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Bermejo S, González E, López-Revuelta K, Ibernon M, López D, Martín-Gómez A, Garcia-Osuna R, Linares T, Díaz M, Martín N, Barros X, Marco H, Navarro MI, Esparza N, Elias S, Coloma A, Robles NR, Agraz I, Poch E, Rodas L, Lozano V, Fernández-Fernández B, Hernández E, Martínez MI, Stanescu RI, Moirón JP, García-Fernández N, Goicoechea M, Calero F, Bonet J, Liaño F, Pascual J, Bestard O, Praga M, Fulladosa X, Soler MJ. The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes. Clin Kidney J 2023; 16:1656-1663. [PMID: 37779839 PMCID: PMC10539224 DOI: 10.1093/ckj/sfad142] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Indexed: 10/03/2023] Open
Abstract
Background Up to 50-60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR. Methods We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan-Meier and Cox regression analyses. Results Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85-3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26-2.62), P = .001]. Conclusions DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.
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Affiliation(s)
- Sheila Bermejo
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Ester González
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Meritxell Ibernon
- Nephrology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Diana López
- Nephrology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - Tania Linares
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Nàdia Martín
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Xoana Barros
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Helena Marco
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Noemí Esparza
- Nephrology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sandra Elias
- Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Coloma
- Nephrology Department, Hospital San Pedro, Logroño, Spain
- Nephrology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Irene Agraz
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Nephrology Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Víctor Lozano
- Nephrology Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Marian Goicoechea
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Josep Bonet
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Fernando Liaño
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Manuel Praga
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Fulladosa
- Nephrology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - María José Soler
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Nephrology Department, Hospital del Mar, Barcelona, Spain
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Caravaca-Fontán F, Cavero T, Díaz-Encarnación M, Cabello V, Ariceta G, Quintana LF, Marco H, Barros X, Ramos N, Rodríguez-Mendiola N, Cruz S, Fernández-Juárez G, Rodríguez A, Pérez de José A, Rabasco C, Rodado R, Fernández L, Pérez-Gómez V, Ávila A, Bravo L, Espinosa N, Allende N, Sanchez de la Nieta MD, Rodríguez E, Rivas B, Melgosa M, Huerta A, Miquel R, Mon C, Fraga G, de Lorenzo A, Draibe J, González F, Shabaka A, López-Rubio ME, Fenollosa MÁ, Martín-Penagos L, Da Silva I, Titos JA, Rodríguez de Córdoba S, Goicoechea de Jorge E, Praga M. Clinical Profiles and Patterns of Kidney Disease Progression in C3 Glomerulopathy. Kidney360 2023; 4:659-672. [PMID: 36996481 PMCID: PMC10278771 DOI: 10.34067/kid.0000000000000115] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 04/01/2023]
Abstract
Key Points Kidney survival in C3 glomerulopathy is significantly higher in patients with a disease chronicity score <4 and proteinuria <3.5 g/d, regardless of baseline eGFR. A faster eGFR decline in C3 glomerulopathy is associated with higher probability of kidney failure. Patients with glomerulopathy with a progressive reduction in proteinuria over time did not reach kidney failure. Background C3 glomerulopathy is a rare kidney disease, which makes it difficult to collect large cohorts of patients to better understand its variability. The aims of this study were to describe the clinical profiles and patterns of progression of kidney disease. Methods This was a retrospective, observational cohort study. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. Study population was divided into clinical profiles by combining the following predictors: eGFR under/above 30 ml/min per 1.73 m2, proteinuria under/above 3.5 g/d, and histologic chronicity score under/above 4. The change in eGFR and proteinuria over time was evaluated in a subgroup with consecutive measurements of eGFR and proteinuria. Results One hundred and fifteen patients with a median age of 30 years (interquartile range 19–50) were included. Patients were divided into eight clinical profiles. Kidney survival was significantly higher in patients with a chronicity score <4 and proteinuria <3.5 g/d, both in those presenting with an eGFR under/above 30 ml/min per 1.73 m2. The median eGFR slope of patients who reached kidney failure was −6.5 ml/min per 1.73 m2 per year (interquartile range −1.6 to −17). Patients who showed a reduction in proteinuria over time did not reach kidney failure. On the basis of the rate of eGFR decline, patients were classified as faster eGFR decline (≥5 ml/min per 1.73 m2 per year), slower (<5 ml/min per 1.73 m2 per year), and those without decline. A faster eGFR decline was associated with higher probability of kidney failure. Conclusions Kidney survival is significantly higher in patients with a chronicity score <4 and proteinuria <3.5 g/d regardless of baseline eGFR, and a faster rate of decline in eGFR is associated with higher probability of kidney failure.
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Affiliation(s)
- Fernando Caravaca-Fontán
- Department of Nephrology, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Cavero
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Virginia Cabello
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luis F. Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona; Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Helena Marco
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Current address: Department of Nephrology, Fundación Puigvert, Barcelona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitario Doctor Josep Trueta, Gerona, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | | | - Sonia Cruz
- Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Gema Fernández-Juárez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
- Current address: Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Adela Rodríguez
- Department of Pediatric Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez de José
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rabasco
- Department of Nephrology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Raquel Rodado
- Department of Nephrology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Loreto Fernández
- Department of Nephrology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Vanessa Pérez-Gómez
- Department of Nephrology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Ávila
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Luis Bravo
- Department of Nephrology, Hospital Universitario A Coruña, La Coruña, Spain
| | - Natalia Espinosa
- Pediatric Nephrology Unit, Hospital Universitario Son Espases, Balearic Islands Health Research Institute (IdISBa). Palma de Mallorca, Spain
| | - Natalia Allende
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Begoña Rivas
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Melgosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rosa Miquel
- Department of Nephrology, Hospital Universitario Canarias, Tenerife, Spain
| | - Carmen Mon
- Department of Nephrology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Gloria Fraga
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario de Getafe, Madrid, Spain
| | - Juliana Draibe
- Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fayna González
- Department of Nephrology, Hospital Doctor Negrín, Gran Canaria, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Luis Martín-Penagos
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Iara Da Silva
- Department of Nephrology, Fundación Puigvert, Barcelona, Spain
- Current address: Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juana Alonso Titos
- Department of Nephrology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Santiago Rodríguez de Córdoba
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid and Centro de Investigación Biomédica en Red en Enfermedades Raras, Madrid, Spain
| | - Elena Goicoechea de Jorge
- Department of Nephrology, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Immunology, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Caravaca-Fontán F, Rivero M, Cavero T, Díaz-Encarnación M, Cabello V, Ariceta G, Quintana LF, Marco H, Barros X, Ramos N, Rodríguez-Mendiola N, Cruz S, Fernández-Juárez G, Rodríguez A, de José AP, Rabasco C, Rodado R, Fernández L, Pérez-Gómez V, Ávila A, Bravo L, Espinosa N, Allende N, de la Nieta MDS, Rodríguez E, Olea T, Melgosa M, Huerta A, Miquel R, Mon C, Fraga G, de Lorenzo A, Draibe J, González F, Shabaka A, López-Rubio ME, María Ángeles F, Martín-Penagos L, Da Silva I, Titos JA, de Córdoba SR, de Jorge EG, Praga M. Development and validation of a nomogram to predict kidney survival at baseline in patients with C3 glomerulopathy. Clin Kidney J 2022; 15:1737-1746. [PMID: 36003665 PMCID: PMC9394716 DOI: 10.1093/ckj/sfac108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background C3 glomerulopathy is a rare and heterogeneous complement-driven disease. It is often challenging to accurately predict in clinical practice the individual kidney prognosis at baseline. We herein sought to develop and validate a prognostic nomogram to predict long-term kidney survival. Methods We conducted a retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. The dataset was randomly divided into a training group (n = 87) and a validation group (n = 28). The least absolute shrinkage and selection operator (LASSO) regression was used to screen the main predictors of kidney outcome and to build the nomogram. The accuracy of the nomogram was assessed by discrimination and risk calibration in the training and validation sets. Results The study group comprised 115 patients, of whom 46 (40%) reached kidney failure in a median follow-up of 49 months (range 24–112). No significant differences were observed in baseline estimated glomerular filtration rate (eGFR), proteinuria or total chronicity score of kidney biopsies, between patients in the training versus those in the validation set. The selected variables by LASSO were eGFR, proteinuria and total chronicity score. Based on a Cox model, a nomogram was developed for the prediction of kidney survival at 1, 2, 5 and 10 years from diagnosis. The C-index of the nomogram was 0.860 (95% confidence interval 0.834–0.887) and calibration plots showed optimal agreement between predicted and observed outcomes. Conclusions We constructed and validated a practical nomogram with good discrimination and calibration to predict the risk of kidney failure in C3 glomerulopathy patients at 1, 2, 5 and 10 years.
