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Marzuillo P, Guarino S, Alfiero S, Annicchiarico Petruzzelli L, Arenella M, Baccelli F, Brugnara M, Corrado C, Delcaro G, Di Sessa A, Gallotta G, Lanari M, Lorenzi M, Malgieri G, Miraglia Del Giudice E, Pecoraro C, Pennesi M, Picassi S, Pierantoni L, Puccio G, Scozzola F, Taroni F, Tosolini C, Venditto L, Pasini A, La Scola C, Montini G. Acute kidney injury in children hospitalised for febrile urinary tract infection. Acta Paediatr 2024. [PMID: 38641985 DOI: 10.1111/apa.17247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/05/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIM To determine (i) prevalence and the risk factors for acute kidney injury (AKI) in children hospitalised for febrile urinary tract infection (fUTI) and (ii) role of AKI as indicator of an underlying VUR. AKI, in fact, is favoured by a reduced nephron mass, often associated to VUR. METHODS This retrospective Italian multicentre study enrolled children aged 18 years or younger (median age = 0.5 years) discharged with a primary diagnosis of fUTI. AKI was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. RESULTS Of 849 children hospitalised for fUTI (44.2% females, median age 0.5 years; IQR = 1.8), 124 (14.6%) developed AKI. AKI prevalence rose to 30% in the presence of underlying congenital anomalies of the kidney and urinary tract (CAKUT). The strongest AKI predictors were presence of CAKUT (OR = 7.5; 95%CI: 3.8-15.2; p = 9.4e-09) and neutrophils levels (OR = 1.13; 95%CI: 1.08-1.2; p = 6.8e-07). At multiple logistic regression analysis, AKI during fUTI episode was a significant indicator of VUR (OR = 3.4; 95%CI: 1.7-6.9; p = 0.001) despite correction for the diagnostic covariates usually used to assess the risk of VUR after the first fUTI episode. Moreover, AKI showed the best positive likelihood ratio, positive predictive value, negative predictive value and specificity for VUR. CONCLUSION AKI occurs in 14.6% of children hospitalised for fUTI and is a significant indicator of VUR.
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Affiliation(s)
- Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Alfiero
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Mattia Arenella
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Baccelli
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Ciro Corrado
- Pediatric Nephrology, "G. Di Cristina" Hospital, Palermo, Italy
| | - Giulia Delcaro
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia Gallotta
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Maya Lorenzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Gabriele Malgieri
- Pediatric Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy
| | - Marco Pennesi
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Sara Picassi
- Pediatria C, Ospedale Donna Bambino, Verona, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giuseppe Puccio
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Di Milano, Milano, Italy
| | | | - Laura Venditto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Andrea Pasini
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Claudio La Scola
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Di Milano, Milano, Italy
- Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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2
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Barbour SJ, Coppo R, Er L, Pillebout E, Russo ML, Alpers CE, Fogo AB, Ferrario F, Jennette JC, Roberts IS, Cook HT, Ding J, Su B, Zhong X, Fervenza FC, Zand L, Peruzzi L, Lucchetti L, Katafuchi R, Shima Y, Yoshikawa N, Ichikawa D, Suzuki Y, Murer L, Wyatt RJ, Park C, Nelson RD, Narus JH, Wenderfer S, Geetha D, Daugas E, Monteiro RC, Nakatani S, Mastrangelo A, Nuutinen M, Koskela M, Weber LT, Hackl A, Pohl M, Pecoraro C, Tsuboi N, Yokoo T, Takafumi I, Fujimoto S, Conti G, Santoro D, Materassi M, Zhang H, Shi S, Liu ZH, Tesar V, Maixnerova D, Avila-Casado C, Bajema I, Barreca A, Becker JU, Comstock JM, Cornea V, Eldin K, Hernandez LH, Hou J, Joh K, Lin M, Messias N, Muda AO, Pagni F, Diomedi-Camassei F, Tokola H, D'Armiento M, Seidl M, Rosenberg A, Sannier A, Soares MF, Wang S, Zeng C, Haas M. Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis. Clin J Am Soc Nephrol 2024; 19:438-451. [PMID: 38261310 PMCID: PMC11020428 DOI: 10.2215/cjn.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Nephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts. METHODS Biopsies from 262 children and 99 adults with IgA vasculitis nephritis ( N =361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients ( N =309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. RESULTS M, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N =91) and another with stable eGFR (class 2, N =218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2. CONCLUSIONS Kidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification.
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Affiliation(s)
- Sean J. Barbour
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Renal, Vancouver, British Columbia, Canada
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Lee Er
- BC Renal, Vancouver, British Columbia, Canada
| | | | - Maria Luisa Russo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Charles E. Alpers
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington
| | - Agnes B. Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Franco Ferrario
- Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy
| | - J. Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ian S.D. Roberts
- Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom
| | | | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Baige Su
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | | | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute della Scienza di Torino, Turin, Italy
| | - Laura Lucchetti
- Division of Nephrology, Bambino Gesù Children's Hospital–IRCCS, Rome, Italy
| | - Ritsuko Katafuchi
- Kidney Unit, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Norishige Yoshikawa
- Clinical Research Center, Takatsuki General Hospital, Wakayam Medical University, Takatsuki City, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Luisa Murer
- Pediatric Nephrology Dialysis and Transplant Unit, Department of Women's and Child's Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | - Robert J. Wyatt
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Catherine Park
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Raoul D. Nelson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - JoAnn H. Narus
- Pediatrics Clinical Trials Office, University of Utah, Salt Lake City, Utah
| | - Scott Wenderfer
- Division of Pediatric Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Texas Children's Hospital, Houston, Texas
| | - Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Daugas
- Nephrology, Bichat Hospital, AP-HP, Paris, France
- INSERM U1149 and Université Paris Cité, Paris, France
| | - Renato C. Monteiro
- Centre for Research on Inflammation, Bichat Hospital, Inserm and Université Paris Cité, Paris, France
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCC Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Mikael Koskela
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lutz T. Weber
- Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Agnes Hackl
- Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Martin Pohl
- Medical Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carmine Pecoraro
- Comitato Tecnico Scientifico per la Ricerca e Innovaziione, A.O. Santobono-Pausilipon, Naples, Italy
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Department of Nephrology and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Ito Takafumi
- Kidney Center, Department of Internal Medicine, Nephrology, Teikyo University School of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Shouichi Fujimoto
- Division of Dialysis, Department of Nephrology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU Policlinic G Martino, University of Messina, Messina, Italy
| | - Domenico Santoro
- Nephrology and Dialysis Unit AOU, G. Martino, University of Messina, Messina, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Sufang Shi
- Kidney Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Dita Maixnerova
- Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | | | - Ingeborg Bajema
- Department of Pathology and Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Antonella Barreca
- Pathology Unit, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy
| | - Jan U. Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Virgilius Cornea
- Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky
| | - Karen Eldin
- Department of Pathology, Mass General Brigham, Salem Hospital, Salem, Massachusetts
| | | | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kensuke Joh
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mercury Lin
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nidia Messias
- Department of Pathology, Washington University in Saint Louis, St. Louis, Missouri
| | | | - Fabio Pagni
- Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy
| | | | - Heikki Tokola
- Pathology, University Oulu and Oulu University Hospital, Oulu, Finland
| | - Maria D'Armiento
- Pathology Section, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maximilian Seidl
- Medical Center-University of Freiburg and Faculty of Medicine, Institute for Surgical Pathology, University of Freiburg, Freiburg, Germany
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aurélie Sannier
- Department of Pathology, AP-HP, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Maria Fernanda Soares
- Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Pecoraro C, Fioretti T, Perruno A, Klain A, Cioffi D, Ambrosio A, Passaro D, Annicchiarico Petruzzelli L, Di Domenico C, de Girolamo D, Vallone S, Cattaneo F, Ammendola R, Esposito G. De Novo Large Deletions in the PHEX Gene Caused X-Linked Hypophosphataemic Rickets in Two Italian Female Infants Successfully Treated with Burosumab. Diagnostics (Basel) 2023; 13:2552. [PMID: 37568915 PMCID: PMC10417872 DOI: 10.3390/diagnostics13152552] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/10/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Pathogenic variants in the PHEX gene cause rare and severe X-linked dominant hypophosphataemia (XLH), a form of heritable hypophosphatemic rickets (HR) characterized by renal phosphate wasting and elevated fibroblast growth factor 23 (FGF23) levels. Burosumab, the approved human monoclonal anti-FGF23 antibody, is the treatment of choice for XLH. The genetic and phenotypic heterogeneity of HR often delays XLH diagnoses, with critical effects on disease course and therapy. We herein report the clinical and genetic features of two Italian female infants with sporadic HR who successfully responded to burosumab. Their diagnoses were based on clinical and laboratory findings and physical examinations. Next-generation sequencing (NGS) of the genes associated with inherited HR and multiple ligation probe amplification (MLPA) analysis of the PHEX and FGF23 genes were performed. While a conventional analysis of the NGS data did not reveal pathogenic or likely pathogenic small nucleotide variants (SNVs) in the known HR-related genes, a quantitative analysis identified two different heterozygous de novo large intragenic deletions in PHEX, and this was confirmed by MLPA. Our molecular data indicated that deletions in the PHEX gene can be the cause of a significant fraction of XLH; hence, their presence should be evaluated in SNV-negative female patients. Our patients successfully responded to burosumab, demonstrating the efficacy of this drug in the treatment of XLH. In conclusion, the execution of a phenotype-oriented genetic test, guided by known types of variants, including the rarest ones, was crucial to reach the definitive diagnoses and ensure our patients of long-term therapy administration.
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Affiliation(s)
- Carmine Pecoraro
- Paediatric Nephrology, Dialysis and Renal Transplantation Unit, Santobono Pausilipon Children’s Hospital, 80129 Naples, Italy;
| | - Tiziana Fioretti
- CEINGE—Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy; (T.F.); (A.A.); (D.P.); (C.D.D.); (D.d.G.)
| | - Assunta Perruno
- Primary Care Pediatrician, ASL NA2 North, 80027 Naples, Italy;
| | - Antonella Klain
- Pediatric Endocrinology Unit, Santobono Pausilipon Children’s Hospital, 80129 Naples, Italy; (A.K.); (D.C.)
| | - Daniela Cioffi
- Pediatric Endocrinology Unit, Santobono Pausilipon Children’s Hospital, 80129 Naples, Italy; (A.K.); (D.C.)
| | - Adelaide Ambrosio
- CEINGE—Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy; (T.F.); (A.A.); (D.P.); (C.D.D.); (D.d.G.)
| | - Diego Passaro
- CEINGE—Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy; (T.F.); (A.A.); (D.P.); (C.D.D.); (D.d.G.)
| | - Luigi Annicchiarico Petruzzelli
- Paediatric Nephrology, Dialysis and Renal Transplantation Unit, Santobono Pausilipon Children’s Hospital, 80129 Naples, Italy;
| | - Carmela Di Domenico
- CEINGE—Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy; (T.F.); (A.A.); (D.P.); (C.D.D.); (D.d.G.)
| | - Domenico de Girolamo
- CEINGE—Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy; (T.F.); (A.A.); (D.P.); (C.D.D.); (D.d.G.)
| | - Sabrina Vallone
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy; (S.V.); (F.C.); (R.A.)
| | - Fabio Cattaneo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy; (S.V.); (F.C.); (R.A.)
| | - Rosario Ammendola
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy; (S.V.); (F.C.); (R.A.)
| | - Gabriella Esposito
- CEINGE—Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy; (T.F.); (A.A.); (D.P.); (C.D.D.); (D.d.G.)
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy; (S.V.); (F.C.); (R.A.)
