1
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Avasare R, Andeen N, Beck L. Novel Antigens and Clinical Updates in Membranous Nephropathy. Annu Rev Med 2024; 75:219-332. [PMID: 37552894 DOI: 10.1146/annurev-med-050522-034537] [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] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Membranous nephropathy (MN), an autoimmune kidney disease and leading cause of nephrotic syndrome, leads to kidney failure in up to one-third of affected individuals. Most MN cases are due to an autoimmune reaction against the phospholipase A2 receptor (PLA2R) located on kidney podocytes. Serum PLA2R antibody quantification is now part of routine clinical practice because antibody titers correlate with disease activity and treatment response. Recent advances in target antigen detection have led to the discovery of more than 20 other podocyte antigens, yet the clinical impact of additional antigen detection remains unknown and is under active investigation. Here we review recent findings and hypothesize how current research will inform future care of patients with MN.
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Affiliation(s)
- Rupali Avasare
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA;
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA;
| | - Laurence Beck
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Section of Nephrology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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2
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Ye J, Croom N, Troxell ML, Kambham N, Zuckerman JE, Andeen N, Dall’Era M, Hsu R, Walavalkar V, Laszik ZG, Urisman A. Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset. Kidney360 2023; 4:935-942. [PMID: 37257088 PMCID: PMC10371271 DOI: 10.34067/kid.0000000000000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023]
Abstract
Key Points Non-full house (NFH) membranous lupus nephritis (MLN) is a minor subset of all MLN cases. Patients with NFH MLN tend to be older when diagnosed with systemic lupus erythematosus, undergo first renal biopsy at an older age, and have fewer extrarenal systemic manifestations. Lower load of C3 glomerular deposits seen in NFH MLN biopsies suggests attenuation of complement-mediated injury, which may have wider systemic implications. Background Renal involvement in systemic lupus erythematosus (SLE) is a key predictor of morbidity and mortality. Immunofluorescence (IF) staining of glomeruli is typically positive for IgG, IgA, IgM, C3, and C1q—the full house (FH) pattern. However, a subset of patients with membranous lupus nephritis (MLN) have a Non-FH (NFH) IF pattern more typical of idiopathic membranous nephropathy. Methods From a multi-institutional cohort of 113 MLN cases, we identified 29 NFH MLN biopsies. NFH MLN was defined by IF criteria: ≥1+ glomerular capillary loop IgG staining and<1+ IgA, IgM, and C1q. FH MLN was defined as ≥1+ staining for all five antibodies. Intermediate (Int) cases did not meet criteria for FH or NFH. We compared the pathological and clinical characteristics and outcomes among patients with FH, NFH, and Int IF patterns on kidney biopsy. Results NFH MLN represents a subset of MLN biopsies (13.4%). Compared with patients with FH MLN, patients with NFH MLN were older at SLE diagnosis (29 versus 22.5 years), had a longer time to initial kidney biopsy (8 versus 3.16 years), and had fewer SLE manifestations (2.5 versus 3.36 involved systems). NFH MLN biopsies showed lower C3 IF intensity (1.16+ versus 2.38+). Int biopsies had findings intermediate between those of NFH and FH groups. Conclusions NFH IF pattern defines a small subset of MLN biopsies and appears to be associated with milder clinical manifestations and slower disease progression. Less robust C3 deposition in NFH MLN may suggest a pathophysiology distinct from that of FH MLN.
