1
|
Bekassy Z, Lindström M, Rosenblad T, Aradóttir S, Sartz L, Tullus K. Is kidney biopsy necessary in children with idiopathic nephrotic syndrome? Acta Paediatr 2023; 112:2611-2618. [PMID: 37642221 DOI: 10.1111/apa.16959] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
AIM To investigate the need, in the Northern European setting, to perform kidney biopsy in children with steroid-sensitive nephrotic syndrome. METHODS In this retrospective study 124 individuals aged 1-18 years with idiopathic nephrotic syndrome, followed in the paediatric hospitals in southern Sweden from 1999 to 2018, were included. RESULTS There was a median follow-up time of 6.5 (0.2-16.8) years. The majority (92%) of children were steroid-sensitive and of them, 60.5% were frequently relapsing or steroid-dependent. Microscopic haematuria was found at onset in 81.1% and hypertension in 8.7%. At least one kidney biopsy was performed in 93 (75%). The most common indication was a steroid-dependent or relapsing course (58.4%). One of 79 steroid-sensitive children had another histological diagnosis than minimal change nephropathy 1.3%, 95% confidence interval (0.002, 0.068). Bleeding occurred after eight biopsies (6.6%). Twenty individuals (30.7%) were transferred to adult units, 18 still on immunosuppression. CONCLUSION We have in our cohort of unselected children with idiopathic nephrotic syndrome confirmed that a kidney biopsy rarely gives important medical information in steroid-sensitive children without any other complicating factor and that the liberal policy of kidney biopsy in the Nordic countries safely can be changed.
Collapse
Affiliation(s)
- Zivile Bekassy
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Section for Paediatric Nephrology, Skåne University Hospital, Lund, Sweden
| | - Martin Lindström
- Department of Clinical Sciences, Division of Pathology, Lund University, Lund, Sweden
| | - Therese Rosenblad
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Section for Paediatric Nephrology, Skåne University Hospital, Lund, Sweden
| | - Sunna Aradóttir
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lisa Sartz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Section for Paediatric Nephrology, Skåne University Hospital, Lund, Sweden
| | - Kjell Tullus
- Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Ariceta G, Fakhouri F, Sartz L, Miller B, Nikolaou V, Cohen D, Siedlecki AM, Ardissino G. Eculizumab discontinuation in atypical haemolytic uraemic syndrome: TMA recurrence risk and renal outcomes. Clin Kidney J 2021; 14:2075-2084. [PMID: 35261761 PMCID: PMC8894930 DOI: 10.1093/ckj/sfab005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background Eculizumab modifies the course of disease in patients with atypical haemolytic uraemic syndrome (aHUS), but data evaluating whether eculizumab discontinuation is safe are limited. Methods Patients enrolled in the Global aHUS Registry who received ≥1 month of eculizumab before discontinuing, demonstrated haematologic or renal response prior to discontinuation and had ≥6 months of follow-up were analysed. The primary endpoint was the proportion of patients suffering from thrombotic microangiopathy (TMA) recurrence after eculizumab discontinuation. Additional endpoints included: estimated glomerular filtration rate changes following eculizumab discontinuation to last available follow-up; number of TMA recurrences; time to TMA recurrence; proportion of patients restarting eculizumab; and changes in renal function. Results We analysed 151 patients with clinically diagnosed aHUS who had evidence of haematologic or renal response to eculizumab, before discontinuing. Thirty-three (22%) experienced a TMA recurrence. Univariate analysis revealed that patients with an increased risk of TMA recurrence after discontinuing eculizumab were those with a history of extrarenal manifestations prior to initiating eculizumab, pathogenic variants or a family history of aHUS. Multivariate analysis showed an increased risk of TMA recurrence in patients with pathogenic variants and a family history of aHUS. Twelve (8%) patients progressed to end-stage renal disease after eculizumab discontinuation; seven (5%) patients eventually received a kidney transplant. Forty (27%) patients experienced an extrarenal manifestation of aHUS after eculizumab discontinuation. Conclusions Eculizumab discontinuation in patients with aHUS is not without risk, potentially leading to TMA recurrence and renal failure. A thorough assessment of risk factors prior to the decision to discontinue eculizumab is essential.