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4
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Marlais M, Wlodkowski T, Printza N, Kronsteiner D, Krisam R, Sauer L, Aksenova M, Ashoor I, Awan A, Bacchetta J, Balasubramanian R, Basu B, Bekassy Z, Boyer O, Chan EYH, Csaicsich D, Decramer S, Dorresteijn E, Drozynska-Duklas M, Eid LA, Espinosa L, Ferraris V, Flögelová H, Forero-Delgadillo J, Gianviti A, Gracchi V, González ML, Hansen M, Hattori M, Hong X, Hooman N, Ivanov D, Kang HG, Karava V, Kazyra I, Lungu A, Marks S, Maxted A, Moczulska A, Müller R, Nastausheva T, Parolin M, Pecoraro C, Principi I, Sanchez-Kazi C, Saygili S, Schild R, Shenoy M, Sinha R, Spizzirri AP, Stack M, Szczepanska M, Tsygin A, Tzeng J, Urbonas V, Zapata C, Zieg J, Schaefer F, Vivarelli M, Tullus K. Clinical Factors and Adverse Kidney Outcomes in Children With Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Am J Kidney Dis 2023; 81:119-122. [PMID: 35810826 DOI: 10.1053/j.ajkd.2022.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/18/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Tanja Wlodkowski
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nikoleta Printza
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Regina Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Lukas Sauer
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Marina Aksenova
- Y. Veltischev Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Isa Ashoor
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Atif Awan
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Biswanath Basu
- Department of Pediatrics, N. R. S. Medical College & Hospital, Kolkata, India
| | | | - Olivia Boyer
- Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Paris University, Necker Hospital, APHP, Paris, France
| | | | - Dagmar Csaicsich
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria
| | - Stéphane Decramer
- Pediatric Nephrology and Internal Medicine, CHU Purpan, Toulouse, France
| | | | | | - Loai Akram Eid
- Pediatric Nephrology, Dubai Medical College & Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Laura Espinosa
- Paediatric Nephrology Department, University Hospital La Paz, Madrid, Spain
| | | | - Hana Flögelová
- Department of Paediatrics, Faculty of Medicine, Palacky University, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | | | | | - Valentina Gracchi
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Beatrix Children's Hospital, Groningen, The Netherlands
| | | | - Matthias Hansen
- KfH Kidney Center for Children and Adolescents, Frankfurt, Germany
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Xu Hong
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Nakysa Hooman
- Aliasghar Children's Hospital, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Dmytro Ivanov
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Vasiliki Karava
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ina Kazyra
- Belarus State Medical University, Minsk, Belarus
| | - Adrian Lungu
- Pediatric Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Stephen Marks
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Andrew Maxted
- Nottingham Children's Hospital Renal and Urology Unit, Nottingham, United Kingdom
| | - Anna Moczulska
- Jagiellonian University Medical College of Krakow, Krakow, Poland
| | - Rebekka Müller
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mattia Parolin
- Pediatric Nephrology, Dialysis and Transplantation Unit, Woman's and Child's Health Department, University Hospital of Padova, Padova, Italy
| | | | - Iliana Principi
- Department of Nephrology, Hospital Pediátrico Humberto J Notti, Mendoza, Argentina
| | | | - Seha Saygili
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Raphael Schild
- Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Ana Paula Spizzirri
- Nephrology Department, Hospital de Niños "Superiora Sor Maria Ludovica," La Plata, Argentina
| | - Maria Stack
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Alexey Tsygin
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland; National Medical Research Center for Children's Health, Moscow, Russia
| | - Julia Tzeng
- Valley Children's Healthcare, Madera, California
| | - Vaidotas Urbonas
- Vilnius University Clinic for Children's Diseases, Vilnius, Lithuania
| | - Carlos Zapata
- Hospital Infantil Universitario "Rafael Henao Toro," Manizales, Colombia
| | - Jakub Zieg
- Department of Paediatrics, Second Medical Faculty, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Kjell Tullus
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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5
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Annicchiarico Petruzzelli L, Minale B, Serio V, De Luca A, Marino Marsilia G, Campione S, Diomedi Camassei F, D'Arcangelo R, Luongo I, Lepore L, Giannattasio P, Molino D, Pirro L, Lonardo MC, Malgieri G, Pecoraro C. Pediatric Minimal Change Disease and AKI following the Pfizer-BioNTech COVID-19 Vaccine: causal or incidental correlation? G Ital Nefrol 2022; 39:39-06-2022-04. [PMID: 36655832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The global coronavirus 2019 (COVID-19) pandemic required vaccination even in children to reduce infection. We report on the development of acute kidney injury (AKI) and minimal change disease (MCD) nephrotic syndrome (NS), shortly after the first injection BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). A 12-year-old previously healthy boy was referred to our hospital with complaints of peripheral edema and nephrotic range proteinuria. Nine days earlier he had received his first injection BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). Seven days after injection, he developed leg edema, which rapidly progressed to anasarca with significant weight gain. On admission, serum creatinine was 1.3 mg/dL and 24-hour urinary protein excretion was 4 grams with fluid overload. As kidney function continued to decline over the next days, empirical steroid treatment and renal replacement therapy with ultrafiltration were started and kidney biopsy was performed. Seven days after steroid therapy, kidney function began to improve, gradually returning to normal. The association of MCD, nephrotic syndrome and AKI hasn't been previously described following the Pfizer-BioNTech COVID-19 vaccine in pediatric population, but this triad has been reported in adults. We need further similar case reports to establish the real incidence of this possible vaccine side effect.
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Affiliation(s)
| | - Bruno Minale
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Vittorio Serio
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Angela De Luca
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | | | - Severo Campione
- Section of Pathology, Antonio Cardarelli Hospital, Naples, Italy
| | | | - Rosamunda D'Arcangelo
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Ilaria Luongo
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Lorenza Lepore
- Emergency department, Antonio Cardarelli Hospital, Naples, Italy
| | - Paolo Giannattasio
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Daniela Molino
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Laura Pirro
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Maria Concetta Lonardo
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Gabriele Malgieri
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Carmine Pecoraro
- Paediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy
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6
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Pedoto D, DE Gregorio F, Tosco A, Pecoraro C, D'Armiento M, Raia V. Renal involvement in cystic fibrosis: is it a contraindication to transplant? Minerva Pediatr (Torino) 2022; 74:610-612. [PMID: 31621279 DOI: 10.23736/s2724-5276.19.05681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Deianira Pedoto
- Regional Cystic Fibrosis Center, Pediatric Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy -
| | - Fabiola DE Gregorio
- Regional Cystic Fibrosis Center, Pediatric Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonella Tosco
- Regional Cystic Fibrosis Center, Pediatric Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmine Pecoraro
- Nephrology Section, Santobono Children's Hospital, Naples, Italy
| | - Maria D'Armiento
- Section of Pathology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Raia
- Regional Cystic Fibrosis Center, Pediatric Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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7
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Morello W, Mastrangelo A, Guzzo I, Cusinato L, Petruzzelli L, Benvenuta C, Martelli L, Dall'Amico R, Vianello FA, Puccio G, Massella L, Benetti E, Pecoraro C, Peruzzi L, Montini G. Prevalence of SARS-CoV-2-IgG Antibodies in Children with CKD or Immunosuppression. Clin J Am Soc Nephrol 2021; 16:1097-1099. [PMID: 34099499 PMCID: PMC8425622 DOI: 10.2215/cjn.00330121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022]
Affiliation(s)
- William Morello
- W Morello, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Antonio Mastrangelo
- A Mastrangelo, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Isabella Guzzo
- I Guzzo, Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lisa Cusinato
- L Cusinato, Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luigi Petruzzelli
- L Petruzzelli, Pediatric Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy
| | - Chiara Benvenuta
- C Benvenuta, Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laura Martelli
- L Martelli, Paediatric Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto Dall'Amico
- R Dall'Amico, Department of Pediatrics, Azienda per l'Assistenza Sanitaria n 5 Friuli Occidentale, Pordenone, Italy
| | - Federica Alessandra Vianello
- F Vianello, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Puccio
- G Puccio, Department of Sciences for Health Promotion, University of Palermo, Palermo, Italy
| | - Laura Massella
- L Massella, Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elisa Benetti
- E Benetti, Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Carmine Pecoraro
- C Pecoraro, Pediatric Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy
| | - Licia Peruzzi
- L Peruzzi, Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giovanni Montini
- G Montini, Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
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8
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Mastrangelo A, Morello W, Vidal E, Guzzo I, Annicchiarico Petruzzelli L, Benetti E, Materassi M, Giordano M, Pasini A, Corrado C, Puccio G, Chimenz R, Pecoraro C, Massella L, Peruzzi L, Montini G. Impact of COVID-19 Pandemic in Children with CKD or Immunosuppression. Clin J Am Soc Nephrol 2021; 16:449-451. [PMID: 33318026 PMCID: PMC8011005 DOI: 10.2215/cjn.13120820] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Isabella Guzzo
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | | | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
| | - Mario Giordano
- Nephrology Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Ciro Corrado
- Pediatric Nephrology Unit, Children’s Hospital “G. Di Cristina,” Azienda di Rilievo Nazionale ad Alta Specializzazione. “Civico,” Palermo, Italy
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion, University of Palermo, Palermo, Italy
| | - Roberto Chimenz
- Pediatric Nephrology and Rheumatology Unit with Dialysis, Azienda Opedaliero-Universitaria G. Martino, Messina, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology and Dialysis Unit, Santobono Children’s Hospital, Naples, Italy
| | - Laura Massella
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children’s Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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9
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Iafusco F, Meola S, Pecoraro C, Mazzaccara C, Iafusco D, Tinto N. Prenatal diagnosis of HNF1b mutation allows recognition of neonatal dysglycemia. Acta Diabetol 2021; 58:393-395. [PMID: 33259036 PMCID: PMC7906928 DOI: 10.1007/s00592-020-01641-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Fernanda Iafusco
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy
- CEINGE Advanced Biotechnology, Naples, Italy
| | - Serena Meola
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy
- CEINGE Advanced Biotechnology, Naples, Italy
| | | | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy
- CEINGE Advanced Biotechnology, Naples, Italy
| | - Dario Iafusco
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy.
- CEINGE Advanced Biotechnology, Naples, Italy.
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10
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Parasole R, Stellato P, Conter V, De Matteo A, D'Amato L, Colombini A, Pecoraro C, Bencivenga C, Raimondo M, Silvestri S, Tipo V, Annicchiarico Petruzzelli L, Giagnuolo G, Curatolo A, Biondi A, Menna G. Collateral effects of COVID-19 pandemic in pediatric hematooncology: Fatalities caused by diagnostic delay. Pediatr Blood Cancer 2020; 67:e28482. [PMID: 32525616 PMCID: PMC7300556 DOI: 10.1002/pbc.28482] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Rosanna Parasole
- Department of Pediatric Hemato‐OncologySantobono‐Pausilipon HospitalNaplesItaly
| | - Pio Stellato
- Department of Pediatric Hemato‐OncologySantobono‐Pausilipon HospitalNaplesItaly
| | - Valentino Conter
- Pediatric Hemato‐OncologyUniversity of Milano‐BicoccaFondazione MBBM/Hospital San GerardoMonzaItaly
| | - Antonia De Matteo
- Department of Pediatric Hemato‐OncologySantobono‐Pausilipon HospitalNaplesItaly
| | - Luigia D'Amato
- Intensive Care UnitSantobono‐Pausilipon HospitalNaplesItaly
| | - Antonella Colombini
- Pediatric Hemato‐OncologyUniversity of Milano‐BicoccaFondazione MBBM/Hospital San GerardoMonzaItaly
| | | | | | - Marta Raimondo
- Department of Pediatric Hemato‐OncologySantobono‐Pausilipon HospitalNaplesItaly
| | | | - Vincenzo Tipo
- Emergency UnitSantobono‐Pausilipon HospitalNaplesItaly
| | | | - Giovanna Giagnuolo
- Department of Pediatric Hemato‐OncologySantobono‐Pausilipon HospitalNaplesItaly
| | | | - Andrea Biondi
- Pediatric Hemato‐OncologyUniversity of Milano‐BicoccaFondazione MBBM/Hospital San GerardoMonzaItaly
| | - Giuseppe Menna
- Department of Pediatric Hemato‐OncologySantobono‐Pausilipon HospitalNaplesItaly
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11
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Pedoto D, Corcione A, Apuzzo D, Nuzzi F, Annicchiarico Petruzzelli L, Barra G, Malgieri G, Pecoraro C. P1814ATYPICAL FEATURES IN A TYPICAL DISEASE: ONE THOUSANDS FACES OF IGA NEPHROPATHY IN PAEDIATRIC PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1814] [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
Immunoglobulin A Nephropathy (IgAN) is the most common cause of idiopathic glomerulonephritis in paediatric patients.
