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Chan EYH, Boyer O. Levamisole in childhood idiopathic nephrotic syndrome: new promises, and advocacy for global access. Kidney Int 2024; 105:932-934. [PMID: 38642993 DOI: 10.1016/j.kint.2024.01.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 04/22/2024]
Abstract
In the current issue of Kidney International, Sinha et al. present data from an open-label, noninferior, randomized controlled trial comparing 12-months of alternate-day prednisolone, given daily during infection, versus levamisole, in children with frequently relapsing or steroid-dependent nephrotic syndrome. This study suggests that both of these strategies are efficacious and safe. Results of this study should redefine the role of levamisole in future guidelines, and a call for global availability of levamisole should be advocated.
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Affiliation(s)
- Eugene Yu-Hin Chan
- Paediatric Nephrology Centre, Hong Kong Children's Hospital, Department of Paediatrics, Chinese University of Hong Kong, Shatin, Hong Kong SAR.
| | - Olivia Boyer
- Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Necker - Enfants Malades University Hospital, APHP, Inserm U1163, Imagine Institute, Paris Cité University, Paris, France.
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2
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Taghavi K, Sarnacki S, Blanc T, Boyer O, Heloury Y. The rationale for nephron-sparing surgery in unilateral non-syndromic Wilms tumour. Pediatr Nephrol 2024; 39:1023-1032. [PMID: 37603086 PMCID: PMC10899288 DOI: 10.1007/s00467-023-06099-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023]
Abstract
The central question of nephron-sparing surgery in unilateral non-syndromic Wilms tumour sits at a crossroads between surgery, oncology, and nephrology. There has been a significant paradigm shift in paediatric oncology towards reducing toxicity and addressing long-term treatment-related sequalae amongst childhood cancer survivors. After paediatric nephrectomy and 30-50 years of follow-up, 40% of patients will have chronic kidney disease, including 22% with hypertension and 23% with albuminuria. It is difficult to predict which patients will progress to develop hypertension, reduced glomerular filtration rate, albuminuria, and a higher cardiovascular risk. For these reasons, nephron-sparing surgery when it is technically feasible must be considered. To decrease the incidence of positive surgical margins (viable tumour present at a resection margin), incomplete lymph node sampling, and complications, these procedures should be performed at specialist and experienced reference centres. Based on the impacts of individual treatment pathways, survivors of childhood WT need to be followed through adulthood for early detection of chronic kidney disease, hypertension, and prevention of cardiovascular events.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Victoria, Melbourne, Australia.
- Department of Paediatrics, Monash University, Victoria, Melbourne, Australia.
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France.
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Yves Heloury
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
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3
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Bakkaloğlu SA, Ezgü D, Hari P, Boyer O, Schaefer F. Perception and knowledge of pediatric nephrologists on evidence-based guideline development methodology. Pediatr Nephrol 2024; 39:1015-1018. [PMID: 37648842 DOI: 10.1007/s00467-023-06139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Sevcan A Bakkaloğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Defne Ezgü
- Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Université Paris Cité, Inserm U1163, Paris, France
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
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4
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Cambier A, Roy JP, Dossier C, Patey N, Rabant M, Boyer O, Delbet JD, Lapeyraque AL, Hogan J. IgA nephropathy in children with minimal proteinuria: to biopsy or not to biopsy? Pediatr Nephrol 2024; 39:781-787. [PMID: 37698655 DOI: 10.1007/s00467-023-06121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Tubulointerstitial lesions and glomerular inflammation severity have been shown to correlate with proteinuria in children with IgA nephropathy (cIgAN). However, there is a lack of data regarding severity of histopathologic findings in cIgAN in patients with minimal to absent proteinuria since kidney biopsy indications are not well defined in these cases. METHODS Twenty-eight cIgAN patients with kidney biopsy from 4 different centers in Paris (France) and Montreal (Canada) with a urine protein/creatinine ratio (UPCr) ≤ 0.03 g/mmol and a normal estimated glomerular filtration rate (eGFR > 90 ml/min/1.73 m2) on the day of kidney biopsy prior to treatment were included. RESULTS Median age was 11.82 (9.32-13.45) years, and median follow-up was 4 years (2.87-6.53). At time of biopsy, median eGFR was 116 (102.3-139.7) ml/min/1.73 m2, and median UPCr was 0.02 (0.011-0.03) g/mmol. Microscopic or macroscopic hematuria was present in 35.7% and 64.3% of cases, respectively. Kidney biopsy microscopy analysis showed mesangial (M1), endocapillary (E1), or extracapillary (C1) hypercellularity in 53.5%, 32.1%, and 7.1% of patients, respectively. Chronic histological lesions were also present: glomerulosclerosis (S1) in 42.8% and tubular atrophy/interstitial fibrosis in 7.1%. Podocytopathic features were detected in 21.4%. An ACE inhibitor or immunosuppressive therapy (IS) was prescribed in 42.8% and 21.4% of these patients respectively. One-third (35.7%) received no treatment. At last follow-up, median eGFR was 111.9 (90.47-136.1) ml/min/1.73 m2, and median UPCr was 0.028 (0.01-0.03) g/mmol. CONCLUSION cIgAN with minimal proteinuria at time of biopsy might be linked with acute and chronic glomerular lesions.
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Affiliation(s)
- Alexandra Cambier
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada.
- Sainte-Justine Hospital Pediatric Research Centre: Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, QC, Canada.
| | - Jean-Philippe Roy
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Claire Dossier
- Division of Nephrology, Hôpital Robert Debré, Paris, France
| | - Natacha Patey
- Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Marion Rabant
- Division of Pathology, Hôpital Necker, Paris, France
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Centre, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
| | | | - Anne-Laure Lapeyraque
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Julien Hogan
- Division of Nephrology, Hôpital Robert Debré, Paris, France
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Faviez C, Vincent M, Garcelon N, Boyer O, Knebelmann B, Heidet L, Saunier S, Chen X, Burgun A. Performance and clinical utility of a new supervised machine-learning pipeline in detecting rare ciliopathy patients based on deep phenotyping from electronic health records and semantic similarity. Orphanet J Rare Dis 2024; 19:55. [PMID: 38336713 PMCID: PMC10858490 DOI: 10.1186/s13023-024-03063-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Rare diseases affect approximately 400 million people worldwide. Many of them suffer from delayed diagnosis. Among them, NPHP1-related renal ciliopathies need to be diagnosed as early as possible as potential treatments have been recently investigated with promising results. Our objective was to develop a supervised machine learning pipeline for the detection of NPHP1 ciliopathy patients from a large number of nephrology patients using electronic health records (EHRs). METHODS AND RESULTS We designed a pipeline combining a phenotyping module re-using unstructured EHR data, a semantic similarity module to address the phenotype dependence, a feature selection step to deal with high dimensionality, an undersampling step to address the class imbalance, and a classification step with multiple train-test split for the small number of rare cases. The pipeline was applied to thirty NPHP1 patients and 7231 controls and achieved good performances (sensitivity 86% with specificity 90%). A qualitative review of the EHRs of 40 misclassified controls showed that 25% had phenotypes belonging to the ciliopathy spectrum, which demonstrates the ability of our system to detect patients with similar conditions. CONCLUSIONS Our pipeline reached very encouraging performance scores for pre-diagnosing ciliopathy patients. The identified patients could then undergo genetic testing. The same data-driven approach can be adapted to other rare diseases facing underdiagnosis challenges.
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Affiliation(s)
- Carole Faviez
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France.
- Inria, 75012, Paris, France.
| | - Marc Vincent
- Université Paris Cité, Imagine Institute, Data Science Platform, INSERM UMR 1163, 75015, Paris, France
| | - Nicolas Garcelon
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France
- Inria, 75012, Paris, France
- Université Paris Cité, Imagine Institute, Data Science Platform, INSERM UMR 1163, 75015, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, APHP-Centre, Reference Center for Inherited Renal Diseases (MARHEA), Imagine Institute, Hôpital Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
- Laboratory of Renal Hereditary Diseases, INSERM UMR 1163, Imagine Institute, Université Paris Cité, 75015, Paris, France
| | - Bertrand Knebelmann
- Nephrology and Transplantation Department, MARHEA, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, 75015, Paris, France
| | - Laurence Heidet
- Department of Pediatric Nephrology, APHP-Centre, Reference Center for Inherited Renal Diseases (MARHEA), Imagine Institute, Hôpital Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
| | - Sophie Saunier
- Laboratory of Renal Hereditary Diseases, INSERM UMR 1163, Imagine Institute, Université Paris Cité, 75015, Paris, France
| | - Xiaoyi Chen
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France
- Inria, 75012, Paris, France
- Université Paris Cité, Imagine Institute, Data Science Platform, INSERM UMR 1163, 75015, Paris, France
| | - Anita Burgun
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France
- Inria, 75012, Paris, France
- Département d'informatique Médicale, Hôpital Necker-Enfants Malades, AP-HP, 75015, Paris, France
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6
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Boyer O, Dorval G. Multipopulation genome-wide association meta-analysis in pediatric steroid-sensitive nephrotic syndrome. Kidney Int 2024; 105:14-17. [PMID: 37714428 DOI: 10.1016/j.kint.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/09/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence du Syndrome Néphrotique Idiopathique de l'Enfant et l'Adulte, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France.
| | - Guillaume Dorval
- Service de Médecine Génomique des Maladies Rares, Centre de Référence MAladies REnales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France
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Malakasioti G, Iancu D, Milovanova A, Tsygin A, Horinouchi T, Nagano C, Nozu K, Kamei K, Fujinaga S, Iijima K, Kang HG, Sinha R, Basu B, Morello W, Montini G, Waters A, Boyer O, Yıldırım ZY, Yel S, Dursun İ, McCarthy HJ, Vivarelli M, Prikhodina L, Besouw MTP, Chan EYH, Huang W, Kemper MJ, Loos S, Prestidge C, Wong W, Zlatanova G, Ehren R, Weber LT, Chehade H, Hooman N, Tkaczyk M, Stańczyk M, Miligkos M, Tullus K. Corrigendum to "A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants." Kidney Int. 2023;103:962-972. Kidney Int 2024; 105:213-214. [PMID: 38182294 DOI: 10.1016/j.kint.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Affiliation(s)
| | - Daniela Iancu
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Alexey Tsygin
- National Medical Research Centre of Children's Health, Moscow, Russia
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Aoife Waters
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Hôpital Necker Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Zeynep Yürük Yıldırım
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hugh J McCarthy
- Department of Nephrology, Sydney Children's Hospitals Network & Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Larisa Prikhodina
- Veltishev Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Martine T P Besouw
- Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Wenyan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Markus J Kemper
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | | | - William Wong
- Starship Children's Hospital, Auckland, New Zealand
| | - Galia Zlatanova
- Department of Nephrology and Dialysis University Pediatric Hospital "Prof. Ivan Mitev", Department of Pediatrics Medical University, Sofia, Bulgaria
| | - Rasmus Ehren
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hassib Chehade
- Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, Switzerland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Michael Miligkos
- Second Department of Pediatrics, University of Athens School of Medicine and P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Donà D, Bravo-Gallego LY, Remacha EF, Cananzi M, Gastaldi A, Canizalez JT, Stephenne X, Lacaille F, Lindemans C, Calore E, Galea N, Benetti E, Nachbaur E, Sandes AR, Teixeira A, Ferreira S, Klaudel-Dreszler M, Ackermann O, Boyer O, Espinosa L, Guereta LG, Sciveres M, Fischler B, Schwerk N, Neland M, Nicastro E, Dello Strologo L, Toporski J, Vainumae I, Rascon J, Urbonas V, Del Rosal T, López-Granados E, Perilongo G, Baker A, Vega PJ. Vaccination practices in pediatric transplantation: A survey among member centers of the European reference network TransplantChild. Pediatr Transplant 2023; 27:e14589. [PMID: 37543721 DOI: 10.1111/petr.14589] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/24/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND There is considerable variation in vaccination practices between pediatric transplant centers. This study aims to evaluate active immunization attitudes and practices among ERN-TransplantChild centers and identify potential areas of improvement that could be addressed by shared evidence-based protocols. METHODS A cross-sectional questionnaire of attitudes and practices toward immunization of pediatric SOT and HSCT candidates and recipients was sent to a representative member of multidisciplinary teams from 27 European centers belonging to the ERN-TransplantChild. RESULTS A total of 28/62 SOT programs and 6/12 HSCT programs across 21 European centers participated. A quarter of centers did not have an on-site protocol for the immunizations. At the time of transplantation, pediatric candidates were fully immunized (80%-100%) in 57% and 33% of the SOT and HSCT programs. Variations in the time between vaccine administration and admission to the waiting list were reported between the centers, with 2 weeks for inactivated vaccines and variable time (2-4 weeks) for live-attenuated vaccines (LAVs). Almost all sites recommended immunization in the post-transplant period, with a time window of 4-8 months for the inactivated vaccines and 16-24 months for MMR and Varicella vaccines. Only five sites administer LAVs after transplantation, with seroconversion evaluated in 80% of cases. CONCLUSIONS The immunization coverage of European pediatric transplant recipients is still inconsistent and far from adequate. This survey is a starting point for developing shared evidence-based immunization protocols for safe vaccination among pediatric transplant centers and generating new research studies.
