Divergent manifestations and outcomes of diffuse crescentic immunoglobulin A nephropathy and pauci-immune crescentic glomerulonephritis on long-term

BACKGROUND

Diffuse crescentic IgAN (CIgAN) is an uncommon phenotype of IgAN, which presents as rapidly progressive renal failure, similar to patients with pauci-immune crescentic glomerulonephritis(PCGN). There are limited data on outcomes comparisons between the two.

METHODS

In this single-center, retrospective cohort study, we compared the clinical features, pathological presentation, and renal outcomes of 52 patients with CIgAN and 42 patients with renal-limited PCGN from January 2007 to December 2019.

RESULTS

The CIgAN patients were younger (30.5 ± 13.8 years) than PCGN patients (46.1 ± 11.8 years) (P = 0.001). The CIgAN patients had a higher prevalence of hypertension (86.5% Vs. 41.3%, P = 0.001); and degree of proteinuria (4.2 ± 2.7 g/24 h Vs. 2.3 ± 1.16 g/24 h; P = 0.001) than PCGN patients. The chronicity in terms of global glomerulosclerosis, interstitial fibrosis, and tubular atrophy was higher in the CIgAN group than in the PCGN group. The remission rate with immunosuppression was significantly higher in the PCGN group than in the CIgAN group (P = 0.016). The end-stage renal disease (ESRD) or death within 1 year of diagnosis was significantly more in the CIgAN group (62.3% Vs. 39.1%) than PCGNgroup. For patients who were dialysis-dependent at presentation, the primary outcome of ESRD or death within one year was seen in 90.9% of patients of CIgAN and 44.1% in the PCGN group (P = 0.001). The long-term death non-censored renal survival is poor in the CIgAN group than in PCGN patients. However, patient survival is poor in PCGN patients.

CONCLUSION

CIgAN is a different form of RPGN compared to PCGN and carries a poor prognosis despite similar immunosuppressive therapy in the long term.

Clinicopathologic Manifestations of Immunoglobulin A Nephropathy in a Northern Indian Cohort: A Mute Assassin with Delayed Diagnosis

Introduction

Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide, but there is a marked geographic difference in its prevalence and prognosis. IgAN is known to have an aggressive course in Asians. However, its exact prevalence and clinicopathologic spectrum in North India are not well documented.

Materials and Methods

The study included all patients aged above 12 years with primary IgAN on kidney biopsy from January 2007 to December 2018. Clinical and pathological parameters were noted. Two histopathologists independently reviewed all kidney biopsies, and MEST-C score was assigned as per the Oxford classification.

Results

IgAN was diagnosed in 681 (11.85%) out of 5751 native kidney biopsies. The mean age was 32 ± 12.3 years, and the male to female ratio was 2.5:1. At presentation, 69.8% had hypertension, 68% had an estimated glomerular filtration rate (eGFR) of less than 60 ml/min, 63.2% had microscopic hematuria, and 4.6% had gross hematuria. The mean proteinuria was 3.61 ± 2.26 g/day, with 46.8% showing nephrotic range proteinuria and 15.2% showing nephrotic syndrome manifestation. Histopathologically, 34.4% of patients had diffuse global glomerulosclerosis. Oxford MEST-C scoring revealed M1 in 67%, E1 in 23.9%, S1 in 46.9%, T1/T2 in 33%, and crescents in 19.6% of biopsies. The mean serum creatinine was significantly higher in cases with E1, T1/2, and C1/2 scores (P < 0.05). Hematuria and proteinuria were significantly higher (P < 0.05) with E1 and C1/2 scores. Coexisting C3 was associated with higher serum creatinine at presentation (P < 0.05).

Conclusion

IgAN patients with late presentation and advanced disease became less amenable to immunomodulation in our cohort. The implementation of point-of-care screening strategies, early diagnosis, and retarding disease progression should be prioritized in the Indian strategy.

Two Decades Outcomes of Posttransplant Immunoglobulin A Nephropathy in Live Donor Renal Transplantation

Background:

The data on long-term outcomes of posttransplant immunoglobulin A nephropathy (IgAN) are confounding and vary with geography and ethnicity worldwide. We aimed to study the long-term graft outcomes of patients with posttransplant IgAN in the northern Indian cohort.