The typical presentation is characterized by recurrent episodes of macroscopic haematuria or persistent microhaematuria with mild or overt proteinuria. Renal function is normally preserved, though a slow progression to chronic kidney disease (CKD) may occur.
However, in rare cases IgAN may assume atypical features, presenting with nephrotic syndrome (NS), acute kidney injury (AKI) or assuming the characteristic of a rapidly progressive glomerulonephritis, leading to significant difficulties in management and critical impact on prognosis.
Method
Of total 756 renal biopsies performed in our centre from 2000 till 2019, 174 (23%) diagnosis of IgA nephropathy were made: 123 (70,6%) of 174 with a milder histological stage (I or II according to Lee’s) and 51 (29,3%) with severe stages (III-IV).
Clinical onset of these 51 patients was mostly characterized by a nephritic syndrome with micro-macrohaematuria, though in 7 of them it assumed atypical features (table 1).
Results
Patients 1, 2, 3 and 4 showed a rapidly progressive IgAN with extensive crescentic lesions at histological evaluation.
In all of the four patients the onset of the disease was characterised by a compromised renal function, thought, according to the medical history, in patients 2 and 4 clinical signs of nephropathy had started some months before the first medical evaluation.
This detail, considering the poorer clinical outcome of patients 2 and 4 (table 1), strongly highlights the need of promptness in the treatment of these conditions.
Patient 1 achieved a complete remission after steroid pulse therapy (Pozzi scheme), while for patients 2,3,4 an additional immunosuppressive treatment was required.
The nephropathy of patient 5 was, instead, characterized by AKI with consistent macrohaematuria. Interestingly, the severity of the clinical presentation was not related to the glomerular lesion (the histology showed a minimal change disease), rather to the intra-tubular haemorrhage, causing an obstructive acute kidney injury. Patient 5 achieved a complete remission after steroid treatment.
The onset of IgAN in patients 6 and 7 was characterized by a nephrotic syndrome, which is a very uncommon feature (<2% of all IgAN).
Patient 6, who showed a massive proteinuria (till 11 grams/24 hours) was promptly treated with steroid and tacrolimus, achieving a complete remission in 6 moths.
Patient 7, a sri-lankan girl, was diagnosed in 2008 in Sri-Lanka.
She underwent treatment with steroid and Mycophenolate and successively, for the persistence of proteinuria, with Cyclosporine A.
From 2014 she has been followed by our centre. Despite a second cycle with Cyclosporine she has shown a persistence of proteinuria and a slow progression to CKD.
Conclusion
This study highlights that a typical disease like IgAN may hide behind an atypical and severe presentation.
Moreover, the blackboard of the atypical forms is extremely heterogeneous, stretching from NS to crescentic and progressive diseases.
As a consequence, the treatment of these conditions is not codified and represents an important challenge for the clinician.
This calls for multicentric studies which could provide shared recommendation for the management of these atypical forms of IgAN.
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Affiliation(s)
- Deianira Pedoto
- Federico II University, Department of Medical Translational Sciences, Naples, Italy
| | - Adele Corcione
- Federico II University, Department of Medical Translational Sciences, Naples, Italy
| | - Diletta Apuzzo
- Federico II University, Department of Medical Translational Sciences, Naples, Italy
| | - Francesca Nuzzi
- Santobono-Pausilipon Children's Hospital, Paediatric Nephrology Unit, Naples, Italy
| | | | | | - Gabriele Malgieri
- Santobono-Pausilipon Children's Hospital, Paediatric Nephrology Unit, Naples, Italy
| | - Carmine Pecoraro
- Santobono-Pausilipon Children's Hospital, Paediatric Nephrology Unit, Naples, Italy
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Apuzzo D, Annicchiarico Petruzzelli L, Ascione S, Corcione A, Pedoto D, Barra G, Rocco MC, Pecoraro C, Malgieri G. P0165HYPERTENSION IN OVERWEIGHT AND OBESE CHILDREN: IMPACT ASSESMENT OF ABPM PARAMETERS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0165] [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: 11/12/2022] Open
Abstract
Abstract
Background and Aims
We describe the relationship between overweight and obesity and Hypertension on ABPM.
Method
We conducted a cross-sectional study using a database of patients aged 6-16 years, who had undergone 24h ABPM from December 2002 through December 2016. ABPM were performed using the validated device Spacelab 90217. Were evaluated the 24h MAP, daytime MAP, nocturnal MAP, systolic and diastolic load, MAP Systolic and Diastolic. Subjects were grouped by BMI Z-score into overweight (>1<2), obese (BMI Z-score >2<3) and severe obese (BMI Z-score >3). A total of 1016 patients were enrolled and recorded n.1210 ABPMs. Obese pts were 202 (19.8%); 126 M;76F;median age 10,2 y. Overweight childrens were 97 (11.9%);52 M;45F;median age 8,4y.
Results
Among overweight childrens (BMI Z-Score >1<2): 12 (12.3%) had hypertension, 22 (22.6%) pre-hypertension, 15 (15.4%) MH; non dipping pattern was recorded in 26 (52%). 48 were normotensive. Among obese childrens, 122 had hypertension (60.3%): 24 pts had Masked Hypertension (19.6%); 72 (59.0%) had severe ambulatory hypertension with BMI z-score >3 (mean 3.8) ,and in this category all pts were both systolic and diastolic non dipping. 32 (64%) obese with BMI z-score >2, <3 were non-dipping. Diastolic load was significantly higher (p>0,0001) in severe obese. 28 pts had ambulatory prehypertension (13.8%), 11 pts had White Coat Hypertension (4.9%).41 pts had normotension (20.2%).
Conclusion
The severity of ambulatory hypertension increased with increased BMI Z-score. The non-dipping status is associated, not only with higher BMI Z-score, but was present in overweight and obese with BMI z-score >2<3 also. ABPM is an effective tool that should become routine in all obese patient, but also in overweight childrens, which may lead to better treatments and prevention methods.
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Affiliation(s)
- Diletta Apuzzo
- Santobono Childrens Hospital, Pediatric Nephrology, Napoli, Italy
| | | | - Serena Ascione
- Santobono Childrens Hospital, Pediatric Nephrology, Napoli, Italy
| | - Adele Corcione
- Santobono Childrens Hospital, Pediatric Nephrology, Napoli, Italy
| | - Deianira Pedoto
- Santobono Childrens Hospital, Pediatric Nephrology, Napoli, Italy
| | - Giuseppina Barra
- Santobono Childrens Hospital, Pediatric Nephrology, Napoli, Italy
| | | | - Carmine Pecoraro
- Santobono Childrens Hospital, Pediatric Nephrology, Napoli, Italy
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Annicchiarico Petruzzelli L, Serio V, Luongo I, Molino D, Minale B, Lepore L, Ascione S, Lubrano C, Malgieri G, Pecoraro C. P1369ACUTE EXTRACORPOREAL DIALYSIS USING TWO-WAY PICC POWER INJECTABLE IN YOUNG CHILDREN. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1369] [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
Acute extracorporeal dialysis is a short treatment, performed by a central venous catheter of large size, ensuring high flow. These devices have limitations: high caliber, excessive length, impossibility of tunneling and exit-site location in the supraclavicular region, with a subsequent high risk of dislocation and contamination. The authors report a new approach to dialytic central venous catheters selection in children.
Method
From January 2013 to December 2017, 16 children weighing less than 15 kg needed acute extracorporeal dialysis. Patients received an ultrasound guided percutaneous implantation of a two-way PICC power injectable catheter, in the right internal jugular vein or in the anonymous right vein. The device size always respected the ratio of 1/3; the catheters were cut to be adapted to child height, and subclavear tunnelizations and stabilizations were ensured. The hemodialysis was performed with the Prismaflex Gambro system. The effectiveness of treatment was evaluated by recirculation test and by measuring the KT/Vat the third hour, expressing the dialysis adequacy.
Results
Two-way power injectable central venous catheter,sized from 5 to 7 Fr and long from 8 to 15 cm were used. The recorded blood flow ranged from 4.7ml/min/kg to 7ml/min/kg; a KT/V variable from 0.5 to 1 was detected; the recycling rate was between 32% and 40%. No catheter related complications were observed.
Conclusion
In children weighing less than 15 kg, PICC power injectable have lower blood flow and higher recirculation rate compared to traditional dialysis catheters. However, the dialytic adequacy was suitable for an acute hemodialysis treatment. In addition, these catheters are available in a wide range of calibers and result more adaptable to the venous system of younger children.
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Affiliation(s)
| | - Vittorio Serio
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Ilaria Luongo
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Daniela Molino
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Bruno Minale
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Lorenza Lepore
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Serena Ascione
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Carmen Lubrano
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Gabriele Malgieri
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
| | - Carmine Pecoraro
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Nephrology and Dialysis, Napoli, Italy
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Corcione A, Apuzzo D, Pedoto D, Barra G, Annicchiarico Petruzzelli L, Pecoraro C, Malgieri G, Ascione S, Barra P, Pagano A, Lepore L. P1831ABPM DIFFERENCE BETWEEN OBESE AND NON OVERWEIGHT HYPERTENSIVE CHILDREN. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1831] [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
The goal of our study was to analyze the difference in ABPM pattern in overweight and non overweight hypertensive children
Method
The ABPM were performed using Spacelab 90207 and recorded over 24h.Readings were taken every 15 minutes while awake,and every 20 minutes while asleep. In both groups were evaluated the 24h MAP,daytime MAP,nocturnal MAP, systolic and diastolic load,mean 24h SBP and DBP.
A total of 108 pts were enrolled. Pts were divided in two groups.In the first group 54 pts non overweight with primary hypertension:33 male and 21 female with mean age of 10.4 y. In the second group the obese hypertensive children, with mean age of 10.5 y, were divided into two subgroups according to BMI Z-scores:subgroup 1 BMI Z-score >2<3 n 40 pts (17 f;21m); subgroup 2 BMI Z-score >3 n (4f;10m).
Results
Systolic load was significantly higher in obese group (p 0,0409).In obese group n.12 were dipper (22,2%).Obese with BMI zscore >3 was all non dipper (n14 ;100%). In the lean group n 26 was dipper (48.1%),and 28 (51.8%) non dipper. 24 h MAP, Systolic and Diastolic load were significantly higher (p 0,0001) in the obese with BMI z score >3 compared to the lean group.
Conclusion
The statistically significant pathological pattern among obese is the increase inmean PAS and systolic load, as well as the absence of night dipping in severe obese. The increase in systolic load is already evident in obese mild.This gives a significant predictive value of cardiovascular damage to ABPM which increases with the severity of obesity worse.