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Affiliation(s)
- Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luz Yadira Bravo-Gallego
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Esteban Frauca Remacha
- Pediatric Hepatology Department, La Paz University Hospital, Molecular Hepatology Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | - Mara Cananzi
- Unit of Paediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Andrea Gastaldi
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Department of Pediatrics, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Juan Torres Canizalez
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Xavier Stephenne
- Laboratoire d'Hépatologie Pédiatrique et Thérapie Cellulaire, Unité PEDI, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Florence Lacaille
- Service de Gastroentérologie-Hépatologie-Nutrition Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - Caroline Lindemans
- Princess Maxima Center for Pediatric Oncology, Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elisabetta Calore
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Nathalie Galea
- Paediatric Department of Mater Dei Hospital, Msida, Malta
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Azienda Ospedaliera di Padova, Padua, Italy
| | - Edith Nachbaur
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ana Rita Sandes
- Unidade de Nefrologia e Transplantação Renal, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria, Centro Académico de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Teixeira
- Department of Pediatric Nephrology, Pediatric Service, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Sandra Ferreira
- Hepatology and Pediatric Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maja Klaudel-Dreszler
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Oanez Ackermann
- Hepatologie et Transplantation Hepatique Pediatriques, Centre de reference de l'atresie des voies biliaires et des cholestases genetiques, FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, AP-HP, Centre de Référence de maladies rénales rares de l'enfant et de l'adulte (MARHEA), Hôpital Necker-Enfants Malades, Paris, France
- Institut Imagine, Laboratoire des maladies rénales héréditaires, INSERM UMR 1163, Université de Paris, Paris, France
| | - Laura Espinosa
- Pediatric Nephrology Department, La Paz University Hospital, Diagnosis and Treatment of Diseases Associated with Abnormalities of the Complement System Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | | | - Marco Sciveres
- Pediatric Hepatology and Liver Transplantation, ISMETT-University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Björn Fischler
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Nicolaus Schwerk
- Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Mette Neland
- Department of Paediatrics and Adolescence Medicine, Odense University Hospital, Odense, Denmark
| | - Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Dello Strologo
- Nephrology Unit, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Jacek Toporski
- Department of Pediatrics, Section of Pediatric Oncology, Hematology, Immunology and Nephrology, Skåne University Hospital, Lund, Sweden
- Center of Allogenic Stem Cell Transplantation and Cellular Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Inga Vainumae
- Department of Pediatrics, Tartu University Hospital, Tartu, Estonia
| | - Jelena Rascon
- Centre for Paediatric Oncology and Haematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vaidotas Urbonas
- Department of Paediatric Gastroenterology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Teresa Del Rosal
- Paediatric Infectious and Tropical Diseases Department, La Paz University Hospital, Translational Research Network in Paediatric Infectious Diseases (RITIP), La Paz Institute of Biomedical Research (IdiPAZ), and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Eduardo López-Granados
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
- Clinical Immunology Department, La Paz University Hospital, Madrid, Spain
| | - Giorgio Perilongo
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Alastair Baker
- Paediatric Liver, Gastrointestinal and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK
| | - Paloma Jara Vega
- Pediatric Hepatology Department, La Paz University Hospital, Molecular Hepatology Group, La Paz Institute of Biomedical Research (IdiPAZ), ERN TransplantChild Coordinator, Madrid, Spain
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9
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d’Izarny-Gargas T, Grapin M, Grunenwald A, Duong-Van-Huyen JP, Rabant M, Lévy R, Puel A, Toubiana J, Boyer O, Frémeaux-Bacchi V, Charbit M, Isnard P. Diffuse Endocapillary Glomerulonephritis in a Child With IL-17RA Deficiency Emphasizes the Pivotal Role of the Complement Cascade and Anaphylatoxins. Kidney Int Rep 2023; 8:2488-2491. [PMID: 38025236 PMCID: PMC10658284 DOI: 10.1016/j.ekir.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
| | - Mathilde Grapin
- Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Université Paris Cité, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Anne Grunenwald
- Université Paris Cité and Sorbonne Université, INSERM UMRS 1138, Centre de Recherche des Cordeliers, Inflammation, Complement and Cancer Team, Paris, France; Department of Immunology, Assistance Publique-Hôpitaux de Paris, Hopital Européen Georges Pompidou, Paris, France
| | | | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Romain Lévy
- Pediatric Hematology-Immunology-Rheumatology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Anne Puel
- Laboratoire de Génétique Humaine des Maladies Infectieuses, UMR1163, Imagine Institute, Paris, France
| | - Julie Toubiana
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Olivia Boyer
- Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Université Paris Cité, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Véronique Frémeaux-Bacchi
- Université Paris Cité and Sorbonne Université, INSERM UMRS 1138, Centre de Recherche des Cordeliers, Inflammation, Complement and Cancer Team, Paris, France; Department of Immunology, Assistance Publique-Hôpitaux de Paris, Hopital Européen Georges Pompidou, Paris, France
| | - Marina Charbit
- Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Université Paris Cité, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Pierre Isnard
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker Enfants Malades, Département Croissance et Signalisation, Paris, France
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10
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Burke L, Sethi SK, Boyer O, Licht C, McCulloch M, Shah R, Luyckx VA, Raina R. Voice of a caregiver: call for action for multidisciplinary teams in the care for children with atypical hemolytic uremic syndrome. Pediatr Nephrol 2023:10.1007/s00467-023-06158-8. [PMID: 37782345 DOI: 10.1007/s00467-023-06158-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023]
Affiliation(s)
| | - Sidharth Kumar Sethi
- Kidney and Renal Transplant Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Imagine Institute, Paris University, Necker Hospital, APHP, Paris, France
| | - Christoph Licht
- Department of Paediatrics, Division of Nephrology, University of Toronto, Toronto, ON, Canada
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Raghav Shah
- Northeast Ohio Medical University, Rootstown, OH, USA
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Valerie A Luyckx
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rupesh Raina
- Northeast Ohio Medical University, Rootstown, OH, USA.
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
- Department of Nephrology, Cleveland Clinic Akron General and Akron Children's Hospital, Akron, OH, USA.
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11
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Hogan J, Divard G, Aubert O, Garro R, Boyer O, Donald Cooper LA, Farris AB, Fila M, Seifert M, Sellier-Leclerc AL, Smith J, Fichtner A, Tönshoff B, Twombley K, Warady B, Pearl M, Zahr RS, Lefaucheur C, Patzer R, Loupy A. Validation of a prediction system for risk of kidney allograft failure in pediatric kidney transplant recipients: An international observational study. Am J Transplant 2023; 23:1561-1569. [PMID: 37453485 DOI: 10.1016/j.ajt.2023.07.004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Predicting long-term kidney allograft failure is an unmet need for clinical care and clinical trial optimization in children. We aimed to validate a kidney allograft failure risk prediction system in a large international cohort of pediatric kidney transplant recipients. Patients from 20 centers in Europe and the United States, transplanted between 2004 and 2017, were included. Allograft assessment included estimated glomerular filtration rate, urine protein-to-creatinine ratio, circulating antihuman leukocyte antigen donor-specific antibody, and kidney allograft histology. Individual predictions of allograft failure were calculated using the integrative box (iBox) system. Prediction performances were assessed using discrimination and calibration. The allograft evaluations were performed in 706 kidney transplant recipients at a median time of 9.1 (interquartile range, 3.3-19.2) months posttransplant; mean estimated glomerular filtration rate was 68.7 ± 28.1 mL/min/1.73 m2, and median urine protein-to-creatinine ratio was 0.1 (0.0-0.4) g/g, and 134 (19.0%) patients had antihuman leukocyte antigen donor-specific antibodies. The iBox exhibited accurate calibration and discrimination for predicting the outcomes up to 10 years after evaluation, with a C-index of 0.81 (95% confidence interval, 0.75-0.87). This study confirms the generalizability of the iBox to predict long-term kidney allograft failure in children, with performances similar to those reported in adults. These results support the use of the iBox to improve patient monitoring and facilitate clinical trials in children.
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Affiliation(s)
- Julien Hogan
- Université Paris Cité, INSERM, UMR-S970, PARCC, Paris Translational Research Center for Organ Transplantation, Paris, France; Pediatric nephrology department, Robert Debré Hospital, APHP, Paris, France; Emory Transplant Center, Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Gillian Divard
- Université Paris Cité, INSERM, UMR-S970, PARCC, Paris Translational Research Center for Organ Transplantation, Paris, France
| | - Olivier Aubert
- Université Paris Cité, INSERM, UMR-S970, PARCC, Paris Translational Research Center for Organ Transplantation, Paris, France
| | - Rouba Garro
- Pediatric Nephrology Department, Children Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Olivia Boyer
- Pediatric Nephrology, MARHEA Reference Center, INSERM U1163, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP.Centre, Paris, France
| | - Lee Alex Donald Cooper
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alton Brad Farris
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marc Fila
- Pediatric Nephrology Department, Montpellier University Hospital, Montpellier, France
| | - Michael Seifert
- Pediatric Nephrology Department, University of Alabama, Birmingham, Alabama, USA
| | | | - Jody Smith
- Pediatric Nephrology Department, Seattle Children, Seattle, New York, USA
| | - Alexander Fichtner
- Department of Pediatrics I, University Childrens Hospital Heidelberg, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Childrens Hospital Heidelberg, Heidelberg, Germany
| | - Katherine Twombley
- Pediatric Nephrology Department, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bradley Warady
- Pediatric Nephrology Department, Children's Mercy, Kansas City, Michigan, USA
| | - Meghan Pearl
- Pediatric Nephrology Department, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rima S Zahr
- UTHSC Department of Pediatric Nephrology and Hypertension, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Carmen Lefaucheur
- Université Paris Cité, INSERM, UMR-S970, PARCC, Paris Translational Research Center for Organ Transplantation, Paris, France
| | - Rachel Patzer
- Emory Transplant Center, Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Alexandre Loupy
- Université Paris Cité, INSERM, UMR-S970, PARCC, Paris Translational Research Center for Organ Transplantation, Paris, France.