Collapse
Affiliation(s)
- Gema Ariceta
- Department of Pediatric Nephrology, Vall d'Hebron Hospital, and the Autonomous University of Barcelona, Barcelona, Spain
| | - Fadi Fakhouri
- Department of Nephrology and Immunology, CHU de Nantes, Nantes, France
| | - Lisa Sartz
- Department of Pediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | | | | | - David Cohen
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Andrew M Siedlecki
- Department of Internal Medicine, Renal Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Gianluigi Ardissino
- Centro per la Cura e lo Studio della Sindrome Emolitico-Uremica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
3
|
Lopez-Garcia SC, Downie ML, Kim JS, Boyer O, Walsh SB, Nijenhuis T, Papizh S, Yadav P, Reynolds BC, Decramer S, Besouw M, Perelló Carrascosa M, La Scola C, Trepiccione F, Ariceta G, Hummel A, Dossier C, Sayer JA, Konrad M, Keijzer-Veen MG, Awan A, Basu B, Chauveau D, Madariaga L, Koster-Kamphuis L, Furlano M, Zacchia M, Marzuillo P, Tse Y, Dursun I, Pinarbasi AS, Tramma D, Hoorn EJ, Gokce I, Nicholls K, Eid LA, Sartz L, Riordan M, Hooman N, Printza N, Bonny O, Arango Sancho P, Schild R, Sinha R, Guarino S, Martinez Jimenez V, Rodríguez Peña L, Belge H, Devuyst O, Wlodkowski T, Emma F, Levtchenko E, Knoers NVAM, Bichet DG, Schaefer F, Kleta R, Bockenhauer D. Treatment and long-term outcome in primary nephrogenic diabetes insipidus. Nephrol Dial Transplant 2020; 38:gfaa243. [PMID: 33367818 DOI: 10.1093/ndt/gfaa243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary nephrogenic diabetes insipidus (NDI) is a rare disorder and little is known about treatment practices and long-term outcome. METHODS Paediatric and adult nephrologists contacted through European professional organizations entered data in an online form. RESULTS Data were collected on 315 patients (22 countries, male 84%, adults 35%). Mutation testing had been performed in 270 (86%); pathogenic variants were identified in 258 (96%). The median (range) age at diagnosis was 0.6 (0.0-60) years and at last follow-up 14.0 (0.1-70) years. In adults, height was normal with a mean (standard deviation) score of -0.39 (±1.0), yet there was increased prevalence of obesity (body mass index >30 kg/m2; 41% versus 16% European average; P < 0.001). There was also increased prevalence of chronic kidney disease (CKD) Stage ≥2 in children (32%) and adults (48%). Evidence of flow uropathy was present in 38%. A higher proportion of children than adults (85% versus 54%; P < 0.001) received medications to reduce urine output. Patients ≥25 years were less likely to have a university degree than the European average (21% versus 35%; P = 0.003) but full-time employment was similar. Mental health problems, predominantly attention-deficit hyperactivity disorder (16%), were reported in 36% of patients. CONCLUSION This large NDI cohort shows an overall favourable outcome with normal adult height and only mild to moderate CKD in most. Yet, while full-time employment was similar to the European average, educational achievement was lower, and more than half had urological and/or mental health problems.
Collapse
Affiliation(s)
- Sergio C Lopez-Garcia
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Ji Soo Kim
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Hereditary Kidney Diseases (MARHEA), Laboratory of Hereditary Kidney Diseases, Imagine Institute, INSERM U1163, Paris Descartes University, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris,France
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London,UK
| | - Tom Nijenhuis
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboudumc Expertisecentrum Zeldzame Nierziekten, Radboud University Medical Center, Nijmegen, TheNetherlands
| | - Svetlana Papizh
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Pallavi Yadav
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ben C Reynolds
- Department of Hereditary and Acquired Kidney Diseases, Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Stéphane Decramer
- Department of Paediatric Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds,UK
| | - Martine Besouw
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow,UK
| | | | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Woman, Child and Urological Diseases, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna,Italy
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Naples,Italy
| | - Gema Ariceta
- Department of Paediatric Nephrology, Hospital Universitario Vall d'Hebron, Barcelona,Spain
| | - Aurélie Hummel
- Department of Nephrology and Transplantation, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris,France
| | - Claire Dossier
- Department of Paediatric Nephrology, Hôpital Robert-Debre, Paris,France
| | - John A Sayer
- Translational and Clinical Medicine Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle Upon Tyne,UK
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne,UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne,UK
| | - Martin Konrad
- Department of Paediatric Nephrology, University Children's Hospital, Münster,Germany
| | - Mandy G Keijzer-Veen
- Department of Pediatric Nephrology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, TheNetherlands
| | - Atif Awan
- Department of Paediatric Nephrology, Temple Street Children's University Hospital, Dublin,Ireland
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, N. R. S. Medical College & Hospital, Kolkata,India
| | - Dominique Chauveau
- Department of Nephrology and Transplantation, Centre de Référence des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Université Toulouse-III, Toulouse,France
| | - Leire Madariaga
- Department of Paediatric Nephrology, Cruces University Hospital, IIS Biocruces-Bizkaia, University of the Basque Country, Bizkaia,Spain
| | - Linda Koster-Kamphuis
- Department of Paediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, TheNetherlands