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Affiliation(s)
- Julia Ye
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Nicole Croom
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Megan L. Troxell
- Department of Pathology, Stanford University, Palo Alto, California
| | - Neeraja Kambham
- Department of Pathology, Stanford University, Palo Alto, California
| | - Jonathan E. Zuckerman
- Department of Pathology, University of California, Los Angeles, Los Angeles, California
| | - Nicole Andeen
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Maria Dall’Era
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Raymond Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Vighnesh Walavalkar
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Zoltan G. Laszik
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Anatoly Urisman
- Department of Pathology, University of California, San Francisco, San Francisco, California
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Li N, Ferracane J, Lewis S, Andeen N, Woltjer R, Farsad K, Kaufman J, Rugonyi S, Jahangiri Y, Uchida B, Gabr A, Li J, Yamada K, Al-Hakim R. Abstract No. 299 Impact of post-thrombotic vein wall biomechanics on luminal flow during venous angioplasty and stent placement: computational modeling results. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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4
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Morrison GM, Morrison LH, Koon SM, Andeen N, Chung J. Melanoma presenting as a Marjolin ulcer on the lower extremity. Dermatol Online J 2022; 28. [DOI: 10.5070/d328157073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/08/2022] Open
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Lindsay SE, Hutchison C, Andeen N, Yang S. Salmonella Osteomyelitis in a Pediatric Patient with a Proximal Humerus Fracture: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00007. [PMID: 37440613 DOI: 10.2106/jbjs.cc.21.00746] [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: 07/15/2023]
Abstract
CASE A 5-year-old previously healthy girl sustained a left proximal humerus fracture after a fall from a trampoline. The injury was initially treated nonoperatively, but during routine follow-up, the patient was found to have a previously unrecognized bony erosion at the fracture site. Workup was negative for neoplasm but instead demonstrated Salmonella osteomyelitis. The patient underwent debridement and treatment with antibiotics. CONCLUSION This is an unusual presentation of a humerus fracture in a child with concomitant Salmonella osteomyelitis. Osteomyelitis is an important diagnostic consideration when considering bony erosions in the pediatric patient, even in those patients without apparent risk factors.
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Affiliation(s)
- Sarah E Lindsay
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Catherine Hutchison
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Scott Yang
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Li N, Ferracane J, Andeen N, Lewis S, Woltjer R, Rugonyi S, Jahangiri Y, Uchida B, Farsad K, Kaufman JA, Al-Hakim R. Impact of Postthrombotic Vein Wall Biomechanics on Luminal Flow during Venous Angioplasty and Stent Placement: Computational Modeling Results. J Vasc Interv Radiol 2022; 33:262-267. [PMID: 35221046 DOI: 10.1016/j.jvir.2021.12.006] [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] [Received: 09/21/2021] [Revised: 11/04/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022] Open
Abstract
This study characterized the impact of vein wall biomechanics on inflow diameter and luminal flow during venous angioplasty and stent placement, using postthrombotic and healthy biomechanical properties from an ovine venous stenosis and thrombosis model. Finite element analysis demonstrated more pronounced inflow channel narrowing in the postthrombotic vein compared with the healthy control vein during angioplasty and stent placement (relative inflow diameter reduction of 42% versus 13%, P < .0001). Computational fluid dynamics modeling showed increased relative areas of low wall shear rate in the postthrombotic vein compared with the normal vein (0.46 vs 0.24 for shear rate < 50 s-1; 0.13 vs 0.07 for shear rate < 15 s-1; P < .05), with flow stagnation and recirculation. Since inflow narrowing and low wall shear rate are associated with in-stent restenosis and reintervention, these computational results based on experimentally obtained biomechanical values highlight the significance of postthrombotic venous properties in optimizing venous intervention outcomes.
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Affiliation(s)
- Ningcheng Li
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Jack Ferracane
- School of Dentistry, Oregon Health and Science University, Portland, Oregon; Department of Biomaterials and Biomechanics, Oregon Health and Science University, Portland, Oregon
| | - Nicole Andeen
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Steven Lewis
- School of Dentistry, Oregon Health and Science University, Portland, Oregon; Department of Biomaterials and Biomechanics, Oregon Health and Science University, Portland, Oregon
| | - Randy Woltjer
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon
| | - Younes Jahangiri
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Barry Uchida
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Khashayar Farsad
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - John A Kaufman
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Ramsey Al-Hakim
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon.