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12
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Mary AL, Clave S, Rousset-Rouviere C, Berard E, Boyer O, Decramer S, Fila M, Guigonis V, Cloarec S, Harambat J, Hogan J, Lahoche A, Roussey-Kesler G, Zaloszyc A, Ulinski T, Parmentier C, Delbet JD. Outcome of children with IgA vasculitis with nephritis treated with steroids: a matched controlled study. Pediatr Nephrol 2023; 38:3317-3326. [PMID: 37154959 DOI: 10.1007/s00467-023-05981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND IgA vasculitis (IgAV) is the most common vasculitis in children. IgAV long-term prognosis depends on kidney involvement or IgA vasculitis with nephritis (IgAVN). To date, steroid treatment (oral steroids or methylprednisolone pulses) has not proven to be formally efficient. This study aimed to assess the role of steroids on IgAVN outcome. METHODS All children with IgAVN diagnosed 2000-2019 in 14 French pediatric nephrology units with minimal follow-up of 6 months were retrospectively included. Outcomes of patients treated with steroids were compared with those of a control group of untreated patients matched for age, sex, proteinuria, eGFR, and histological features. The primary endpoint was IgAVN remission defined as urine protein-to-creatinine ratio < 20 mg/mmol without impaired eGFR one year after disease onset. RESULTS A total of 359 patients with IgAVN were included with a median follow-up time of 249 days (range 43-809). One hundred eight (30%) patients received oral steroids alone, 207 (51%) patients received three methylprednisolone pulses followed by oral steroids, and 44 patients (12.5%) did not receive steroids. Thirty-two children treated with oral steroids alone were compared with 32 matched control patients who did not receive steroids. One year after disease onset, IgAVN remission proportion was not different between these two groups: 62% versus 68%, respectively. Ninety-three children treated with oral steroids alone were compared with 93 matched patients treated with three methylprednisolone pulses followed by oral corticosteroids. IgAVN remission proportion was not different between these two groups: 77% versus 73%, respectively. CONCLUSION The benefit of oral steroids alone and methylprednisolone pulses could not be established based on this observational study. Randomized controlled trials are thus required to determine the efficacy of steroids in IgAVN. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Anne-Lise Mary
- Intensive Care Unit, Armand Trousseau Hospital, AP-HP, 75012, Paris, France
| | - Stéphanie Clave
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique Des Hôpitaux de Marseille, Marseille, France
| | - Caroline Rousset-Rouviere
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique Des Hôpitaux de Marseille, Marseille, France
| | - Etienne Berard
- Department of Pediatrics, Hôpital de L'Archet, University Hospital of Nice, Nice, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Necker Hospital, APHP, 75015, Paris, France
| | - Stéphane Decramer
- Department of Pediatric Nephrology, Hôpital Des Enfants, Reference Center for Rare Kidney Diseases SORARE, University Hospital of Toulouse, Toulouse, France
| | - Marc Fila
- Department of Pediatric Nephrology, Reference Center for Rare Kidney Diseases SORARE, Hôpital Arnaud-de-Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Vincent Guigonis
- Department of Pediatrics, Hôpital Mère-Enfant, University Hospital of Limoges, Reference Center for Rare Kidney Diseases SORARE, Limoges, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology and Hemodialysis, Clocheville Hospital, University Hospital of Tours, Tours, France
| | - Jérôme Harambat
- Department of Pediatrics, Hôpital Pellegrin-Enfants, University Hospital of Bordeaux, Reference Center for Rare Kidney Diseases SORARE, Bordeaux, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, APHP and French Reference Center for Rare Diseases (CRMR) Idiopathic Nephrotic Syndrome, Paris, France
| | - Annie Lahoche
- Pediatric Nephrology Unit Jeanne de Flandre Hospital, Regional University Hospital of Lille, Lille, France
| | | | - Ariane Zaloszyc
- Department of Pediatrics 1, University Hospital of Strasbourg, Strasbourg, France
| | - Tim Ulinski
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP and French Reference Center for Rare Diseases MARHEA, Paris, France
- Sorbonnes Université, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP and French Reference Center for Rare Diseases MARHEA, Paris, France
| | - Jean-Daniel Delbet
- Pediatric Nephrology Department, Armand Trousseau Hospital, DMU Origyne, APHP and French Reference Center for Rare Diseases MARHEA, Paris, France.
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13
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Capri Y, Kwon T, Boyer O, Bourmance L, Testa N, Baudouin V, Bonnefoy R, Couderc A, Meziane C, Tournier-Lasserve E, Heidet L, Melki J. Biallelic NPR1 loss of function variants are responsible for neonatal systemic hypertension. J Med Genet 2023; 60:993-998. [PMID: 37080586 PMCID: PMC10579472 DOI: 10.1136/jmg-2023-109176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Early-onset isolated systemic hypertension is a rare condition of unknown genetic origin. Renovascular, renal parenchymal diseases or aortic coarctation are the most common causes of secondary systemic hypertension in younger children and neonates. We investigated the genetic bases of early-onset isolated systemic hypertension. METHODS Whole-exome sequencing (WES) was followed by variant filtering and Sanger sequencing for validation and familial segregation of selected variants in a large consanguineous family. mRNA expression was performed to evaluate the impact of the predicted pathogenic variant on gene expression. WES or Sanger sequencing was performed in additional unrelated affected individuals. RESULTS In one consanguineous family with four children presenting with isolated neonatal-onset systemic hypertension, we identified homozygous stop-gain variant in the NPR1 gene (NM_000906.4:c.1159C>T (p.Arg387Ter)) in the affected individuals. This variant leads to a dramatic reduction of NPR1 RNA levels. NPR1 gene analysis of additional families allowed the identification of another family with two affected children carrying homozygous frameshift variant in NPR1 (NM_000906.4:c.175del (p.Val59TrpfsTer8)). CONCLUSION We show for the first time that biallelic loss of function of NPR1 is responsible for isolated neonatal-onset systemic hypertension in humans, which represents a new autosomal recessive genetic cause of infantile systemic hypertension or cardiogenic shock. This is consistent with studies reporting early-onset systemic hypertension and sudden death in Npr1-deficient mice. NPR1 gene analysis should be therefore investigated in infants with early-onset systemic hypertension with or without cardiogenic shock of unknown origin.
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Affiliation(s)
- Yline Capri
- Département de Génétique, Assistance publique-Hôpitaux de Paris, APHP-Nord, Hôpital Robert Debré, Paris, France
- UMR-1195, Institut National de la Santé et de la Recherche Médicale (Inserm) and University Paris Saclay, Le Kremlin Bicêtre, France
| | - Theresa Kwon
- Nephrology Department, Robert Debré University Hospital-APHP, Paris, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Hôpital Necker-Enfants Malades, APHP-centre, Université Paris Cité, Paris, France
| | - Lucas Bourmance
- UMR-1195, Institut National de la Santé et de la Recherche Médicale (Inserm) and University Paris Saclay, Le Kremlin Bicêtre, France
| | - Noe Testa
- UMR-1195, Institut National de la Santé et de la Recherche Médicale (Inserm) and University Paris Saclay, Le Kremlin Bicêtre, France
| | - Véronique Baudouin
- Nephrology Department, Robert Debré University Hospital-APHP, Paris, France
| | - Ronan Bonnefoy
- Service de Cardiologie Pédiatrique, Hôpital Robert Debré, APHP-Nord, Paris, France
| | - Anne Couderc
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Hôpital Necker-Enfants Malades, APHP-centre, Université Paris Cité, Paris, France
| | - Chakib Meziane
- Service de Néonatologie, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Elisabeth Tournier-Lasserve
- Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis, AP-HP, Université de Paris, INSERM, Paris, France
| | - Laurence Heidet
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Hôpital Necker-Enfants Malades, APHP-centre, Université Paris Cité, Paris, France
| | - Judith Melki
- UMR-1195, Institut National de la Santé et de la Recherche Médicale (Inserm) and University Paris Saclay, Le Kremlin Bicêtre, France
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Boyer O, Pape L. Is ABO Incompatible Living Donor Kidney Transplantation in Children a Better Option than the Use of Optimal Grafts From Deceased Donors? A Plea for Better Prioritization of Deceased Kidney Grafts for Children. Transpl Int 2023; 36:11911. [PMID: 37789913 PMCID: PMC10542672 DOI: 10.3389/ti.2023.11911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et l’Adulte, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Lars Pape
- Department of Pediatric Nephrology, Children’s Hospital, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Abstract
Idiopathic nephrotic syndrome is the most common glomerular disease in children. Corticosteroids are the cornerstone of its treatment, and steroid response is the main prognostic factor. Most children respond to a cycle of oral steroids, and are defined as having steroid-sensitive nephrotic syndrome. Among the children who do not respond, defined as having steroid-resistant nephrotic syndrome, most respond to second-line immunosuppression, mainly with calcineurin inhibitors, and children in whom a response is not observed are described as multidrug resistant. The pathophysiology of nephrotic syndrome remains elusive. In cases of immune-mediated origin, dysregulation of immune cells and production of circulating factors that damage the glomerular filtration barrier have been described. Conversely, up to a third of cases of steroid-resistant nephrotic syndrome have a monogenic origin. Multidrug resistant nephrotic syndrome often leads to kidney failure and can cause relapse after kidney transplant. Although steroid-sensitive nephrotic syndrome does not affect renal function, most children with steroid-sensitive nephrotic syndrome have a relapsing course that requires repeated steroid cycles with significant side-effects. To minimise morbidity, some patients require steroid-sparing immunosuppressive agents, including levamisole, mycophenolate mofetil, calcineurin inhibitors, anti-CD20 monoclonal antibodies, and cyclophosphamide. Close monitoring and preventive measures are warranted at onset and during relapse to prevent acute complications (eg, hypovolaemia, acute kidney injury, infections, and thrombosis), whereas long-term management requires minimising treatment-related side-effects. A subset of patients have active disease into adulthood.
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Affiliation(s)
- Marina Vivarelli
- Division of Nephrology, Laboratory of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Keisha Gibson
- Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina at Chapel Hill, NC, USA
| | - Aditi Sinha
- Division of Nephrology, Indian Council of Medical Research Center for Advanced Research in Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Hôpital Necker - Enfants Malades, Assistance Publique Hôpitaux de Paris, Inserm U1163, Institut Imagine, Université Paris Cité, Paris, France
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16
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Ndoudi Likoho B, Berthaud R, Dossier C, Delbet JD, Boyer O, Baudouin V, Alison M, Biran V, Hurtaud MF, Hogan J, Kwon T, Couderc A. Renal vein thrombosis in neonates: a case series of diagnosis, treatment and childhood kidney function follow-up. Pediatr Nephrol 2023; 38:3055-3063. [PMID: 36988695 DOI: 10.1007/s00467-023-05918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Neonatal renal vein thrombosis (NRVT) is a rare condition with little data available. METHODS We retrospectively analyzed newborns diagnosed with NRVT admitted to 3 pediatric nephrology units in Paris from 2005 to 2020. RESULTS Twenty-seven patients were analyzed (male = 59%). The median age at diagnosis was 2.5 days (1 - 4.5). Diagnosis was suspected based on at least one of the three cardinal signs of renal vein thrombosis in 93%: flank mass (67%), hematuria (67%) and thrombocytopenia (70%). In all patients, diagnosis was confirmed by ultrasound. All patients had at least one known perinatal risk factor. A prothrombotic risk factor was found in 13 patients (48%). NRVT was unilateral in 70%, involving the left renal vein in 58%. Among 25 treated patients, 19 (76%) received low molecular weight heparin (LMWH) as initial therapy, 2 (8%) received unfractionated heparin and 4 (16%) received fibrinolysis. Median duration of treatment was 8 weeks (4 - 12). Bleeding occurred significantly more often with fibrinolysis than with LMWH/supportive therapy (3 of 4: 75% vs 0 of 4: 0%, p = 0.05). Clot resolution in patients treated with fibrinolysis did not differ significantly from those treated with LMWH/supportive therapy. After a median follow-up of 5.7 years (3 years - 9.9 years), pathological kidney features were observed in 73% of the patients (19 of 26), kidney atrophy in 18 (69%), hypertension in 2 (8%), chronic kidney disease (CKD) in 1 (4%) and proteinuria in 2 (8%). CONCLUSIONS NRVT remains a challenging condition, which still requires further study because of its associated morbidity. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Bellaure Ndoudi Likoho
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France.