| | - Mónica Furlano
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Department of Medicine-Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona,Spain
| | - Miriam Zacchia
- Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Naples,Italy
| | - Pierluigi Marzuillo
- Department of Women, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne,UK
| | - Ismail Dursun
- Department of Paediatrics, Division of Nephrology, Erciyes University Faculty of Medicine, Kayseri,Turkey
| | - Ayse Seda Pinarbasi
- Department of Paediatrics, Division of Nephrology, Erciyes University Faculty of Medicine, Kayseri,Turkey
| | - Despoina Tramma
- 4th Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki,Greece
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, TheNetherlands
| | - Ibrahim Gokce
- Department of Paediatric Nephrology, Marmara University, Faculty of Medicine, İstanbul,Turkey
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville,Australia
- Department of Nephrology, University of Melbourne, Parkville,Australia
| | - Loai A Eid
- Department of Paediatric Nephrology, Dubai Hospital-Dubai Health Authority, Dubai, United Arab Emirates
| | - Lisa Sartz
- Department of Clinical Sciences, Paediatric nephrology, Skåne University hospital, Lund University, Lund,Sweden
| | - Michael Riordan
- Department of Paediatric Nephrology, Temple Street Children's University Hospital, Dublin,Ireland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center (ACRDC), Aliasghar Children Hospital, Iran University of Medical Sciences, Tehran,Iran
| | - Nikoleta Printza
- 1st Paediatric Department, Aristotle University, Thessaloniki,Greece
| | - Olivier Bonny
- Service of Nephrology, Rue du Bugnon 17, Lausanne University Hospital, Lausanne,Switzerland
| | - Pedro Arango Sancho
- Department of Paediatric Nephrology and Transplantation, Hospital Sant Joan De Déu, Esplugues De Llobregat, Barcelona,Spain
| | - Raphael Schild
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg,Germany
| | - Rajiv Sinha
- Division of Paediatric Nephrology, Institute of Child Health, Kolkata,India
| | - Stefano Guarino
- Department of Women, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples,Italy
| | - Victor Martinez Jimenez
- Department of Nephrology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia,Spain
| | - Lidia Rodríguez Peña
- Section of Medical Genetics, Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia,Spain
| | - Hendrica Belge
- Center of Human Genetics, Institut de Pathologie et Genetique, Gosselies,Belgium
| | - Olivier Devuyst
- Institute of Physiology, Zurich Center for Integrative Human Physiology (ZHIP), Mechanism of Inherited Kidney Disorders Group, University of Zurich, Zurich,Switzerland
| | - Tanja Wlodkowski
- Department of Paediatric Nephrology, University Children's Hospital, Heidelberg,Germany
| | - Francesco Emma
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome,Italy
| | - Elena Levtchenko
- Department of development and regeneration, Laboratory of Paediatric Nephrology, University Hospital, Leuven,Belgium
| | - Nine V A M Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, TheNetherlands
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, TheNetherlands
| | - Daniel G Bichet
- Nephrology Service, Department of Medicine, Pharmacology and Physiology, University of Montreal, Montreal, Quebec,Canada
| | - Franz Schaefer
- Department of Paediatric Nephrology, University Children's Hospital, Heidelberg,Germany
| | - Robert Kleta
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, London,UK
- Paediatric Nephrology Unit, Great Ormond Street Hospital, London,UK
| |
Collapse
|
4
|
Greenbaum LA, Licht C, Nikolaou V, Al-Dakkak I, Green J, Haas CS, Román-Ortiz E, Cheong HI, Sartz L, Swinford R, Tomazos I, Miller B, Cataland S. Functional Assessment of Fatigue and Other Patient-Reported Outcomes in Patients Enrolled in the Global aHUS Registry. Kidney Int Rep 2020; 5:1161-1171. [PMID: 32775815 PMCID: PMC7403628 DOI: 10.1016/j.ekir.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Atypical hemolytic uremic syndrome (aHUS) is a progressive and potentially life-threatening disease characterized by complement-mediated thrombotic microangiopathy. Patients with aHUS may experience fatigue, which can negatively impact their lives, but there is a knowledge gap regarding disease burden in these patients. Methods In this longitudinal study, patients with aHUS from the Global aHUS Registry who completed patient-reported outcome assessments (Functional Assessment of Chronic Illness Therapy-Fatigue scale [FACIT-Fatigue], general health status, and work status) at ≥2 time points were assessed relative to treatment status: (i) never treated with eculizumab; (ii) on eculizumab at registry enrollment and continued therapy; and (iii) started eculizumab after registry enrollment. Results Patients who started eculizumab after the baseline visit (n = 23) exhibited improvements in fatigue (nearly 75% achieved clinically meaningful improvement), improved general health status (55%), and 25% to 30% rate reduction in symptoms of fatigue, weakness, irritability, nausea/vomiting, and swelling at last follow-up. Among patients already on eculizumab at registry enrollment (n = 295) and those never treated (n = 233), these parameters changed minimally relative to the baseline. Emergency room visits and hospital admissions were similar between groups. The number of health care provider visits and work days missed were higher in patients who started eculizumab after registry enrollment. Conclusion These real-world findings confirm the detrimental effects of aHUS on patients’ daily lives, including high levels of fatigue and impairments in general health status. The results suggest clinically meaningful improvement in fatigue, other patient-reported outcomes, and symptoms with eculizumab initiation after enrollment into the aHUS registry.
