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Zhang P, Yan SJ, Hu J, Liu HP, Xia W, Yang M, Kuang QH, Shi KL, Fu MZ, Gao CL, Xia ZK. EXPRESS: Clinical Outcomes and Clinico-Pathological Correlations in Children with MPO-ANCA-Associated Glomerulonephritis Showing Renal Arteritis. J Investig Med 2024:10815589241248073. [PMID: 38594222 DOI: 10.1177/10815589241248073] [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] [Indexed: 04/11/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical features, pathological characteristics and prognosis in myeloperoxidase (MPO)-antineutrophil cytoplasmic antibodies-associated glomerulonephritis (AAGN) with renal arteritis. METHODS The study involved 97 children from five pediatric clinical centers with MPO-AAGN who exhibited distinct clinical features. The patients were divided into AAGN-A+ and AAGN-A-, based on the presence or absence of arteritis, and the disparities in clinical, histopathological characteristics, and prognosis between the two groups were evaluated. RESULT In contrast to the AAGN-A- group, the children in the AAGN-A+ group exhibited more pronounced clinical symptoms and renal pathological injury. Arteritis positively moderately correlated with the serum creatinine (Scr), IL-6 (interleukin-6), urinary neutrophil gelatinase-associated lipocalin (NGAL), negatively moderately correlated with serum complement C3. The renal survival rate in the AAGN-A+ group was significantly poorer than AAGN-A- group (χ2=4.278, P=0.039). Arteritis showed a good predictive value for end-stage kidney disease (ESKD), and C3 deposition and arteritis were independent risk factors for the development of ESKD in children with MPO-AAGN. CONCLUSION Arteritis is a significant pathological change observed in children with MPO-AAGN, and the formation of arteritis may be related to the inflammatory response and activation of the complement system.
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Affiliation(s)
- Pei Zhang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shi-Jun Yan
- Department of Pediatric, Qinhuai Medical District, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jian Hu
- Department of Pediatrics, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Hai-Peng Liu
- Department of Emergency, Xuzhou Children's Hospital, Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Wei Xia
- Department of pediatric nephrology, BenQ Medical Center,The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Yang
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qian-Huining Kuang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kai-Li Shi
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Meng-Zhen Fu
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Chun-Lin Gao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zheng-Kun Xia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Tang ZL, Yao J, Zhang P, He X, Jia LL, Shi KL, Xia ZK, Gao CL. [A case of X-linked Alport syndrome with esophageal leiomyomatosis]. Zhonghua Er Ke Za Zhi 2024; 62:275-277. [PMID: 38378292 DOI: 10.3760/cma.j.cn112140-20231014-00287] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Z L Tang
- Department of Pediatrics, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing 210002, China
| | - J Yao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - P Zhang
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - X He
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - L L Jia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - K L Shi
- Department of Pediatrics, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing 210002, China
| | - Z K Xia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - C L Gao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
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Zhang P, Jia LL, Fu MZ, Shi KL, Gao CL, Xia ZK. Bowman capsule rupture in children with myeloperoxidase-antineutrophil cytoplasmic antibody-associated glomerulonephritis predicts poor renal survival. Kidney Res Clin Pract 2023:j.krcp.23.051. [PMID: 37919894 DOI: 10.23876/j.krcp.23.051] [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: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 11/04/2023] Open
Abstract
Background Recent developments indicated that Bowman capsule rupture (BCR) is observed in antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN). We aimed to explore the relationship between BCR and clinical manifestations, pathological changes, and prognosis in children with myeloperoxidase (MPO)-AAGN. Methods A total of 56 children with MPO-AAGN were divided into BCR (+) and BCR (-) groups according to the status of Bowman's capsule. Clinical and histological features and renal outcomes were compared, and the predictive value of BCR for end-stage kidney disease (ESKD) of MPO-AAGN was evaluated. Results After retrospective analysis of the data, 24 children (42.9%) were found to have BCR. The results showed that BCR positively correlated with intrarenal immune cell infiltrates, obsolescence and crescents in glomeruli, tubulointerstitial inflammation, tubulitis, and tubular atrophy negatively correlated with normal glomeruli and immunoglobulin G deposition in the kidney. The clinical features and kidney pathological changes were more severe in the BCR (+) group than BCR (-) group, and the renal survival rate was significantly poorer in the BCR (+) group than BCR (-) group (χ2 = 5.45, p = 0.02). Moreover, estimated glomerular filtration rate (≤15 mL/min/1.73 m2), BCR and ANCA renal risk score (ARRS) were independent risk factors for the development of ESKD in children with MPO-AAGN. After combining BCR with the Berden classification and ARRS, our data suggested that the Berden classification + BCR and ARRS + BCR showed better predictive values for ESKD than those of the Berden classification and ARRS, respectively. Conclusion BCR is an important pathological lesion that correlates with severe clinical manifestations, pathological changes, and poor prognosis in children with MPO-AAGN.
