive therapy.
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Affiliation(s)
- Rosanna Coppo
- City of the Health and the Science of Turin Health Agency, Regina Margherita Children's Hospital, Turin, Italy
| | | | | | - Daniel Cattran
- Unversity Health Network, Toronto General Hospital, Toronto, Canada
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Saddadi F, Najafi I, Hakemi M, Jahani M, Ali Moghadam K, Ghavamzadeh A, Soleimanian T, Perkowska-Ptasinska A, Wagrowska-Danilewicz M, Danilewicz M, Halon A, Komuda E, Karkoszka H, Andrzejewska A, Okon K, Kurnatowska I, Krasnicka M, Hryszko T, Kusztal M, Wiechecka-Korenkiewicz J, Marcinkowska E, Korenkiewicz J, Marszalek A, Sypniewska G, Manitius J, Cappuccino L, Verzola D, Tosetti F, Marre S, Villaggio B, Salvidio G, Garibotto G, Pasquariello A, Innocenti M, Pasquariello G, Mattei P, Samoni S, Sami N, Cupisti A, Malvar B, Viana H, Galvao M, Carvalho F, Oksa A, Demes M, Danis D, Hilhorst M, van Paassen P, van Breda Vriesman P, Cohen Tervaert JW, Perkowska-Ptasinska A, Ciszek M, Urbanowicz A, Kwiatkowski A, Durlik M, Saito T, Kawano M, Saeki T, Nishi S, Yamaguchi Y, Hisano S, Nakashima H, Yamanaka N, Oh SW, Chin HJ, Na KY, Chae DW, Ozkan G, Ulusoy S, Ersoz S, Orem A, Alkanat M, Yucesan F, Kaynar K, Al S, Simic Ogrziovic S, Bojic S, Basta Jovanovic G, Kotur Stevuljevic J, Dosaj V, Lezaic V, Yagisawa T, Kimura T, Ishikawa N, Yashi M. Renal histopathology. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wazna E, Pazik J, Perkowska-Ptasinska A, Lewandowski Z, Kwiatkowski A, Galazka Z, Durlik M. DONOR-DERIVED ARTERIOLAR HYALINISATION DIMINISHES GRAFT FUNCTION IN PATIENTS WITH A PROPENSITY TO ACUTE REJECTION OR ON CYCLOSPORIN A-BASED IMMUNOSUPPRESSION. Transplantation 2010. [DOI: 10.1097/00007890-201007272-01831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baczkowska T, Sadowska A, Perkowska-Ptasinska A, Lewandowski Z, Cieciura T, Pazik J, Wazna E, Kozinska OP, Nowacka Cieciura E, Chmura A, Durlik M. Optimal mycophenolic acid and mycophenolic acid glucuronide levels at the early period after kidney transplantation are the key contributors to improving long-term outcomes. Transplant Proc 2010; 41:3019-23. [PMID: 19857666 DOI: 10.1016/j.transproceed.2009.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Suboptimal mycophenolic acid (MPA) and its metabolite MPA glucuronide (MPAG) levels are associated with significant increased incidences of graft loss. This study assessed the influence of MPA and MPAG C(0) levels on glomerular filtration rate (GFR) values and histopathologic changes in protocol biopsies of kidney allograft recipients. PATIENTS AND METHODS This prospective study of 42 low-risk patients receiving mycophenolate mofetil, prednisone, and a low or normal cyclosporine dose included histological assessment, according to the Banff'97 classification, of protocol biopsies before and at 3, 12, and 36 months after transplantation, as well as GFR at 1, 3, 12, 36, and 60 months and MPA enzyme-linked immunosorbent assay, MPAG (HPLC/UV) C(0) levels at 7 days as well as at 1, 3, 12, and 36 months. RESULTS We observed nonlinear, significant correlations between MPA, MPAG C(0) levels and subclinical rejection episodes (SCR) according to chronic interstitial changes (ci), chronic tubulitis (ct), arteriolar hyalinization (ah) and chronic allograph nephropathy (CAN) indices in protocol biopsies. MPA C(0) levels below 1.0 to 1.5 microg/mL at day 7 were associated with an increased risk of SCR (P < .03), ci > or = 2 (P < .05), CAN > or = 2 (P < .04), and ah > or = 2 (P < .07). MPAG C(0) levels above 100 to 150 microg/mL at day 7 were associated with a decreased risk of ct > or = 2 (P < .01), ci > or = 2 (P < .04), or CAN > or = 2 (P < .04). We also observed a significant linear positive correlation between MPA C(0) level and a significant negative correlation between MPAG C(0) level at 1 month with GFR. CONCLUSION Optimal MPA and MPAG exposure in the early posttransplant period may improve renal graft outcomes.