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Li N, Ferracane J, Andeen N, Lewis S, Woltjer R, Rugonyi S, Jahangiri Y, Uchida B, Farsad K, Kaufman JA, Al-Hakim R. Endovascular Venous Stenosis and Thrombosis Large Animal Model: angiographic, histological, and biomechanical characterization. J Vasc Interv Radiol 2021; 33:255-261.e2. [PMID: 34915165 DOI: 10.1016/j.jvir.2021.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/07/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Characterize an ovine endovascular radiofrequency ablation based venous stenosis and thrombosis model for studying venous biomechanics and response to intervention. MATERIALS AND METHODS Unilateral short-segment (n= 2) or long-segment (n = 6) iliac vein stenoses were created in eight adult sheep using an endovenous radiofrequency (RF) ablation technique. Angiographic assessment was performed at baseline, immediately after venous stenosis creation, and after 2-week (n = 6) or 3-month (n = 2) survival. Stenosed iliac veins and contralateral healthy controls were harvested for histological and biomechanical assessment. RESULTS At follow-up, the short-segment RF ablation group showed stable stenosis without occlusion. The long-segment group showed complete venous occlusion/thrombosis with formation of collateral veins. Stenosed veins showed significant wall thickening (0.28 mm vs 0.16 mm; p = 0.0175) and confluent collagen deposition compared to healthy controls. Subacute non-adherent thrombi were apparent at 2 weeks, which were replaced by fibrous luminal obliteration with channels of recanalization at 3 months. Stenosed veins demonstrated increased longitudinal stiffness (448.5 ± 5.4 kPa vs. 314.6 ± 1.5 kPa, p < 0.0001) and decreased circumferential stiffness (140.8 ± 2.6 kPa vs. 246.0 ± 1.6 kPa, p < 0.0001) compared to healthy controls. CONCLUSION Endovenous radiofrequency ablation is a reliable technique for creating venous stenosis and thrombosis in a large animal model with histological and biomechanical attributes similar to those seen in humans. This platform can facilitate understanding of venous biomechanics and testing of venous specific devices and interventions.
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Affiliation(s)
- Ningcheng Li
- Dotter Interventional Institute, Oregon Health & Science University
| | - Jack Ferracane
- School of Dentistry, Oregon Health & Science University; Biomaterials and Biomechanics, Oregon Health & Science University
| | | | - Steven Lewis
- School of Dentistry, Oregon Health & Science University; Biomaterials and Biomechanics, Oregon Health & Science University
| | | | - Sandra Rugonyi
- Biomedical Engineering, Oregon Health & Science University
| | - Younes Jahangiri
- Dotter Interventional Institute, Oregon Health & Science University
| | - Barry Uchida
- Dotter Interventional Institute, Oregon Health & Science University
| | - Khashayar Farsad
- Dotter Interventional Institute, Oregon Health & Science University
| | - John A Kaufman
- Dotter Interventional Institute, Oregon Health & Science University
| | - Ramsey Al-Hakim
- Dotter Interventional Institute, Oregon Health & Science University.