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Affiliation(s)
- Fernando Caravaca-Fontán
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta Rivero
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Cavero
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Virginia Cabello
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona; Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Helena Marco
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitario Doctor Josep Trueta, Gerona, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Sonia Cruz
- Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Gema Fernández-Juárez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Adela Rodríguez
- Department of Pediatric Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez de José
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rabasco
- Department of Nephrology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Raquel Rodado
- Department of Nephrology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Loreto Fernández
- Department of Nephrology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Vanessa Pérez-Gómez
- Department of Nephrology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Ávila
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Luis Bravo
- Department of Nephrology, Hospital Universitario A Coruña, La Coruña, Spain
| | - Natalia Espinosa
- Pediatric Nephrology Unit, Hospital Universitario Son Espases, Balearic Islands Health Research Institute (IdISBa). Palma de Mallorca, Spain
| | - Natalia Allende
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Teresa Olea
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Melgosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rosa Miquel
- Department of Nephrology, Hospital Universitario Canarias, Tenerife, Spain
| | - Carmen Mon
- Department of Nephrology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Gloria Fraga
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario de Getafe, Madrid, Spain
| | - Juliana Draibe
- Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fayna González
- Department of Nephrology, Hospital Doctor Negrín, Gran Canaria, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Luis Martín-Penagos
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Iara Da Silva
- Department of Nephrology, Fundación Puigvert, Barcelona, Spain
| | - Juana Alonso Titos
- Department of Nephrology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Santiago Rodríguez de Córdoba
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid and Centro de Investigación Biomédica en Red en Enfermedades Raras, Madrid, Spain
| | - Elena Goicoechea de Jorge
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Immunology, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Praga
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Caravaca-Fontán F, Díaz-Encarnación M, Cabello V, Ariceta G, Quintana LF, Marco H, Barros X, Ramos N, Rodríguez-Mendiola N, Cruz S, Fernández-Juárez G, Rodríguez A, de José AP, Rabasco C, Rodado R, Fernández L, Gómez VP, Ávila A, Bravo L, Espinosa N, Allende N, Sanchez de la Nieta MD, Rodríguez E, Olea T, Melgosa M, Huerta A, Miquel R, Mon C, Fraga G, de Lorenzo A, Draibe J, Cano-Megías M, González F, Shabaka A, López-Rubio ME, Fenollosa MÁ, Martín-Penagos L, Da Silva I, Titos JA, de Córdoba SR, de Jorge EG, Praga M. Longitudinal change in proteinuria and kidney outcomes in C3 glomerulopathy. Nephrol Dial Transplant 2021; 37:1270-1280. [PMID: 33779754 DOI: 10.1093/ndt/gfab075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/27/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The association between a change in proteinuria over time and its impact in kidney prognosis has not been analyzed in C3 glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure. METHODS Retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modeling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure. RESULTS The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13-41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥ 50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (HR: 0.79; 95% CI : 0.56-0.97; p < 0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up. CONCLUSION The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.
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Affiliation(s)
- Fernando Caravaca-Fontán
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Virginia Cabello
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona; Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Helena Marco
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitario Doctor Josep Trueta, Gerona, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Sonia Cruz
- Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Gema Fernández-Juárez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Adela Rodríguez
- Department of Pediatric Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez de José
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rabasco
- Department of Nephrology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Raquel Rodado
- Department of Nephrology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Loreto Fernández
- Department of Nephrology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Vanessa Pérez Gómez
- Department of Nephrology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Ávila
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Luis Bravo
- Department of Nephrology, Hospital Universitario A Coruña, La Coruña, Spain
| | - Natalia Espinosa
- Pediatric Nephrology Unit, Hospital Universitario Son Espases, Balearic Islands Health Research Institute (IdISBa), . Palma de Mallorca, Spain
| | - Natalia Allende
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Teresa Olea
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Melgosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rosa Miquel
- Department of Nephrology, Hospital Universitario Canarias, Tenerife, Spain
| | - Carmen Mon
- Department of Nephrology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Gloria Fraga
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario de Getafe, Madrid, Spain
| | - Juliana Draibe
- Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Marta Cano-Megías
- Department of Nephrology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Fayna González
- Department of Nephrology, Hospital Doctor Negrín, Gran Canaria, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Luis Martín-Penagos
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Iara Da Silva
- Department of Nephrology, Fundación Puigvert, Barcelona, Spain
| | - Juana Alonso Titos
- Department of Nephrology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Santiago Rodríguez de Córdoba
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid and Centro de Investigación Biomédica en Red en Enfermedades Raras, Madrid, Spain
| | - Elena Goicoechea de Jorge
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Immunology, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Praga
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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5
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Caravaca-Fontán F, Trujillo H, Alonso M, Díaz-Encarnación M, Cabello V, Ariceta G, Quintana LF, Marco H, Barros X, Ramos N, Rodríguez-Mendiola N, Cruz S, Fernández-Juárez G, Rodríguez E, de la Cerda F, Pérez de José A, López I, Fernández L, Pérez Gómez V, Ávila A, Bravo L, Lumbreras J, Allende N, Sanchez de la Nieta MD, Olea T, Melgosa M, Huerta A, Miquel R, Mon C, Fraga G, de Lorenzo A, Draibe J, González F, Shabaka A, Illescas ML, Calvo C, Oviedo V, Da Silva I, Goicoechea de Jorge E, Caravaca F, Praga M. Validation of a Histologic Scoring Index for C3 Glomerulopathy. Am J Kidney Dis 2020; 77:684-695.e1. [PMID: 33359150 DOI: 10.1053/j.ajkd.2020.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022]
Abstract
RATIONALE & OBJECTIVE A previous study that evaluated associations of kidney biopsy findings with disease progression in patients with C3 glomerulopathy (C3G) proposed a prognostic histologic index (C3G-HI) that has not yet been validated. Our objective was to validate the performance of the C3G-HI in a new patient population. STUDY DESIGN Multicenter, retrospective cohort study. SETTING & PARTICIPANTS 111 patients fulfilling diagnostic criteria of C3G between January 1995 and December 2019, from 33 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). PREDICTORS Demographic, clinical parameters, C3G-HI total activity score, and the C3G-HI total chronicity score. OUTCOME Time to kidney failure. ANALYTICAL APPROACH Intraclass correlation coefficients and κ statistic were used to summarize inter-rater reproducibility for assessment of histopathology in kidney biopsies. The nonlinear relationships of risk of kidney failure with the total activity score and total chronicity score were modeled using Cox proportional hazards analysis that incorporated cubic splines. RESULTS The study group included 93 patients with C3 glomerulonephritis and 18 with dense-deposit disease. Participants had an overall meanage of 35±22 (SD) years. Forty-eight patients (43%) developed kidney failure after a mean follow-up of 65±27 months. The overall inter-rater reproducibility was very good for the total activity score (intraclass correlation coefficient [ICC]=0.63) and excellent for total chronicity score (ICC=0.89). Baseline estimated glomerular filtration rate (eGFR), 24-hour proteinuria, and treatment with immunosuppression were the main determinants of kidney failure in a model with only clinical variables. Only tubular atrophy and interstitial fibrosis were identified as predictors in a model with histological variables. When the total activity score and total chronicity score were added to the model, only the latter was identified as an independent predictor of kidney failure. LIMITATIONS Only a subset of the kidney biopsies was centrally reviewed. Residual confounding. CONCLUSIONS We validated the performance of C3G-HI as a predictor of kidney failure in patients with C3G. The total chronicity score was the principal histologic correlate of kidney failure.