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Affiliation(s)
- Adele Corcione
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Diletta Apuzzo
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Deianira Pedoto
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Giuseppina Barra
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | | | - Carmine Pecoraro
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Gabriele Malgieri
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Serena Ascione
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Pasquale Barra
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Annamaria Pagano
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
| | - Lorenza Lepore
- A.O.R.N. Santobono-Pausilipon - Ospedale Santobono, Pediatric Nephrology, Napoli, Italy
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Esposito C, Soria-Gondek A, Castagnetti M, Cerulo M, Del Conte F, Esposito G, Pecoraro C, Cicala D, Farina A, Escolino M. Laparoscopic or Robotic Deroofing Guided by Indocyanine Green Fluorescence and Perirenal Fat Tissue Wadding Technique of Pediatric Simple Renal Cysts. J Laparoendosc Adv Surg Tech A 2020; 30:471-476. [PMID: 32175803 DOI: 10.1089/lap.2019.0650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To present the outcomes of the laparoscopic and robotic treatment of pediatric simple renal cysts with two novel modifications: the indocyanine green (ICG) fluorescence and the perirenal fat tissue wadding technique. Methods: Between 2012 and 2019, 13 patients with solitary renal cysts were treated through minimally invasive approach. Preoperative work-up included ultrasonography and computed tomography or magnetic resonance. A cyst deroofing was performed in all cases. In the last 3 cases, the ICG fluorescence technique enabled a clear identification and safe puncture of the cyst dome. Five cysts were filled with perirenal fat tissue after deroofing. Results: Thirteen patients (9 boys) were treated through laparoscopic (6 patients), retroperitoneoscopic (3 patients), or robotic approach (4 patients). Median age was 8 years (5-15 years). The median cyst size was 70 mm (42-160 mm). Eight cysts were located in the right kidney. All cysts were progressive and symptomatic. Thirteen cysts (100%) were graded as type II according to the Bosniak classification. No conversion was recorded. The median operative time for laparoscopy was 50 minutes (35-90 minutes) and 85 minutes for robotics (65-120 minutes) including surgical and docking time. No intraoperative complications occurred. The median hospital stay was 2 days (36-96 hours). No residual liquid was detected on follow-up after deroofing and fat tissue wadding technique. Conclusions: Cyst deroofing is an effective and durable treatment for symptomatic simple renal cysts. Robotics enables excellent tissue dissection and ergonomics. The perirenal fat tissue wadding of the cyst seems to reduce the recurrence rate. The ICG fluorescence technique allows for better identification of the cyst and safer surgical procedure.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Andrea Soria-Gondek
- Pediatric Surgery Unit, Hospital Universitari Germans Trias i Pujol., Badalona, Barcelona, Spain
| | | | - Mariapina Cerulo
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Fulvia Del Conte
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Giovanni Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Carmine Pecoraro
- Pediatric Surgery Unit, Santobono Children Hospital, Naples, Italy
| | - Domenico Cicala
- Pediatric Surgery Unit, Santobono Children Hospital, Naples, Italy
| | - Alessandra Farina
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University Naples, Naples, Italy
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16
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Rinaldi S, Sera F, Verrina E, Edefonti A, Gianoglio B, Perfumo F, Sorino P, Zacchello G, Cutaia I, Lavoratti G, Leozappa G, Pecoraro C, Rizzoni G. Chronic Peritoneal Dialysis Catheters in Children: A Fifteen-year Experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080402400515] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectiveTo analyze data on 503 chronic peritoneal dialysis (CPD) catheters implanted between 1986 and 2000 in pediatric patients enrolled in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (the Registry), comparing three different time periods: 1986 – 1990, 1991 – 1995, and 1996 – 2000.DesignRetrospective study.Setting23 dialysis centers participating in the Registry.MethodsData were collected from questionnaires filled in every year. The information for each peritoneal catheter included type, site and technique of insertion, exit-site orientation, exit-site care, complications, survival, and reason for removal.Patients503 catheters were implanted in 363 pediatric patients aged younger than 15 years at the start of CPD: 97 catheters in patients under 2 years of age, 67 in patients aged 2 – 5 years, and 339 in patients over 5 years of age. Mean patient age at onset of CPD was 8.0 ± 5.1 years. All catheters were surgically implanted and omentectomy was performed in 82.4% of cases. The catheters used were Tenckhoff [468 (93.0%): 443 double cuff, 25 single cuff] and double-cuffed Valli [35 (7.0%)]. The entry site was in the midline in 153 cases (30.4%) and paramedian in 350 (69.6%).ResultsDuring 9048 dialysis-months we observed 451 catheter-related complications, yielding an incidence of 1 episode/20.1 CPD-months: 330 catheter infections (exit-site and/or tunnel infections), 26 leakages, 26 dislocations, 24 obstructions, 22 cuff extrusions, 6 hemoperitoneums, 17 others. 171 catheters were removed due to catheter-related causes; exit-site and/or tunnel infections were the main cause for removal (75.4%), followed by obstruction, dislocation, outer-cuff extrusion, and leakage. Younger children (< 2 years) had a higher risk of infectious causes of catheter removal compared to children aged 2 – 5 years ( p = 0.004) and over 5 years of age ( p = 0.002). During the 15-year observation period, a significant reduction in the incidence of leakage was observed and risk of leakage was lower in catheters with paramedian entry site compared to catheters with midline entry site. Removal and replacement of peritoneal catheters during the same surgical operation was performed in 76.3% of catheter removals. Catheter survival rate was 78.1% at 12 months, 58.5% at 24 months, 43.8% at 36 months, and 34.6% at 48 months. No difference in catheter survival was observed in younger children (< 2 years) compared with the two other age groups: < 2 years versus 2 – 5 years hazard ratio 0.7, 95% confidence interval (95%CI) 0.4 – 1.2; < 2 years versus > 5 years hazard ratio 0.8, 95%CI 0.5 – 1.1.ConclusionsIn this survey, we observed better catheter survival in comparison with data reported by the Registry in 1998. Catheter survival improved especially in younger children (< 2 years), a group that previously had a decreased catheter survival rate compared to older age groups. In addition to the progressive increase in experience acquired by dialysis centers, this upward trend may also be related to greater use of double-cuffed catheters, with paramedian exit site, and a higher frequency of omentectomy.
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Affiliation(s)
- Stefano Rinaldi
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Francesco Sera
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Enrico Verrina
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Alberto Edefonti
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | - Bruno Gianoglio
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | | | - Palma Sorino
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | | | - Ignazio Cutaia
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
| | | | | | - Carmine Pecoraro
- Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy
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17
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Cappa M, Maghnie M, Carbone V, Chioma L, Errichiello C, Giavoli C, Giordano M, Guazzarotti L, Klain A, Montini G, Murer L, Parpagnoli M, Pecoraro C, Pesce S, Verrina E. Summary of Expert Opinion on the Management of Children With Chronic Kidney Disease and Growth Failure With Human Growth Hormone. Front Endocrinol (Lausanne) 2020; 11:587. [PMID: 33013690 PMCID: PMC7493742 DOI: 10.3389/fendo.2020.00587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The management of children and adolescents with chronic kidney disease (CKD) and growth failure candidate for recombinant human growth hormone therapy (rhGH) is based on an appraisal of the literature established on a 2006 consensus statement and 2019 Clinical practice recommendations. The performance of these guidelines has never been tested. Aims: The objective of this study was to establish the level of adherence to international guidelines based on the 2006 consensus and the 2019 criteria that lead to the initiation of growth hormone treatment by both pediatric endocrinologists and pediatric nephrologists. Methods: A multidisciplinary team of pediatric endocrinologists and pediatric nephrologists, members of the Italian Society of Pediatric Endocrinology or of the Italian Society of Pediatric Nephrology, discussed and reviewed the main issues related to the management of pediatric patients with CKD who need treatment with rhGH. Experts developed 11 questions focusing on risk assessment and decision makings in October 2019 and a survey was sent to forty pediatric endocrinologists (n = 20) and nephrologists (n = 20) covering the whole national territory. The results were then analyzed and discussed in light of current clinical practice guidelines and recent recommendations. Results: Responses were received from 32 of the 40 invited specialists, 17 of whom were pediatric endocrinologists (42.5%) and 15 pediatric nephrologists (37.5%). Although all the centers that participated in the survey agreed to follow the clinical and biochemical diagnostic work-up and the criteria for the treatment of patients with CKD, among the Italian centers there was a wide variety of decision-making processes. Conclusions: Despite current guidelines for the management of children with CKD and growth failure, its use varies widely between centers and rhGH is prescribed in a relatively small number of patients and rarely after kidney transplantation. Several raised issues are not taken into account by international guidelines and a multidisciplinary approach with mutual collaboration between specialists will improve patient care based on their unmet needs.
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Affiliation(s)
- Marco Cappa
- Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- *Correspondence: Marco Cappa
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Mohamad Maghnie
| | - Vincenza Carbone
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII”, Bari, Italy
| | - Laura Chioma
- Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Claudia Giavoli
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mario Giordano
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII”, Bari, Italy
| | - Laura Guazzarotti
- Pediatric Endocrinology and Auxology, Adolescence Unit - Department of Women's and Children's Health, Pediatric Department - Padua University Hospital, Padua, Italy
| | - Antonella Klain
- Pediatric Endocrinology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman's and Child's Health, Azienda Ospedaliera –University of Padova, Padua, Italy
| | - Maria Parpagnoli
- Auxo-Endocrinology and Gynecology Meyer Children's University Hospital, Florence, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology and Dialysis Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - Sabino Pesce
- Pediatric Endocrinology and Metabolic Diseases, Pediatric Hospital “Giovanni XXIII”, Bari, Italy
| | - Enrico Verrina
- Unit of Dialysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Enrico Verrina
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18
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Pedoto D, De Gregorio F, Tosco A, Pecoraro C, D'armiento M, Raia V. Renal involvement in cystic fibrosis: is it a contraindication to transplant? Minerva Pediatr 2019. [PMID: 31621279 DOI: 10.23736/s0026-4946.19.05681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Deianira Pedoto
- Paediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Centre, University of Naples Federico II, Naples, Italy - 2
| | - Fabiola De Gregorio
- Paediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Centre, University of Naples Federico II, Naples, Italy
| | - Antonella Tosco
- Paediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Centre, University of Naples Federico II, Naples, Italy
| | - Carmine Pecoraro
- Nephrology Section, Santobono Children's Hospital, Naples, Italy
| | - Maria D'armiento
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Raia
- Paediatric Unit, Department of Translational Medical Sciences, Regional Cystic Fibrosis Centre, University of Naples Federico II, Naples, Italy
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19
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Naddei R, Bruno V, Martemucci L, Pecoraro C, Di Nardo G. Shiga Toxin Producing Escherichia coli-Hemolytic Uremic Syndrome Mimicking Acute Severe Ulcerative Colitis in a Child With Bloody Diarrhea. Inflamm Bowel Dis 2019; 25:e92-e93. [PMID: 30934058 DOI: 10.1093/ibd/izz058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Roberta Naddei
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II," Naples, Italy
| | - Valentina Bruno
- Pediatric Nephrology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
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20
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Annicchiarico Petruzzelli L, Ascione S, Bruno V, Ferretti A, De Luca A, Malgieri G, Scavia G, Bresin E, Noris M, Pecoraro C. FP818Typical hemolytic uremic syndrome cohort screened for genetic complement abnormalities. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Serena Ascione
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | - Valentina Bruno
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | - Alfonso Ferretti
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | - Angela De Luca
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | - Gabriele Malgieri
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | | | | | | | - Carmine Pecoraro
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
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21
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Ascione S, Bruno V, Annicchiarico Petruzzelli L, Malgieri G, Nuzzi F, Pecoraro C. FP811Acute post-infectious glomerulonephritis: behind the mask. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Valentina Bruno
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | | | - Gabriele Malgieri
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | - Francesca Nuzzi
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
| | - Carmine Pecoraro
- Nephrology and Dialysis Unit, Santobono Children Hospital, Naples, Metropolitan City of Naples, Italy, Italy
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22
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Bruno V, Riedl M, Teoh CW, Pecoraro C, Licht C. SP022IMPAIRED ENDOTHELIAL CELL MIGRATION: NEW INSIGHTS INTO THE MECHANISMS OF COMPLEMENT-MEDIATED ENDOTHELIAL CELL INJURY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Galbusera M, Noris M, Gastoldi S, Bresin E, Mele C, Breno M, Cuccarolo P, Alberti M, Valoti E, Piras R, Donadelli R, Vivarelli M, Murer L, Pecoraro C, Ferrari E, Perna A, Benigni A, Portalupi V, Remuzzi G. An Ex Vivo Test of Complement Activation on Endothelium for Individualized Eculizumab Therapy in Hemolytic Uremic Syndrome. Am J Kidney Dis 2019; 74:56-72. [PMID: 30851964 DOI: 10.1053/j.ajkd.2018.11.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 03/12/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
RATIONALE & OBJECTIVE Although primary atypical hemolytic uremic syndrome (aHUS) is associated with abnormalities in complement genes and antibodies to complement factor H, the role of complement in secondary aHUS remains debatable. We evaluated the usefulness of an ex vivo test to: (1) detect complement activation within the endothelium in primary and secondary aHUS, (2) differentiate active disease from remission, (3) monitor the effectiveness of eculizumab therapy, and (4) identify relapses during eculizumab dosage tapering and after discontinuation of treatment. STUDY DESIGN Case series. SETTING & PARTICIPANTS 121 patients with primary aHUS and 28 with secondary aHUS. Serum samples were collected during acute episodes, following remission, and during eculizumab treatment and were assessed using a serum-induced ex vivo C5b-9 endothelial deposition test. RESULTS Serum-induced C5b-9 deposition on cultured microvascular endothelium was quantified by calculating the endothelial area covered by C5b-9 staining; values were expressed as percentage of C5b-9 deposits induced by a serum pool from healthy controls. Testing with adenosine diphosphate-activated endothelium demonstrated elevated C5b-9 deposits for all untreated patients with aHUS independent of disease activity, while testing with unstimulated endothelium demonstrated deposits only in active disease. Similar findings were observed in secondary aHUS. Serum-induced C5b-9 deposits on activated and unstimulated endothelium normalized during eculizumab treatment. 96% (22/23) of patients receiving eculizumab at extended 3- or 4-week dosing intervals demonstrated normal C5b-9 deposits on activated endothelium, despite most patients having CH50Eq (serum complement activity) > 20 UEq/mL, indicating that adequate complement control was achieved even with incomplete blockade of circulating C5. During eculizumab dosage tapering or after treatment discontinuation, all patients experiencing relapses versus only 6% (1/17) of those in stable remission had elevated C5b-9 deposits on unstimulated endothelium. LIMITATIONS The C5b-9 endothelial deposition test can be performed in only specialized laboratories. Findings on eculizumab dosage tapering need to be confirmed with longitudinal monitoring of C5b-9 deposition. CONCLUSIONS The C5b-9 endothelial deposition assay may represent an advance in our ability to monitor aHUS activity and individualize therapy.