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Affiliation(s)
- T Baczkowska
- Department of Transplantation Medicine and Nephrology, Warsaw Medical University, Warsaw, Poland.
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Domagala P, Kwiatkowski A, Perkowska-Ptasinska A, Wszola M, Panufnik L, Paczek L, Durlik M, Chmura A. Assessment of Kidneys Procured From Expanded Criteria Donors Before Transplantation. Transplant Proc 2009; 41:2966-9. [DOI: 10.1016/j.transproceed.2009.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gozdowska J, Urbanowicz A, Perkowska-Ptasinska A, Michalska K, Chmura A, Szmidt J, Durlik M. Use of High-Dose Human Immune Globulin in Highly Sensitized Patients on the Kidney Transplant Waiting List: One Center's Experience. Transplant Proc 2009; 41:2997-3001. [DOI: 10.1016/j.transproceed.2009.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wszola M, Berman A, Fabisiak M, Domagala P, Zmudzka M, Kieszek R, Perkowska-Ptasinska A, Sabat M, Pawelec K, Kownacki L, Piotrowska-Kownacka D, Ostrowski K, Januchta M, Klucinski W, Rowinski O, Kwiatkowski A, Chmura A. TransEndoscopic Gastric SubMucosa Islet Transplantation (eGSM-ITx) in pigs with streptozotocine induced diabetes - technical aspects of the procedure - preliminary report. Ann Transplant 2009; 14:45-50. [PMID: 19487794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Accepted: 04/15/2009] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Islets and pancreas transplantation have become standard treatments of patients with diabetic complications. However pancreas transplantation is associated with high incidence of complications and the long-term results of islet transplantation are still unsatisfactory. Loss of pancreatic islets grafts is caused not only by immunological reactions but also due to the site of grafting and IBMIR. Gastric submucosal space could be an alternative site for transplantation. The aim of this study was to assess the possibility of endoscopic islets transplantation into the gastric submucosa-its efficacy and potential complications.<br /> MATERIAL/METHOD 20 Landrace pigs weighing 19-24 kg were obtained for the study. Seven animals were controls (C-group) and 13 formed the transplantation group (TX group). In both groups diabetes was induced by streptozotocine (stz) infusion at a dose of 200 mg/kg. At 7 days post stz infusion pigs of both groups underwent endoscopy-in group C to assess the feasibility of gastroscopic examination under general anaesthesia in pigs with diabetes and to study the influence of basiliximab infusion on pigs, in the Tx-group to perform endoscopic submucosal islet transplantation (eGSM-ITx). Immunosuppression consisted of tacrolimus 0.2 mg/kg and sirolimus 6 mg/m(2). At 7 days post transplantation, control gastroscopy was performed to assess the gastric mucosa and to obtain biopsies for histopathology. 10 to 30 days after eGSM-ITx, magnetic resonance (MRI) scan was performed. Stomach and pancreas were obtained at autopsy for histopathology. Glycemia was assessed twice daily during the experiment. For 10 days after diabetes induction (up to three days after eGSM-ITx) in both groups, insulin was given to reach glycemia between 150-200 mg/dl, after that period insulin was given only when glycemia exceeded 600 mg/dl.<br /> RESULTS There were no differences in insulin requirement and glycemia up to the day of eGSM-ITx between the groups. Tx-group animals received a mean of 6000+/-3170 IEQ/kg. Tx-group animals had a significantly lower insulin requirement and significantly lower mean glycemia since the first day post transplantation. C-group animals all required insulin once daily to keep glycemia below 600 mg/dl. There were no signs of perforation, ulceration or bleeding after eGSM-ITx on gastroscopy and histopathological examination. MRI scans revealed unspecific thickening of gastric wall at sites of islet deposition.<br /> CONCLUSIONS Transendoscopic islets transplantation into gastric submucosa is feasible and a safe procedure in an experimental animal setting. Its potential for clinical application in human subjects needs further studies.<br /> <br /> <br />
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Affiliation(s)
- Michal Wszola
- Department of General and Transplantation Surgery, Warsaw Medical University, Poland.
