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Warach SJ, Ranta A, Kim J, Song SS, Wallace A, Beharry J, Gibson D, Cadilhac DA, Bladin CF, Kleinig TJ, Harvey J, Palanikumar L, Doss VT, Marescalco R, Fink JN, Tyson A, Schlick KH, Noh L, Wilson D, Figueroa S, Pech MA, Paletz LB, Lewis MK, Castro M, Sahlein DH, Lafranchise EF, Sandall J, Asif KS, Geraghty SR, Cullis PA, Malisch T, Neill TA, LaMonte MP, Campbell BCV, Wu TY. Symptomatic Intracranial Hemorrhage With Tenecteplase vs Alteplase in Patients With Acute Ischemic Stroke: The Comparative Effectiveness of Routine Tenecteplase vs Alteplase in Acute Ischemic Stroke (CERTAIN) Collaboration. JAMA Neurol 2023:2805552. [PMID: 37252708 DOI: 10.1001/jamaneurol.2023.1449] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Importance Symptomatic intracranial hemorrhage (sICH) is a serious complication of stroke thrombolytic therapy. Many stroke centers have adopted 0.25-mg/kg tenecteplase instead of alteplase for stroke thrombolysis based on evidence from randomized comparisons to alteplase as well as for its practical advantages. There have been no significant differences in symptomatic intracranial hemorrhage (sICH) reported from randomized clinical trials or published case series for the 0.25-mg/Kg dose. Objective To assess the risk of sICH following ischemic stroke in patients treated with tenecteplase compared to those treated with alteplase. Design, Setting, and Participants This was a retrospective observational study using data from the large multicenter international Comparative Effectiveness of Routine Tenecteplase vs Alteplase in Acute Ischemic Stroke (CERTAIN) collaboration comprising deidentified data on patients with ischemic stroke treated with intravenous thrombolysis. Data from more than 100 hospitals in New Zealand, Australia, and the US that used alteplase or tenecteplase for patients treated between July 1, 2018, and June 30, 2021, were included for analysis. Participating centers included a mix of nonthrombectomy- and thrombectomy-capacity comprehensive stroke centers. Standardized data were abstracted and harmonized from local or regional clinical registries. Consecutive patients with acute ischemic stroke who were considered eligible and received thrombolysis at the participating stroke registries during the study period were included. All 9238 patients who received thrombolysis were included in this retrospective analysis. Main Outcomes and Measures sICH was defined as clinical worsening of at least 4 points on the National Institutes of Health Stroke Scale (NIHSS), attributed to parenchymal hematoma, subarachnoid, or intraventricular hemorrhage. Differences between tenecteplase and alteplase in the risk of sICH were assessed using logistic regression, adjusted for age, sex, NIHSS score, and thrombectomy. Results Of the 9238 patients included in the analysis, the median (IQR) age was 71 (59-80) years, and 4449 patients (48%) were female. Tenecteplase was administered to 1925 patients. The tenecteplase group was older (median [IQR], 73 [61-81] years vs 70 [58-80] years; P < .001), more likely to be male (1034 of 7313 [54%] vs 3755 of 1925 [51%]; P < .01), had higher NIHSS scores (median [IQR], 9 [5-17] vs 7 [4-14]; P < .001), and more frequently underwent endovascular thrombectomy (38% vs 20%; P < .001). The proportion of patients with sICH was 1.8% for tenecteplase and 3.6% for alteplase (P < .001), with an adjusted odds ratio (aOR) of 0.42 (95% CI, 0.30-0.58; P < .01). Similar results were observed in both thrombectomy and nonthrombectomy subgroups. Conclusions and Relevance In this large study, ischemic stroke treatment with 0.25-mg/kg tenecteplase was associated with lower odds of sICH than treatment with alteplase. The results provide evidence supporting the safety of tenecteplase for stroke thrombolysis in real-world clinical practice.