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8
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Al-Rabadi LF, Caza T, Trivin-Avillach C, Rodan AR, Andeen N, Hayashi N, Williams B, Revelo MP, Clayton F, Abraham J, Lin E, Liou W, Zou CJ, Ramkumar N, Cummins T, Wilkey DW, Kawalit I, Herzog C, Storey A, Edmondson R, Sjoberg R, Yang T, Chien J, Merchant M, Arthur J, Klein J, Larsen C, Beck LH. Serine Protease HTRA1 as a Novel Target Antigen in Primary Membranous Nephropathy. J Am Soc Nephrol 2021; 32:1666-1681. [PMID: 33952630 PMCID: PMC8425645 DOI: 10.1681/asn.2020101395] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 10/01/2020] [Accepted: 02/21/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Identification of target antigens PLA2R, THSD7A, NELL1, or Semaphorin-3B can explain the majority of cases of primary membranous nephropathy (MN). However, target antigens remain unidentified in 15%-20% of patients. METHODS A multipronged approach, using traditional and modern technologies, converged on a novel target antigen, and capitalized on the temporal variation in autoantibody titer for biomarker discovery. Immunoblotting of human glomerular proteins followed by differential immunoprecipitation and mass spectrometric analysis was complemented by laser-capture microdissection followed by mass spectrometry, elution of immune complexes from renal biopsy specimen tissue, and autoimmune profiling on a protein fragment microarray. RESULTS These approaches identified serine protease HTRA1 as a novel podocyte antigen in a subset of patients with primary MN. Sera from two patients reacted by immunoblotting with a 51-kD protein within glomerular extract and with recombinant human HTRA1, under reducing and nonreducing conditions. Longitudinal serum samples from these patients seemed to correlate with clinical disease activity. As in PLA2R- and THSD7A- associated MN, anti-HTRA1 antibodies were predominantly IgG4, suggesting a primary etiology. Analysis of sera collected during active disease versus remission on protein fragment microarrays detected significantly higher titers of anti-HTRA1 antibody in active disease. HTRA1 was specifically detected within immune deposits of HTRA1-associated MN in 14 patients identified among three cohorts. Screening of 118 "quadruple-negative" (PLA2R-, THSD7A-, NELL1-, EXT2-negative) patients in a large repository of MN biopsy specimens revealed a prevalence of 4.2%. CONCLUSIONS Conventional and more modern techniques converged to identify serine protease HTRA1 as a target antigen in MN.
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Affiliation(s)
- Laith Farah Al-Rabadi
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | | | - Claire Trivin-Avillach
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Aylin R. Rodan
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah,Molecular Medicine Program, University of Utah Health, Salt Lake City, Utah,Department of Human Genetics, University of Utah Health, Salt Lake City, Utah,Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Nicole Andeen
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Norifumi Hayashi
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts,Kanazawa Medical University, Ishikawa, Japan
| | - Brandi Williams
- Moran Eye Center, University of Utah Health, Salt Lake City, Utah
| | - Monica P. Revelo
- Department of Pathology, University of Utah Health, Salt Lake City, Utah
| | - Fred Clayton
- Department of Pathology, University of Utah Health, Salt Lake City, Utah
| | - Jo Abraham
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Edwin Lin
- Department of Human Genetics, University of Utah Health, Salt Lake City, Utah
| | - Willisa Liou
- Department of Pathology, University of Utah Health, Salt Lake City, Utah
| | - Chang-Jiang Zou
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Nirupama Ramkumar
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Tim Cummins
- Clinical Proteomics Laboratory, Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Daniel W. Wilkey
- Clinical Proteomics Laboratory, Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Issa Kawalit
- International Renal Care Association, Amman, Jordan
| | - Christian Herzog
- Nephrology Division, Internal Medicine Department, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Aaron Storey
- Nephrology Division, Internal Medicine Department, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Rick Edmondson
- Nephrology Division, Internal Medicine Department, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Ronald Sjoberg
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Tianxin Yang
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah,Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Jeremy Chien
- Department of Biochemistry and Molecular Medicine, University of California Davis Health, Davis, California
| | - Michael Merchant
- Clinical Proteomics Laboratory, Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - John Arthur
- Nephrology Division, Internal Medicine Department, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Jon Klein
- Clinical Proteomics Laboratory, Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky,Robley Rex Veterans Administration Medical Center, Louisville, Kentucky
| | | | - Laurence H. Beck
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
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Sacker A, Kung V, Andeen N. Anti-GBM nephritis with mesangial IgA deposits after SARS-CoV-2 mRNA vaccination. Kidney Int 2021; 100:471-472. [PMID: 34119511 PMCID: PMC8191282 DOI: 10.1016/j.kint.2021.06.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Allan Sacker
- Pathology, Providence St. Vincent Medical Center, Portland, Oregon, USA
| | - Vanderlene Kung
- Pathology, Oregon Health and Science University, Portland, Oregon, USA
| | - Nicole Andeen
- Pathology, Oregon Health and Science University, Portland, Oregon, USA.