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Affiliation(s)
- Miriam Galbusera
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Marina Noris
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy.
| | - Sara Gastoldi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Elena Bresin
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Caterina Mele
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Matteo Breno
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Paola Cuccarolo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Marta Alberti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Elisabetta Valoti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Rossella Piras
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Roberta Donadelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Luisa Murer
- Unit of Pediatric Nephrology, Dialysis and Transplantation, Azienda Ospedaliera di Padova, Padua, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - Elisa Ferrari
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Annalisa Perna
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Ariela Benigni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Valentina Portalupi
- Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò and Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy; Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy; L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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24
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Daga S, Fallerini C, Furini S, Pecoraro C, Scolari F, Ariani F, Bruttini M, Mencarelli MA, Mari F, Renieri A, Pinto AM. Non-collagen genes role in digenic Alport syndrome. BMC Nephrol 2019; 20:70. [PMID: 30808327 PMCID: PMC6391820 DOI: 10.1186/s12882-019-1258-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/05/2018] [Accepted: 02/18/2019] [Indexed: 02/04/2023] Open
Abstract
Background Alport syndrome is a clinically heterogeneous nephropathy characterized by severe symptomatology at kidney level due to ultrastructural lesions of the glomerular basement membrane (GBM) as consequence of mutations in COL4 genes. The disease has been linked to COL4A3/COL4A4/COL4A5 mutations, which impair GBM functionality and can be inherited in a dominant, recessive or X-linked transmission. Although a targeted Next Generation Sequencing approach has allowed identifying families with pathogenic mutations in more than one COL4 α3-α4-α5 heterotrimer encoding genes, leading to conclude for a digenic pattern of inheritance, the role of non-collagen genes in digenic Alport syndrome has not yet been established. Methods We employed a whole-exome sequencing approach on three families in whom a digenic pattern of transmission could be suspected because of a likely biparental contribution or an unexplained phenotype in the proband. Results We identified in the three probands hypomorphic LAMA5 mutations co-inherited with pathogenic COL4 α4-α5 chains mutations. Segregation analysis revealed that the combination of LAMA5/COL4 variants co-segregate with a fully penetrant phenotype in line with a digenic inheritance. In one of the three probands an hypomorphic variant in NPHS2 was also found, suggesting that role of other kidney disease related-genes as modifiers. Conclusion These findings validate the impact of LAMA5 mutations in digenic ATS and highlight the role of extracellular matrix’s genes, basement membrane, slit diaphragm and podocyte cytoskeleton in ATS. This underline the need for a more extensive panel approach in the presence of a digenic ATS, in order to better define clinical severity and recurrence risk for family members. Electronic supplementary material The online version of this article (10.1186/s12882-019-1258-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Daga
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
| | - C Fallerini
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
| | - S Furini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - C Pecoraro
- Pediatric Nephrology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - F Scolari
- Department of Nephrology, University of Brescia, Brescia, Italy
| | - F Ariani
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - M Bruttini
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - M A Mencarelli
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - F Mari
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - A Renieri
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy. .,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - A M Pinto
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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25
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Ferrara D, Esposito F, Blasio R, Mamone R, Severino R, Di Serafino M, Pecoraro C, Zeccolini M. Role of color Doppler ultrasound in the early diagnosis of a major complication after percutaneous renal biopsy: two case reports. J Ultrasound 2018; 21:343-349. [PMID: 30311148 DOI: 10.1007/s40477-018-0326-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022] Open
Abstract
Percutaneous renal biopsy (PRB) is an important procedure in the diagnostic and prognostic evaluation of renal disorders. Despite the relative simplicity, it can be a possible cause of iatrogenic renovascular injury. We describe two cases of iatrogenic pseudoaneurysm, a major post-biopsy complication, in two pediatric patients with persistent micro- and macro-hematuria, promptly diagnosed using color Doppler ultrasound, confirmed with renal arteriography and treated with embolization.
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Affiliation(s)
- Dolores Ferrara
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy.
| | - Francesco Esposito
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy
| | - Roberta Blasio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Rosanna Mamone
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy
| | - Rosa Severino
- Emergency Radiology Department, San Carlo Hospital, Potenza, Italy
| | | | - Carmine Pecoraro
- Nephrology and Urology Unit AORN Santobono-Pausilipon, Naples, Italy
| | - Massimo Zeccolini
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy
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26
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Ruggiero B, Vivarelli M, Gianviti A, Pecoraro C, Peruzzi L, Benetti E, Ventura G, Pennesi M, Murer L, Coppo R, Emma F. Outcome of childhood-onset full-house nephropathy. Nephrol Dial Transplant 2018; 32:1194-1204. [PMID: 27270291 DOI: 10.1093/ndt/gfw230] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/14/2016] [Accepted: 04/27/2016] [Indexed: 11/14/2022] Open
Abstract
Background Patients with full-house nephropathy (FHN) present renal lesions that are indistinguishable from those of lupus nephritis (LN) but lack the systemic features necessary to meet diagnostic criteria for systemic lupus erithematosus (SLE). Some have been reported to develop a delayed SLE with time. The clinical outcome of children having FHN without SLE has never been reported. Methods Children with biopsy-proven FHN were selected after excluding SLE cases by the absence of America College of Rheumatology criteria. The proportion of patients with complete (proteinuria <0.5 g/day) or partial remission (proteinuria ≤50% from baseline), relapse (estimated glomerular filtration rate <25% and/or proteinuria ≥50% from baseline) and progression to Stage III chronic kidney disease (CKD) was described according to age and gender groups with the Kaplan-Meier curve and compared with the Log-rank test. Entity of treatment was summarized by a score at induction (0-6 months) and maintenance (6-18 months). Cox-regression model was performed to test predictors of remission, relapse and progression to CKD. Results Among 42 patients (28 pre-pubertal) who met the inclusion criteria, 39 (92.9%) achieved partial and 32 (76.2%) complete remission of nephropathy over 2.78 and 7.51 months of follow-up. At 10 years, the probability of progressing to CKD was 4.8%. Of those achieving remission, 18% had a renal flare mainly within 4 years after remission. Pre-pubertal males achieved complete remission more frequently than other patients but often relapsed; pre-pubertal females were treated more aggressively. Cox-regression analysis did not find independent predictors of remission or relapse. Conclusions The outcome of the patients with FHN we investigated was encouraging. Recurrences are limited to the first 4 years following diagnosis, allowing progressive withdrawal of immunosuppression in patients achieving remission. Evaluation of risk factors for adverse outcome is necessary especially in pre-pubertal children.
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Affiliation(s)
- Barbara Ruggiero
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Clinical Reasearch Center for Rare Diseases 'Aldo e Cele Daccò', Bergamo, Italy
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Alessandra Gianviti
- Division of Nephrology and Dialysis, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Carmine Pecoraro
- Unit of Nephrology and Dialysis, Santobono Hospital, Naples, Italy
| | - Licia Peruzzi
- Division of Nephrology, Regina Margherita Children's Hospital, Turin, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | - Giovanna Ventura
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Pennesi
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Woman and Child Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | - Rosanna Coppo
- Division of Nephrology, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesco Emma
- Division of Nephrology and Dialysis, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
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27
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Daga S, Baldassarri M, Lo Rizzo C, Fallerini C, Imperatore V, Longo I, Frullanti E, Landucci E, Massella L, Pecoraro C, Garosi G, Ariani F, Mencarelli MA, Mari F, Renieri A, Pinto AM. Urine-derived podocytes-lineage cells: A promising tool for precision medicine in Alport Syndrome. Hum Mutat 2017; 39:302-314. [PMID: 29098738 DOI: 10.1002/humu.23364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/18/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022]
Abstract
Alport Syndrome (ATS) is a rare genetic disorder caused by collagen IV genes mutations, leading to glomerular basement membrane damage up to end-stage renal disease. Podocytes, the main component of the glomerular structure, are the only cells able to produce all the three collagens IV alpha chains associated with ATS and thus, they are key players in ATS pathogenesis. However, podocytes-targeted therapeutic strategies have been hampered by the difficulty of non-invasively isolating them and transcripts-based diagnostic approaches are complicated by the inaccessibility of other COL4 chains-expressing cells. We firstly isolated podocyte-lineage cells from ATS patients' urine samples, in a non-invasive way. RT-PCR analysis revealed COL4A3, COL4A4, and COL4A5 expression. Transcripts analysis on RNA extracted from patient's urine derived podocyte-lineage cells allowed defining the pathogenic role of intronic variants, namely one mutation in COL4A3 (c.3882+5G>A), three mutations in COL4A4 (c.1623+2T>A, c.3699_3706+1del, c.2545+143T>A), and one mutation in COL4A5 (c.3454+2T>C). Therefore, our cellular model represents a novel tool, essential to unequivocally prove the effect of spliceogenic intronic variants on transcripts expressed exclusively at a glomerular level. This process is a key step for providing the patient with a definite molecular diagnosis and with a proper recurrence risk. The established system also opens up the possibility of testing personalized therapeutic approaches on disease-relevant cells.