| | - Romain Berthaud
- Department of Pediatric Nephrology, Necker-Enfants-Malades University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Claire Dossier
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Jean-Daniel Delbet
- Department of Pediatric Nephrology, Trousseau University Hospital, Assistance Publique - Hôpitaux de Paris, and Sorbonne University, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Necker-Enfants-Malades University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Véronique Baudouin
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Marianne Alison
- Department of Pediatric Radiology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Marie-Françoise Hurtaud
- Biological Hematology Department, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Theresa Kwon
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Anne Couderc
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
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Zurowska A, Drozynska-Duklas M, Topaloglu R, Bouts A, Boyer O, Shenoy M, Vivarelli M. Rituximab-associated hypogammaglobulinemia in children with idiopathic nephrotic syndrome: results of an ESPN survey. Pediatr Nephrol 2023; 38:3035-3042. [PMID: 37014530 PMCID: PMC10432325 DOI: 10.1007/s00467-023-05913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND There is paucity of information on rituximab-associated hypogammaglobulinemia (HGG) and its potential infectious consequences in children treated for idiopathic nephrotic syndrome (INS). METHODS A survey was distributed by the European Society Pediatric Nephrology to its members. It addressed the screening and management practices of pediatric nephrology units for recognizing and treating RTX-associated HGG and its morbidity and mortality. Eighty-four centers which had treated an overall 1328 INS children with RTX responded. RESULTS The majority of centers administered several courses of RTX and continued concomitant immunosuppressive therapy. Sixty-five percent of centers routinely screened children for HGG prior to RTX infusion, 59% during, and 52% following RTX treatment. Forty-seven percent had observed HGG prior to RTX administration, 61% during and 47% >9 months following treatment in 121, 210, and 128 subjects respectively. Thirty-three severe infections were reported among the cohort of 1328 RTX-treated subjects, of whom 3 children died. HGG had been recognized in 30/33 (80%) of them. CONCLUSIONS HGG in steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) children is probably multifactorial and can be observed prior to RTX administration in children with SDNS/FRNS. Persistent HGG lasting >9 months from RTX infusion is not uncommon and may increase the risk of severe infections in this cohort. We advocate for the obligatory screening for HGG in children with SDNS/FRNS prior to, during, and following RTX treatment. Further research is necessary to identify risk factors for developing both HGG and severe infections before recommendations are made for its optimal management. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Aleksandra Zurowska
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, ul. Debinki 7, 80-952, Gdańsk, Poland.
- Centre for Rare Diseases, Medical University of Gdańsk, Gdańsk, Poland.
| | - Magdalena Drozynska-Duklas
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, ul. Debinki 7, 80-952, Gdańsk, Poland
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine Hacettepe University, Ankara, Turkey
| | - Antonia Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Necker Hospital, Paris, France
- Laboratory of Hereditary Kidney Diseases, Imagine Institute, Paris Descartes University, Paris, France
| | - Mohan Shenoy
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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Yerigeri K, Kadatane S, Mongan K, Boyer O, Burke LLG, Sethi SK, Licht C, Raina R. Atypical Hemolytic-Uremic Syndrome: Genetic Basis, Clinical Manifestations, and a Multidisciplinary Approach to Management. J Multidiscip Healthc 2023; 16:2233-2249. [PMID: 37560408 PMCID: PMC10408684 DOI: 10.2147/jmdh.s245620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/12/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy (TMA) defined by the triad of hemolytic anemia, thrombocytopenia, and acute kidney injury. Microthrombi develop in the glomerular capillaries secondary to endothelial damage and exert shear stress on red blood cells, consume platelets, and contribute to renal dysfunction and failure. Per current understanding of pathophysiology, HUS is classified into infectious, secondary, and atypical disease. The most common etiology is infectious sequelae of Shiga toxin-producing Escherichia coli (STEC); other causative organisms include shigella and salmonella. Secondary HUS arises from cancer, chemotherapy, solid organ and hematopoietic stem cell transplant, pregnancy, or autoimmune disorders. Primary atypical hemolytic-uremic syndrome (aHUS) is associated with genetic mutations in complement and complement regulatory proteins. Under physiologic conditions, complement regulators keep the alternative complement system continuously active at low levels. In times of inflammation, mutations in complement-related proteins lead to uncontrolled complement activity. The hyperactive inflammatory state leads to glomerular endothelial damage, activation of the coagulation cascade, and TMA findings. Atypical hemolytic-uremic syndrome is a rare disorder with a prevalence of 2.21 to 9.4 per million people aged 20 years or younger; children between the ages of 0 and 4 are most affected. Multidisciplinary health care is necessary for timely management of its extra-renal manifestations. These include vascular disease of the heart, brain, and skin, pulmonary hypertension and hemorrhage, and pregnancy complications. Adequate screening is required to monitor for sequelae. First-line treatment is the monoclonal antibody eculizumab, but several organ systems may require specialized interventions and coordination of care with sub-specialists.
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Affiliation(s)
- Keval Yerigeri
- Department of Internal Medicine-Pediatrics, Case Western Reserve University/The MetroHealth System, Cleveland, OH, USA
| | - Saurav Kadatane
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kai Mongan
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Olivia Boyer
- Department of Pediatric Nephrology, Dialysis and Transplantation, Necker-Enfants Malades Hospital, MARHEA reference Center, Imagine Institute, Paris Cité University, Paris, France
| | - Linda L G Burke
- aHUS Global Advocate with aHUS Alliance, Cape Elizabeth, ME, USA
| | - Sidharth Kumar Sethi
- Department of Pediatric Nephrology and Pediatric Renal Transplant Medicine, Kidney and Urology Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Christoph Licht
- Department of Paediatrics, Division of Nephrology, University of Toronto, Toronto, ON, Canada
| | - Rupesh Raina
- Division of Pediatric Nephrology, Akron Children’s Hospital, Akron, OH, USA
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Bertholet-Thomas A, Manso-Silván MA, Navas-Serrano V, Guittet C, Joukoff S, Bacchetta J, Boyer O, Rodriguez Portillo M, Granier LA. Bone mineral density and growth changes in patients with distal renal tubular acidosis after two-years treatment with a new alkalizing drug (ADV7103). Nefrologia 2023; 43:458-466. [PMID: 36529656 DOI: 10.1016/j.nefroe.2022.02.012] [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] [Received: 09/09/2021] [Accepted: 02/27/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES ADV7103 is a new prolonged-release treatment for distal renal tubular acidosis (dRTA), containing potassium citrate and potassium bicarbonate. Since acidosis may affect bone mineral contents, the effects of ADV7103 on bone mineral density (BMD) and growth in patients with dRTA over 24 months were evaluated. PATIENTS AND METHODS Thirty patients (24 paediatric patients and 6 adults) were included in an open-label extension study after a phase II/III trial. BMD, measured by densitometry, was assessed at baseline and at 24 months. Growth was evaluated throughout the study. Plasma bicarbonate, parathyroid hormone, 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, bone alkaline phosphatase, calciuria and citraturia, were also determined. Safety and treatment compliance were evaluated as well. RESULTS After 24 months of treatment with ADV7103, mean spine BMD z-score values significantly increased as compared with baseline (p=0.024). In adults, spine and whole-body densitometry z-scores showed a significant correlation with plasma bicarbonate levels (rS=0.82 and rS=0.97, respectively, p<0.005). There was an increase>0.5 units in z-scores for height and weight in 18% and 36% of the paediatric patients, respectively. With treatment, plasma bicarbonate concentration and calciuria at the different visits were normal in 69-86% and 93-96% patients, respectively. Only nine treatment-related gastrointestinal AEs of mild/moderate severity, were reported in five patients. CONCLUSIONS Two years of ADV7103 treatment improved growth and increased spine BMD. These results suggest that control of acidosis by ADV7103 treatment improves bone parameters.
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Affiliation(s)
- Aurélia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares - Néphrogones - Hôpital Femme Mère Enfant, Hospices Civils de Lyon - Filière ORKiD, Bron, France
| | | | | | | | | | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares - Néphrogones - Hôpital Femme Mère Enfant, Hospices Civils de Lyon - Filière ORKiD, Bron, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Institut Imagine, Hôpital Necker-Enfants Malades, Université de Paris, France
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Avramescu M, Isnard P, Temmam S, Chevalier A, Bastard P, Attia M, Berthaud R, Fila M, Dossier C, Hogan J, Ulinski T, Leguevaques D, Louillet F, Casado EM, Halimi JM, Cloarec S, Zaloszyc A, Faudeux C, Rousset-Rouvière C, Clavé S, Harambat J, Rollot E, Simon T, Nallet-Amate M, Ranchin B, Bacchetta J, Porcheret F, Bernard J, Ryckewaert A, Jamet A, Fourgeaud J, Da Rocha N, Pérot P, Kuperwasser N, Bouazza N, Rabant M, Duong Van Huyen JP, Robert MP, Zuber J, Casanova JL, Eloit M, Sermet-Gaudelus I, Boyer O. Acute tubulointerstitial nephritis with or without uveitis: a novel form of post-acute COVID-19 syndrome in children. Kidney Int 2023; 103:1193-1198. [PMID: 36918081 PMCID: PMC10008186 DOI: 10.1016/j.kint.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Affiliation(s)
- Marina Avramescu
- Pediatric Nephrology, Maladies REnales Héréditaires de l'Enfant et de l'Adulte (MARHEA) Reference Center, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Pierre Isnard
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France; Université de Paris, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1151, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 8253, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Paris, France
| | - Sarah Temmam
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Agnès Chevalier
- Department of Pediatric Nephrology, Arnaud-de-Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France; Paris Cité University, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA; Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Mikael Attia
- Molecular Genetics of RNA Viruses, Department of Virology, Institut Pasteur, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 3569, Paris, France
| | - Romain Berthaud
- Pediatric Nephrology, Maladies REnales Héréditaires de l'Enfant et de l'Adulte (MARHEA) Reference Center, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Marc Fila
- Department of Pediatric Nephrology, Arnaud-de-Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Claire Dossier
- Department of Pediatric Nephrology, Robert Debré Hospital, Paris Cité University, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology, Robert Debré Hospital, Paris Cité University, Paris, France
| | - Tim Ulinski
- Department of Pediatric Nephrology, Armand Trousseau Hospital, Paris, France
| | - Damia Leguevaques
- Department of Pediatric Nephrology, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille, France
| | | | | | - Jean-Michel Halimi
- Department of Adult Nephrology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology, Clocheville Hospital, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | - Ariane Zaloszyc
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Strasbourg, Strasbourg, France
| | - Camille Faudeux
- Department of Pediatrics, Pediatric Nephrology Unit, L'Archet Hospital, University Hospital of Nice, Nice, France
| | - Caroline Rousset-Rouvière
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Stéphanie Clavé
- Department of Multidisciplinary Pediatrics, Pediatric Nephrology Unit, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Jérôme Harambat
- Department of Pediatrics, Pediatric Nephrology Unit, SoRare Reference Center, Bordeaux University Hospital, Bordeaux, France
| | - Edouard Rollot
- Department of Pediatrics, Pediatric Nephrology Unit, SoRare Reference Center, Bordeaux University Hospital, Bordeaux, France
| | - Thomas Simon
- Department of Pediatric Nephrology, SoRare Reference Center, Toulouse University Hospital, Toulouse, France
| | | | - Bruno Ranchin
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Lyon, Lyon, France
| | - Justine Bacchetta
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Lyon, Lyon, France
| | | | - Josselin Bernard
- Pediatric Department, Nantes University Hospital, Nantes, France
| | - Amélie Ryckewaert
- Department of Pediatric Nephrology, centre Hospitalier Universitaire (CHU) de Rennes, Rennes, France
| | - Anne Jamet
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France
| | - Jacques Fourgeaud
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France
| | - Nicolas Da Rocha
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Philippe Pérot
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Nicolas Kuperwasser