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Li N, Ferracane J, Lewis S, Andeen N, Woltjer R, Farsad K, Kaufman J, Rugonyi S, Jahangiri Y, Uchida B, Gabr A, Li J, Yamada K, Al-Hakim R. Abstract No. 225 Venous large animal model for stenosis, thrombosis, and chronic occlusion: short-term results, with biomechanical analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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11
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Luong J, Andeen N, Rope R, Silbermann R, Khalighi M, Avasare R. Acute Kidney Injury in a Patient With Monoclonal Gammopathy. Am J Kidney Dis 2020; 76:A10-A12. [PMID: 33222763 DOI: 10.1053/j.ajkd.2020.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/23/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Janie Luong
- Division of Nephrology, Department of Medicine, Oregon Health & Science University, Salt Lake City, UT
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Salt Lake City, UT
| | - Robert Rope
- Division of Nephrology, Department of Medicine, Oregon Health & Science University, Salt Lake City, UT
| | - Rebecca Silbermann
- Department of Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Mazdak Khalighi
- Department of Dermatology, University of Utah Health, Salt Lake City, UT
| | - Rupali Avasare
- Division of Nephrology, Department of Medicine, Oregon Health & Science University, Salt Lake City, UT
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12
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Charu V, Andeen N, Walavalkar V, Lapasia J, Kim JY, Lin A, Sibley R, Higgins J, Troxell M, Kambham N. Membranous nephropathy in patients with HIV: a report of 11 cases. BMC Nephrol 2020; 21:401. [PMID: 32948130 PMCID: PMC7501617 DOI: 10.1186/s12882-020-02042-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/08/2020] [Accepted: 08/23/2020] [Indexed: 01/26/2023] Open
Abstract
Background Membranous nephropathy (MN) has been recognized to occur in patients with human immunodeficiency virus (HIV) infection since the beginning of the HIV epidemic. The prevalence of phospholipase A2 receptor (PLA2R)-associated MN in this group has not been well studied. Methods We conducted a retrospective review of electronic pathology databases at three institutions to identify patients with MN and known HIV at the time of renal biopsy. Patients with comorbidities and coinfections known to be independently associated with MN were excluded. Results We identified 11 HIV-positive patients with biopsy-confirmed MN meeting inclusion and exclusion criteria. Patient ages ranged from 39 to 66 years old, and 10 of 11 patients (91%) were male. The majority of patients presented with nephrotic-range proteinuria, were on anti-retroviral therapy at the time of biopsy and had low or undetectable HIV viral loads. Biopsies from 5 of 10 (50%) patients demonstrated capillary wall staining for PLA2R. Measurement of serum anti-PLA2R antibodies was performed in three patients, one of whom had positive anti-PLA2R antibody titers. Follow-up data was available on 10 of 11 patients (median length of follow-up: 44 months; range: 4–145 months). All patients were maintained on anti-retroviral therapy (ARV) and 5 patients (52%) received concomitant immunosuppressive regimens. Three patients developed end-stage renal disease (ESRD) during the follow-up period. Conclusions MN in the setting of HIV is often identified in the setting of an undetectable viral loads, and similar to other chronic viral infection-associated MNs, ~ 50% of cases demonstrate tissue reactivity with PLA2R antigen, which may be seen without corresponding anti-PLA2R serum antibodies.
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Affiliation(s)
- Vivek Charu
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA.