Collapse
Affiliation(s)
- Larry A Greenbaum
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Imad Al-Dakkak
- Alexion Pharmaceuticals, Inc., Boston, Massachusetts, USA
| | | | - Christian Stefan Haas
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, Philipps-University, Marburg, Germany
| | | | - Hae Il Cheong
- Seoul National University Children's Hospital, Seoul, Korea
| | - Lisa Sartz
- Lund University, Skåne University Hospital, Lund, Sweden
| | - Rita Swinford
- McGovern Medical School at UTHealth, University of Texas-Houston, Houston, Texas, USA
| | | | | | - Spero Cataland
- The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
5
|
Preka E, Bonthuis M, Harambat J, Jager KJ, Groothoff JW, Baiko S, Bayazit AK, Boehm M, Cvetkovic M, Edvardsson VO, Fomina S, Heaf JG, Holtta T, Kis E, Kolvek G, Koster-Kamphuis L, Molchanova EA, Muňoz M, Neto G, Novljan G, Printza N, Sahpazova E, Sartz L, Sinha MD, Vidal E, Vondrak K, Vrillon I, Weber LT, Weitz M, Zagozdzon I, Stefanidis CJ, Bakkaloglu SA. Association between timing of dialysis initiation and clinical outcomes in the paediatric population: an ESPN/ERA-EDTA registry study. Nephrol Dial Transplant 2019; 34:1932-1940. [PMID: 31038179 DOI: 10.1093/ndt/gfz069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/13/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is no consensus regarding the timing of dialysis therapy initiation for end-stage kidney disease (ESKD) in children. As studies investigating the association between timing of dialysis initiation and clinical outcomes are lacking, we aimed to study this relationship in a cohort of European children who started maintenance dialysis treatment. METHODS We used data on 2963 children from 21 different countries included in the European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry who started renal replacement therapy before 18 years of age between 2000 and 2014. We compared two groups according to the estimated glomerular filtration rate (eGFR) at start: eGFR ≥8 mL/min/1.73 m2 (early starters) and eGFR <8 mL/min/1.73 m2 (late starters). The primary outcomes were patient survival and access to transplantation. Secondary outcomes were growth and cardiovascular risk factors. Sensitivity analyses were performed to account for selection- and lead time-bias. RESULTS The median eGFR at the start of dialysis was 6.1 for late versus 10.5 mL/min/1.73 m2 for early starters. Early starters were older [median: 11.0, interquartile range (IQR): 5.7-14.5 versus 9.4, IQR: 2.6-14.1 years]. There were no differences observed between the two groups in mortality and access to transplantation at 1, 2 and 5 years of follow-up. One-year evolution of height standard deviation scores was similar among the groups, whereas hypertension was more prevalent among late initiators. Sensitivity analyses resulted in similar findings. CONCLUSIONS We found no evidence for a clinically relevant benefit of early start of dialysis in children with ESKD. Presence of cardiovascular risk factors, such as high blood pressure, should be taken into account when deciding to initiate or postpone dialysis in children with ESKD, as this affects the survival.
Collapse
Affiliation(s)
- Evgenia Preka
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Jerome Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Amsterdam UMC, University of Amsterdam, Department of Paediatric Nephrology, Emma Children's Academic Medical Center, Amsterdam, The Netherlands
| | - Sergey Baiko
- Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | - Aysun K Bayazit
- Department of Pediatric Nephrology, School of Medicine, Cukurova University, Adana, Turkey
| | - Michael Boehm
- Department of Pediatric Nephrology, University Children's Hospital, Vienna, Austria
| | - Mirjana Cvetkovic
- Nephrology Department, University Children's Hospital, Belgrade, Serbia
| | - Vidar O Edvardsson
- Children's Medical Center, Landspitali-The National University Hospital of Iceland, and Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Svitlana Fomina
- Department of Pediatric Nephrology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Tuula Holtta
- Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Eva Kis
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Gabriel Kolvek
- Pediatric Department, Faculty of Medicine, Safarik University, Kosice, Slovakia
| | - Linda Koster-Kamphuis
- Department of Pediatric Nephrology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Elena A Molchanova
- Department of Kidney Transplantation, Russian Children's Clinical Hospital, Moscow, Russia
| | - Marina Muňoz
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Gisela Neto
- Paediatric Nephrology Unit, Hospital de Dona Estefânia, Lisbon, Portugal
| | - Gregor Novljan
- Department of Pediatric Nephrology, University Medical Center Ljubjana, Faculty of Medicine, University of Ljubjana, Slovenia
| | - Nikoleta Printza
- 1st Pediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Lisa Sartz
- Department of Clinical Sciences, Pediatric Nephrology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Enrico Vidal
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Karel Vondrak
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | - Isabelle Vrillon
- Pediatric Nephrology Department, Nancy University Hospital, Nancy, France
| | - Lutz T Weber
- Pediatric Nephrology, Childreńs and Adolescents` Hospital, University Hospital of Cologne, Cologne, Germany
| | - Marcus Weitz
- Pediatric Nephrology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ilona Zagozdzon
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | | | | |
Collapse
|
6
|
Schaefer F, Benner L, Borzych-Dużałka D, Zaritsky J, Xu H, Rees L, Antonio ZL, Serdaroglu E, Hooman N, Patel H, Sever L, Vondrak K, Flynn J, Rébori A, Wong W, Hölttä T, Yildirim ZY, Ranchin B, Grenda R, Testa S, Drożdz D, Szabo AJ, Eid L, Basu B, Vitkevic R, Wong C, Pottoore SJ, Müller D, Dusunsel R, Celedon CG, Fila M, Sartz L, Sander A, Warady BA. Global Variation of Nutritional Status in Children Undergoing Chronic Peritoneal Dialysis: A Longitudinal Study of the International Pediatric Peritoneal Dialysis Network. Sci Rep 2019; 9:4886. [PMID: 30894599 PMCID: PMC6426856 DOI: 10.1038/s41598-018-36975-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 06/27/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022] Open