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Affiliation(s)
- Fernando Caravaca-Fontán
- Instituto de Investigación Hospital 12 de octubre (i+12), Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Hernando Trujillo
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marina Alonso
- Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Virginia Cabello
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology, Hospital Clinic de Barcelona Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Helena Marco
- Department of Nephrology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitario Doctor Josep Trueta, Gerona, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Sonia Cruz
- Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Gema Fernández-Juárez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Francisco de la Cerda
- Department of Pediatric Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez de José
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Inmaculada López
- Department of Nephrology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Loreto Fernández
- Department of Nephrology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Vanessa Pérez Gómez
- Department of Nephrology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Ávila
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Luis Bravo
- Department of Nephrology, Hospital Universitario A Coruña, La Coruña, Spain
| | - Javier Lumbreras
- Pediatric Nephrology Unit, Hospital Universitario Son Espases, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Natalia Allende
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Teresa Olea
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Melgosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rosa Miquel
- Department of Nephrology, Hospital Universitario Canarias, Tenerife, Spain
| | - Carmen Mon
- Department of Nephrology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Gloria Fraga
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario de Getafe, Madrid, Spain
| | - Juliana Draibe
- Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fayna González
- Department of Nephrology, Hospital Doctor Negrín, Gran Canaria, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Maria Luisa Illescas
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Consuelo Calvo
- Department of Nephrology, Hospital General Universitario de Castellón, Castellón, Spain
| | - Victoria Oviedo
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Iara Da Silva
- Department of Nephrology, Fundación Puigvert, Barcelona, Spain
| | - Elena Goicoechea de Jorge
- Department of Immunlogy, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid and Centro de Investigación Biomédica en Red en Enfermedades Raras, Madrid, Spain
| | - Francisco Caravaca
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Manuel Praga
- Instituto de Investigación Hospital 12 de octubre (i+12), Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
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6
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Caravaca-Fontán F, Díaz-Encarnación MM, Lucientes L, Cavero T, Cabello V, Ariceta G, Quintana LF, Marco H, Barros X, Ramos N, Rodríguez-Mendiola N, Cruz S, Fernández-Juárez G, Rodríguez A, Pérez de José A, Rabasco C, Rodado R, Fernández L, Pérez Gómez V, Ávila AI, Bravo L, Lumbreras J, Allende N, Sanchez de la Nieta MD, Rodríguez E, Olea T, Melgosa M, Huerta A, Miquel R, Mon C, Fraga G, de Lorenzo A, Draibe J, Cano-Megías M, González F, Shabaka A, López-Rubio ME, Fenollosa MÁ, Martín-Penagos L, Da Silva I, Alonso Titos J, Rodríguez de Córdoba S, Goicoechea de Jorge E, Praga M. Mycophenolate Mofetil in C3 Glomerulopathy and Pathogenic Drivers of the Disease. Clin J Am Soc Nephrol 2020; 15:1287-1298. [PMID: 32816888 PMCID: PMC7480558 DOI: 10.2215/cjn.15241219] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES C3 glomerulopathy is a complement-mediated disease arising from abnormalities in complement genes and/or antibodies against complement components. Previous studies showed that treatment with corticosteroids plus mycophenolate mofetil (MMF) was associated with improved outcomes, although the genetic profile of these patients was not systematically analyzed. This study aims to analyze the main determinants of disease progression and response to this therapeutic regimen. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective, multicenter, observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients diagnosed with C3 glomerulopathy (n=81) or dense deposit disease (n=16) between January 1995 and March 2018 were enrolled. Multivariable and propensity score matching analyses were used to evaluate the association of clinical and genetic factors with response to treatment with corticosteroids and MMF as measured by proportion of patients with disease remission and kidney survival (status free of kidney failure). RESULTS The study group comprised 97 patients (84% C3 glomerulopathy, 16% dense deposit disease). Forty-two patients were treated with corticosteroids plus MMF, and this treatment was associated with a higher rate of remission and lower probability of kidney failure (79% and 14%, respectively) compared with patients treated with other immunosuppressives (24% and 59%, respectively), or ecluzimab (33% and 67%, respectively), or conservative management (18% and 65%, respectively). The therapeutic superiority of corticosteroids plus MMF was observed both in patients with complement abnormalities and with autoantibodies. However, patients with pathogenic variants in complement genes only achieved partial remission, whereas complete remissions were common among patients with autoantibody-mediated forms. The main determinant of no remission was baseline proteinuria. Relapses occurred after treatment discontinuation in 33% of the patients who had achieved remission with corticosteroids plus MMF, and a longer treatment length of MMF was associated with a lower risk of relapse. CONCLUSIONS The beneficial response to corticosteroids plus MMF treatment in C3 glomerulopathy appears independent of the pathogenic drivers analyzed in this study.
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Affiliation(s)
- Fernando Caravaca-Fontán
- Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Laura Lucientes
- Department of Immunology, Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Cavero
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Virginia Cabello
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR); Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Helena Marco
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitario Doctor Josep Trueta, Gerona, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Sonia Cruz
- Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Gema Fernández-Juárez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Adela Rodríguez
- Department of Pediatric Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez de José
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rabasco
- Department of Nephrology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Raquel Rodado
- Department of Nephrology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Loreto Fernández
- Department of Nephrology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Vanessa Pérez Gómez
- Department of Nephrology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana I Ávila
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Luis Bravo
- Department of Nephrology, Hospital Universitario A Coruña, La Coruña, Spain
| | - Javier Lumbreras
- Pediatric Nephrology Unit, Hospital Universitario Son Espases, Balearic Islands Health Research Institute, Palma de Mallorca, Spain
| | - Natalia Allende
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Teresa Olea
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Melgosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rosa Miquel
- Department of Nephrology, Hospital Universitario Canarias, Tenerife, Spain
| | - Carmen Mon
- Department of Nephrology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Gloria Fraga
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario de Getafe, Madrid, Spain
| | - Juliana Draibe
- Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Marta Cano-Megías
- Department of Nephrology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Fayna González
- Department of Nephrology, Hospital Doctor Negrín, Gran Canaria, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Luis Martín-Penagos
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Iara Da Silva
- Department of Nephrology, Fundación Puigvert, Barcelona, Spain
| | - Juana Alonso Titos
- Department of Nephrology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Santiago Rodríguez de Córdoba
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid and Centro de Investigación Biomédica en Red en Enfermedades Raras, Madrid, Spain
| | - Elena Goicoechea de Jorge
- Department of Nephrology, Fundación Puigvert, Barcelona, Spain.,Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid and Centro de Investigación Biomédica en Red en Enfermedades Raras, Madrid, Spain
| | - Manuel Praga
- Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain .,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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7
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Bermejo S, González E, López-Revuelta K, Ibernon M, López D, Martín-Gómez A, Garcia-Osuna R, Linares T, Díaz M, Martín N, Barros X, Marco H, Navarro MI, Esparza N, Elias S, Coloma A, Robles NR, Agraz I, Poch E, Rodas L, Lozano V, Fernández B, Hernández E, Martínez MI, Stanescu RI, Moirón JP, García N, Goicoechea M, Calero F, Bonet J, Galceran JM, Liaño F, Pascual J, Praga M, Fulladosa X, Soler MJ. Risk factors for non-diabetic renal disease in diabetic patients. Clin Kidney J 2020; 13:380-388. [PMID: 32699618 PMCID: PMC7367112 DOI: 10.1093/ckj/sfz177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/15/2019] [Indexed: 11/28/2022] Open
Abstract
Background Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 ± 12.8 years, creatinine was 2.8 ± 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02–1.05, P < 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03–2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19–0.42, P < 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P = 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality. Conclusions The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.