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Affiliation(s)
- Steven J Warach
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin
- Ascension Texas, Austin
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Shlee S Song
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
- Department of Neurology, Torrance Memorial Medical Centre, Torrance, California
- Department of Neurology, Cedars Sinai Marina Del Rey Hospital, Marina del Rey, California
| | | | - James Beharry
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | | | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Christopher F Bladin
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Timothy J Kleinig
- Department of Neurology. Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jackson Harvey
- Department of Neurology. Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Logesh Palanikumar
- Department of Neurology. Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Vinodh T Doss
- Department of Neurology, Novant Health - New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Ruth Marescalco
- Department of Neurology, Novant Health - New Hanover Regional Medical Center, Wilmington, North Carolina
| | - John N Fink
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Alicia Tyson
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - Konrad H Schlick
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
| | - Lydia Noh
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
| | - Duncan Wilson
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Sonia Figueroa
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
| | - Marco A Pech
- Department of Neurology, Torrance Memorial Medical Centre, Torrance, California
| | - Laurie B Paletz
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
| | - Maya K Lewis
- Department of Neurology, Cedars Sinai Marina Del Rey Hospital, Marina del Rey, California
| | - Marissa Castro
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, California
- Department of Neurology, Cedars Sinai Marina Del Rey Hospital, Marina del Rey, California
| | - Daniel H Sahlein
- Goodman Campbell Brain and Spine, Indianapolis, Indiana
- Ascension St Vincent's, Indianapolis, Indiana
| | | | | | | | | | | | | | | | | | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
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Warach SJ, Ranta A, Song SS, Gibson D, Wallace A, Beharry J, Bladin C, Kleinig TJ, Harvey J, Doss VT, Marescalco R, Fink JN, Kim J, Cadilhac DA, Wilson D, Figueroa S, Pech MA, Paletz LB, Castro M, Sahlein D, Lafranchise EF, Sandall J, Geraghty SR, Cullis PA, Malisch T, Neill TA, LaMonte MP, Campbell B, Wu TY. Abstract 43: Comparative Effectiveness Of Routine Tenecteplase Thrombolysis In Acute Stroke Compared With Alteplase: An INternational Collaboration (CERTAIN Collaboration): Rates Of Symptomatic Intracranial Hemorrhage. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Despite pharmacological and practical advantages for tenecteplase (TNK) over alteplase (ALT), no differences were observed in percent of symptomatic intracranial hemorrhage (sICH) in randomized trials (fewer than 900 total patients for either treatment). We compared rates of sICH in patients treated with either drug, using a large, multicenter, international registry.
Methods:
The CERTAIN collaboration is an ongoing registry of deidentified patient-level data of thrombolytic treated ischemic stroke from various hospitals/programs in New Zealand, Australia, and the United States that have used ALT or TNK since July 1, 2018. Standardized data were abstracted and harmonized from local or regional clinical registries. We defined sICH as clinical worsening of at least 4 points on NIHSS, attributed to parenchymal hematoma, subarachnoid or intraventricular hemorrhage. We used logistic regression for binary variables, adjusting sICH differences for age, baseline NIHSS, thrombectomy, and source hospital network and Mann-Whitney test for continuous baseline variables.
Results:
A total of 7891 patients were included in the initial analysis. The TNK group was older, more likely to be male, had higher NIHSS, and more frequently underwent mechanical thrombectomy (Table. Sample Characteristics). The sICH rate was 3.71% for ALT and 2.13% for TNK: adjusted OR (95%CI) = 0.49 (0.31-0.76) p=0.002. For patients not undergoing thrombectomy after thrombolytic, the sICH rate was 3.00% for ALT and 1.74% for TNK, adjusted OR (95%CI) = 0.48 (0.27-0.87), p=0.016. For thrombectomy treated cases, sICH rate was 6.80% for ALT and 2.80% for TNK, adjusted OR (95%CI) 0.60 (0.31-1.16), p=0.129.
Conclusion:
In this preliminary analysis from a large, multicenter registry, ischemic stroke treated with tenecteplase was associated with a lower rate of sICH than with alteplase. An updated analysis with patient data from additional sites will be presented at the Conference.
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Affiliation(s)
- Steven J Warach
- Ascension Healthcare and Univ of Texas at Austin, Austin, TX
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tim Malisch
- Amita Health Adventist Med Cntr-Hinsdale., Elk Grove Village, IL
| | | | - MP LaMonte
- Ascension Saint Agnes Hosp, Ellicott City, MD