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Vighnesh Walavalkar
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Jessica Lapasia
- Department of Nephrology, The Permanente Medical Group, San Francisco, CA, USA
| | - Jin-Yon Kim
- Department of Nephrology, The Permanente Medical Group, Sacramento, CA, USA
| | - Andrew Lin
- Department of Nephrology, The Permanente Medical Group, San Francisco, CA, USA
| | - Richard Sibley
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - John Higgins
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - Megan Troxell
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
| | - Neeraja Kambham
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2110A, Stanford, CA, 94304, USA
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13
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Roberts D, Siegman I, Andeen N, Woodland D, Deloughery T, Rueda J, Olyaei A, Rehman S, Norman D, Lockridge J. De novo thrombotic microangiopathy in two kidney transplant recipients from the same deceased donor: A case series. Clin Transplant 2020; 34:e13885. [PMID: 32314417 DOI: 10.1111/ctr.13885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
Thrombotic microangiopathy (TMA) is a recognized and serious complication of renal transplantation. Atypical hemolytic uremic syndrome (aHUS), a subset of TMA, occurs in the setting of dysregulation of the alternative complement pathway and can cause disease in native kidneys as well as recurrence in allografts. De novo TMA represents a classification of TMA post-transplant in the absence of clinical or histopathological evidence of TMA or aHUS in the native kidney. De novo TMA is a more heterogeneous syndrome than aHUS and the pathogenesis and risk factors for de novo TMA are poorly understood. The association between calcineurin inhibitors (CNI) and de novo TMA is controversial. Anti-complement blockade therapy with eculizumab is effective in some cases, but more studies are needed to identify appropriate candidates for therapy. We present two cases of de novo TMA occurring immediately in recipients from the same deceased donor and provoking the question of whether deceased donor-related factors could represent risks for developing de novo TMA.
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Affiliation(s)
- Daniel Roberts
- Division of Nephrology, Oregon Health and Science University, Portland, OR, USA
| | - Ingrid Siegman
- Portland VA Operative Care Division, VA Medical Center, Portland, OR, USA
| | - Nicole Andeen
- Division of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - David Woodland
- Division of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Thomas Deloughery
- Division of Hematology, Oregon Health and Science University, Portland, OR, USA
| | - Jose Rueda
- Division of Nephrology, Oregon Health and Science University, Portland, OR, USA
| | - Ali Olyaei
- School of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Shehzad Rehman
- Division of Nephrology, Oregon Health and Science University, Portland, OR, USA.,Section of Nephrology, VA Medical Center, Portland, OR, USA
| | - Doug Norman
- Division of Nephrology, Oregon Health and Science University, Portland, OR, USA.,Section of Nephrology, VA Medical Center, Portland, OR, USA
| | - Joe Lockridge
- Division of Nephrology, Oregon Health and Science University, Portland, OR, USA.,Section of Nephrology, VA Medical Center, Portland, OR, USA
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14
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Batal I, Vasilescu ER, Dadhania DM, Adel AA, Husain SA, Avasare R, Serban G, Santoriello D, Khairallah P, Patel A, Moritz MJ, Latulippe E, Riopel J, Khallout K, Swanson SJ, Bomback AS, Mohan S, Ratner L, Radhakrishnan J, Cohen DJ, Appel GB, Stokes MB, Markowitz GS, Seshan SV, De Serres SA, Andeen N, Loupy A, Kiryluk K, D'Agati VD. Association of HLA Typing and Alloimmunity With Posttransplantation Membranous Nephropathy: A Multicenter Case Series. Am J Kidney Dis 2020; 76:374-383. [PMID: 32359820 PMCID: PMC7483441 DOI: 10.1053/j.ajkd.2020.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE & OBJECTIVES Posttransplantation membranous nephropathy (MN) represents a rare complication of kidney transplantation that can be classified as recurrent or de novo. The clinical, pathologic, and immunogenetic characteristics of posttransplantation MN and the differences between de novo and recurrent MN are not well understood. STUDY DESIGN Multicenter case series. SETTING & PARTICIPANTS We included 77 patients from 5 North American and European medical centers with post-kidney transplantation MN (27 de novo and 50 recurrent). Patients with MN in the native kidney who received kidney allografts but did not develop recurrent MN were used as nonrecurrent controls (n = 43). To improve understanding of posttransplantation MN, we compared de novo MN with recurrent MN and then contrasted recurrent MN with nonrecurrent controls. FINDINGS Compared with recurrent MN, de novo MN was less likely to be classified as primary MN (OR, 0.04; P < 0.001) and had more concurrent antibody-mediated rejection (OR, 12.0; P < 0.001) and inferior allograft survival (HR for allograft failure, 3.2; P = 0.007). HLA-DQ2 and HLA-DR17 antigens were more common in