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Affiliation(s)
- Sergio Daga
- Medical Genetics, University of Siena, Siena, Italy
| | - Margherita Baldassarri
- Medical Genetics, University of Siena, Siena, Italy.,Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Caterina Lo Rizzo
- Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | - Ilaria Longo
- Medical Genetics, University of Siena, Siena, Italy.,Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | - Laura Massella
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | - Guido Garosi
- Nephrology, Dialysis and Transplantation Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesca Ariani
- Medical Genetics, University of Siena, Siena, Italy.,Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Francesca Mari
- Medical Genetics, University of Siena, Siena, Italy.,Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy.,Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Maria Pinto
- Medical Genetics, University of Siena, Siena, Italy.,Medical Genetics, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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28
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Pasini A, Benetti E, Conti G, Ghio L, Lepore M, Massella L, Molino D, Peruzzi L, Emma F, Fede C, Trivelli A, Maringhini S, Materassi M, Messina G, Montini G, Murer L, Pecoraro C, Pennesi M. The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse. Ital J Pediatr 2017; 43:41. [PMID: 28427453 PMCID: PMC5399429 DOI: 10.1186/s13052-017-0356-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
This consensus document is aimed at providing an updated, multidisciplinary overview on the diagnosis and treatment of pediatric nephrotic syndrome (NS) at first presentation. It is the first consensus document of its kind to be produced by all the pediatric nephrology centres in Italy, in line with what is already present in other countries such as France, Germany and the USA. It is based on the current knowledge surrounding the symptomatic and steroid treatment of NS, with a view to providing the basis for a separate consensus document on the treatment of relapses. NS is one of the most common pediatric glomerular diseases, with an incidence of around 2-7 cases per 100000 children per year. Corticosteroids are the mainstay of treatment, but the optimal therapeutic regimen for managing childhood idiopathic NS is still under debate. In Italy, shared treatment guidelines were lacking and, consequently, the choice of steroid regimen was based on the clinical expertise of each individual unit. On the basis of the 2015 Cochrane systematic review, KDIGO Guidelines and more recent data from the literature, this working group, with the contribution of all the pediatric nephrology centres in Italy and on the behalf of the Italian Society of Pediatric Nephrology, has produced a shared steroid protocol that will be useful for National Health System hospitals and pediatricians. Investigations at initial presentation and the principal causes of NS to be screened are suggested. In the early phase of the disease, symptomatic treatment is also important as many severe complications can occur which are either directly related to the pathophysiology of the underlying NS or to the steroid treatment itself. To date, very few studies have been published on the prophylaxis and treatment of these early complications, while recommendations are either lacking or conflicting. This consensus provides indications for the prevention, early recognition and treatment of these complications (management of edema and hypovolemia, therapy and prophylaxis of infections and thromboembolic events). Finally, recommendations about the clinical definition of steroid resistance and its initial diagnostic management, as well as indications for renal biopsy are provided.
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Affiliation(s)
- Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padua, Padua, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit with Dialysis, AOU G. Martino, Messina, Italy
| | - Luciana Ghio
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda, IRCCS Ospedale Maggiore, Policlinico Milano, Milan, Italy
| | - Marta Lepore
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda, IRCCS Ospedale Maggiore, Policlinico Milano, Milan, Italy
| | - Laura Massella
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Licia Peruzzi
- City of the Health and the Science of Turin Health Agency, Regina Margherita Children’s Hospital, Turin, Italy
| | - Francesco Emma
- Nephrology and Dialysis Unit, Pediatric Subspecialties Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Carmelo Fede
- Pediatric Nephrology and Rheumatology Unit with Dialysis, AOU G. Martino, Messina, Italy
| | - Antonella Trivelli
- Division of Nephrology, Dialysis, Transplantation, and Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Genoa, Italy
| | - Silvio Maringhini
- Pediatric Nephrology Unit, Children’s Hospital ‘G. Di Cristina’, A.R.N.A.S. ‘Civico’, Palermo, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy
| | - Giovanni Messina
- Nephrology Unit, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Giovanni Montini
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda, IRCCS Ospedale Maggiore, Policlinico Milano, Milan, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padua, Padua, Italy
| | | | - Marco Pennesi
- Institute of Maternal and Child Health IRCCS “Burlo Garofolo”, Department of Pediatrics, Trieste, Italy
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29
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Peruzzi L, Gianoglio B, Pecoraro C, Alessandrella A, Murer L, Benetti E, Deschenes G, Materassi M, Gallo P, Lugani F, Ghiggeri G, Spasojevic Dimitrieva B, Jankauskiene A, Mizerska-Wasiak M, Lungu A, Coppo R. TO044A EUROPEAN REGISTRY OF HENOCH SCHOENLEINPURPURA NEPHRITIS IN CHILDREN TO DETECT RISK FACTORS FOR PROGRESSION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw151.03] [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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30
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Paglialonga F, Consolo S, Pecoraro C, Vidal E, Gianoglio B, Puteo F, Picca S, Saravo MT, Edefonti A, Verrina E. Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry. Pediatr Nephrol 2016; 31:833-41. [PMID: 26692024 DOI: 10.1007/s00467-015-3272-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic haemodialysis (HD) in small children has not been adequately investigated. METHODS This was a retrospective investigation of the use of chronic HD in 21 children aged <2 years (n = 12 aged <1 year) who were registered in the Italian Pediatric Dialysis Registry. Data collected over a period of >10 years were analysed. RESULTS The median age of the 21 children at start of HD was 11.4 [interquartile range (IQR) 6.2-14.6] months, and HD consisted mainly of haemodiafiltration for 3-4 h in ≥4 sessions/week. A total of 51 central venous catheters were placed, and the median survival of tunnelled and temporary lines was 349 and 31 days, respectively (p < 0.001). Eight children (38 %) showed evidence of central vein thrombosis. Although 19 % of patients received growth hormone and 63.6 % received enteral feeding, the weight and height of these patients remained suboptimal. During the HD period the haemoglobin level increased in all patients, but not to normal levels (from 8.5 to 9.6 g/dl) despite erythropoietin administration (503-600 U/kg/week). The hospitalisation rate was 1.94/patient-year. Seventeen patients underwent renal transplantation at a median age of 3.0 years. Four patients, all affected by severe comorbidities, died during follow-up (in 2 cases due to absence of a vascular access). The 5- and 10-year cumulative survival was 82.4 and 68.7 %, respectively. CONCLUSIONS Extracorporeal dialysis is feasible in children aged <2 years, but comorbidities, vascular access, growth and anaemia remain major concerns.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Silvia Consolo
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Carmine Pecoraro
- Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy
| | - Enrico Vidal
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
| | - Bruno Gianoglio
- Nephrology Dialysis and Transplantation Unit, Regina Margherita University Hospital, Turin, Italy
| | - Flora Puteo
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Stefano Picca
- Nephrology and Dialysis Unit, Department of Nephrology-Urology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | | | - Alberto Edefonti
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Enrico Verrina
- Dialysis Unit, Paediatric Nephrology and Dialysis Department, IRCCS Giannina Gaslini Institute, Genoa, Italy
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31
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Loirat C, Fakhouri F, Ariceta G, Besbas N, Bitzan M, Bjerre A, Coppo R, Emma F, Johnson S, Karpman D, Landau D, Langman CB, Lapeyraque AL, Licht C, Nester C, Pecoraro C, Riedl M, van de Kar NCAJ, Van de Walle J, Vivarelli M, Frémeaux-Bacchi V. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol 2016. [PMID: 25859752 DOI: 10.1007/s00467-015-3076-8)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Atypical hemolytic uremic syndrome (aHUS) emerged during the last decade as a disease largely of complement dysregulation. This advance facilitated the development of novel, rational treatment options targeting terminal complement activation, e.g., using an anti-C5 antibody (eculizumab). We review treatment and patient management issues related to this therapeutic approach. We present consensus clinical practice recommendations generated by HUS International, an international expert group of clinicians and basic scientists with a focused interest in HUS. We aim to address the following questions of high relevance to daily clinical practice: Which complement investigations should be done and when? What is the importance of anti-factor H antibody detection? Who should be treated with eculizumab? Is plasma exchange therapy still needed? When should eculizumab therapy be initiated? How and when should complement blockade be monitored? Can the approved treatment schedule be modified? What approach should be taken to kidney and/or combined liver-kidney transplantation? How should we limit the risk of meningococcal infection under complement blockade therapy? A pressing question today regards the treatment duration. We discuss the need for prospective studies to establish evidence-based criteria for the continuation or cessation of anticomplement therapy in patients with and without identified complement mutations.
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Affiliation(s)
- Chantal Loirat
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Department of Pediatric Nephrology, Université Paris Diderot Sorbonne Paris Cité, Paris, France.
| | - Fadi Fakhouri
- Centre Hospitalier Universitaire de Nantes, Department of Nephrology and Immunology, ITUN and INSERM UMR S-1064, Nantes, France
| | - Gema Ariceta
- Pediatric Nephrology, Vall d'Hebron Hospital, Autonoma University of Barcelona, Barcelona, Spain
| | - Nesrin Besbas
- Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Martin Bitzan
- Division of Nephrology, Montreal Children's Hospital and Mc Gill University, Montreal, Canada
| | - Anna Bjerre
- Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Rosanna Coppo
- City of the Health and the Science of Turin Health Agency, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Sally Johnson
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Diana Karpman
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
| | - Daniel Landau
- Soroka University Medical Center, Beer Sheva, Israel
| | - Craig B Langman
- The Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anne-Laure Lapeyraque
- Service de Néphrologie, Département de Pédiatrie, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | | | - Carla Nester
- Departments of Internal Medicine and the Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | | | - Magdalena Riedl
- Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria
| | - Nicole C A J van de Kar
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Véronique Frémeaux-Bacchi
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Laboratory of Immunology, INSERM UMRS 1138, Paris, France
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32
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Pecoraro C, Ferretti AVS, Rurali E, Galbusera M, Noris M, Remuzzi G. Treatment of Congenital Thrombotic Thrombocytopenic Purpura With Eculizumab. Am J Kidney Dis 2015; 66:1067-70. [PMID: 26409664 DOI: 10.1053/j.ajkd.2015.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 02/18/2015] [Accepted: 06/23/2015] [Indexed: 11/11/2022]
Abstract
A 12-year-old boy was hospitalized for hemolytic anemia, thrombocytopenia, acute kidney injury, and generalized seizures. The childhood onset, severely decreased kidney function, absence of prodromal diarrhea, negative test results for Shiga-like toxin-producing Escherichia coli, elevated plasma levels of the terminal complement complex sC5b-9, and ex vivo testing in endothelial cells showing serum-induced complement activation were all consistent with a diagnosis of complement-mediated atypical hemolytic uremic syndrome. Before plasma ADAMTS13 (von Willebrand factor protease) activity results were available, the patient was treated with the anti-C5 monoclonal antibody eculizumab, and treatment was followed by prompt disease remission. However, results of ADAMT13 activity level tests and gene screening revealed a severe deficiency associated with 2 heterozygous mutations in the ADAMTS13 gene, fully consistent with a diagnosis of congenital thrombotic thrombocytopenic purpura. Screening for atypical hemolytic uremic syndrome-associated genes failed to show a mutation and an assay for plasma anti-factor H antibodies gave negative results both before and after eculizumab treatment initiation. The patient's clinical evolution suggests that complement activation plays a role in the pathogenesis of thrombotic thrombocytopenic purpura and provides unexpected new insights into the treatment of this life-threatening disease.