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Affiliation(s)
- Sheila Bermejo
- Nephrology Department, Hospital del Mar, Barcelona, Spain.,Nephrology Department, Fundació Althaia, Manresa, Spain
| | - Ester González
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Meritxell Ibernon
- Nephrology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Diana López
- Nephrology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | | | - Tania Linares
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Nàdia Martín
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Xoana Barros
- Nephrology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Helena Marco
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Noemí Esparza
- Nephrology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Sandra Elias
- Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Coloma
- Nephrology Department, Hospital San Pedro, Logroño, Spain
| | | | - Irene Agraz
- Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department, Hospital Clínic, Barcelona, Spain.,IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Nephrology Department, Hospital Clínic, Barcelona, Spain.,IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Víctor Lozano
- Nephrology Department, Hospital Clínic, Barcelona, Spain.,IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | - José Pelayo Moirón
- Nephrology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Núria García
- Nephrology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Marian Goicoechea
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Josep Bonet
- Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Fernando Liaño
- Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Manuel Praga
- Nephrology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Fulladosa
- Nephrology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Spanish Group for the Study of Glomerular Diseases (GLOSEN), Grup de Treball de Malalties Glomerulars de la Societat Catalana de. Nefrologia (GlomCAT), and Grupo Español de Estudio de Nefropatía Diabética (GEENDIAB)
| | - María José Soler
- Nephrology Department, Hospital del Mar, Barcelona, Spain.,Nephrology Department, Hospital Vall d'Hebron, Barcelona, Spain
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8
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Bermejo S, González E, López K, Ibernón M, López D, Martín-Gómez A, García R, Linares T, Díaz M, Martín N, Barros X, Marco H, Navarro MI, Esparza N, Elías S, Coloma A, Robles NR, Hernández E, Martínez MI, Agraz I, Pelayo Moirón J, Goicoechea M, Bonet J, García N, Liaño F, Pascual J, Praga M, Fulladosa X, Soler MJ. SP416DIABETIC PATIENTS WITH DIABETIC NEPHROPATHY HAVE WORSE RENAL PROGNOSIS. STUDY BIODIAB-GLOSEN-GEENDIAB. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp416] [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: 11/12/2022] Open
Affiliation(s)
- Sheila Bermejo
- Nephrology, Fundació Althaia, Manresa, Spain
- Nephrology, Hospital del Mar, Barcelona, Spain
| | | | - Katia López
- Nephrology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Diana López
- Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | - Rosa García
- Nephrology, Hospital de Palamós, Girona, Spain
| | - Tania Linares
- Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Nadia Martín
- Nephrology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital de Bellvitge, Barcelona, Spain
| | - Helena Marco
- Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Noemí Esparza
- Nephrology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sandra Elías
- Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Coloma
- Nephrology, Hospital San Pedro, Logroño, Spain
| | | | | | | | - Irene Agraz
- Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - José Pelayo Moirón
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | - Josep Bonet
- Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Núria García
- Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Fernando Liaño
- Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Manuel Praga
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Fulladosa
- Nephrology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - María José Soler
- Nephrology. Instituto Carlos III. PI14/00557. FEDER., Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Nephrology, Barcelona, Spain
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9
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Bermejo S, González E, López K, Ibernón M, López D, Martín-Gómez A, García R, Linares T, Díaz M, Martin N, Barros X, Marco H, Navarro MI, Esparza N, Elias S, Coloma A, Robles NR, Hernández E, García N, Martínez MI, Goicoechea M, Agraz I, Pelayo Moirón J, Bonet J, Liaño F, Pascual J, Stanescu RL, Praga M, Fulladosa X, Soler MJ. SP425RENAL BIOPSY IN DIABETIC PATIENTS: PRELIMINARY RESULTS OF THE SPANISH MULTICENTER STUDY BIODIAB-GLOSEN-GEENDIAB. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp425] [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: 11/12/2022] Open
Affiliation(s)
- Sheila Bermejo
- Nephrology, Fundació Althaia, Manresa, Spain
- Nephrology, Hospital del Mar, Barcelona, Spain
| | | | - Katia López
- Nephrology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Diana López
- Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | - Rosa García
- Nephrology, Hospital de Palamós, Girona, Spain
| | - Tania Linares
- Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Nadia Martin
- Nephrology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitari JosepTrueta, Girona, Spain
| | - Helena Marco
- Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Noemi Esparza
- Nephrology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canarias, Spain
| | - Sandra Elias
- Nephrology, Hospital Ramón y Cajal, Madrid, Spain
| | - Ana Coloma
- Nephrology, Hospital San Pedro, Logroño, Spain
| | | | | | - Nuria García
- Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | | | - Irene Agraz
- Nephrology, Hospital Vall Hebron, Barcelona, Spain
| | - José Pelayo Moirón
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Josep Bonet
- Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Manuel Praga
- Nephrology, Hospital 12 de Octubre, madrid, Spain
| | - Xavier Fulladosa
- Nephrology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - María José Soler
- Nephrology. Instituto Carlos III. PI14/00557. FEDER., Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Nephrology, Barcelona, Spain
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Draibe J, Rodó X, Fulladosa X, Martínez-Valenzuela L, Diaz-Encarnación M, Santos L, Marco H, Quintana L, Rodriguez E, Barros X, Garcia R, Balius A, Cruzado JM, Torras J. Seasonal variations in the onset of positive and negative renal ANCA-associated vasculitis in Spain. Clin Kidney J 2017; 11:468-473. [PMID: 30094010 PMCID: PMC6070110 DOI: 10.1093/ckj/sfx127] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/25/2017] [Indexed: 11/13/2022] Open
Abstract
Background The closure of long-standing gaps in our knowledge of aetiological factors behind anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a major challenge. Descriptive and analytical epidemiological studies can improve our understanding of environmental influences. Reported seasonal variations in AAV, mainly related to Wegener's disease, have shown an increasing number of cases in the winter months, which could be related to an extrinsic factor underlying infection. The objective of this paper was to study seasonal variations in AAV with respect to renal affectation diagnosed in Catalonia, Spain. Methods Two hundred and thirty-four patients diagnosed for renal AAV between 2001 and 2014 in eight hospitals in Catalonia were included in the study. We used medical records to retrospectively analyse the date of the first symptoms attributed to the AAV, ANCA subtypes, the degree of renal impairment and renal histology. Results Of the 234 patients studied, 49.2% were male and 50.8% female. For ANCA status, 8.5% were positive, 15.9% were proteinase-3-positive and 75.6% were myeloperoxidase-positive. In relation to histological classification, 17.8% were sclerotic, 11.7% focal, 38.8% crescentic and 31.7% mixed. Regarding seasonal distribution, we observed a clear seasonal periodicity with a significantly higher incidence of cases in the winter. Applying an Eigen decomposition, we observed a periodic fluctuation of frequencies around the annual cycle with peaks every 10-12 months, and higher incidence of AAV cases in February. Conclusions Our results confirm, in Catalonia, the seasonal periodicity of AAV with a higher incidence in the winter, as formerly described in the literature for other regions. An environmental factor, likely one that is infectious, may explain this finding.