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Padrick MM, Sangha N, Paletz L, Mirocha J, Figueroa S, Manoukian V, Schlick K, Lyden PD, Liebeskind DS, Chatfield FK, Tarpley JW, Burgos A, Tenser M, Gaffney D, Pech MA, Nazareth E, Jackson R, Kauffman H, Arnold L, Cox J, Joyce T, Nakamura C, Fitzgerald D, Ogami K, Steiner N, Wolber N, Robertson B, Izzo R, Gorski S, Manuel H, Valdez K, Reyes L, Sharma LK, Song SS. COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles. Cerebrovasc Dis 2021; 50:707-714. [PMID: 34175851 PMCID: PMC8339042 DOI: 10.1159/000516908] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To describe the impact of COVID-19 on acute cerebrovascular disease care across 9 comprehensive stroke centers throughout Los Angeles County (LAC). Methods Volume of emergency stroke code activations, patient characteristics, stroke severity, reperfusion rates, treatment times, and outcomes from February 1 to April 30, 2020, were compared against the same time period in 2019. Demographic data were provided by each participating institution. Results There was a 17.3% decrease in stroke code activations across LAC in 2020 compared to 2019 (1,786 vs. 2,159, respectively, χ<sup>2</sup> goodness of fit test p < 0.0001) across 9 participating comprehensive stroke centers. Patients who did not receive any reperfusion therapy decreased by 16.6% in 2020 (1,527) compared to 2019 (1,832). Patients who received only intravenous thrombolytic (IVT) therapy decreased by 31.8% (107 vs. 157). Patients who received only mechanical thrombectomy (MT) increased by 3% (102 vs. 99). Patients who received both IVT and MT decreased by 31.8% (45 vs. 66). Recanalization treatment times in 2020 were comparable to 2019. CSCs serving a higher proportion of Latinx populations in the eastern parts of LAC experienced a higher incidence of MT in 2020 compared to 2019. Mild increase in stroke severity was seen in 2020 compared to 2019 (8.95 vs. 8.23, p = 0.046). A higher percentage of patients were discharged home in 2020 compared to 2019 (59.5 vs. 56.1%, p = 0.034), a lower percentage of patients were discharged to skilled nursing facility (16.1 vs. 20.7%, p = 0.0004), and a higher percentage of patients expired (8.6 vs. 6.3%, p = 0.008). Conclusion LAC saw a decrease in overall stroke code activations in 2020 compared to 2019. Reperfusion treatment times remained comparable to prepandemic metrics. There has been an increase in severe stroke incidence and higher volume of thrombectomy treatments in Latinx communities within LAC during the pandemic of 2020. More patients were discharged home, less patients discharged to skilled nursing facilities, and more patients expired in 2020, compared to the same time frame in 2019.
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Affiliation(s)
| | - Navdeep Sangha
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Laurie Paletz
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James Mirocha
- Cedars-Sinai Medical Center, Biostatistics and Bioinformatics Research Center, Los Angeles, California, USA
| | - Sonia Figueroa
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vicki Manoukian
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Konrad Schlick
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Patrick D Lyden
- Zilka Neurogenetic Institute at Keck School of Medicine of USC, Los Angeles, California, USA
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Fiona K Chatfield
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Jason W Tarpley
- Providence Saint John's Health Center, Santa Monica, California, USA.,Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Adrian Burgos
- PIH Health Whittier Hospital, Whittier, California, USA
| | - Matthew Tenser
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.,PIH Health Good Samaritan Hospital, Los Angeles, California, USA
| | - Denise Gaffney
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Marco A Pech
- Torrance Memorial Medical Center, Torrance, California, USA
| | | | - Robert Jackson
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Helaine Kauffman
- Providence Saint John's Health Center, Santa Monica, California, USA.,Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA.,Torrance Memorial Medical Center, Torrance, California, USA
| | - Lisa Arnold
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Jennifer Cox
- Providence Saint Joseph Medical Center, Burbank, California, USA
| | - Treasure Joyce
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Catrice Nakamura
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Darcie Fitzgerald
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Kyle Ogami
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nili Steiner
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicole Wolber
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Betty Robertson
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rachel Izzo
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Krystal Valdez
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA.,Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Liliana Reyes
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Latisha K Sharma
- Zilka Neurogenetic Institute at Keck School of Medicine of USC, Los Angeles, California, USA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Vedie B, Myara I, Pech MA, Maziere JC, Maziere C, Caprani A, Moatti N. Fractionation of charge-modified low density lipoproteins by fast protein liquid chromatography. J Lipid Res 1991; 32:1359-69. [PMID: 1770318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We describe a methodology developed to separate different forms of charge-modified low density lipoproteins (LDL) using the fast protein liquid chromatography (FPLC) system from Pharmacia. Lipoproteins were isolated by sequential ultracentrifugation and introduced onto an anion-exchange column (Mono Q HR 5/5). The multistep NaCl gradient elution was optimized and the analytical variables were determined on copper-oxidized LDL. After oxidation by copper for various times (up to 48 h), five forms were obtained (fractions A, B, C, D, and E). Within-run and day-to-day reproducibility were better than 8.6% and 10%, respectively. Protein and cholesterol recovery after the chromatographic separation was good (greater than 82%) and the detection limit was about 1 microgram. The more negative forms of collected LDL were mainly characterized by an increase in the lipid peroxidation product content, a depletion of vitamin E, an alteration of apoB and increased degradation by macrophages. The proposed methodology was applied to the study of LDL modifications generated by human umbilical endothelial cells and the protective effect of antioxidants (vitamin E and probucol).