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Affiliation(s)
- Carmine Pecoraro
- Paediatric Nephrology Unit, Santobono-Pausilipon Hospital, Naples, Italy
| | | | - Erica Rurali
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy
| | - Miriam Galbusera
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy
| | - Marina Noris
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy
| | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy; Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
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Vidal E, Chimenz R, Edefonti A, Gianoglio B, Leozappa G, Longo G, Maringhini S, Mencarelli F, Pecoraro C, Puteo F, Ratsch IM, Roperto RM, Verrina E. SP868A PROPENSITY-MATCHED COMPARISON OF HARD OUTCOMES IN CHILDREN ON CHRONIC DIALYSIS: THE ITALIAN REGISTRY EXPERIENCE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv203.06] [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: 11/14/2022] Open
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Picca S, Dionisi-Vici C, Bartuli A, De Palo T, Papadia F, Montini G, Materassi M, Donati MA, Verrina E, Schiaffino MC, Pecoraro C, Iaccarino E, Vidal E, Burlina A, Emma F. Short-term survival of hyperammonemic neonates treated with dialysis. Pediatr Nephrol 2015; 30:839-47. [PMID: 25185886 DOI: 10.1007/s00467-014-2945-x] [Citation(s) in RCA: 30] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 07/07/2014] [Accepted: 08/10/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND In severe neonatal hyperammonemia, extracorporeal dialysis (ECD) provides higher ammonium clearance than peritoneal dialysis (PD). However, there are limited outcome data in relation to dialysis modality. METHODS Data from infants with hyperammonemia secondary to inborn errors of metabolism (IEM) treated with dialysis were collected in six Italian centers and retrospectively analyzed. RESULTS Forty-five neonates born between 1990 and 2011 were enrolled in the study. Of these, 23 were treated with PD and 22 with ECD (14 with continuous venovenous hemodialysis [CVVHD], 5 with continuous arteriovenous hemodialysis [CAVHD], 3 with hemodialysis [HD]). Patients treated with PD experienced a shorter duration of predialysis coma, while those treated with HD had a shorter ammonium decay time compared with all the other patients (p < 0.05). No difference in ammonium reduction rate was observed between patients treated with PD, CAVHD or CVVHD. Carbamoyl phosphate synthetase deficiency (CPS) was significantly associated with increased risk of death (OR: 9.37 [1.52-57.6], p = 0.016). Predialysis ammonium levels were significantly associated with a composite end-point of death or neurological sequelae (adjusted OR: 1.13 [1.02-1.27] per 100 μmol/l, p = 0.026). No association was found between outcome and dialysis modality. CONCLUSIONS In this study, a delayed ECD treatment was not superior to PD in improving the short-term outcome of neonates with hyperammonemia secondary to IEM.
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Affiliation(s)
- Stefano Picca
- Nephrology and Dialysis Unit, Department of Nephrology-Urology, "Bambino Gesù" Children's Hospital-IRCCS, Rome, Italy,
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Pecoraro C, Carbonaro L, Saravo MT, Manese M, Borgia G, Usberti M. Heterogeneity of hereditary nephritis. Contrib Nephrol 2015; 80:107-12. [PMID: 2282807 DOI: 10.1159/000418635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- C Pecoraro
- Dipartimento di Pediatria, II Facoltà di Medicina e Chirurgia, Università di Napoli, Leno, Italia
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Johnson S, Stojanovic J, Ariceta G, Bitzan M, Besbas N, Frieling M, Karpman D, Landau D, Langman C, Licht C, Pecoraro C, Riedl M, Siomou E, van de Kar N, Walle JV, Loirat C, Taylor CM. An audit analysis of a guideline for the investigation and initial therapy of diarrhea negative (atypical) hemolytic uremic syndrome. Pediatr Nephrol 2014. [PMID: 24817340 DOI: 10.1007/s00467-014-2817-4)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND In 2009, the European Paediatric Study Group for Haemolytic Uraemic Syndrome (HUS) published a clinical practice guideline for the investigation and initial therapy of diarrhea-negative HUS (now more widely referred to as atypical HUS, aHUS). The therapeutic component of the guideline (comprising early, high-volume plasmapheresis) was derived from anecdotal evidence and expert consensus, and the authors committed to auditing outcome. METHODS Questionnaires were distributed to pediatric nephrologists across Europe, North America, and the Middle East, who were asked to complete one questionnaire per patient episode of aHUS between July 1, 2009 and December 31, 2010. Comprehensive, anonymous demographic and clinical data were collected. RESULTS Seventy-one children were reported with an episode of aHUS during the audit period. Six cases occurred on a background of influenza A H1N1 infection. Of 71 patients, 59 (83 %) received plasma therapy within the first 33 days, of whom ten received plasma infusion only. Complications of central venous catheters occurred in 16 out of 51 patients with a catheter in-situ (31 %). Median time to enter hematological remission was 11.5 days, and eight of 71 (11 %) patients did not enter hematological remission by day 33. Twelve patients (17 %) remained dialysis dependent at day 33. CONCLUSIONS This audit provides a snapshot of the early outcome of a group of children with aHUS in the months prior to more widespread use of eculizumab.
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Affiliation(s)
- Sally Johnson
- Great North Children's Hospital, Newcastle Upon Tyne, UK,
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Johnson S, Stojanovic J, Ariceta G, Bitzan M, Besbas N, Frieling M, Karpman D, Landau D, Langman C, Licht C, Pecoraro C, Riedl M, Siomou E, van de Kar N, Walle JV, Loirat C, Taylor CM. An audit analysis of a guideline for the investigation and initial therapy of diarrhea negative (atypical) hemolytic uremic syndrome. Pediatr Nephrol 2014; 29:1967-78. [PMID: 24817340 DOI: 10.1007/s00467-014-2817-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/03/2014] [Accepted: 03/27/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND In 2009, the European Paediatric Study Group for Haemolytic Uraemic Syndrome (HUS) published a clinical practice guideline for the investigation and initial therapy of diarrhea-negative HUS (now more widely referred to as atypical HUS, aHUS). The therapeutic component of the guideline (comprising early, high-volume plasmapheresis) was derived from anecdotal evidence and expert consensus, and the authors committed to auditing outcome. METHODS Questionnaires were distributed to pediatric nephrologists across Europe, North America, and the Middle East, who were asked to complete one questionnaire per patient episode of aHUS between July 1, 2009 and December 31, 2010. Comprehensive, anonymous demographic and clinical data were collected. RESULTS Seventy-one children were reported with an episode of aHUS during the audit period. Six cases occurred on a background of influenza A H1N1 infection. Of 71 patients, 59 (83 %) received plasma therapy within the first 33 days, of whom ten received plasma infusion only. Complications of central venous catheters occurred in 16 out of 51 patients with a catheter in-situ (31 %). Median time to enter hematological remission was 11.5 days, and eight of 71 (11 %) patients did not enter hematological remission by day 33. Twelve patients (17 %) remained dialysis dependent at day 33. CONCLUSIONS This audit provides a snapshot of the early outcome of a group of children with aHUS in the months prior to more widespread use of eculizumab.
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Affiliation(s)
- Sally Johnson
- Great North Children's Hospital, Newcastle Upon Tyne, UK,
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Vidal E, Edefonti A, Puteo F, Chimenz R, Gianoglio B, Lavoratti G, Leozappa G, Maringhini S, Mencarelli F, Pecoraro C, Ratsch IM, Cannavò R, De Palo T, Testa S, Murer L, Verrina E. Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients: the experience of the Italian Registry of Pediatric Chronic Dialysis. Nephrol Dial Transplant 2013; 28:1603-9. [DOI: 10.1093/ndt/gft061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Enrico Vidal
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Pediatrics, University of Padova, Padova, Italy
| | - Alberto Edefonti
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Flora Puteo
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Roberto Chimenz
- Department of Pediatrics, Nephrology Unit, University School of Medicine, Messina, Italy
| | - Bruno Gianoglio
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita Children's Hospital, Torino, Italy
| | | | - Giovanna Leozappa
- Nephrology and Urology Department, Bambino Gesù Children's Hospital, Roma, Italy
| | - Silvio Maringhini
- Pediatric Nephrology Unit, Children's Hospital ‘G. Di Cristina’, A.R.N.A.S. ‘Civico’, Palermo, Italy
| | - Francesca Mencarelli
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Carmine Pecoraro
- Nephrology and Dialysis Unit, Santobono Children's Hospital, Napoli, Italy
| | | | - Rossella Cannavò
- Dialysis Unit, Nephrology and Dialysis Division, IRCCS Giannina Gaslini, Genova, Italy
| | - Tommaso De Palo
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Sara Testa
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Pediatrics, University of Padova, Padova, Italy
| | - Enrico Verrina
- Dialysis Unit, Nephrology and Dialysis Division, IRCCS Giannina Gaslini, Genova, Italy
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Ruggiero B, Vivarelli M, Gianviti A, Benetti E, Peruzzi L, Barbano G, Corona F, Ventura G, Pecoraro C, Murer L, Ghiggeri GM, Pennesi M, Edefonti A, Coppo R, Emma F. Lupus nephritis in children and adolescents: results of the Italian Collaborative Study. Nephrol Dial Transplant 2013; 28:1487-96. [DOI: 10.1093/ndt/gfs589] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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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40
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Esposito F, Di Serafino M, Sgambati P, Erra P, Mercogliano C, Pecoraro C, Oresta P. Ultrasound in the diagnosis of peritoneal catheter obstruction in children. Kidney Int 2012; 82:499. [DOI: 10.1038/ki.2012.132] [Citation(s) in RCA: 8] [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: 11/09/2022]
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Beck FX, Kuper C, Neuhofer W, Rodrigues-Diez R, Stark Aroeira LG, Jimenez JA, Rodrigues-Diez R, Rayego-Mateos S, Bajo Rubio A, Ortiz A, Egido J, Lopez-Cabrera M, Selgas R, Ruiz-Ortega M, Pedro Ventura A, Olivia S, Teixeira L, Joana V, Francisco F, Maria Joao C, Antonio C, Rodrigues AS, Vychytil A, Kerschbaum J, Lhotta K, Prischl F, Wiesholzer M, Kopriva-Altfahrt G, Machold-Fabrizii V, Schwarz C, Balcke P, Oberbauer R, Kramar R, Konig P, Rudnicki M, Habib M, Betjes M, Korte M, Vidal E, Edefonti A, Chimenz R, Gianoglio B, Leozappa G, Maringhini S, Mencarelli F, Pecoraro C, Puteo F, Testa S, Cannavo R, Verrina E. Peritoneal dialysis. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs197] [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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42
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Conte G, Viglianesi A, D'Amore A, Chiaramonte R, Pecoraro C, Nastasi L, Giuffrida S, Pero G, Chiaramonte I. Advanced Ossification of the Posterior Longitudinal Ligament in a Mildly Symptomatic Patient. Neuroradiol J 2011; 24:643-7. [DOI: 10.1177/197140091102400422] [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] [Received: 12/09/2010] [Accepted: 04/26/2011] [Indexed: 11/17/2022] Open
Abstract
We describe the imaging findings of a man who developed neurologic symptoms due to ossification of the posterior longitudinal ligament with narrowing of the spinal canal and compression of the spinal cord. CT study allowed a detailed evaluation of the stenosis and the extension of the ossification while MRI gave an excellent visualization of the spinal lesions caused by spinal cord compression by the mass. The neurological status of patients with ossification of the posterior longitudinal ligament depends on many factors such as the degree of spinal canal stenosis, life style, accidental mechanical stress and trauma.