Abstract
While children approaching end-stage kidney disease (ESKD) are considered at risk of uremic anorexia and underweight they are also exposed to the global obesity epidemic. We sought to investigate the variation of nutritional status in children undergoing chronic peritoneal dialysis (CPD) around the globe. The distribution and course of body mass index (BMI) standard deviation score over time was examined prospectively in 1001 children and adolescents from 35 countries starting CPD who were followed in the International Pediatric PD Network (IPPN) Registry. The overall prevalence of underweight, and overweight/obesity at start of CPD was 8.9% and 19.7%, respectively. Underweight was most prevalent in South and Southeast Asia (20%), Central Europe (16.7%) and Turkey (15.2%), whereas overweight and obesity were most common in the Middle East (40%) and the US (33%). BMI SDS at PD initiation was associated positively with current eGFR and gastrostomy feeding prior to PD start. Over the course of PD BMI SDS tended to increase on CPD in underweight and normal weight children, whereas it decreased in initially overweight patients. In infancy, mortality risk was amplified by obesity, whereas in older children mortality was markedly increased in association with underweight. Both underweight and overweight are prevalent in pediatric ESKD, with the prevalence varying across the globe. Late dialysis start is associated with underweight, while enteral feeding can lead to obesity. Nutritional abnormalities tend to attenuate with time on dialysis. Mortality risk appears increased with obesity in infants and with underweight in older children.
Collapse
Affiliation(s)
- Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.
| | - Laura Benner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Dagmara Borzych-Dużałka
- Medical University of Gdansk, Department of Pediatrics, Nephrology and Hypertension, Gdańsk, Poland
| | - Joshua Zaritsky
- Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Hong Xu
- Children's Hospital of Fundan University, Shanghai, China
| | - Lesley Rees
- Great Ormond Street Hospital, London, United Kingdom
| | - Zenaida L Antonio
- Department of Pediatric Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Erkin Serdaroglu
- Dr. Behcet Uz Children Research and Educational Hospital, Izmir, Turkey
| | | | - Hiren Patel
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Lale Sever
- Carrahpasa School of Medicine, Istanbul, Turkey
| | | | | | | | - William Wong
- Department of Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Tuula Hölttä
- HUCH Hospital for Children and Adolescents, Helsinki, Finland
| | | | - Bruno Ranchin
- Service de Néphrologie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | | | - Sara Testa
- Pediatric nephrology, Dialysis and Transplantation Unit Fondazione IRCCS Ca' Granda Osp. Maggiore Policlinico, Milan, Italy
| | - Dorota Drożdz
- Jagellonian University Medical College, Kraków, Poland
| | | | - Loai Eid
- Dubai Hospital, Dubai, United Arab Emirates
| | | | - Renata Vitkevic
- Children Hospital, affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Cynthia Wong
- Lucile Packard Children's Hospital at Stanford, Palo Alto, USA
| | | | - Dominik Müller
- Department of Pediatric Gastroenterology, Nephrology and Metabolism, Charité, Berlin, Germany
| | | | | | - Marc Fila
- CHU Arnaud de Villeneuve, Université de Montpellier, Montpellier, France
| | | | - Anja Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | | | | |
Collapse
|
7
|
Zaniew M, Bökenkamp A, Kolbuc M, La Scola C, Baronio F, Niemirska A, Szczepanska M, Bürger J, La Manna A, Miklaszewska M, Rogowska-Kalisz A, Gellermann J, Zampetoglou A, Wasilewska A, Roszak M, Moczko J, Krzemien A, Runowski D, Siten G, Zaluska-Lesniewska I, Fonduli P, Zurrida F, Paglialonga F, Gucev Z, Paripovic D, Rus R, Said-Conti V, Sartz L, Chung WY, Park SJ, Lee JW, Park YH, Ahn YH, Sikora P, Stefanidis CJ, Tasic V, Konrad M, Anglani F, Addis M, Cheong HI, Ludwig M, Bockenhauer D. Long-term renal outcome in children with OCRL mutations: retrospective analysis of a large international cohort. Nephrol Dial Transplant 2018; 33:85-94. [PMID: 27708066 DOI: 10.1093/ndt/gfw350] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/25/2016] [Indexed: 12/19/2022] Open
Abstract
Background Lowe syndrome (LS) and Dent-2 disease (DD2) are disorders associated with mutations in the OCRL gene and characterized by progressive chronic kidney disease (CKD). Here, we aimed to investigate the long-term renal outcome and identify potential determinants of CKD and its progression in children with these tubulopathies. Methods Retrospective analyses were conducted of clinical and genetic data in a cohort of 106 boys (LS: 88 and DD2: 18). For genotype-phenotype analysis, we grouped mutations according to their type and localization. To investigate progression of CKD we used survival analysis by Kaplan-Meier method using stage 3 CKD as the end-point. Results Median estimated glomerular filtration rate (eGFR) was lower in the LS group compared with DD2 (58.8 versus 87.4 mL/min/1.73 m2, P < 0.01). CKD stage II-V was found in 82% of patients, of these 58% and 28% had moderate-to-severe CKD in LS and DD2, respectively. Three patients (3%), all with LS, developed stage 5 of CKD. Survival analysis showed that LS was also associated with a faster CKD progression than DD2 (P < 0.01). On multivariate analysis, eGFR was dependent only on age (b = -0.46, P < 0.001). Localization, but not type of mutations, tended to correlate with eGFR. There was also no significant association between presence of nephrocalcinosis, hypercalciuria, proteinuria and number of adverse clinical events and CKD. Conclusions CKD is commonly found in children with OCRL mutations. CKD progression was strongly related to the underlying diagnosis but did not associate with clinical parameters, such as nephrocalcinosis or proteinuria.