Methods:

The long-term graft outcomes of 51 live donor renal transplant recipients with biopsy-proven posttransplant IgAN (recurrence/de novo) were analyzed. The risk factors for graft failure in the posttransplant IgA groups were analyzed using the Cox regression analysis.

Results:

Out of the total of 51 patients who had posttransplant IgAN, 40 patients had a biopsy-proven native kidney IgAN. The mean duration of the clinical presentation of posttransplant IgAN was 62.4 months (5.2 years) posttransplant. Proteinuria at the time of biopsy was 3.03 ± 2.2 g/day, and 41.2% had proteinuria of more than 3 g/day at the time of biopsy. The estimated 1, 5, 10, and 20 years patient survival was 98%, 95.4%, 75.9%, and 25.2%, respectively, and the estimated 1, 5, 10, and 20 years graft survival was 98%, 88.5%, 44.6%, and 11.9%, respectively, in patients who had posttransplant IgA. Many of the traditional risk factors associated with progression in native kidney IgAN, such as the degree of proteinuria, Oxford MEST (mesangial and endocapillary hypercellularity, segmental sclerosis, and interstitial fibrosis/tubular atrophy) scoring, recipient's age, and sex were not predictive of early graft failure among patients with posttransplant IgAN. In our cohort, the only significant graft failure predictor was serum creatinine at 5 years. Chronic antibody-mediated rejection (ABMR) was seen in 21.6% of patients with posttransplant IgAN. Whether this coexistence of chronic ABMR is an incidental finding or posttransplant IgAN predisposes to chronic ABMR requires further investigation.

Conclusion:

Posttransplant IgAN is associated with poor long-term graft outcomes in live donor renal transplants. Proteinuria and MEST scoring were not predictive of graft failure in living donor posttransplant IgAN.

Influence of zinc supply on the phytotoxicity of cadmium in maize (Zea mays L.) grown on cadmium-contaminated soil

Zinc and cadmium have been found to interact with each other differently under different conditions. The zinc supply may enhance or offset the phytotoxicity of Cd. Therefore, in a pot experiment, a sandy loam soil (Typic Ustipsamments) was treated with cadmium at rates of 0, 10, 20 and 40 mg kg−1 and with zinc at rates of 0 and 20 mg kg−1 soil to assess their effect on dry matter yield and the concentrations of Cd and micronutrients. There was a significant decrease in dry matter yield due to the phytotoxic effect of Cd. The dry matter yield was not affected by the application of zinc at any rate of Cd application. The concentration and uptake of Cd in the crop increased gradually at increasing rates of cadmium application. The increase in cadmium concentration was greater in the presence of zinc than in its absence. This suggests that the effect of soilapplied Zn is reflected in the enhancement of the Cd content in plants. Thus, zinc application cannot offset the toxic effect of Cd. The relationship of Cd with Zn and Fe was synergistic at all rates of Cd application, whereas Mn and Cu exhibited an antagonistic relationship.

Implications of obesity for drug therapy: limitations and challenges

Obesity has become a worldwide challenge with significant health and socioeconomic implications. One of the major implications is its impact on drug therapy. In order to gain a better understanding of this impact, we surveyed the regulatory guidances, the newly approved molecular entity drug products, and drug product labels in the Physician's Desk Reference. This review summarizes the findings of the survey along with the existing knowledge on pharmacokinetic and pharmacodynamic changes associated with obesity.

Effect of cadmium-contaminated soils on dry matter yield and mineral composition of raya (Brassica juncea) and spinach (Spinacia oleracea)