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Affiliation(s)
| | - Xavier Rodó
- Institució Catalana de Recerca i estudis Avançats (ICREA), Barcelona, Spain.,Institut Català de Ciències del Clima (IC3), Barcelona, Spain.,ISGlobal, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Joan Torras
- Hospital Universitari de Bellvitge, Barcelona, Spain
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11
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Sandoval D, Poveda R, Draibe J, Pérez-Oller L, Díaz M, Ballarín J, Saurina A, Marco H, Bonet J, Barros X, Fulladosa X, Torras J, Cruzado JM. Efficacy of mycophenolate treatment in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome. Clin Kidney J 2017; 10:632-638. [PMID: 28979773 PMCID: PMC5622890 DOI: 10.1093/ckj/sfx035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/19/2016] [Accepted: 03/28/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study assessed the efficacy of therapy with mycophenolate (MF) and reduced doses of steroids in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome (SD/FR-INS). METHODS Twenty-nine nephrotic patients (including 16 males and 13 females; mean age: 40 years, range: 18-74) were treated. Starting doses of MF were 2000 mg/day for mofetil MF (1500 mg/day in one patient) or 1440 mg/day for sodium MF. The initial prednisone (PDN) dose was 10 mg/day in 14 patients, 5 mg/day in two patients and no steroids in one patient. In the remaining 12 patients, moderate initial doses of PDN were administered (mean: 23.7 mg/day, range: 15-40), tapering to 10 mg/day after 1 month. RESULTS Nephrotic syndrome remission was achieved in 27/29 cases (93.1%) (25 complete, 2 partial). Two patients showed resistance to the prescribed schedule. The first cycle of MF therapy was concluded in 20 patients after a mean (range) of 16.9 months (12-49). Maintenance of remission was observed in 11 of these 20 cases (55%) after a mean follow-up of 32.8 months (12-108). In nine patients with nephrotic syndrome relapse after tapering of MF (MF dependency), the same MF-PDN schedule was restarted, leading again to remission in all nine. The remaining seven MF-sensitive patients are still receiving their first therapeutic cycle. To date, the mean time under therapy in the 27 MF-sensitive patients is 38 months (4-216). Regarding complications, only minor digestive disorders and a slight decrease in blood haemoglobin levels were observed in a few patients. CONCLUSIONS MF plus reduced doses of PDN is an effective and well-tolerated therapy for adult SD/FR-INS. Though MF dependence is observed, its low toxicity could allow long periods of therapy if it is required to maintain nephrotic syndrome remission.
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Affiliation(s)
- Diego Sandoval
- Department of Nephrology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Poveda
- Department of Nephrology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juliana Draibe
- Department of Nephrology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laureà Pérez-Oller
- Department of Nephrology, Hospital General de Vic, Vic, Catalunya, Spain
| | - Montserrat Díaz
- Renal and Hypertension Unit, Fundació Puigvert de Barcelona, Barcelona, Spain
| | - José Ballarín
- Renal and Hypertension Unit, Fundació Puigvert de Barcelona, Barcelona, Spain
| | - Anna Saurina
- Department of Nephrology, Hospital de Terrassa, Terrassa, Catalunya, Spain
| | - Helena Marco
- Department of Dialysis, Hospital Germans Trias i Pujol de Badalona, Barcelona, Spain
| | - Josep Bonet
- Department of Dialysis, Hospital Germans Trias i Pujol de Badalona, Barcelona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Josep Trueta de Girona, Girona, Catalunya, Spain
| | - Xavier Fulladosa
- Department of Nephrology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Torras
- Department of Nephrology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Cruzado
- Department of Nephrology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Tortajada A, Gutiérrez E, Goicoechea de Jorge E, Anter J, Segarra A, Espinosa M, Blasco M, Roman E, Marco H, Quintana LF, Gutiérrez J, Pinto S, Lopez-Trascasa M, Praga M, Rodriguez de Córdoba S. Elevated factor H–related protein 1 and factor H pathogenic variants decrease complement regulation in IgA nephropathy. Kidney Int 2017. [DOI: 10.1016/j.kint.2017.03.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Morante I, Guelvenzu B, Marco H, Olivé A. Granulomatosis eosinofílica con poliangitis y nefropatía IgA en paciente con infección por VIH. Med Clin (Barc) 2016; 147:e1-2. [DOI: 10.1016/j.medcli.2016.01.025] [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] [Received: 12/01/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 11/17/2022]
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Fernandez-Juarez G, Villacorta J, Ruiz-Roso G, Panizo N, Martinez-Marín I, Marco H, Arrizabalaga P, Díaz M, Perez-Gómez V, Vaca M, Rodríguez E, Cobelo C, Fernandez L, Avila A, Praga M, Quereda C, Ortiz A. Therapeutic variability in adult minimal change disease and focal segmental glomerulosclerosis. Clin Kidney J 2016; 9:381-6. [PMID: 27274821 PMCID: PMC4886920 DOI: 10.1093/ckj/sfw028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/25/2016] [Indexed: 12/01/2022] Open
Abstract
Background Variability in the management of glomerulonephritis may negatively impact efficacy and safety. However, there are little/no data on actual variability in the treatment of minimal change disease (MCD)/focal segmental glomerulosclerosis (FSGS) in adults. We assessed Spanish practice patterns for the management of adult nephrotic syndrome due to MCD or FSGS. The absence of reasonably good evidence on treatment for a disease often increases the variability substantially. Identification of evidence–practice gaps is the first necessary step in the knowledge-to-action cyclical process. We aim to analyse the real clinical practice in adults in hospitals in Spain and compare this with the recently released Kidney Disease: Improving Global Outcomes clinical practice guideline for glomerulonephritis. Methods Participating centres were required to include all adult patients (age >18 years) with a biopsy-proven diagnosis of MCD or FSGS from 2007 to 2011. Exclusion criteria included the diagnosis of secondary nephropathy. Results We studied 119 Caucasian patients with biopsy-proven MCD (n = 71) or FSGS (n = 48) from 13 Spanish hospitals. Of these patients, 102 received immunosuppressive treatment and 17 conservative treatment. The initial treatment was steroids, except in one patient in which mycophenolate mofetil was used. In all patients, the steroids were given as a single daily dose. The mean duration of steroid treatment at initial high doses was 8.7 ± 13.2 weeks and the mean global duration was 38 ± 32 weeks. The duration of initial high-dose steroids was <4 weeks in 41% of patients and >16 weeks in 10.5% of patients. We did find a weak and negative correlation between the duration of whole steroid treatment in the first episode and the number of the later relapses (r = −0.24, P = 0.023). There were 98 relapses and they were more frequent in MCD than in FSGs patients (2.10 ± 1.6 versus 1.56 ± 1.2; P = 0.09). The chosen treatment was mainly steroids (95%). Only seven relapses were treated with another drug as a first-line treatment: two relapses were treated with mycophenolate and five relapses were treated with anticalcineurinics. A second-line treatment was needed in 29 patients (24.4%), and the most frequent drugs were the calcineurin inhibitors (55%), followed by mycophenolate mofetil (31%). Although cyclophosphamide is the recommended treatment, it was used in only 14% of the patients. Conclusions We found variation from the guidelines in the duration of initial and tapered steroid therapy, in the medical criteria for classifying a steroid-resistant condition and in the chosen treatment for the second-line treatment. All nephrologists started with a daily dose of steroids as the first-line treatment. The most frequently used steroid-sparing drug was calcineurin inhibitors. Cyclophosphamide use was much lower than expected.