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Affiliation(s)
- Pei Zhang
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Li-Li Jia
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Meng-Zhen Fu
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kai-Li Shi
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chun-Lin Gao
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zheng-Kun Xia
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Wang JJ, Shi KL, Li JW, Jiang LQ, Caspi O, Fang F, Xiao J, Jing H, Zou LP. Risk factors for arterial ischemic and hemorrhagic stroke in childhood. Pediatr Neurol 2009; 40:277-81. [PMID: 19302940 DOI: 10.1016/j.pediatrneurol.2008.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 06/11/2008] [Revised: 11/03/2008] [Accepted: 11/19/2008] [Indexed: 10/21/2022]
Abstract
This study assessed potential etiologies of arterial ischemic stroke and hemorrhagic stroke among children of Mainland China. From January 1996-June 2006, 251 patients with consecutive childhood stroke (aged 1 month through 16 years) were admitted to Beijing Children's Hospital. Arterial ischemic stroke accounted for the majority of cases (62.5%). Idiopathic stroke (32.5%) was more common than cardiac stroke (8.9%), vascular or arteriopathic stroke (21.0%), hematologic disorder-associated stroke (10.8%), and other etiologies (26.8%). Vitamin K deficiency was a major etiology in 72 of 94 hemorrhagic strokes (76.6%), most of which occurred in breastfeeding infants (80.6%) and those who received no vitamin K after birth (73.6%). Arteriovenous malformation (6.4%) was a frequent etiology in the remaining hemorrhagic stroke cases. We found that ischemic stroke in children is more common than hemorrhagic stroke, and many cases of ischemic stroke are idiopathic. Vitamin K deficiency was a major etiology in these young infants who experienced hemorrhagic stroke.
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Affiliation(s)
- Jian-Jun Wang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Abstract
Etiology of the idiopathic childhood stroke remains unknown. In previous studies, the immunologic process may be involved in the idiopathic stroke. Tumor necrosis factor- alpha (TNF-alpha), an important immune mediator, may contribute to the initiation and progression in the stroke. The main purpose of this study was to investigate correlation of TNF-alpha genetic variation and idiopathic childhood ischemic stroke. Using the direct DNA sequencing method, polymorphisms in the TNF-alpha promoter region were genotyped in 67 Chinese patients with idiopathic childhood stroke and 70 controls. Among totally 7 single nucleotide polymorphisms identified in the TNF-alpha promoter region, the variant of the -863C/A is associated with increased risk of idiopathic childhood ischemic stroke in our study group. TNF-alpha molecule may have genetically as well as functionally an important role in the pathogenesis of idiopathic childhood ischemic stroke in the Chinese population.
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Affiliation(s)
- Kai-Li Shi
- Department of Neurology, Beijing Children's Hospital, The Capital Medical University, Beijing, China
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Shi KL, Wang JJ, Li JW, Jiang LQ, Mix E, Fang F, Wu HS, Jin X, Jing H, Zou LP. Arterial ischemic stroke: experience in Chinese children. Pediatr Neurol 2008; 38:186-90. [PMID: 18279753 DOI: 10.1016/j.pediatrneurol.2007.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 07/05/2007] [Revised: 09/17/2007] [Accepted: 11/12/2007] [Indexed: 11/18/2022]
Abstract
The aim of this study was to review cases of pediatric arterial ischemic stroke among Chinese subjects and thereby evaluate risk factors, clinical and neuroimaging features, and treatment, to establish a reasonable guideline for assessment and management of the disease. Between 1996 and 2006, 157 children (male:female ratio, 1.4:1) with arterial ischemic stroke were identified at Beijing Children's Hospital. The median age at stroke was 32 months (range, 4-192). Among patients with determined etiology, infections (12.1%), moyamoya disease (12.1%), and trauma (10.8%) were the most common. In 51 patients, there were no obvious risk factors (32.5%). Hemiplegia was the most common presenting feature (81.5%). The region of left middle cerebral artery was most frequently affected (36.3%), followed by the right middle cerebral artery (29.9%). Of the 157 patients, 56 were treated by intravenous thrombolytic agents (35.7%), all but one of them successfully (the one exception involving hemorrhagic complication). Randomized controlled trials are needed to establish primary prevention, acute treatment, and secondary prevention of pediatric ischemic stroke.
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Affiliation(s)
- Kai-Li Shi
- Department of Neurology, Beijing Children's Hospital, The Capital Medical University, Beijing, China
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Chen XM, Yao YX, Shi KL, Mak TCW. Two Metal Complexes of the Macrocyclic Ligand 1,4,7-Triazacyclodecane (tacd). Crystal Structures of [Zn(tacd)2](ClO4)2 and [Cu(tacd)2]Br2.4H2O. Aust J Chem 1995. [DOI: 10.1071/ch9950139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Two metal complexes of 1,4,7-triazacyclodecane ( tacd ), [Zn( tacd )2] (ClO4)2 (1) and [Cu( tacd )2] Br2.4H2O (2), have been prepared and characterized by X-ray crystallography. Crystals of (1) are monoclinic, P21/n, a 9.506(2), b 10.279(3), c 11.505(2) Ǻ, β 91.29(2)°; crystals of (2) are orthorhombic, Pbca, a 12.035(3), b 13.673(3), c 14.248(2) Ǻ. The zinc(II) atom in (1) is surrounded in a distorted octahedral N6 environment with Zn-N bonds at 2.121(5)-2.131(4) Ǻ; the copper(II) atom in (2) adopts an elongated octahedral coordination geometry with the Cu-N bonds at 2.066(4)-2.294(5) Ǻ.
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