Raya (Brassica juncea) and spinach (Spinacia oleracea), grown as leafy vegetables, are known to accumulate large amounts of heavy metals in their shoots and roots because of their high biomass and root proliferation. In a pot experiment, a sandy loam soil was polluted with cadmium (Cd) at rates of 0, 5, 10, 20, 40 and 80 mg kg−1 soil to assess the accumulation pattern and its effect on the dry matter yield and mineral composition of these vegetables. There was a decrease in dry matter yield due to the phytotoxic effect of Cd. The rate of Cd application at which a significant decline in root and shoot dry matter yield occurred varied depending on the vegetable. It was 20 mg Cd kg−1 soil in the shoots for both crops. However, the roots of raya were found to be more tolerant of Cd toxicity than those of spinach, as is evident from the fact that a significant decline in dry matter yield occurred at 20 and 10 mg Cd kg−1 soil, respectively. Since no visual toxic symptoms were observed on the leaves of raya in any of the treatments, it is clear that the metal may accumulate in this vegetable without visual evidence of its presence. However, at application levels beyond 40 mg kg−1 soil, toxicity symptoms, in the form of interveinal chlorosis of the leaf lamina followed by necrosis and leaf rolling, were clearly evident in the case of spinach. The reduction in root and shoot growth corresponded with the amounts of extractable Cd in the soils. The total content of Cd in the crops increased gradually as the rate of applied Cd rose and the roots accumulated much higher amounts than the shoots. The relationship of Cd with Zn and Fe was synergistic in both roots and shoots at the lower rates, but antagonistic at higher Cd application rates for both the crops, while in the case of Mn and Cu, the relationship was negative and antagonistic.

A test method to monitor in vitro storage and degradation effects on a skin substitute

We have investigated a potential test method to monitor changes through possible degradation of a collagen/glycosaminoglycan tissue engineering scaffold in vitro. The method used cyclic voltammetry where the degradation process was measured by determining changes in the apparent diffusion coefficients of thermodynamically reversible couples, ferrocyanide and 1,4-benzoquinone, through the scaffold before and after degradation at low pH and at different temperatures. Scaffold samples were degraded in vitro by exposure to pH 3 for 44 days and also stored in pH 7.4 phosphate saline buffer for one week. Sample temperatures used were 21 degrees C, 37 degrees C and 40 degrees C. The greatest apparent degradation was observed for scaffolds stored at 40 degrees C. Prior to storage, effective diffusion coefficients were 4.4x10(-6) cm2 s(-1) and 2.6x10(-10) cm2 s(-1) for ferrocyanide and 1,4-benzoquinone, respectively. For these respective compounds values changed to 1.2x10(-6) cm2 s(-1) and 1.0x10(-6) cm2 s(-1) after 37 degrees C degradation and 2.6x10(-6) cm2 s(-1) and 5.5x10(-8) cm2 s(-1) after pH 3 degradation.

Bacillus lehensis sp. nov., an alkalitolerant bacterium isolated from soil

A Gram-positive, endospore-forming, alkalitolerant bacterial strain, designated MLB2T, was isolated from soil from Leh, India, and was subjected to a polyphasic taxonomic study. The strain exhibited phenotypic properties that included chemotaxonomic characteristics consistent with its classification in the genusBacillus. Growth was observed at pH 7.0–11.0, but not at pH 6.0. The DNA G+C content was 41.4 mol%. The highest level of 16S rRNA gene sequence similarity was withBacillus oshimensisJCM 12663T(98.8 %). However, DNA–DNA hybridization experiments indicated low levels of genomic relatedness with the type strains ofB. oshimensis(62 %),Bacillus patagoniensis(55 %),Bacillus clausii(51 %) andBacillus gibsonii(34 %), the species with which strain MLB2Tformed a coherent cluster (based on the results of the phylogenetic analysis). On the basis of the phenotypic characteristics and genotypic distinctiveness of strain MLB2T, it should be classified within a novel species ofBacillus, for which the nameBacillus lehensissp. nov. is proposed. The type strain is MLB2T(=MTCC 7633T=JCM 13820T).