Collapse
Affiliation(s)
- Marcin Zaniew
- Children's Hospital, Poznan, Poland.,Polish Registry of Inherited Tubulopathies (POLtube), Polish Society of Pediatric Nephrology, Poland
| | - Arend Bökenkamp
- Department of Pediatrics, VU Medical Center, Amsterdam, The Netherlands
| | | | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Woman, Child and Urological Diseases, Azienda Ospedaliero-Universitaria 'Sant'Orsola-Malpighi', Bologna, Italy
| | - Federico Baronio
- Endocrinology Unit, Department of Woman, Child and Urological Diseases, Azienda Ospedaliero-Universitaria 'Sant'Orsola-Malpighi', Bologna, Italy
| | - Anna Niemirska
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Maria Szczepanska
- Chair and Clinical Department of Pediatrics, SMDZ in Zabrze, SUM in Katowice, Katowice, Poland
| | - Julia Bürger
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Angela La Manna
- Department of Pediatrics, II University of Naples, Naples, Italy
| | - Monika Miklaszewska
- Department of Pediatric Nephrology, Collegium Medicum of the Jagiellonian University, Cracow, Poland
| | - Anna Rogowska-Kalisz
- Department of Pediatrics, Immunology and Nephrology, Polish Mothers Memorial Hospital Research Institute, Lódz, Poland
| | - Jutta Gellermann
- Department of Pediatric Nephrology, Charité Universitätsmedizin Berlin, Charité Children's Hospital, Berlin, Germany
| | | | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, Bialystok, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Dariusz Runowski
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Iga Zaluska-Lesniewska
- Department of Pediatrics, Medical University of Gdansk, Nephrology and Hypertension, Gdansk, Poland
| | | | - Franca Zurrida
- Pediatric Nephrology, Hospital G.Brotzu, Cagliari, Italy
| | - Fabio Paglialonga
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Zoran Gucev
- University Children's Hospital, Medical Faculty Skopje, Skopje, Macedonia
| | - Dusan Paripovic
- Nephrology Department, University Children's Hospital, Belgrade, Serbia
| | - Rina Rus
- Division of Nephrology, University Children's Hospital, Ljubljana, Slovenia
| | | | - Lisa Sartz
- Department of Pediatric and Adolescent Medicine, Skåne University Hospital, Lund, Sweden
| | - Woo Yeong Chung
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea
| | - Se Jin Park
- Department of Pediatrics, Ajou University Daewoo Hospital, Geoje, Korea
| | - Jung Won Lee
- Department of Pediatrics, Ehwa University Mokdong Hospital, Seoul, Korea
| | - Yong Hoon Park
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Przemyslaw Sikora
- Polish Registry of Inherited Tubulopathies (POLtube), Polish Society of Pediatric Nephrology, Poland.,Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | | | - Velibor Tasic
- University Children's Hospital, Medical Faculty Skopje, Skopje, Macedonia
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Franca Anglani
- Laboratory of Histomorphology and Molecular Biology of the Kidney, Department of Medicine, University of Padova, Padova, Italy
| | - Maria Addis
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Detlef Bockenhauer
- University College London, Institute of Child Health and Great Ormond Street Hospital for Children, National Health Service Trust, London, UK
| |
Collapse
|
8
|
Sartz L, Greenbaum L, Haas C, Román-Ortiz E, Cheong HI, Al-Dakkak I, Ogawa M, Cataland S, Licht C. FP250FACIT-FATIGUE SCORES IN ADULT PATIENTS AT ENROLLMENT INTO THE GLOBAL AHUS REGISTRY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa Sartz
- Barnkliniken, Dept of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Larry Greenbaum
- Pediatric Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Christian Haas
- Nephrologie und Internistische Intensivmedizin, Klinik für Innere Medizin, Marburg, Germany
| | - Elena Román-Ortiz
- Divison of Pediatric Nephrology, Hospital Universitario La Fe, Valencia, Spain
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea, Republic of
| | - Imad Al-Dakkak
- Global Epidemiology, Alexion Pharmaceuticals, Inc., New Haven, CT, United States
| | - Masayo Ogawa
- Medical Sciences, Alexion Pharmaceuticals, Inc., New Haven, CT, United States
| | - Spero Cataland
- Division of Hematology, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
9
|