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Affiliation(s)
- Gema Fernandez-Juarez
- Department of Nephrology , Hospital Universitario Fundación Alcorcón , calle Budapest 1, Alcorcón, Madrid , Spain
| | - Javier Villacorta
- Department of Nephrology , Hospital Universitario Fundación Alcorcón , calle Budapest 1, Alcorcón, Madrid , Spain
| | - Gloria Ruiz-Roso
- Department of Nephrology , Hospital Ramón y Cajal , Madrid , Spain
| | - Nayara Panizo
- Department of Nephrology , Hospital General Universitario Gregorio Marañon , C/Doctor Esquerdo 46, Madrid , Spain
| | - Isabel Martinez-Marín
- Department of Nephrology , Hospital Universitario Fundación Alcorcón , calle Budapest 1, Alcorcón, Madrid , Spain
| | - Helena Marco
- Department of Dialysis , Fundacio Puigvert , Barcelona , Spain
| | - Pilar Arrizabalaga
- Department of Nephrology , Hospital Clinico , c/Villarroel 170, Barcelona , Spain
| | - Montserrat Díaz
- Department of Nephrology , Fundació Puigvert , Barcelona , Spain
| | | | - Marco Vaca
- Department of Nephrology , Hospital Universitario La Paz , Madrid , Spain
| | - Eva Rodríguez
- Department of Nephrology , Hospital del Mar , Barcelona , Spain
| | - Carmen Cobelo
- Department of Nephrology , Hospital Lucus Augusti Ulises Romero , Lugo , Spain
| | - Loreto Fernandez
- Department of Nephrology , Hospital Universitario Principe de Asturias , Alcala de Henares, Madrid , Spain
| | - Ana Avila
- Department of Nephrology , Dr Peset Hospital , Avda Gaspar Aguilar, 90, 46027 Valencia , Spain
| | - Manuel Praga
- Department of Nephrology , Hospital 12 de Octubre , Carretera de Andalucia, km 5,400, Madrid , Spain
| | - Carlos Quereda
- Department of Nephrology , Hospital Ramón y Cajal , Madrid , Spain
| | - Alberto Ortiz
- Fundacion Jimenez Diaz , Universidad Autonoma, Unidad de Dialisis , Av. Reyes Catolicos 2, Madrid , Spain
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Marco H, Fulladosa X, Fernandez-Juárez G, Quintana L, Martin N, Garcia-Osuna R, Cabre C, Martin D, Balius A, Saurina A, Praga M, Ballarin J, Diaz-Encarnación M. MO042VALIDATION OF THE 2010 HISTOPATHOLOGIC CLASSIFICATION OF ANCA ASSOCIATED GLOMERULONEPHRITIS IN A SPANISH COHORT. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw137.04] [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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16
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Soler-Majoral J, García Y, Navarro M, Guermah I, Guelvenzu B, Samaniego D, Serra A, Subirats JL, López D, Olivé A, Marco H, Bonet J. MP136LUPUS NEPHRITIS: 15 YEARS EXPERIENCE FROM A SINGLE CENTRE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw185.27] [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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Guermah I, Gonzalez A, Lopez D, Hernandez A, Navarro M, Serra A, Marco H, Bonet J. SP077INFLUENCE OF VASCULAR LESIONS IN RENAL BIOPSY IN ANTINEUTROPHIL CYTOPLASMIC ANTIBODY ASSOCIATED GLOMERULONEPHRITIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv188.40] [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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Marco H, Smith RM, Jones RB, Guerry MJ, Catapano F, Burns S, Chaudhry AN, Smith KGC, Jayne DRW. The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease. BMC Musculoskelet Disord 2014; 15:178. [PMID: 24884562 PMCID: PMC4038057 DOI: 10.1186/1471-2474-15-178] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/15/2014] [Indexed: 02/07/2023] Open
Abstract
Background Rituximab is a B cell depleting anti-CD20 monoclonal antibody. CD20 is not expressed on mature plasma cells and accordingly rituximab does not have immediate effects on immunoglobulin levels. However, after rituximab some patients develop hypogammaglobulinaemia. Methods We performed a single centre retrospective review of 177 patients with multisystem autoimmune disease receiving rituximab between 2002 and 2010. The incidence, severity and complications of hypogammaglobulinaemia were investigated. Results Median rituximab dose was 6 g (1–20.2) and total follow-up was 8012 patient-months. At first rituximab, the proportion of patients with IgG <6 g/L was 13% and remained stable at 17% at 24 months and 14% at 60 months. Following rituximab, 61/177 patients (34%) had IgG <6 g/L for at least three consecutive months, of whom 7/177 (4%) had IgG <3 g/L. Low immunoglobulin levels were associated with higher glucocorticoid doses during follow up and there was a trend for median IgG levels to fall after ≥ 6 g rituximab. 45/115 (39%) with IgG ≥6 g/L versus 26/62 (42%) with IgG <6 g/L experienced severe infections (p = 0.750). 6/177 patients (3%) received intravenous immunoglobulin replacement therapy, all with IgG <5 g/L and recurrent infection. Conclusions In multi-system autoimmune disease, prior cyclophosphamide exposure and glucocorticoid therapy but not cumulative rituximab dose was associated with an increased incidence of hypogammaglobulinaemia. Severe infections were common but were not associated with immunoglobulin levels. Repeat dose rituximab therapy appears safe with judicious monitoring.