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Affiliation(s)
- B Vedie
- Laboratoire de Biochimie, Faculté des Sciences Pharmaceutiques et Biologiques, Chatenay-Malabry, France
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5
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Vedie B, Myara I, Pech MA, Maziere JC, Maziere C, Caprani A, Moatti N. Fractionation of charge-modified low density lipoproteins by fast protein liquid chromatography. J Lipid Res 1991. [DOI: 10.1016/s0022-2275(20)41966-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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6
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Pech MA, Rostoker G, Soria C, Lang P, Weil B, Caen J, Lagrue G. Heparin cofactor II in adult glomerulopathy and nephrotic syndrome. Am J Nephrol 1991; 11:74-5. [PMID: 2048583 DOI: 10.1159/000168278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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7
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Rostoker G, Pech MA, Petit-Phar M, BenMaadi A, Cholin S, Lang P, Dubert JM, Weil B, Lagrue G. Mucosal immunity in adult primary glomerulonephritis. I. Evaluation of salivary IgA subclasses and components. Nephron Clin Pract 1990; 54:42-6. [PMID: 2296344 DOI: 10.1159/000185808] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Salivary components (proteins, albumin, IgA1, IgA2, IgG, IgM, beta 2-microglobulin, neopterin and peroxidase) were investigated in 3 adult types of primary glomerulonephritis (PGN): IgA mesangial glomerulonephritis (IgAGN; n = 14); idiopathic membranous glomerulonephritis (n = 8); idiopathic nephrotic syndrome (INS; n = 14), and a control group (n = 11). Salivary IgA1 levels were significantly increased in all these PGN whereas salivary IgA2 levels were only higher than controls in INS. Albumin and proteins did not differ between PGN and controls, while the IgA1 + IgA2/protein ratio was significantly increased in these 3 PGN. Salivary neopterin levels were enhanced in the 3 types of PGN, whereas beta 2-microglobulin levels were not. The other salivary components did not differ from controls. These results demonstrate the nonspecificity of the IgA increase at mucosal sites previously found in IgAGN and raise the hypothesis of an activation of mucosal immunity of PGN or of a disturbed isotypic network or lymphokine secretion in these diseases.
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Affiliation(s)
- G Rostoker
- Department of Nephrology, INSERM U 139, Centre Claude Bernard, Hôpital Henri Mondor, Créteil; France
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8
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Rostoker G, Pech MA, Del Prato S, Petit-Phar M, Ben Maadi A, Dubert JM, Lang P, Weil B, Lagrue G. Serum IgG subclasses and IgM imbalances in adult IgA mesangial glomerulonephritis and idiopathic Henoch-Schoenlein purpura. Clin Exp Immunol 1989; 75:30-4. [PMID: 2702774 PMCID: PMC1541867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Serum IgG subclass levels were investigated in 27 IgA GN and HSP patients and 19 healthy paired controls using a panel of monoclonal antibodies. IgG1 and IgG2 were statistically lower than in the controls in both the non-nephrotic and nephrotic patients, and 80% of the non-nephrotic patients exhibited a partial deficiency for either IgG1, IgG2 or IgG3. Urinary losses of IgG only accounted for decreased levels of IgG4. Fifty-four percent of these patients exhibited decreased IgM levels. This IgG-IgM imbalance may increase the susceptibility of these patients to viral and bacterial infections of the upper respiratory tract and trigger the renal disease. These findings raise the hypothesis that this IgG-IgM imbalance might be involved in the etiopathogenesis of these diseases.
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Affiliation(s)
- G Rostoker
- Department of Nephrology, INSERM U 139, Centre Claude Bernard, Hôpital Henri Mondor, Créteil, France
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9
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Rostoker G, Parente T, Pech MA, Gouault-Heilmann M, Levent M, Intrator L, Branellec A, Lagrue G. Natural anticoagulant proteins in adult nephrotic syndrome. Clin Nephrol 1988; 29:214-5. [PMID: 2966689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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10
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Rostoker G, Pech MA, Lagrue G. [Proteins C and S of coagulation: new markers of thrombotic risk in nephrotic syndromes?]. Pathol Biol (Paris) 1988; 36:297-9. [PMID: 3287298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Thromboembolic events remain one of the most serious complications in patients with nephrotic syndrome (NS). The natural anticoagulant system protein C-protein S was evaluated in patients with proteinuria and NS. Protein C levels were found to be normal or increased in NS. Protein C levels correlated positively with proteinuria, cholesterol and triglycerides and negatively with serum albumin. All of the 17 patients with NS exhibited urinary loss of protein C. Total protein S and C4BP were increased in mild and moderate forms of NS. Free protein S was identical in controls and NS patients. Nine of ten patients had urinary loss of protein S. No correlation was found between protein S and the various usual biologic parameters of NS. However, two patients with NS and thrombosis of the renal veins had an acquired deficit in either free protein S or protein C. Thus, in some patients, an acquired deficit in free protein S and/or protein C may contribute to the development of thrombotic complications in NS.
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Affiliation(s)
- G Rostoker
- INSERM U 139, Hôpital Henri-Mondor, Créteil, France
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