Antiremodeling agents influence osteoblast activity differently in modeling and remodeling sites of canine rib

Antiremodeling agents reduce bone loss in part through direct actions on osteoclasts. Their effects on osteoblasts and bone formation activity are less clear and may differ at sites undergoing modeling vs. remodeling. Skeletally mature intact beagles, 1-2 years old at the start of the study, were treated daily with clinically relevant doses of alendronate (0.10 or 0.20 mg/kg), risedronate (0.05 or 0.10 mg/kg), raloxifene (0.50 mg/kg), or vehicle (1 mL/kg). Dynamic bone formation parameters were histologically assessed on periosteal, endocortical/trabecular, and intracortical bone envelopes of the rib. Raloxifene significantly increased periosteal surface mineral apposition rate (MAR), a measure of osteoblast activity, compared to all other treatments (+108 to +175%, P < 0.02), while having no significant effect on MAR at either the endocortical/trabecular or intracortical envelope. Alendronate (both 0.10 and 0.20 doses) and risedronate (only the 0.10 dose) significantly (P < or = 0.05) suppressed MAR on the endocortical/trabecular envelope, while none of the bisphosphonate doses significantly altered MAR at either the periosteal or intracortical envelopes compared to vehicle. Based on these results, we conclude that (1) at clinically relevant doses the two classes of antiremodeling agents, bisphosphonates and selective estrogen receptor modulators, exert differential effects on osteoblast activity in the canine rib and (2) this effect depends on whether modeling or remodeling is the predominant mechanism of bone formation.

Evaluation of interaction potential of certain concurrently administered drugs with pharmacological and pharmacokinetic profile of centchroman in rats

Centchroman (Ormeloxifene) is a nonsteroidal, selective estrogen receptor modulator, oral contraceptive and anticancer agent, and is intended for long-term use by women. In view of its vast clinical application and the interaction of steroidal oral contraceptives with certain commonly used therapeutic agents, evaluation of interaction of certain concomitantly administered therapeutic agents (ibuprofen, rifampicin, diazepam, salbutamol, nifedipine, paracetamol, haloperidol, and tetracycline), in terms of both the postcoital contraceptive efficacy and pharmacokinetic profile, with centchroman was undertaken in female Sprague-Dawley rats. Among the representatives from each commonly used therapeutic category, interaction (pharmacokinetic) was observed with ibuprofen (60 mg/kg, twice daily), haloperidol (0.7 mg/kg, twice daily), and tetracycline (140 mg/kg, twice daily) coadministration on Days 1 through 5 postcoitum. Of these three therapeutic agents, only tetracycline interfered with the contraceptive efficacy of centchroman. It reduced the bioavailability of centchroman and its active metabolite by increasing their excretion through bile and feces. Increased metabolite excretion on tetracycline coadministration indicates the enterohepatic recirculation of the metabolite, not the parent drug. However, the effect of tetracycline was negated by the inclusion of lactic acid bacillus spores in the regimen.

Lipid profile in smokers and tobacco chewers--a comparative study

OBJECTIVE

The present study was undertaken to evaluate lipid profile in cigarette smokers and tobacco chewers and to see whether tobacco chewing causes same degree of alteration in lipid profile as done by smoking.

METHODS

Serum lipid profile was studied in 30 smokers (Group A), 30 tobacco chewers (Group B) and 30 controls i.e., non-smokers and non-tobacco chewers (Group C).

RESULTS

High density lipoprotein-cholesterol was lower both in smoker (P < 0.01) as well as in tobacco chewers (P < 0.001) than the controls. Both smokers and tobacco chewers had higher values of total cholesterol, low density lipoprotein cholesterol, very low density lipoprotein-cholesterol and, triglycerides as compared to non-smoker, non-tobacco chewer group whereas the differences in levels of lipids in smokers and tobacco chewers were not statistically significant.

CONCLUSION

Though different mode of addictions, smoking and tobacco chewing have an equal and comparable adverse effects on lipid profile and therefore raising cardiovascular risk in same proportion.

Binding of centchroman with human serum as determined by charcoal adsorption method

Protein binding of drugs is an important factor influencing both pharmacokinetic and pharmacodynamic parameters. Thus, knowing the extent of protein binding of drugs is crucial. Centchroman is a non-steroidal once a week oral contraceptive. It has been reported to be useful for the treatment of breast cancer and osteoporosis. Ample data has been generated on pharmacokinetics of centchroman in animals and humans. The extent of protein binding of centchroman has not been established so far. Non-specific adsorption of the drug limits the use of conventional methods like ultrafiltration and equilibrium dialysis. A method of charcoal adsorption as reported by Yuan et al. (method I) was used after modification (method II) to determine its binding to human serum. The extent of protein binding (%) is estimated from decline of percent drug remaining in the supernatant after adding the charcoal. Study was carried out at 1- and 10-microg/ml concentrations in drug free human serum samples and an HPLC assay was used to determine concentration-time data. The percentage of centchroman remaining in serum versus time data was analysed using non-linear fitting programs on WinNonlin software. Method II was found to give higher estimates of protein binding than the former method by preventing the dilution effect. Using this method, the extent of protein binding of centchroman was found to be 101.83+/-1.28 and 94.87+/-3.59% at 1 and 10 microg/ml, respectively. However, it was approximately 90% in the individual serum samples showing intersubject variability in protein binding of centchroman.