- Paris Cité University, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1151, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 8253, Necker Enfants Malades Institute, Department « Croissance et Signalisation », Paris, France
| | - Naïm Bouazza
- Equipe Associée (EA) 7323, Université Paris, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France; Unité de Recherche Clinique, Hôpital Tarnier, Paris, France; Centre d'Investigation Clinique (CIC)-1419 Institut National de la Santé Et de la Recherche Médicale (Inserm), Cochin-Necker, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Matthieu P Robert
- Department of Ophthalmology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cité University, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris Cité University, Paris, France
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France; Paris Cité University, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA
| | - Marc Eloit
- Pathogen Discovery Laboratory, Department of Virology, Institut Pasteur, Paris, France
| | - Isabelle Sermet-Gaudelus
- Department of Pediatric Pulmonology and Allergology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Olivia Boyer
- Pediatric Nephrology, Maladies REnales Héréditaires de l'Enfant et de l'Adulte (MARHEA) Reference Center, Institut National de la Santé Et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
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Petzold F, Billot K, Chen X, Henry C, Filhol E, Martin Y, Avramescu M, Douillet M, Morinière V, Krug P, Jeanpierre C, Tory K, Boyer O, Burgun A, Servais A, Salomon R, Benmerah A, Heidet L, Garcelon N, Antignac C, Zaidan M, Saunier S. The genetic landscape and clinical spectrum of nephronophthisis and related ciliopathies. Kidney Int 2023:S0085-2538(23)00377-0. [PMID: 37230223 DOI: 10.1016/j.kint.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/15/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
Nephronophthisis (NPH) is an autosomal-recessive ciliopathy representing one of the most frequent causes of kidney failure in childhood characterized by a broad clinical and genetic heterogeneity. Applied to one of the worldwide largest cohorts of patients with NPH, genetic analysis encompassing targeted and whole exome sequencing identified disease-causing variants in 600 patients from 496 families with a detection rate of 71%. Of 788 pathogenic variants, 40 known ciliopathy genes were identified. However, the majority of patients (53%) bore biallelic pathogenic variants in NPHP1. NPH-causing gene alterations affected all ciliary modules defined by structural and/or functional subdomains. Seventy six percent of these patients had progressed to kidney failure, of which 18% had an infantile form (under five years) and harbored variants affecting the Inversin compartment or intraflagellar transport complex A. Forty eight percent of patients showed a juvenile (5-15 years) and 34% a late-onset disease (over 15 years), the latter mostly carrying variants belonging to the Transition Zone module. Furthermore, while more than 85% of patients with an infantile form presented with extra-kidney manifestations, it only concerned half of juvenile and late onset cases. Eye involvement represented a predominant feature, followed by cerebellar hypoplasia and other brain abnormalities, liver and skeletal defects. The phenotypic variability were in a large part associated with mutation types, genes and corresponding ciliary modules with hypomorphic variants in ciliary genes playing a role in early steps of ciliogenesis associated with juvenile-to-late onset NPH forms. Thus, our data confirm a considerable proportion of late-onset NPH suggesting an underdiagnosis in adult chronic kidney disease.
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Affiliation(s)
- Friederike Petzold
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France; Division of Nephrology, Department of Endocrinology, Nephrology, and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Katy Billot
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Xiaoyi Chen
- Université de Paris, Imagine Institute, Data Science Platform, INSERM UMR 1163, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France
| | - Charline Henry
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Emilie Filhol
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Yoann Martin
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Marina Avramescu
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France; Department of Pediatry, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maxime Douillet
- Université de Paris, Imagine Institute, Data Science Platform, INSERM UMR 1163, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France
| | - Vincent Morinière
- APHP, Génétique moléculaire, Hôpital universitaire Necker-Enfants malades, Paris, France
| | - Pauline Krug
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France; Department of Pediatry, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Jeanpierre
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Kalman Tory
- Ist Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary
| | - Olivia Boyer
- Department of Pediatry, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Nephrology and Transplantation Department, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, France
| | - Anita Burgun
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France; Hôpital Necker-Enfants Malades, Department of Medical Informatics, AP-HP, Paris, France; PaRis Artificial Intelligence Research InstitutE (PRAIRIE), France
| | - Aude Servais
- Nephrology and Transplantation Department, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, France
| | - Remi Salomon
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France; Department of Pediatry, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Alexandre Benmerah
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Laurence Heidet
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France; Department of Pediatry, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Nephrology and Transplantation Department, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, France
| | - Nicolas Garcelon
- Université de Paris, Imagine Institute, Data Science Platform, INSERM UMR 1163, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France
| | - Corinne Antignac
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Mohamad Zaidan
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France; Centre de Compétence Maladies Rares « Syndrome Néphrotique Idiopathique », Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sophie Saunier
- Laboratory of Hereditary Kidney Diseases, Université de Paris, Imagine Institute, INSERM UMR 1163, Paris, France.
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22
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Biebuyck N, Destombes C, Prakash R, Boyer O. Is withdrawal of nocturnal hyperhydration possible in children with primary hyperoxaluria treated with RNAi? J Nephrol 2023:10.1007/s40620-023-01611-1. [PMID: 37209362 DOI: 10.1007/s40620-023-01611-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/23/2023] [Indexed: 05/22/2023]
Abstract
Primary hyperoxaluria type 1 is a rare genetic disorder caused by bi-allelic pathogenic variants in the AGXT gene leading to an overproduction of oxalate which accumulates in the kidneys in the form of calcium oxalate crystals. Thus, patients may present with recurrent nephrocalcinosis and lithiasis, with progressive impairment of the renal function and eventually kidney failure. There is no specific treatment besides liver-kidney transplantation, and pre-transplantation management by 24 h-hyperhydration, crystallisation inhibitors and high-dose pyridoxine has a high negative impact on quality of life, especially because of the discomfort due to nocturnal hyperhydration. Since 2020, lumasiran, an RNA-interfering therapy, has been approved for the treatment of primary hyperoxaluria type 1 in adults and children. However, to date, there are no recommendations regarding the discontinuation of other supportive measures during RNAi therapy. In this report, we present two patients with primary hyperoxaluria type 1 who were treated with lumasiran and stopped nocturnal hyperhydration with positive outcomes, i.e. normal urinary oxalate, absence of crystalluria, stable kidney function and improved well-being. These data suggest that discontinuing nocturnal hydration may be safe in children responding to lumasiran, and may have a positive impact on their quality of life. Additional data are needed to update treatment recommendations.
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Affiliation(s)
- Nathalie Biebuyck
- Paediatric Nephrology, Necker Enfants Malades Hospital, MARHEA, APHP, Imagine Institute, Paris Cité University, 149 rue de Sèvres, 75015, Paris, France
| | - Camille Destombes
- Paediatric Nephrology, Necker Enfants Malades Hospital, MARHEA, APHP, Imagine Institute, Paris Cité University, 149 rue de Sèvres, 75015, Paris, France
| | - Richa Prakash
- Paediatric Nephrology, Necker Enfants Malades Hospital, MARHEA, APHP, Imagine Institute, Paris Cité University, 149 rue de Sèvres, 75015, Paris, France
| | - Olivia Boyer
- Paediatric Nephrology, Necker Enfants Malades Hospital, MARHEA, APHP, Imagine Institute, Paris Cité University, 149 rue de Sèvres, 75015, Paris, France.
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Quennelle S, Douillet M, Friedlander L, Boyer O, Neuraz A, Burgun A, Garcelon N. The Smart Data Extractor, a Clinician Friendly Solution to Accelerate and Improve the Data Collection During Clinical Trials. Stud Health Technol Inform 2023; 302:247-251. [PMID: 37203656 DOI: 10.3233/shti230112] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In medical research, the traditional way to collect data, i.e. browsing patient files, has been proven to induce bias, errors, human labor and costs. We propose a semi-automated system able to extract every type of data, including notes. The Smart Data Extractor pre-populates clinic research forms by following rules. We performed a cross-testing experiment to compare semi-automated to manual data collection. 20 target items had to be collected for 79 patients. The average time to complete one form was 6'81" for manual data collection and 3'22" with the Smart Data Extractor. There were also more mistakes during manual data collection (163 for the whole cohort) than with the Smart Data Extractor (46 for the whole cohort). We present an easy to use, understandable and agile solution to fill out clinical research forms. It reduces human effort and provides higher quality data, avoiding data re-entry and fatigue induced errors.
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Affiliation(s)
- Sophie Quennelle
- HeKA Team, Inria Inserm UMR_S1138, PariSantéCampus, Paris, France
- Université de Paris Cité, Paris, France
- Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France
| | | | - Lisa Friedlander
- Université de Paris Cité, Paris, France
- Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France
| | - Olivia Boyer
- Université de Paris Cité, Paris, France
- Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France
| | - Antoine Neuraz
- HeKA Team, Inria Inserm UMR_S1138, PariSantéCampus, Paris, France
- Université de Paris Cité, Paris, France
- Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France
| | - Anita Burgun
- HeKA Team, Inria Inserm UMR_S1138, PariSantéCampus, Paris, France
- Université de Paris Cité, Paris, France
- Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France
| | - Nicolas Garcelon
- HeKA Team, Inria Inserm UMR_S1138, PariSantéCampus, Paris, France
- Université de Paris Cité, Paris, France
- Data Science Platform, Imagine Institute, Paris, France
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24
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Yoo D, Goutaudier V, Divard G, Gueguen J, Astor BC, Aubert O, Raynaud M, Demir Z, Hogan J, Weng P, Smith J, Garro R, Warady BA, Zahr RS, Sablik M, Twombley K, Couzi L, Berney T, Boyer O, Duong-Van-Huyen JP, Giral M, Alsadi A, Gourraud PA, Morelon E, Le Quintrec M, Brouard S, Legendre C, Anglicheau D, Villard J, Zhong W, Kamar N, Bestard O, Djamali A, Budde K, Haas M, Lefaucheur C, Rabant M, Loupy A. An automated histological classification system for precision diagnostics of kidney allografts. Nat Med 2023; 29:1211-1220. [PMID: 37142762 DOI: 10.1038/s41591-023-02323-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/28/2023] [Indexed: 05/06/2023]
Abstract
For three decades, the international Banff classification has been the gold standard for kidney allograft rejection diagnosis, but this system has become complex over time with the integration of multimodal data and rules, leading to misclassifications that can have deleterious therapeutic consequences for patients. To improve diagnosis, we developed a decision-support system, based on an algorithm covering all classification rules and diagnostic scenarios, that automatically assigns kidney allograft diagnoses. We then tested its ability to reclassify rejection diagnoses for adult and pediatric kidney transplant recipients in three international multicentric cohorts and two large prospective clinical trials, including 4,409 biopsies from 3,054 patients (62.05% male and 37.95% female) followed in 20 transplant referral centers in Europe and North America. In the adult kidney transplant population, the Banff Automation System reclassified 83 out of 279 (29.75%) antibody-mediated rejection cases and 57 out of 105 (54.29%) T cell-mediated rejection cases, whereas 237 out of 3,239 (7.32%) biopsies diagnosed as non-rejection by pathologists were reclassified as rejection. In the pediatric population, the reclassification rates were 8 out of 26 (30.77%) for antibody-mediated rejection and 12 out of 39 (30.77%) for T cell-mediated rejection. Finally, we found that reclassification of the initial diagnoses by the Banff Automation System was associated with an improved risk stratification of long-term allograft outcomes. This study demonstrates the potential of an automated histological classification to improve transplant patient care by correcting diagnostic errors and standardizing allograft rejection diagnoses.ClinicalTrials.gov registration: NCT05306795 .