Brackman D, Sartz L, Leh S, Kristoffersson AC, Bjerre A, Tati R, Frémeaux-Bacchi V, Karpman D. Thrombotic microangiopathy mimicking membranoproliferative glomerulonephritis. Nephrol Dial Transplant 2017; 32:584. [PMID: 28168280 DOI: 10.1093/ndt/gfx013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Damien Brackman
- Department of Pediatrics , Haukeland University Hospital, Bergen, Norway
| | - Lisa Sartz
- Department of Pediatric and Adolescent Medicine, Skåne University Hospital, Lund, Sweden
| | - Sabine Leh
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | | | - Anna Bjerre
- Department of Pediatrics , Oslo University Hospital , Norway
| | - Ramesh Tati
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Veronique Frémeaux-Bacchi
- Assistance Publique - Hopitaux de Paris, Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France,INSERM UMRS 1138, Cordeliers Research Center, Complement and Diseases Team, Paris, France
| | - Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
10
|
Carlström M, Cananau C, Checa A, Wide K, Sartz L, Svensson A, Wheelock CE, Westphal S, Békássy Z, Bárány P, Lundberg JO, Hansson S, Weitzberg E, Krmar RT. Peritoneal dialysis impairs nitric oxide homeostasis and may predispose infants with low systolic blood pressure to cerebral ischemia. Nitric Oxide 2016; 58:1-9. [PMID: 27234508 DOI: 10.1016/j.niox.2016.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/05/2016] [Accepted: 05/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND & PURPOSE Infants on chronic peritoneal dialysis (PD) have an increased risk of developing neurological morbidities; however, the underlying biological mechanisms are poorly understood. In this clinical study, we investigated whether PD-mediated impairment of nitric oxide (NO) bioavailability and signaling, in patients with persistently low systolic blood pressure (SBP), can explain the occurrence of cerebral ischemia. METHODS & RESULTS Repeated blood pressure measurements, serial neuroimaging studies, and investigations of systemic nitrate and nitrite levels, as well as NO signaling, were performed in ten pediatric patients on PD. We consistently observed the loss of both inorganic nitrate (-17 ± 3%, P < 0.05) and nitrite (-34 ± 4%, P < 0.05) during PD, which may result in impairment of the nitrate-nitrite-NO pathway. Indeed, PD was associated with significant reduction of cyclic guanosine monophosphate levels (-59.4 ± 15%, P < 0.05). This reduction in NO signaling was partly prevented by using a commercially available PD solution supplemented with l-arginine. Although PD compromised nitrate-nitrite-NO signaling in all cases, only infants with persistently low SBP developed ischemic cerebral complications. CONCLUSIONS Our data suggests that PD impairs NO homeostasis and predisposes infants with persistently low SBP to cerebral ischemia. These findings improve current understanding of the pathogenesis of infantile cerebral ischemia induced by PD and may lead to the new treatment strategies to reduce neurological morbidities.
Collapse
Affiliation(s)
- Mattias Carlström
- Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Carmen Cananau
- Dept. Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Antonio Checa
- Dept. of Medical Biochemistry and Biophysics, Div. of Physiological Chemistry 2, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Wide
- Dept. of Clinical Science, Intervention and Technology, Div. of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
| | - Lisa Sartz
- Dept. of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Svensson
- Dept. Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Craig E Wheelock
- Dept. of Medical Biochemistry and Biophysics, Div. of Physiological Chemistry 2, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Westphal
- Dept. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Zivile Békássy
- Dept. of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter Bárány
- Dept. of Renal Medicine, Karolinska University Hospital, Stockholm, Huddinge, Sweden
| | - Jon O Lundberg
- Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Sverker Hansson
- Dept. of Pediatrics, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Eddie Weitzberg
- Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Rafael T Krmar
- Dept. of Clinical Science, Intervention and Technology, Div. of Pediatrics, Karolinska University Hospital, Huddinge, Sweden.