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Affiliation(s)
| | - Rona M Smith
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
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Monova D, Monov S, Todorov T, Soderberg D, Kurz T, Weiner M, Eriksson P, Segelmark M, Jakuszko K, Sebastian A, Bednarz Z, Krajewska M, Wiland P, Madziarska K, Weyde W, Klinger M, Naidoo J, Wearne N, Jones E, Swanepoel C, Rayner B, Okpechi I, Endo N, Tsuboi N, Furuhashi K, Matsuo S, Maruyama S, Clerte M, Levi C, Touzot M, Fakhouri F, Monge C, Lebas C, Abboud I, Huart A, Durieux P, Charlin E, Thervet E, Karras A, Smykal-Jankowiak K, Niemir ZI, Polcyn-Adamczak M, Whatmough S, Sweeney N, Fernandez S, Hussain M, Dhaygude A, Jakuszko K, Bednarz Z, Sebastian A, Krajewska M, Gniewek K, Wiland P, Weyde W, Klinger M, Manenti L, Urban ML, Vaglio A, Gintoli E, Galletti M, Buzio C, Monova D, Monov S, Argirova T, Wong I, Ibrahim FH, Goh BL, Lim TS, Chan MW, Hiramtasu R, Ubara Y, Hoshino J, Takaichi K, Ghafoor V, Hussain M, Dhaygude A, Whatmough S, Fernandez S, Sweeney N, Hussain M, Dhaygude A, Sahay M, Soma J, Nakaya I, Sasaki N, Yoshikawa K, Sato H, Kaminskyy V, ZAbi Ska M, Krajewska M, Ko Cielska-Kasprzak K, Jakuszko K, Klinger M, Niemir Z, Wozniczka K, Swierzko A, Cedzynski M, Polcyn-Adamczak M, Sokolowska A, Szala A, Arjunan A, Mikhail A, Shrivastava R, Parker C, Aithal S, Gursu M, Ozari M, Yucetas E, Sumnu A, Doner B, Cebeci E, Ozkan O, Aktuglu MB, Karaali Z, Koldas M, Ozturk S, Marco H, Picazo M, Da Silva I, Gonzalez A, Arce Y, Gracia S, Corica M, Llobet J, Diaz M, Ballarin J, Schonermarck U, Hagele H, Baumgartner A, Fischereder M, Muller S, Oliveira CBL, Oliveira ASA, Carvalho CJB, Pessoa CTBC, Sette LHBC, Fernandes GV, Cavalcante MAGM, Valente LM, Wan Q, Hu H, He Y, Li T, Aazair N, Houmaid Z, Rhair A, Bennani N, Demin A, Petrova O, Kotova O, Demina L, Roccatello D, Sciascia S, Rossi D, Naretto C, Baldovino S, Alpa M, Salussola I, Modena V, Zakharova EV, Vinogradova OV, Stolyarevich ES, Yap DYH, Chan TM, Thanaraj V, Dhaygude A, Ponnusamy A, Pillai S, Argentiero L, Schena A, Rossini M, Manno C, Castellano G, Martino M, Mitrotti A, Giliberti M, Digiorgio C, Di Palma AM, Battaglia M, Ditonno P, Grandaliano G, Gesualdo L, Oliveira CBL, Carvalho CJB, Oliveira ASA, Pessoa CTBC, Sette LHBC, Fernandes GV, Cavalcante MAGM, Valente LM, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Rabrenovi V, Kova Evi Z, Jovanovi D, Rabrenovi M, Anti S, Ignjatovi L, Petrovi M, Longhi S, Del Vecchio L, Vigano S, Casartelli D, Bigi MC, Corti M, Limardo M, Tentori F, Pontoriero G, Zeraati AA, Shariati Sarabi Z, Davoudabadi Farahani A, Mirfeizi Z, Bae E. PRIMARY AND SECONDARY GLOMERULONEPHRITIDES 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu170] [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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Marco H, Mirapeix E, Arcos E, Comas J, Ara J, Gil-Vernet S, Puig J, Vinyas O, Perello M, Oppenheimer F, Poveda R, Ibernón M, Díaz M, Ballarin J. Long-term outcome of antineutrophil cytoplasmic antibody-associated small vessel vasculitis after renal transplantation. Clin Transplant 2013; 27:338-47. [DOI: 10.1111/ctr.12084] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Helena Marco
- Department of Nephrology; Fundació Puigvert; Barcelona; Spain
| | | | - Emma Arcos
- Organització Catalana de Trasplantament; Barcelona; Spain
| | - Jordi Comas
- Organització Catalana de Trasplantament; Barcelona; Spain
| | - Jordi Ara
- Department of Nephrology; Hospital Germans Trias i Pujol; Barcelona; Spain
| | - Salvador Gil-Vernet
- Department of Nephrology; Hospital Universitari de Bellvitge; Barcelona; Spain
| | - Josep Puig
- Department of Nephrology; Hospital del Mar; Barcelona; Spain
| | - Odette Vinyas
- Department of Immunology; Hospital Clinic; Barcelona; Spain
| | - Manel Perello
- Department of Nephrology; Hospital Universitari Vall d'Hebró; Barcelona; Spain
| | | | - Rafael Poveda
- Department of Nephrology; Hospital Universitari de Bellvitge; Barcelona; Spain
| | - Meritxell Ibernón
- Department of Nephrology; Hospital Germans Trias i Pujol; Barcelona; Spain
| | - Montserrat Díaz
- Department of Nephrology; Fundació Puigvert; Barcelona; Spain
| | - Jose Ballarin
- Department of Nephrology; Fundació Puigvert; Barcelona; Spain
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Tchebotareva N, Bobkova I, Kozlovskaya L, Li O, Plaisier E, Terrier B, Lacraz A, Bridoux F, Huart A, Marie I, Launay D, Hummel A, Saint-Martin L, Bonnet F, Belenotti P, Kahn JE, Hinschberger O, Rullier P, Cacoub P, Casian A, Szpirt W, Jayne D, Walsh M, Haris A, Polner K, Aranyi J, Braunitzer H, Meran Z, Kaszas I, Mazanowska O, Koscielska-Kasprzak K, Kaminska D, Penar J, Zabinska M, Dziemianko I, Krajewska M, Klinger M, Marco H, Corica M, Picazo M, Arce Y, Llobet JM, Diaz M, Ballarin J, Kuroki A, Akizawa T, Papasotiriou M, Kalliakmani P, Huang L, Gerolymos M, Goumenos DS, Johnson TS, Ogahara S, Abe Y, Ito K, Watanabe M, Saito T, Saito T, Watanabe M, Ito K, Abe Y, Ogahara S, Nesen A, Topchii I, Semenovylh P, Galchinskaya V, Bantis C, Heering P, Kouri NM, Schwandt C, Rump LC, Ivens K, Nagasawa Y, Iio K, Fukuda S, Date Y, Iwatani H, Yamamoto R, Horii A, Inohara H, Imai E, Ohno H, Rakugi H, Rakugi Y, Sahin OZ, Gibyeli Genek D, Alkan Tasli F, Yavas H, Gurses S, Yeniay P, Uzum A, Ersoy R, Cirit M, Christou D, Molyneux K, Peracha J, Feehally J, Smith AC, Barratt J, Yamamoto R, Nagasawa Y, Shoji T, Katakami N, Ohtoshi K, Hayaishi-Okano R, Yamasaki Y, Yamauchi A, Tsubakihara Y, Imai E, Rakugi H, Isaka Y, Faria B, Vidinha J, Pego C, Garrido J, Lemos S, Lima C, Sorbo G, Lorga E, Sousa T, Yavas HH, Sahin OZ, Ozen KP, Gibyeli Genek D, Ersoy R, Alkan Tasli F, Yucel O, Cirit M, Wada Y, Ogata H, Yamamoto M, Ito H, Kinugasa E, Lundberg S, Lundahl J, Gunnarsson I, Jacobson S, Camilla R, Loiacono E, Dapra V, Morando L, Conrieri M, Bianciotto M, Bosetti FM, Gallo R, Peruzzi L, Amore A, Coppo R, Jeong K, Kim Y, Lee TW, Lee SH, Moon JY, Lee S, Ihm C, Komatsu H, Fujimoto S, Kikuchi M, Sato Y, Kitamura K, Sulikowska B, Johnson R, Grajewska M, Donderski R, Odrowaz-Sypniewska G, Manitius J, Amore A, Camilla R, Morando L, Peruzzi L, Rollino C, Quarello F, Colla L, Segoloni G, Caramello E, Cravero R, Quaglia M, Stratta P, Mazzucco G, Coppo R, Coppo R, Grcevska L, Petrusevska G, Nikolov V, Polenakovic M, Lee KW, Ham YR, Jang WI, Jung JY, Jang DS, Chung S, Choi DE, Na KR, Shin YT, Sulikowska B, Johnson R, Grajewska M, Donderski R, Odrowaz-Sypniewska G, Manitius J, Pasquariello A, Innocenti M, Pasquariello G, Mattei P, Colombini E, Ricchiuti G, Sami N, Cupisti A, Rocchetti MT, Di Paolo S, Tamma G, Lasorsa D, Suriano IV, D'Apollo A, Papale M, Mastrofrancesco L, Grandaliano G, Svelto M, Valenti G, Gesualdo L, Wang C, Li Y, Jia N, Fan J, Vigotti FN, Daidola G, Colla L, Besso L, Segoloni GP, Rocchetti MT, Papale M, Di Paolo S, Vocino G, Suriano IV, D'Apollo A, Grandaliano G, Gesualdo L, Berthoux F, Mohey H, Laurent B, Mariat C, Afiani A, Thibaudin L, Rivera F, Segarra