Orthodontics and infective endocarditis

Infective endocarditis associated with orthodontics is a rare occurrence. Unfortunately, many orthodontic practitioners do not treat patients potentially at risk of developing endocarditis due to the lack of practical guidelines and fear of precipitating the infection. Additionally, many patients that undergo orthodontic treatment are inappropriately prescribed antibiotic cover for procedures that have a minimal bacteraemic risk. In this paper the literature linking orthodontic treatment and infective endocarditis is examined. Recommendations are made for the appropriate management of patients at risk of infective endocarditis for orthodontic procedures. Refereed Paper

Hygienic practices and acute respiratory illness in family and group day care homes

OBJECTIVE

To describe hygiene practices in licensed group day care and family day care homes and the association between these practices and the prevalence of respiratory illnesses in the children in attendance.

METHODS

Self-administered surveys were mailed to 137 group and 204 family day care providers.

RESULTS

Wearing diapers and being younger than age three were associated with a higher frequency of respiratory illness. Children attending family day care homes had more respiratory illness than children attending group day care homes. Infrequent washing of children's or providers' hands after nose wiping, after diapering, before meals, and before food preparation was significantly associated with a higher frequency of respiratory illness. Use of shared cloth towels instead of individual paper towels and washing of sleeping mats less than once a week were also associated with a higher frequency of respiratory illness.

CONCLUSIONS

The findings underscore the importance of handwashing and other hygiene practices in reducing the spread of disease in day care settings.

Gender differences in the metabolic response to graded numbers of transplanted islets of Langerhans

Gender differences after treatment with streptozotocin (STZ) have been previously reported; however, differences in the glucose response to islet transplantation in STZ-induced diabetes in male and female rats after islet transplantation have not been examined. Male and female Wistar-Furth rats were made diabetic using STZ (55 mg/kg BW) and then given an intraportal islet transplant. Control animals received sham injections and sham transplant surgery; diabetic animals received STZ and sham surgery. In male animals, islet grafts contained 0 (diabetic), 250, 500, 1000, 1500, 2000, and 3000 islets; in female rats, grafts were made up of 0, 500 700, 750, 1000, or 2500 islets. STZ treatment had more dramatic effects on male than female rats. During the diabetic phase, body weights of male rats were significantly reduced compared to those of control male animals; this was not observed among females. Although all STZ-treated animals were hyperglycemic, plasma glucose levels in male diabetic rats were significantly higher than those in females during this phase (29.8 +/- 2.1 vs. 24.6 +/- 0.6 mM). After islet transplantation, body weight gain was positively associated with the number of islets transplanted in male rats (r2 = 0.59; P < 0.01), but not in females (r2 = 0.09; P > 0.8). In both male and female rats, animals that received 1000 islets or more were generally normoglycemic by 3 weeks posttransplant (males, 10.8 +/- 2.2 mM; females, 7.1 +/- 0.2 mM). Approximately 60% of male and female animals that received 500 islets achieved a reduction in plasma glucose levels. Mean plasma glucose levels were 17.2 +/- 2.3 in the females and 22.6 +/- 1.0 mM in males. However, a significantly larger proportion of female 500-islet animals (6 of 16) achieved a plasma glucose level of 9.5 mM or less compared with males receiving 500 islets (2 of 30). Multivariate regression analysis suggests that sex and islet number interact to affect glycemic normalization after islet transplantation. Gender differences appear to influence body weight and plasma glucose responses to islet transplantation. This finding may have particular relevance when a marginal number of functional islets are available.