recipients with recurrent MN compared with those with de novo MN; however, the frequency of these recipient antigens in recurrent MN was similar to that in nonrecurrent MN controls. Among the 93 kidney transplant recipients with native kidney failure attributed to MN, older recipient age (HR per each year older, 1.03; P = 0.02), recipient HLA-A3 antigen (HR, 2.5; P = 0.003), steroid-free immunosuppressive regimens (HR, 2.84; P < 0.001), and living related allograft (HR, 1.94; P = 0.03) were predictors of MN recurrence. LIMITATIONS Retrospective case series, limited sample size due to rarity of the disease, nonstandardized nature of data collection and biopsies. CONCLUSIONS De novo and recurrent MN likely represent separate diseases. De novo MN is associated with humoral alloimmunity and guarded outcome. Potential predisposing factors for recurrent MN include recipients who are older, recipient HLA-A3 antigen, steroid-free immunosuppressive regimen, and living related donor kidney.
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Affiliation(s)
- Ibrahim Batal
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY.
| | - Elena-Rodica Vasilescu
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Darshana M Dadhania
- Department of Medicine, Nephrology, Weill Cornell Medical College, New York, NY
| | | | - S Ali Husain
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Rupali Avasare
- Department of Medicine, Nephrology, Oregon Health & Science University, Portland, OR
| | - Geo Serban
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Dominick Santoriello
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Pascale Khairallah
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Ankita Patel
- Department of Medicine, Nephrology, Hackensack University Medical Center, Hackensack, NJ
| | - Michael J Moritz
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA
| | - Eva Latulippe
- Department of Pathology, University Health Center of Quebec, Laval University, Québec, QC, Canada
| | - Julie Riopel
- Department of Pathology, University Health Center of Quebec, Laval University, Québec, QC, Canada
| | - Karim Khallout
- Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France
| | | | - Andrew S Bomback
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Sumit Mohan
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lloyd Ratner
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Jai Radhakrishnan
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - David J Cohen
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Gerald B Appel
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Michael B Stokes
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Glen S Markowitz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Sacha A De Serres
- Renal Division, Department of Medicine, University Health Center of Quebec, Laval University, Québec, QC, Canada
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France
| | - Krzysztof Kiryluk
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Vivette D D'Agati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
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15
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DuPriest E, Hebert J, Morita M, Marek N, Meserve EEK, Andeen N, Houseman EA, Qi Y, Alwasel S, Nyengaard J, Morgan T. Fetal Renal DNA Methylation and Developmental Programming of Stress-Induced Hypertension in Growth-Restricted Male Mice. Reprod Sci 2020; 27:1110-1120. [PMID: 32046425 DOI: 10.1007/s43032-019-00121-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
Abstract
Fetal growth restriction (FGR) is associated with developmental programming of adult onset hypertension, which may be related to differences in nephron development. Prior studies showed that maternal nutrient restriction is associated with reduced nephrogenesis in rodents, especially in male progeny. We hypothesized that maternal genetic risk for FGR may similarly affect fetal kidney development, leading to adult onset hypertension. We employed an angiotensinogen (AGT) gene titration transgenic (TG) construct with 3 copies of the mouse AGT gene that mimics a common human genotype (AGT A[-6]G) associated with FGR. We investigated whether FGR in 2-copy (wild type, [WT]) progeny from 3-copy TG dams leads to developmental programming differences in kidney development and adult blood pressure compared with age- and sex-matched controls. Progeny were tested in the late fetal period (e17.5), neonatal period (2 weeks of age), and as young adults (12 weeks). We measured weights, tested for renal oxidative stress, compared renal DNA methylation profiles, counted the number of glomeruli, and measured adult blood pressure ± stress. Progeny from TG dams were growth restricted with evidence of renal oxidative stress, males showed fetal renal DNA hypermethylation, they had fewer glomeruli, and they developed stress-induced hypertension as adults. Their female siblings did not share this pathology and instead resembled progeny from WT dams. Surprisingly, glomerular counts in the neonatal period were not different between sexes or maternal genotypes. In turn, we suspect that differences in fetal renal DNA methylation may affect the long-term viability of glomeruli, rather than reducing nephrogenesis.