A, Praga M, Vozmediano C, Rivera F, Lopez JM, Hernandez D, Pesickova S, Rysava R, Lenicek M, Potlukova E, Jancova E, Vitek L, Honsova E, Zavada J, Svarcova J, Kalousova M, Trendelenburg M, Tesar V, Li X, Ren H, Zhang W, Pan X, Zhang Q, Chen X, Xu Y, Shen P, Chen N, Hruskova Z, Mareckova H, Svobodova B, Jancova E, Bednarova V, Rysava R, Tesar V, Bobrova L, Kozlovskaya N, Khafizova E, Meteleva N, Shakhnova E, Alsuwaida A, Hussain S, Alghonaim M, AlOudah N, Ullah A, Kfoury H, Lorusso P, Bottai A, Cipollini I, Giorgetti M, Barsotti G, Goplani K, Kaswan K, Gera D, Patel H, Gumber M, Shah P, Vanikar A, Trivedi H, Gluhovschi C, Gluhovschi G, Potencz E, Lazar E, Trandafirescu V, Petrica L, Velciov S, Bozdog G, Bob F, Gadalean F, Vernic C, Cioca D, Bantis C, Heering P, Stangou M, Kouri NM, Schwandt C, Memmos D, Rump LC, Ivens K, Tofik R, Rippe B, Torffvit O, Bakoush O, Silska M, Lipkowska K, Warzywoda A, Soltysiak J, Blumczynski A, Musielak A, Ostalska-Nowicka D, Zachwieja J, Spartalis M, Stangou M, Pliakos K, Oikonomidou D, Pantzaki A, Rizopoulou E, Efstratiadis G, Memmos D, Okino VT, Moyses Neto M, Silva GEB, Vieira Neto O, Romao EA, Coelho EB, Dantas M, Liakou H, Stangou M, Ekonomidou D, Pantzaki A, Patinakis P, Sigounas V, Efstratiadis G, Memmos D, Shvetsov M, Bobkova I, Zheng A, Li O, Chebotareva N, Kamyshova E, Rudenko T, Gelpi R, Navarro I, Ngango L, Poveda R, Goma M, Torras J, Grinyo JM, Fulladosa X, Wang Y, Ivany J, Jardine M, Zhong F, Wang W, Ren H, Xie Y, Huang Q, Chen N, Chiappini MG, Di Girolamo M, Grosso A, Muzi L, Panetta V, Khafizova E, Kozlovskaya N, Bobrova L, Bobkova I, Avdonin P, Gluhovschi C, Gluhovschi G, Potencz E, Lazar E, Trandafirescu V, Petrica L, Velciov S, Bozdog G, Bob F, Gadalean F, Vernic C, Cioca D, Ito M, Kimachi M, Nishio S, Koike T, Choi H, Cho AJ, Jang HR, Lee JE, Huh W, Kim DJ, Oh HY, Kim YG. Clinical Nephrology: primary and secondary glomerulonephritis. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.35] [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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Andersen K, Eltrich N, Vielhauer V, Iyoda M, Shibata T, Hirai Y, Kuno Y, Akizawa T, Kim MJ, Barratt J, Molyneux K, Masuda ES, Pusey CD, Tam FWK, Wilde B, Thewissen M, van Paassen P, Hilhorst M, Damoiseaux J, Witzke O, Cohen Tervaert JW, Marco H, Jones RB, Smith RM, Catapano F, Chaudhry AN, Jayne DRW. Immune and inflammatory mechanisms. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.12] [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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Bover J, Aguilar A, Baas J, Reyes J, Lloret MJ, Farré N, Olaya M, Canal C, Marco H, Andrés E, Trinidad P, Ballarin J. Calcimimetics in the chronic kidney disease-mineral and bone disorder. Int J Artif Organs 2009; 32:108-21. [PMID: 19363783 DOI: 10.1177/039139880903200208] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mineral and bone disorders (MBD) are both an early and very common complication of chronic kidney disease (CKD). It is now accepted that they represent a significant risk factor, explaining the high cardiovascular morbidity and mortality in CKD patients. During the last decade, we have been witnessing many advances in the nomenclature, classification, pathophysiology, diagnosis, and treatment of CKD and some of its complications, such as CKD-MBD. The identification of the calcium-sensing receptor (CaSR) involvement in the pathogenesis of primary and secondary hyperparathyroidism (SHPT) and the availability of a new class of drugs called calcimimetics are two outstanding examples. Cinacalcet, the only available calcimimetic, has been shown to be a very effective therapeutic tool in CKD-MBD. Many clinical trials with cinacalcet in hemodialysis patients with SHPT have shown a reduction in parathyroid hormone, calcium (Ca), phosphate (P) and Ca x P product levels, allowing far greater success in reaching therapeutic goals as recommended by international guidelines. Additionally, some studies have shown that the use of cinacalcet may improve other aspects of CKD-MBD, reducing the risk of vascular calcification and parathyroidectomy, among others. Prospective studies on dialysis patients, with hard endpoint data, are currently underway. This review summarizes the most significant aspects of calcimimimetics based on both experimental and clinical results, underlining their possibilities not only for the treatment of isolated SHPT but also for other CKD-MBD related conditions.
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Affiliation(s)
- Jordi Bover
- Fundació Puigvert, Universitat Autònoma de Barcelona, Catalonia. REDinREN, Instituto de Investigación Carlos III - Spain.
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Bover J, Canal C, Marco H, Fernandez-Llama P, Bosch RJ, Ballarín J. Diagnostic procedures and rationale for specific therapies in chronic kidney disease-mineral and bone disorder. Contrib Nephrol 2008; 161:222-233. [PMID: 18451681 DOI: 10.1159/000130690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Chronic kidney disease (CKD) is associated with increased mortality. Non-traditional risk factors, such as mineral metabolism disturbances, seem to contribute to the unexpected high mortality rate. A chronic kidney disease-mineral bone disorder (CKD-MBD) has recently been defined as a systemic disorder manifested by one or a combination of abnormalities in bone biopsy, laboratory parameters, and/or vascular or other soft tissue calcifications. Recent research developments and new available treatments have all contributed to move the former treatment paradigm beyond the control of PTH. Thus, despite much of the advice given by different societies being just opinion-based evidence, the effect of different drugs on laboratory parameters, vascular calcification (VC) or survival may steer the choice of specific treatments. Aluminum and calcium-based phosphorus binders have been associated either with metal toxicity or progression of VC. Sevelamer hydrochloride has been related to an attenuation of the progression of VC and it has also been associated with improved survival at least in certain subgroups of dialysis patients. Lanthanum carbonate decreases phosphorus levels but its impact on surrogate or hard outcomes is not known. Selective vitamin D-receptor activators may have differential effects on VC, are associated with a survival advantage and thereby may have a best-fitted profile for CKD patients. On the other hand, calcimimetics markedly help to achieve current guidelines and ongoing clinical trials are evaluating hard outcomes. It is likely that a regimen combining several drugs might improve individual results. However, the utility of any new approach to CKD-MBD will need to be evaluated in prospective trials including thorough pharmacoeconomic analysis.
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Affiliation(s)
- Jordi Bover
- Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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