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Affiliation(s)
- Daniel Yoo
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Valentin Goutaudier
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Gillian Divard
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Juliette Gueguen
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Brad C Astor
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Olivier Aubert
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marc Raynaud
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Zeynep Demir
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Pediatric Hepatology Unit-Liver Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Julien Hogan
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Division of Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
| | - Patricia Weng
- Pediatric Nephrology, David Geffen School of Medicine at UCLA, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Jodi Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Rouba Garro
- Division of Pediatric Nephrology, Emory University School of Medicine, Children's Pediatric Institute, Atlanta, GA, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, University of Kansas City, Children's Mercy Hospital, Kansas City, MO, USA
| | - Rima S Zahr
- Division of Pediatric Nephrology and Hypertension, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Marta Sablik
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Katherine Twombley
- Acute Dialysis Units, Pediatric Kidney Transplant, Medical University of South Carolina, Charleston, SC, USA
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Thierry Berney
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Boyer
- Division of Pediatric Nephrology, Necker Hospital, Université Paris Cité, Paris, France
| | - Jean-Paul Duong-Van-Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Magali Giral
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Alaa Alsadi
- Department of Pathology, University of Wisconsin, Madison, WI, USA
| | - Pierre A Gourraud
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Emmanuel Morelon
- Department of Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Lyon, University of Lyon I, Lyon, France
| | - Moglie Le Quintrec
- Department of Nephrology, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Sophie Brouard
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Nantes, France
| | - Christophe Legendre
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dany Anglicheau
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean Villard
- Division of Transplantation Immunology, University Hospital of Geneva, Geneva, Switzerland
| | - Weixiong Zhong
- Department of Pathology, University of Wisconsin, Madison, WI, USA
| | - Nassim Kamar
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier, Universitaire de Toulouse, Toulouse, France
| | - Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Arjang Djamali
- Department of Medicine, Maine Medical Center, Portland, ME, USA
| | - Klemens Budde
- Department of Nephrology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Mark Haas
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carmen Lefaucheur
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marion Rabant
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandre Loupy
- Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France.
- Department of Kidney Transplantation, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
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25
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Malakasioti G, Iancu D, Milovanova A, Tsygin A, Horinouchi T, Nagano C, Nozu K, Kamei K, Fujinaga S, Iijima K, Sinha R, Basu B, Morello W, Montini G, Waters A, Boyer O, Yıldırım ZY, Yel S, Dursun İ, McCarthy HJ, Vivarelli M, Prikhodina L, Besouw MTP, Chan EYH, Huang W, Kemper MJ, Loos S, Prestidge C, Wong W, Zlatanova G, Ehren R, Weber LT, Chehade H, Hooman N, Tkaczyk M, Stańczyk M, Miligkos M, Tullus K. A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants. Kidney Int 2023; 103:962-972. [PMID: 36898413 DOI: 10.1016/j.kint.2023.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 05/11/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023]
Abstract
While 44-83% of children with steroid-resistant nephrotic syndrome (SRNS) without a proven genetic cause respond to treatment with a calcineurin inhibitor (CNI), current guidelines recommend against the use of immunosuppression in monogenic SRNS. This is despite existing evidence suggesting that remission with CNI treatment is possible and can improve prognosis in some cases of monogenic SRNS. Herein, our retrospective study assessed response frequency, predictors of response and kidney function outcomes among children with monogenic SRNS treated with a CNI for at least three months. Data from 203 cases (age 0-18 years) were collected from 37 pediatric nephrology centers. Variant pathogenicity was reviewed by a geneticist, and 122 patients with a pathogenic and 19 with a possible pathogenic genotype were included in the analysis. After six months of treatment and at last visit, 27.6% and 22.5% of all patients respectively, demonstrated partial or full response. Achievement of at least partial response at six months of treatment conferred a significant reduction in kidney failure risk at last follow-up compared to no response (hazard ratio [95% confidence interval] 0.25, [0.10-0.62]). Moreover, risk of kidney failure was significantly lower when only those with a follow-up longer than two years were considered (hazard ratio 0.35, [0.14-0.91]). Higher serum albumin level at CNI initiation was the only factor related to increased likelihood of significant remission at six months (odds ratio [95% confidence interval] 1.16, [1.08-1.24]). Thus, our findings justify a treatment trial with a CNI also in children with monogenic SRNS.
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Affiliation(s)
| | - Daniela Iancu
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Alexey Tsygin
- National Medical Research Centre of Children's Health, Moscow, Russia
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Aoife Waters
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Hôpital Necker Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Zeynep Yürük Yıldırım
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hugh J McCarthy
- Department of Nephrology, Sydney Children's Hospitals Network & Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Larisa Prikhodina
- Veltishev Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Martine T P Besouw
- Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Wenyan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Markus J Kemper
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | | | - William Wong
- Starship Children's Hospital, Auckland, New Zealand
| | - Galia Zlatanova
- Department of Nephrology and Dialysis University Pediatric Hospital "Prof. Ivan Mitev", Department of Pediatrics Medical University, Sofia, Bulgaria
| | - Rasmus Ehren
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hassib Chehade
- Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, Switzerland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Michael Miligkos
- Second Department of Pediatrics, University of Athens School of Medicine and P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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26
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Chbihi M, Eveillard LA, Riller Q, Brousse R, Berthaud R, Quartier P, Salomon R, Charbit M, Avramescu M, Biebuyck N, Dehoux L, Garcelon N, Duong-Van-Huyen JP, Bader-Meunier B, Boyer O. Induction therapy for pediatric onset class IV lupus nephritis: Mycophenolate Mofetil versus Cyclophosphamide. J Nephrol 2023; 36:829-839. [PMID: 36208405 DOI: 10.1007/s40620-022-01438-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/04/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Class IV lupus nephritis (LN) is one of the most frequent and severe types of involvement in pediatric systemic lupus erythematosus. Gold standard treatment consists of intravenous (i.v.) Cyclophosphamide (CYC) associated with corticosteroids. Recent studies in adults have shown similar efficacy of oral Mycophenolate Mofetil (MMF) with fewer adverse events. Our aim was to compare the efficacy and tolerance of CYC and MMF as induction therapy in children with class IV LN. METHODS We conducted a retrospective study of children diagnosed with class IV LN who started oral MMF or i.v. CYC treatment at Necker Enfants Malades Hospital (Paris, France). RESULTS The study included 33 patients, 17 treated with oral MMF (51%) and 16 with i.v. CYC (48%). The characteristics at treatment induction did not significantly differ between the two groups except for the neurological involvement, that was only present in the CYC group. Complete remission was obtained in 9/17 (53%) children treated with MMF versus 10/16 (71%) treated with CYC (p = 0.46). Relapse was observed in 59% of patients receiving MMF versus 50% receiving CYC (p = 0.87), after a median of 3.4 years and 4.7 years after the beginning of treatment, respectively (p = 0.41). During the 6.5 years of follow-up, we observed no significant difference regarding the number of treatment-related adverse events between the two groups (p = 0.48). CONCLUSION We report similar efficacy and tolerance of MMF or CYC as induction therapy of class IV LN in children. However, the long-term adverse events such as infertility could not be systematically evaluated in this retrospective pediatric study. Overall, however, considering the long-term safety profile reported in the literature, we suggest that MMF may be used as first-line induction therapy in LN.
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Affiliation(s)
- Marwa Chbihi
- Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France.
| | - Laurye-Anne Eveillard
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Quentin Riller
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Paris Cité University, Imagine Institute, Paris, France
| | - Romain Brousse
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Romain Berthaud
- Pediatric Nephrology, MARHEA Reference Center, Paris Cité University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France
| | - Rémi Salomon
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Marina Charbit
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Marina Avramescu
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Nathalie Biebuyck
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Laurène Dehoux
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Nicolas Garcelon
- Inserm U1163, Imagine Institute, Paris Center University, Paris, France
- Inserm, Cordeliers Research Center, U1138, team 22, Paris Cité University, Paris, France
| | - Jean-Paul Duong-Van-Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Brigitte Bader-Meunier
- Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France
| | - Olivia Boyer
- Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France
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27
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Méaux MN, Harambat J, Rothenbuhler A, Léger J, Kamenicky P, Soskin S, Boyer O, Boros E, D'Anella P, Mignot B, Gebhart M, Vic P, Richard N, Thivichon-Prince B, Francou B, Linglart A, Bacchetta J, Molin A. Genotype-phenotype Description of Vitamin D-dependent Rickets 1A: CYP27B1 p.(Ala129Thr) Variant Induces a Milder Disease. J Clin Endocrinol Metab 2023; 108:812-826. [PMID: 36321535 DOI: 10.1210/clinem/dgac639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/26/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Vitamin D-dependent rickets type 1A (VDDR1A) is a rare genetic disease associated with loss-of-function variations in the gene encoding the vitamin D-activating enzyme 1α-hydroxylase (CYP27B1). Phenotype-genotype correlation is unclear. Long-term outcome data are lacking. The objective of this study was to describe characteristics and outcomes to search for a phenotype-genotype correlation. METHODS We retrospectively collected clinical data, genetic features, and outcomes from 24 genetically confirmed cases from 10 French centers; results are presented as median (min-max). RESULTS Clinical symptoms at diagnosis (age, 1.5 [0.5-8.7] years) were mainly bone and neurological abnormalities, and laboratory data showed hypocalcemia (1.97 [1.40-2.40] mmol/L), hypophosphatemia (-3.4 [-13.4 to (-)0.2] SD score for age), low 25OHD and low 1,25(OH)2D3, secondary hyperparathyroidism with PTH at 6.6 (1.3-13.7) times the upper limit for normal (ULN; PTH expressed as ULN to homogenize data presentation), and increased alkaline phosphatase (1968 [521-7000] IU/L). Bone radiographs were abnormal in 83% of patients. We identified 17 variations (11 missense, 3 frameshift, 2 truncating, and 1 acceptor splice site variations) in 19 families (homozygous state in 58% [11/19]). The partial loss-of-function variation p.(Ala129Thr) was associated with a milder phenotype: older age at diagnosis, higher serum calcium (2.26 vs 1.85 mmol/L), lower PTH (4.7 vs 7.5 ULN), and lower alkaline phosphatase (759 vs 2082 IU/L). Patients were treated with alfacalcidol. Clinical (skeletal, neurological), biochemical, and radiological outcomes were satisfactory, and complications occurred if there was bad adherence. CONCLUSION Overall, our findings highlight good outcomes under substitutive treatment and the need of a closer follow-up of eyes, teeth, kidneys, and blood pressure in VDDR1A.