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Affiliation(s)
- Elizabeth DuPriest
- Departments of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.,Division of Natural Science and Health, Warner Pacific University, Portland, OR, USA
| | - Jessica Hebert
- Departments of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.,Department of Biology, Portland State University, Portland, OR, USA
| | - Mayu Morita
- Departments of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Nicole Marek
- Departments of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Emily E K Meserve
- Departments of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.,Department of Anatomic & Clinical Pathology, Maine Medical Center, Portland, ME, USA
| | - Nicole Andeen
- Departments of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - E Andres Houseman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Yue Qi
- Departments of Cardiovascular Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Saleh Alwasel
- Department of Zoology, King Saud University, Riyadh, Saudi Arabia
| | - Jens Nyengaard
- Core Centre for Molecular Morphology, Department of Clinical Medicine, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University, Aarhus, Denmark
| | - Terry Morgan
- Departments of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
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16
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Balderia PG, Andeen N, Jefferson JA. Characteristics and Outcomes of Patients with Anti-Glomerular Basement Membrane Antibody Disease and Anti-Neutrophil Cytoplasmic Antibodies. Curr Rheumatol Rev 2019; 15:224-228. [DOI: 10.2174/1573397114666180516131240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/29/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022]
Abstract
Background:
It is unclear whether patients with Anti-Glomerular Basement Membrane
(GBM) disease and Anti-Neutrophil Cytoplasmic Antibodies (ANCA), so called “Double-Positive”
(DP), have a different clinical presentation and outcome compared to patients with anti-GBM antibody
disease alone. This study describes the clinical and histologic characteristics as well as the patient
and renal outcomes of DP patients at the University of Washington compared to patients with
anti-GBM antibody disease alone.
Methods:
Adults admitted to the University of Washington and Harborview Medical Centers from
2000 to 2016 who had a kidney biopsy showing anti-GBM disease characterized by crescentic
glomerulonephritis with strong linear staining of glomerular basement membranes for IgG by immunofluorescence
were included. Subjects were classified into anti-GBM or DP based on serologic
testing. Information on demographics, clinical presentation, biopsy findings, initial treatment, and
rates of relapse and patient and renal survival were collected. Continuous and categorical variables
were analyzed using the Mann-Whitney U and Fisher’s exact tests, respectively.
Results:
There were 6 anti-GBM and 7 DP patients. Two patients were lost to follow-up after one
year. There was no significant difference in clinical presentation or outcomes between the two
groups. Two DP patients had greater than 50% global glomerulosclerosis. All the subjects developed
ESRD. Two DP patients had a relapse while off immunosuppression. Two patients in each
group died within 5 years of diagnosis.
Conclusion:
Two DP patients in our cohort had a relapse within 5 years of diagnosis. Multicenter
studies are needed to determine whether DP patients have a higher relapse rate and need prolonged
immunosuppression.
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Affiliation(s)
- Percy G. Balderia
- Division of Rheumatology, University of Washington School of Medicine, Seattle, Washington, United States
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, United States
| | - Jonathan A. Jefferson
- Division of Nephrology, University of Washington School of Medicine, Seattle, Washington, United States
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