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Affiliation(s)
- G. Conte
- Department of Neurosciences, University of Catania; Catania, Italy
| | - A. Viglianesi
- Department of Radiology, University of Catania; Catania, Italy
| | - A. D'Amore
- Department of Neurosciences, University of Catania; Catania, Italy
| | - R. Chiaramonte
- Department of Otorhinolaryngology, University of Catania; Catania, Italy
| | - C. Pecoraro
- Department of Neurosciences, University of Catania; Catania, Italy
| | - L. Nastasi
- Department of Neurosciences, University of Catania; Catania, Italy
| | - S. Giuffrida
- Department of Neurosciences, University of Catania; Catania, Italy
| | - G. Pero
- Department of Neurosciences, University of Catania; Catania, Italy
| | - I. Chiaramonte
- Department of Neurosciences, University of Catania; Catania, Italy
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Mele C, Iatropoulos P, Donadelli R, Calabria A, Maranta R, Cassis P, Buelli S, Tomasoni S, Piras R, Krendel M, Bettoni S, Morigi M, Delledonne M, Pecoraro C, Abbate I, Capobianchi MR, Hildebrandt F, Otto E, Schaefer F, Macciardi F, Ozaltin F, Emre S, Ibsirlioglu T, Benigni A, Remuzzi G, Noris M. MYO1E mutations and childhood familial focal segmental glomerulosclerosis. N Engl J Med 2011; 365:295-306. [PMID: 21756023 PMCID: PMC3701523 DOI: 10.1056/nejmoa1101273] [Citation(s) in RCA: 201] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Focal segmental glomerulosclerosis is a kidney disease that is manifested as the nephrotic syndrome. It is often resistant to glucocorticoid therapy and progresses to end-stage renal disease in 50 to 70% of patients. Genetic studies have shown that familial focal segmental glomerulosclerosis is a disease of the podocytes, which are major components of the glomerular filtration barrier. However, the molecular cause in over half the cases of primary focal segmental glomerulosclerosis is unknown, and effective treatments have been elusive. METHODS We performed whole-genome linkage analysis followed by high-throughput sequencing of the positive-linkage area in a family with autosomal recessive focal segmental glomerulosclerosis (index family) and sequenced a newly discovered gene in 52 unrelated patients with focal segmental glomerulosclerosis. Immunohistochemical studies were performed on human kidney-biopsy specimens and cultured podocytes. Expression studies in vitro were performed to characterize the functional consequences of the mutations identified. RESULTS We identified two mutations (A159P and Y695X) in MYO1E, which encodes a nonmuscle class I myosin, myosin 1E (Myo1E). The mutations in MYO1E segregated with focal segmental glomerulosclerosis in two independent pedigrees (the index family and Family 2). Patients were homozygous for the mutations and did not have a response to glucocorticoid therapy. Electron microscopy showed thickening and disorganization of the glomerular basement membrane. Normal expression of Myo1E was documented in control human kidney-biopsy specimens in vivo and in glomerular podocytes in vitro. Transfection studies revealed abnormal subcellular localization and function of the A159P-Myo1E mutant. The Y695X mutation causes loss of calmodulin binding and of the tail domains of Myo1E. CONCLUSIONS MYO1E mutations are associated with childhood-onset, glucocorticoid-resistant focal segmental glomerulosclerosis. Our data provide evidence of a role of Myo1E in podocyte function and the consequent integrity of the glomerular filtration barrier.
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Affiliation(s)
- Caterina Mele
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
| | - Paraskevas Iatropoulos
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
| | - Roberta Donadelli
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
| | - Andrea Calabria
- Department of Medicine, Surgery and Dentistry, Università degli Studi di Milano, Milan, Italy
| | - Ramona Maranta
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
| | - Paola Cassis
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
| | - Simona Buelli
- Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Susanna Tomasoni
- Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Rossella Piras
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
| | - Mira Krendel
- Department of Cell and Developmental Biology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Serena Bettoni
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
| | - Marina Morigi
- Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Massimo Delledonne
- Center of Functional Genomics, Department of Biotechnologies, University of Verona, Verona Italy
| | - Carmine Pecoraro
- Department of Nephrology and Dialysis ‘Santobono’ Hospital, Napoli, Italy
| | | | | | - Friedhelm Hildebrandt
- Department of Pediatrics, University of Michigan, Ann Arbor MI, USA
- Howard Hughes Medical Institute, University of Michigan, Ann Arbor MI, USA
| | - Edgar Otto
- Department of Pediatrics, University of Michigan, Ann Arbor MI, USA
| | - Franz Schaefer
- Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Fabio Macciardi
- Department of Medicine, Surgery and Dentistry, Università degli Studi di Milano, Milan, Italy
| | - Fatih Ozaltin
- Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevinc Emre
- Department of Pediatric Nephrology, Instanbul Medical Faculty, Instanbul University, Instanbul, Turkey
| | - Tulin Ibsirlioglu
- Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ariela Benigni
- Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Giuseppe Remuzzi
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
- Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori Science and Technology Park Kilometro Rosso, Bergamo, Italy
- Unit of Nephrology and Dialysis, Ospedali Riuniti di Bergamo, Bergamo Italy
| | - Marina Noris
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases ‘Aldo e Cele Daccò’, Ranica, Bergamo, Italy
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Vidal E, Edefonti A, Murer L, Gianoglio B, Maringhini S, Pecoraro C, Sorino P, Leozappa G, Lavoratti G, Ratsch IM, Chimenz R, Verrina E. Peritoneal dialysis in infants: the experience of the Italian Registry of Paediatric Chronic Dialysis. Nephrol Dial Transplant 2011; 27:388-95. [PMID: 21669887 DOI: 10.1093/ndt/gfr322] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although chronic peritoneal dialysis (CPD) is considered the replacement therapy of choice for infants with end-stage renal failure, many questions persist about treatment risks and outcomes. METHODS We present data on 84 infants who started CPD at <1 year of age; these patients represent 12% of the total population of the Italian Registry of Paediatric Chronic Dialysis. We analysed patient records from all children consecutively treated with CPD between 1995 and 2007 in Italy. Growth data analysis was performed only in infants with complete auxological parameters at 0, 6 and 12 months of follow-up. RESULTS Median age at the start of CPD was 6.9 months, weight was 6.1 kg and length 63.6 cm. In one-half of the study population diagnosis leading to renal failure was congenital nephrouropathy. Twenty-eight per cent of the children had at least one pre-existing comorbidity. The mean height standard deviation score was -1.65 at the start of CPD, -1.82 after 12 months and -1.53 after 24 months. Catch-up growth was documented in 50% of patients during dialysis. A positive correlation was observed between longitudinal growth and both exchange volume (R(2) = 0.36) and dialysis session length (R(2) = 0.35), while a negative association was found with the number of peritonitis cases (P = 0.003). Peritonitis incidence was 1:20.7 episode:CPD-months (1:28.3 in the older children from the same registry) and was significantly higher in children with oligoanuria (1:15.5 episode:CPD-months) compared to infants with residual renal function (1:37.4 episode:CPD-months). Catheter survival rate was 70% at 12 months and 51% at 24 months. Catheter-related complications were similar in infants and older children (1:20.5 versus 1:19.8 episode:CPD-months), while clinical complications were more frequent in children under 1 year of age (1:18.3 versus 1:25.2 episode:CPD-months; P < 0.05). During the follow-up period, 33 patients were transplanted (39.3%), 18 were shifted to haemodialysis (21.4%) and 8 died (9.5%). The mortality rate was 4-fold greater than in older children (2.3%). CONCLUSIONS Our data confirm that infants on CPD represent a high-risk group; however, our experience demonstrated that growth was acceptable and a large portion was successfully transplanted. Increased efforts should be aimed at optimizing dialysis efficiency and preventing peritonitis. The higher mortality rate in infants was largely caused by comorbidities.
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Affiliation(s)
- Enrico Vidal
- Paediatric Nephrology, Dialysis and Transplantation Unit, Department of Paediatrics, University of Padua, Padova, Italy.
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van Stralen K, Krischock L, Schaefer F, Verrina E, Groothoff J, Jager K, Tizard J, Harambat J, van Stralen KJ, Espinosa L, Groothoff JW, Hulton SA, Jankauskiene A, Schaefer F, Verrina E, Jager KJ, Cochat P, Ruggiero B, Gianviti A, Benetti E, Peruzzi L, Barbano GC, Corona F, Ventura G, Pecoraro C, Murer L, Ghiggeri GM, Pennesi M, Edefonti A, Coppo R, Emma F, Bonthuis M, van Stralen KJ, Verrina E, Edefonti A, Jager KJ, Schaefer F, Musumeci A, Graziano U, Nuzzi F, Ferraiuolo S, Severino G, Malgieri G, Minale B, Pecoraro C. Pediatric nephrology. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.6] [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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Brigotti M, Tazzari PL, Ravanelli E, Carnicelli D, Barbieri S, Rocchi L, Arfilli V, Scavia G, Ricci F, Bontadini A, Alfieri RR, Petronini PG, Pecoraro C, Tozzi AE, Caprioli A. Endothelial damage induced by Shiga toxins delivered by neutrophils during transmigration. J Leukoc Biol 2010; 88:201-10. [DOI: 10.1189/jlb.0709475] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Scavia G, Escher M, Baldinelli F, Pecoraro C, Caprioli A. Consumption of Unpasteurized Milk as a Risk Factor for Hemolytic Uremic Syndrome in Italian Children. Clin Infect Dis 2009; 48:1637-8. [DOI: 10.1086/598996] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ariceta G, Besbas N, Johnson S, Karpman D, Landau D, Licht C, Loirat C, Pecoraro C, Taylor CM, Van de Kar N, Vandewalle J, Zimmerhackl LB. Guideline for the investigation and initial therapy of diarrhea-negative hemolytic uremic syndrome. Pediatr Nephrol 2009; 24:687-96. [PMID: 18800230 DOI: 10.1007/s00467-008-0964-1] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 12/13/2022]
Abstract
This guideline for the investigation and initial treatment of atypical hemolytic uremic syndrome (HUS) is intended to offer an approach based on opinion, as evidence is lacking. It builds on the current ability to identify the etiology of specific diagnostic sub-groups of HUS. HUS in children is mostly due to infection, enterohemorrhagic Escherichia coli (EHEC), Shigella dysenteriae type 1 in some geographic regions, and invasive Streptococcus pneumoniae. These sub-groups are relatively straightforward to diagnose. Their management, which is outside the remit of this guideline, is related to control of infection where that is necessary and supportive measures for the anemia and acute renal failure. A thorough investigation of the remainder of childhood HUS cases, commonly referred to as "atypical" HUS, will reveal a risk factor for the syndrome in approximately 60% of cases. Disorders of complement regulation are, numerically, the most important. The outcome for children with atypical HUS is poor, and, because of the rarity of these disorders, clinical experience is scanty. Some cases of complement dysfunction appear to respond to plasma therapy. The therapeutic part of this guideline is the consensus of the contributing authors and is based on limited information from uncontrolled studies. The guideline proposes urgent and empirical plasmapheresis replacement with whole plasma fraction for the first month after diagnosis. This should only be undertaken in specialized pediatric nephrology centers where appropriate medical and nursing skills are available. The guideline includes defined terminology and audit points so that the early clinical effectiveness of the strategy can be evaluated.
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Taranta A, Gianviti A, Palma A, De Luca V, Mannucci L, Procaccino MA, Ghiggeri GM, Caridi G, Fruci D, Ferracuti S, Ferretti A, Pecoraro C, Gaido M, Penza R, Edefonti A, Murer L, Tozzi AE, Emma F. Genetic risk factors in typical haemolytic uraemic syndrome. Nephrol Dial Transplant 2008; 24:1851-7. [DOI: 10.1093/ndt/gfn720] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Pecci A, Panza E, Pujol-Moix N, Klersy C, Di Bari F, Bozzi V, Gresele P, Lethagen S, Fabris F, Dufour C, Granata A, Doubek M, Pecoraro C, Koivisto PA, Heller PG, Iolascon A, Alvisi P, Schwabe D, De Candia E, Rocca B, Russo U, Ramenghi U, Noris P, Seri M, Balduini CL, Savoia A. Position of nonmuscle myosin heavy chain IIA (NMMHC-IIA) mutations predicts the natural history ofMYH9-related disease. Hum Mutat 2008; 29:409-17. [DOI: 10.1002/humu.20661] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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