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Affiliation(s)
- Marie-Noëlle Méaux
- CHU de Bordeaux, Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Rares Sorare, 33 000 Bordeaux, France
- CHU de Lyon, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, 69 500 Bron, France
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69 008 Lyon, France
| | - Jérôme Harambat
- CHU de Bordeaux, Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Rares Sorare, 33 000 Bordeaux, France
| | - Anya Rothenbuhler
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, filière OSCAR, France
- Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, INSERM, Service d'Endocrinologie et Diabète de l'enfant, Unité Physiologie et Physiopathologie Endocrinienne, Hôpital Bicêtre Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Juliane Léger
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Endocrinologie Diabétologie Pédiatrique, 75 019 Paris, France
| | - Peter Kamenicky
- Assistance Publique-Hôpitaux de Paris, Hôpital Kremlin Bicêtre, Service d'Endocrinologie et de Biologie de la Reproduction, 94270 Le Kremlin-Bicêtre, France
| | - Sylvie Soskin
- CHU de Strasbourg, Service d'Endocrinologie Pédiatrique, 69 091 Strasbourg, France
| | - Olivia Boyer
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, CRMR MARHEA, Institut Imagine, Université Paris Cité, 75015 Paris, France
| | - Emese Boros
- Hôpital Universitaire des enfants Reine Fabiola, Service d'Endocrinologie Pédiatrique, 1020 Bruxelles, Belgique
| | | | - Brigitte Mignot
- CHU de Besançon, Service d'Endocrinologie Pédiatrique, 25000 Besançon, France
| | - Maite Gebhart
- CHU de Besançon, Service d'Endocrinologie Pédiatrique, 25000 Besançon, France
| | - Philippe Vic
- CH de Cornouailles, Service de Pédiatrie, 29000 Quimper, France
| | - Nicolas Richard
- CHU de Caen, Service de Génétique, EA7450 Biotargen, 14033 Caen, France
| | | | - Bruno Francou
- Assistance Publique-Hôpitaux de Paris, Hôpital Kremlin-Bicêtre, Laboratoire de génétique moléculaire, 94270 Le Kremlin-Bicêtre, France
| | - Agnès Linglart
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, filière OSCAR, France
- Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, INSERM, Service d'Endocrinologie et Diabète de l'enfant, Unité Physiologie et Physiopathologie Endocrinienne, Hôpital Bicêtre Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Justine Bacchetta
- CHU de Lyon, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, 69 500 Bron, France
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69 008 Lyon, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, filière OSCAR, France
- Centre de Référence des Maladies Rénales Rares Néphrogones, filière ORKID, France
| | - Arnaud Molin
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, filière OSCAR, France
- CHU de Caen, Service de Génétique, EA7450 Biotargen, 14033 Caen, France
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28
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Boyer O, Mollet G, Dorval G. [Neurological disorders and hereditary podocytopathies: Some fascinating pathophysiological overlaps]. Med Sci (Paris) 2023; 39:246-252. [PMID: 36943121 DOI: 10.1051/medsci/2023029] [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: 03/23/2023] Open
Abstract
Genetic studies of hereditary steroid resistant nephrotic syndrome (SRNS) have identified more than 60 genes involved in the development of single-gene, isolated or syndromic forms of hereditary podocytoapthies. Sometimes, syndromic SRNS is associated with neurological disorders. Over the past decades, various studies have established links between the podocyte, an epithelial glomerular cell involved in the renal filtration barrier, and neuronal cells, both morphologically (slit diaphragm and synapse) and functionally (signaling platforms). Variants of genes encoding proteins expressed in different compartments of the podocyte and neurons are responsible for phenotypes associating renal lesions with proteinuria to central and/or peripheral neurological disorders. In this review, we aim to focus on genetic syndromes associating proteinuria and neurological disease and to present the latest advances in the description of these neuro-renal disorders.
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Affiliation(s)
- Olivia Boyer
- Service de néphrologie pédiatrique, AP-HP, Centre de référence de maladies rénales rares de l'enfant et de l'adulte (MARHEA), hôpital Necker - Enfants Malades, Paris, France - Université Paris Cité, institut Imagine, laboratoire des maladies rénales héréditaires, Inserm UMR1163, Paris, France
| | - Géraldine Mollet
- Université Paris Cité, institut Imagine, laboratoire des maladies rénales héréditaires, Inserm UMR1163, Paris, France
| | - Guillaume Dorval
- Université Paris Cité, institut Imagine, laboratoire des maladies rénales héréditaires, Inserm UMR1163, Paris, France - Service de génétique moléculaire, AP-HP, hôpital Necker-Enfants Malades, Paris, France
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29
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Groothoff JW, Metry E, Deesker L, Garrelfs S, Acquaviva C, Almardini R, Beck BB, Boyer O, Cerkauskiene R, Ferraro PM, Groen LA, Gupta A, Knebelmann B, Mandrile G, Moochhala SS, Prytula A, Putnik J, Rumsby G, Soliman NA, Somani B, Bacchetta J. Clinical practice recommendations for primary hyperoxaluria: an expert consensus statement from ERKNet and OxalEurope. Nat Rev Nephrol 2023; 19:194-211. [PMID: 36604599 DOI: 10.1038/s41581-022-00661-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 01/06/2023]
Abstract
Primary hyperoxaluria (PH) is an inherited disorder that results from the overproduction of endogenous oxalate, leading to recurrent kidney stones, nephrocalcinosis and eventually kidney failure; the subsequent storage of oxalate can cause life-threatening systemic disease. Diagnosis of PH is often delayed or missed owing to its rarity, variable clinical expression and other diagnostic challenges. Management of patients with PH and kidney failure is also extremely challenging. However, in the past few years, several new developments, including new outcome data from patients with infantile oxalosis, from transplanted patients with type 1 PH (PH1) and from patients with the rarer PH types 2 and 3, have emerged. In addition, two promising therapies based on RNA interference have been introduced. These developments warrant an update of existing guidelines on PH, based on new evidence and on a broad consensus. In response to this need, a consensus development core group, comprising (paediatric) nephrologists, (paediatric) urologists, biochemists and geneticists from OxalEurope and the European Rare Kidney Disease Reference Network (ERKNet), formulated and graded statements relating to the management of PH on the basis of existing evidence. Consensus was reached following review of the recommendations by representatives of OxalEurope, ESPN, ERKNet and ERA, resulting in 48 practical statements relating to the diagnosis and management of PH, including consideration of conventional therapy (conservative therapy, dialysis and transplantation), new therapies and recommendations for patient follow-up.
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Affiliation(s)
- Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ella Metry
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisa Deesker
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander Garrelfs
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cecile Acquaviva
- Service de Biochimie et Biologie Moléculaire, UM Pathologies Héréditaires du Métabolisme et du Globule Rouge, Hospices Civils de Lyon, Lyon, France
| | - Reham Almardini
- Department of Pediatric Nephrology, Princes Rahma Children Teaching Hospital, Applied Balqa University, Medical School, Amman, Jordan
| | - Bodo B Beck
- Institute of Human Genetics, Center for Molecular Medicine Cologne, and Center for Rare and Hereditary Kidney Disease, Cologne, University Hospital of Cologne, Cologne, Germany
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Institut Imagine, Université Paris Cité, Hôpital Necker - Enfants Malades, Paris, France
| | - Rimante Cerkauskiene
- Clinic of Paediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Pietro Manuel Ferraro
- Chronic Kidney Disease Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luitzen A Groen
- Department of Pediatric Urology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Asheeta Gupta
- Department of Nephrology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Bertrand Knebelmann
- Faculté de Santé, UFR de Médecine, AP-HP Centre-Universite de Paris, Departement Néphrologie, Dialyse, Transplantation Adultes, Paris, France
| | - Giorgia Mandrile
- Medical Genetics Unit and Thalassemia Center, San Luigi University Hospital, University of Torino, Orbassano, Italy
| | | | - Agnieszka Prytula
- Department of Paediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Jovana Putnik
- Department of Pediatric Nephrology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gill Rumsby
- Kintbury, UK, formerly Department of Clinical Biochemistry, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neveen A Soliman
- Center of Pediatric Nephrology & Transplantation, Kasr Al Ainy Medical School, Cairo University, Cairo, Egypt
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Justine Bacchetta
- Reference Center for Rare Renal Diseases, Pediatric Nephrology-Rheumatology-Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, INSERM 1033 Unit, Lyon 1 University, Bron, France
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30
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Dorval G, Boyer O. [Pediatric nephrology]. Med Sci (Paris) 2023; 39:205. [PMID: 36943115 DOI: 10.1051/medsci/2023026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Guillaume Dorval
- Université Paris Cité, Institut Imagine laboratoire des maladies rénales héréditaires Inserm UMR1163, Paris, France - Service de génétique moléculaire AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Olivia Boyer
- Service de génétique moléculaire AP-HP, Hôpital Necker-Enfants Malades, Paris, France - Service de néphrologie pédiatrique AP-HP, Centre de référence de maladies rénales rares de l'enfant et de l'adulte (MARHEA) hôpital Necker - Enfants Malades, Paris, France
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31
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Dirix M, Gribouval O, Arrondel C, Benjelloun S, Boyer O, Charbit M, Antignac C, Heidet L, Dorval G. Overcoming the challenges associated with identification of deep intronic variants by whole genome sequencing. Clin Genet 2023; 103:693-698. [PMID: 36705481 DOI: 10.1111/cge.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023]
Abstract
Whole-genome sequencing (WGS) now allows identification of multiple variants in non-coding regions. The large number of variants identified by WGS however complicates their interpretation. Through identification of the first deep intronic variant in NPHS2, which encodes podocin, a protein implicated in autosomal recessive steroid resistant nephrotic syndrome (SRNS), we compare herein three different tools including a newly developed targeted NGS-based RNA-sequencing to explore the splicing effect of intronic variations. WGS identified two different variants in NPHS2 eventually involved in the disease. Through RT-PCR, exon-trapping Minigene assay and targeted RNA sequencing, we were able to identify the splicing defect in NPHS2 mRNA from patient kidney tissue. Only targeted RNA-seq simultaneously analyzed the effect of multiple variants and offered the opportunity to quantify consequences on splicing. Identifying deep intronic variants and their role in disease is of utmost importance. Alternative splicing can be predicted by in silico tools but always requires confirmation through functional testing with RNA analysis from the implicated tissue remaining the gold standard. When several variants with potential effects on splicing are identified by WGS, a targeted RNA sequencing panel could be of great value.
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Affiliation(s)
- Marie Dirix
- INSERM U1163, Laboratoire des Maladies Rénales Héréditaires, Institut Imagine, Université Paris-Cité, France
| | - Olivier Gribouval
- INSERM U1163, Laboratoire des Maladies Rénales Héréditaires, Institut Imagine, Université Paris-Cité, France
| | - Christelle Arrondel
- INSERM U1163, Laboratoire des Maladies Rénales Héréditaires, Institut Imagine, Université Paris-Cité, France
| | | | - Olivia Boyer
- INSERM U1163, Laboratoire des Maladies Rénales Héréditaires, Institut Imagine, Université Paris-Cité, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte MARHEA, Hôpital Necker-Enfants Malades, Paris, France
| | - Marina Charbit
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte MARHEA, Hôpital Necker-Enfants Malades, Paris, France
| | - Corinne Antignac
- INSERM U1163, Laboratoire des Maladies Rénales Héréditaires, Institut Imagine, Université Paris-Cité, France.,Service de Médecine Génomique des Maladies Rares, APHP, Université Paris-Cité, France
| | - Laurence Heidet
- INSERM U1163, Laboratoire des Maladies Rénales Héréditaires, Institut Imagine, Université Paris-Cité, France.,Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte MARHEA, Hôpital Necker-Enfants Malades, Paris, France
| | - Guillaume Dorval
- INSERM U1163, Laboratoire des Maladies Rénales Héréditaires, Institut Imagine, Université Paris-Cité, France.,Service de Médecine Génomique des Maladies Rares, APHP, Université Paris-Cité, France
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32
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Bernardi S, Seugé L, Boyer O. ANCA-associated vasculitis in children. Nephrol Dial Transplant 2023; 38:66-69. [PMID: 36166356 DOI: 10.1093/ndt/gfac265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Silvia Bernardi
- School of Nephrology, Università degli Studi di Milano, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laure Seugé
- Néphrologie pédiatrique, centre de référence MARHEA, Hôpital Necker - Enfants Malades, APHP, Inserm U1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Olivia Boyer
- Néphrologie pédiatrique, centre de référence MARHEA, Hôpital Necker - Enfants Malades, APHP, Inserm U1163, Institut Imagine, Université Paris Cité, Paris, France
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33
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Sobrino S, Abdo C, Neven B, Denis A, Gouge-Biebuyck N, Clave E, Charbonnier S, Blein T, Kergaravat C, Alcantara M, Villarese P, Berthaud R, Dehoux L, Albinni S, Karkeni E, Lagresle-Peyrou C, Cavazzana M, Salomon R, André I, Toubert A, Asnafi V, Picard C, Blanche S, Macintyre E, Boyer O, Six E, Zuber J. Human kidney-derived hematopoietic stem cells can support long-term multilineage hematopoiesis. Kidney Int 2023; 103:70-76. [PMID: 36108807 DOI: 10.1016/j.kint.2022.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 04/28/2022] [Revised: 07/23/2022] [Accepted: 08/12/2022] [Indexed: 01/10/2023]
Abstract
Long-term multilineage hematopoietic donor chimerism occurs sporadically in patients who receive a transplanted solid organ enriched in lymphoid tissues such as the intestine or liver. There is currently no evidence for the presence of kidney-resident hematopoietic stem cells in any mammal species. Graft-versus-host-reactive donor T cells promote engraftment of graft-derived hematopoietic stem cells by making space in the bone marrow. Here, we report full (over 99%) multilineage, donor-derived hematopoietic chimerism in a pediatric kidney transplant recipient with syndromic combined immune deficiency that leads to transplant tolerance. Interestingly, we found that the human kidney-derived hematopoietic stem cells took up long-term residence in the recipient's bone marrow and gradually replaced their host counterparts, leading to blood type conversion and full donor chimerism of both lymphoid and myeloid lineages. Thus, our findings highlight the existence of human kidney-derived hematopoietic stem cells with a self-renewal ability able to support multilineage hematopoiesis.