| |
Collapse
|
11
|
Karpman D, Fehrman-Ekholm I, Bárány P, Békássy Z, Brandström P, Bruchfeld A, Celsi G, Chromek M, Clyne N, Fellström B, Hansson S, Haraldsson B, Nevéus T, Rippe B, Sartz L, Segelmark M, Stegmayr B, Stenvinkel P, Westman K. [The council for new therapies should immediately revoke their decision on eculizumab]. Lakartidningen 2015; 112:DI7D. [PMID: 26079588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
12
|
Karpman D, Fehrman-Ekholm I, Bárány P, Békássy Z, Brandström P, Bruchfeld A, Celsi G, Chromek M, Clyne N, Fellström B, Hansson S, Haraldsson B, Nevéus T, Rippe B, Sartz L, Segelmark M, Stegmayr B, Stenvinkel P, Tufveson G, Westman K. [The council for new therapies position on eculizumab is unacceptable]. Lakartidningen 2015; 112:DI3F. [PMID: 26057644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
13
|
Sartz L, Olin AI, Kristoffersson AC, Ståhl AL, Johansson ME, Westman K, Fremeaux-Bacchi V, Nilsson-Ekdahl K, Karpman D. A novel C3 mutation causing increased formation of the C3 convertase in familial atypical hemolytic uremic syndrome. J Immunol 2012; 188:2030-7. [PMID: 22250080 DOI: 10.4049/jimmunol.1100319] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atypical hemolytic uremic syndrome has been associated with dysregulation of the alternative complement pathway. In this study, a novel heterozygous C3 mutation was identified in a factor B-binding region in exon 41, V1636A (4973 T > C). The mutation was found in three family members affected with late-onset atypical hemolytic uremic syndrome and symptoms of glomerulonephritis. All three patients exhibited increased complement activation detected by decreased C3 levels and glomerular C3 deposits. Platelets from two of the patients had C3 and C9 deposits on the cell surface. Patient sera exhibited more C3 cleavage and higher levels of C3a. The C3 mutation resulted in increased C3 binding to factor B and increased net formation of the C3 convertase, even after decay induced by decay-accelerating factor and factor H, as assayed by surface plasmon resonance. Patient sera incubated with washed human platelets induced more C3 and C9 deposition on the cell surface in comparison with normal sera. More C3a was released into serum over time when washed platelets were exposed to patient sera. Results regarding C3 and C9 deposition on washed platelets were confirmed using purified patient C3 in C3-depleted serum. The results indicated enhanced convertase formation leading to increased complement activation on cell surfaces. Previously described C3 mutations showed loss of function with regard to C3 binding to complement regulators. To our knowledge, this study presents the first known C3 mutation inducing increased formation of the C3 convertase, thus explaining enhanced activation of the alternative pathway of complement.
Collapse
Affiliation(s)
- Lisa Sartz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund 22184, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Brackman D, Sartz L, Leh S, Kristoffersson AC, Bjerre A, Tati R, Frémeaux-Bacchi V, Karpman D. Thrombotic microangiopathy mimicking membranoproliferative glomerulonephritis. Nephrol Dial Transplant 2011; 26:3399-403. [DOI: 10.1093/ndt/gfr422] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Abstract
The typical form of hemolytic uremic syndrome (HUS) is associated with enterohemorrhagic ESCHERICHIA COLI (EHEC) infection. The disease process is initiated and perpetuated by interactions between the pathogen or its virulence factors and host cells, as well as the host response. During EHEC-associated HUS, alterations occurring at the intestinal mucosal barrier and in the circulation, as well as on endothelial cells and other target-organ cells, lead to cell activation and/or cytotoxicity, and trigger a prothrombotic state. This review summarizes current knowledge regarding the interactions of the pathogen and its virulence factors with cells in the intestine, bloodstream, kidney, and brain. Mechanisms of bacterial colonization, toxin circulation, and induction of target organ damage are discussed.
Collapse
Affiliation(s)
- Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
| | | | | |
Collapse
|
16
|
Ståhl AL, Sartz L, Nelsson A, Békássy ZD, Karpman D. Shiga toxin and lipopolysaccharide induce platelet-leukocyte aggregates and tissue factor release, a thrombotic mechanism in hemolytic uremic syndrome. PLoS One 2009; 4:e6990. [PMID: 19750223 PMCID: PMC2735777 DOI: 10.1371/journal.pone.0006990] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 08/03/2009] [Indexed: 01/31/2023] Open
Abstract
Background Aggregates formed between leukocytes and platelets in the circulation lead to release of tissue factor (TF)–bearing microparticles contributing to a prothrombotic state. As enterohemorrhagic Escherichia coli (EHEC) may cause hemolytic uremic syndrome (HUS), in which microthrombi cause tissue damage, this study investigated whether the interaction between blood cells and EHEC virulence factors Shiga toxin (Stx) and lipopolysaccharide (LPS) led to release of TF. Methodology/Principal Findings The interaction between Stx or LPS and blood cells induced platelet-leukocyte aggregate formation and tissue factor (TF) release, as detected by flow cytometry in whole blood. O157LPS was more potent than other LPS serotypes. Aggregates formed mainly between monocytes and platelets and less so between neutrophils and platelets. Stimulated blood cells in complex expressed activation markers, and microparticles were released. Microparticles originated mainly from platelets and monocytes and expressed TF. TF–expressing microparticles, and functional TF in plasma, increased when blood cells were simultaneously exposed to the EHEC virulence factors and high shear stress. Stx and LPS in combination had a more pronounced effect on platelet-monocyte aggregate formation, and TF expression on these aggregates, than each virulence factor alone. Whole blood and plasma from HUS patients (n = 4) were analyzed. All patients had an increase in leukocyte-platelet aggregates, mainly between monocytes and platelets, on which TF was expressed during the acute phase of disease. Patients also exhibited an increase in microparticles, mainly originating from platelets and monocytes, bearing surface-bound TF, and functional TF was detected in their plasma. Blood cell aggregates, microparticles, and TF decreased upon recovery. Conclusions/Significance By triggering TF release in the circulation, Stx and LPS can induce a prothrombotic state contributing to the pathogenesis of HUS.
Collapse
Affiliation(s)
- Anne-lie Ståhl
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lisa Sartz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Nelsson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Zivile D. Békássy
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- * E-mail:
| |
Collapse
|