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Perkowska-Ptasinska A, Glyda M, Paczkowski M, Durlik M. Primary Kidney Allograft Dysfunction Due to Myeloma-Cast Nephropathy: A Case Report. Transplant Proc 2007; 39:1683-4. [PMID: 17580219 DOI: 10.1016/j.transproceed.2007.01.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 01/09/2007] [Accepted: 01/16/2007] [Indexed: 11/22/2022]
Abstract
Cast nephropathy is a rare event among renal transplants, usually associated with multiple myeloma or light chain nephropathy. Herein we have reported primary graft dysfunction early posttransplantation due to cast nephropathy, associated with thrombotic microangiopathy.
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Affiliation(s)
- A Perkowska-Ptasinska
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Warsaw Medical University, Nowogrodzka 59, 02-006 Warsaw, Poland.
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Perkowska-Ptasinska A, Sulikowska-Rowinska A, Pazik J, Komuda-Leszek E, Durlik M. Thrombotic Nephropathy and Pulmonary Hypertension Following Autologous Bone Marrow Transplantation in a Patient With Acute Lymphoblastic Leukemia: Case Report. Transplant Proc 2006; 38:295-6. [PMID: 16504729 DOI: 10.1016/j.transproceed.2005.12.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thrombotic microangiopathy is a severe and life-threatening complication following allogeneic or autologous bone marrow transplantation (BMT). Herein we describe a case of microangiopathic hemolytic anemia with progressive renal failure and pulmonary hypertension subsequent to autologous BMT due to acute lymphoblastic leukemia.
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Affiliation(s)
- A Perkowska-Ptasinska
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Warsaw Medical University, Nowogrodzka 59, 02-006 Warsaw, Poland.
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Deborska-Materkowska D, Sadowska A, Wesolowska A, Perkowska-Ptasinska A, Durlik M. Human herpesvirus 6 variant A infection in renal transplant recipient. Nephrol Dial Transplant 2005; 20:2294. [PMID: 16030042 DOI: 10.1093/ndt/gfh992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Cieciura T, Urbanowicz A, Perkowska-Ptasinska A, Nowacka-Cieciura E, Tronina O, Majchrzak J, Baczkowska T, Matlosz B, Danielewicz R, Nazarewski S, Durlik M. Tubular and Glomerular Proteinuria in Diagnosing Chronic Allograft Nephropathy With Relevance to the Degree of Urinary Albumin Excretion. Transplant Proc 2005; 37:987-90. [PMID: 15848599 DOI: 10.1016/j.transproceed.2005.01.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The diagnosis of chronic allograft nephropathy (CAN) is based on pathological examination according to Banff 97 schema. The aim of the study was to evaluate the usefulness of tubular and glomerular proteinuria for noninvasive recognition of CAN. One hundred and thirty renal allograft recipients (at least 90 days after transplantation) who had undergone diagnostic allograft biopsy were included in the study. Beta2-microglobulin, alpha1-microglobulin, albumin, immunoglobulin G, total protein, and creatinine concentrations were obtained from the second morning urine specimen. Raw data and values calculated per 1 g of creatinine excreted in urine along with time after transplantation, serum creatinine, and its change over a period of 2 months prior to biopsy were taken for analysis. Urine proteins were measured using a nephelometric method. Statistical calculations were performed using MANOVA and stepwise discriminant analysis (SDA). Statistical diagnosis and staging of CAN matched the pathological method in 68% of a preliminary SDA. Therefore patients were divided into normoalbuminuric, microalbuminuric, and macroalbuminuric groups. There was no significant differences between protein excretion, except alpha1-microglobulinuria (CAN 0 vs 2, P = .018; CAN 1 vs 2, P = .041), beta2-microglobulinuria (CAN 0 vs 2, P = .026; CAN 1 vs 2, P = .0033), and total proteinuria (CAN 0 vs 2, P = .042) in the normoalbuminuric group. Nevertheless, diagnoses obtained using SDA were 89%, 91%, and 92% identical to the results of pathological examinations, for normoalbuminuric, microalbuminuric, and macroalbuminuric groups, respectively. In conclusion, tubular and glomerular proteinuria measurements may be useful for a noninvasive CAN diagnosis and staging only with regard to degree of urinary albumin excretion.
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Affiliation(s)
- T Cieciura
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
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Mroz A, Matlosz B, Perkowska-Ptasinska A, Pazik J, Baczkowska T, Durlik M. HISTOPATHOLOGICAL FINDINGS IN RENAL ALLOGRAFT RECIPIENTS WITH BK NEPHROPATHY. Transplantation 2004. [DOI: 10.1097/00007890-200407271-01316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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