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Affiliation(s)
- Steicy Sobrino
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France
| | - Chrystelle Abdo
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Bénédicte Neven
- Université Paris Cité, Paris, France; Service d'Immuno-Hématologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | | | - Nathalie Gouge-Biebuyck
- Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Emmanuel Clave
- INSERM UMR_S1160, Institut de Recherche Saint Louis, Paris, France
| | | | | | | | - Marion Alcantara
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Patrick Villarese
- Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Romain Berthaud
- Université Paris Cité, Paris, France; Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Laurène Dehoux
- Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Souha Albinni
- Etablissement Français du Sang Ile-de-France, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Esma Karkeni
- Cytometry and Biomarkers UTechS, Center for Translational Science, Institut Pasteur, Paris, France
| | | | - Marina Cavazzana
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France
| | - Rémi Salomon
- Université Paris Cité, Paris, France; Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | | | - Antoine Toubert
- Université Paris Cité, Paris, France; INSERM UMR_S1160, Institut de Recherche Saint Louis, Paris, France
| | - Vahid Asnafi
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Capucine Picard
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France; CEDI, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Stéphane Blanche
- Université Paris Cité, Paris, France; Service d'Immuno-Hématologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Elizabeth Macintyre
- Université Paris Cité, Paris, France; Laboratoire d'Onco-Hématologie, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Olivia Boyer
- Université Paris Cité, Paris, France; Service de Néphrologie Pédiatrique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France
| | | | - Julien Zuber
- INSERM UMR_S1163, Institut IMAGINE, Paris, France; Université Paris Cité, Paris, France; Service des Maladies du Rein et Métabolisme, Transplantation et Immunologie Clinique, Hôpital Necker, Assistance-Publique Hôpitaux de Paris, Paris, France.
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34
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Marlais M, Wlodkowski T, Printza N, Kronsteiner D, Krisam R, Sauer L, Aksenova M, Ashoor I, Awan A, Bacchetta J, Balasubramanian R, Basu B, Bekassy Z, Boyer O, Chan EYH, Csaicsich D, Decramer S, Dorresteijn E, Drozynska-Duklas M, Eid LA, Espinosa L, Ferraris V, Flögelová H, Forero-Delgadillo J, Gianviti A, Gracchi V, González ML, Hansen M, Hattori M, Hong X, Hooman N, Ivanov D, Kang HG, Karava V, Kazyra I, Lungu A, Marks S, Maxted A, Moczulska A, Müller R, Nastausheva T, Parolin M, Pecoraro C, Principi I, Sanchez-Kazi C, Saygili S, Schild R, Shenoy M, Sinha R, Spizzirri AP, Stack M, Szczepanska M, Tsygin A, Tzeng J, Urbonas V, Zapata C, Zieg J, Schaefer F, Vivarelli M, Tullus K. Clinical Factors and Adverse Kidney Outcomes in Children With Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Am J Kidney Dis 2023; 81:119-122. [PMID: 35810826 DOI: 10.1053/j.ajkd.2022.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/18/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Tanja Wlodkowski
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nikoleta Printza
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Regina Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Lukas Sauer
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Marina Aksenova
- Y. Veltischev Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Isa Ashoor
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Atif Awan
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Biswanath Basu
- Department of Pediatrics, N. R. S. Medical College & Hospital, Kolkata, India
| | | | - Olivia Boyer
- Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Paris University, Necker Hospital, APHP, Paris, France
| | | | - Dagmar Csaicsich
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria
| | - Stéphane Decramer
- Pediatric Nephrology and Internal Medicine, CHU Purpan, Toulouse, France
| | | | | | - Loai Akram Eid
- Pediatric Nephrology, Dubai Medical College & Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Laura Espinosa
- Paediatric Nephrology Department, University Hospital La Paz, Madrid, Spain
| | | | - Hana Flögelová
- Department of Paediatrics, Faculty of Medicine, Palacky University, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | | | | | - Valentina Gracchi
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Beatrix Children's Hospital, Groningen, The Netherlands
| | | | - Matthias Hansen
- KfH Kidney Center for Children and Adolescents, Frankfurt, Germany
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Xu Hong
- Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Nakysa Hooman
- Aliasghar Children's Hospital, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Dmytro Ivanov
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Vasiliki Karava
- Paediatric Nephrology, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ina Kazyra
- Belarus State Medical University, Minsk, Belarus
| | - Adrian Lungu
- Pediatric Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Stephen Marks
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Andrew Maxted
- Nottingham Children's Hospital Renal and Urology Unit, Nottingham, United Kingdom
| | - Anna Moczulska
- Jagiellonian University Medical College of Krakow, Krakow, Poland
| | - Rebekka Müller
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mattia Parolin
- Pediatric Nephrology, Dialysis and Transplantation Unit, Woman's and Child's Health Department, University Hospital of Padova, Padova, Italy
| | | | - Iliana Principi
- Department of Nephrology, Hospital Pediátrico Humberto J Notti, Mendoza, Argentina
| | | | - Seha Saygili
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Raphael Schild
- Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Ana Paula Spizzirri
- Nephrology Department, Hospital de Niños "Superiora Sor Maria Ludovica," La Plata, Argentina
| | - Maria Stack
- Children's Hospital Ireland at Temple Street, Dublin, Ireland
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Alexey Tsygin
- Department of Pediatrics, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland; National Medical Research Center for Children's Health, Moscow, Russia
| | - Julia Tzeng
- Valley Children's Healthcare, Madera, California
| | - Vaidotas Urbonas
- Vilnius University Clinic for Children's Diseases, Vilnius, Lithuania
| | - Carlos Zapata
- Hospital Infantil Universitario "Rafael Henao Toro," Manizales, Colombia
| | - Jakub Zieg
- Department of Paediatrics, Second Medical Faculty, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Kjell Tullus
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Trautmann A, Boyer O, Hodson E, Bagga A, Gipson DS, Samuel S, Wetzels J, Alhasan K, Banerjee S, Bhimma R, Bonilla-Felix M, Cano F, Christian M, Hahn D, Kang HG, Nakanishi K, Safouh H, Trachtman H, Xu H, Cook W, Vivarelli M, Haffner D. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2023; 38:877-919. [PMID: 36269406 PMCID: PMC9589698 DOI: 10.1007/s00467-022-05739-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/22/2022] [Indexed: 01/19/2023]
Abstract
Idiopathic nephrotic syndrome is the most frequent pediatric glomerular disease, affecting from 1.15 to 16.9 per 100,000 children per year globally. It is characterized by massive proteinuria, hypoalbuminemia, and/or concomitant edema. Approximately 85-90% of patients attain complete remission of proteinuria within 4-6 weeks of treatment with glucocorticoids, and therefore, have steroid-sensitive nephrotic syndrome (SSNS). Among those patients who are steroid sensitive, 70-80% will have at least one relapse during follow-up, and up to 50% of these patients will experience frequent relapses or become dependent on glucocorticoids to maintain remission. The dose and duration of steroid treatment to prolong time between relapses remains a subject of much debate, and patients continue to experience a high prevalence of steroid-related morbidity. Various steroid-sparing immunosuppressive drugs have been used in clinical practice; however, there is marked practice variation in the selection of these drugs and timing of their introduction during the course of the disease. Therefore, international evidence-based clinical practice recommendations (CPRs) are needed to guide clinical practice and reduce practice variation. The International Pediatric Nephrology Association (IPNA) convened a team of experts including pediatric nephrologists, an adult nephrologist, and a patient representative to develop comprehensive CPRs on the diagnosis and management of SSNS in children. After performing a systematic literature review on 12 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, recommendations were formulated and formally graded at several virtual consensus meetings. New definitions for treatment outcomes to help guide change of therapy and recommendations for important research questions are given.
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Affiliation(s)
- Agnes Trautmann
- grid.7700.00000 0001 2190 4373Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Olivia Boyer
- grid.50550.350000 0001 2175 4109Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Imagine Institute, Paris University, Necker Children’s Hospital, APHP, Paris, France
| | - Elisabeth Hodson
- grid.413973.b0000 0000 9690 854XCochrane Kidney and Transplant, Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - Arvind Bagga
- grid.413618.90000 0004 1767 6103Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Debbie S. Gipson
- grid.214458.e0000000086837370Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI USA
| | - Susan Samuel
- grid.22072.350000 0004 1936 7697Section of Pediatric Nephrology, Department of Pediatrics, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Jack Wetzels
- grid.10417.330000 0004 0444 9382Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Khalid Alhasan
- grid.56302.320000 0004 1773 5396Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sushmita Banerjee
- grid.414710.70000 0004 1801 0469Department of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Rajendra Bhimma
- grid.16463.360000 0001 0723 4123University of KwaZulu-Natal, Durban, South Africa
| | - Melvin Bonilla-Felix
- grid.267034.40000 0001 0153 191XDepartment of Pediatrics, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - Francisco Cano
- grid.443909.30000 0004 0385 4466Department of Pediatric Nephrology, Luis Calvo Mackenna Children’s Hospital, University of Chile, Santiago, Chile
| | - Martin Christian
- Children’s Kidney Unit, Nottingham Children’s Hospital, Nottingham, UK
| | - Deirdre Hahn
- grid.413973.b0000 0000 9690 854XDivision of Pediatric Nephrology, Department of Paediatrics, The Children’s Hospital at Westmead, Sydney, Australia
| | - Hee Gyung Kang
- grid.31501.360000 0004 0470 5905Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children’s Hospital & Seoul National University College of Medicine, Seoul, Korea
| | - Koichi Nakanishi
- grid.267625.20000 0001 0685 5104Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hesham Safouh
- grid.7776.10000 0004 0639 9286Pediatric Nephrology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Howard Trachtman
- grid.214458.e0000000086837370Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI USA
| | - Hong Xu
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, Shanghai, China
| | - Wendy Cook
- Nephrotic Syndrome Trust (NeST), Somerset, UK
| | - Marina Vivarelli
- grid.414125.70000 0001 0727 6809Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hannover and Center for Rare Diseases, Hannover Medical School, Hannover, Germany.
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Tanné C, Javouhey E, Boyer O, Recher M, Allain-Launay E, Monet-Didailler C, Rouset-Rouvière C, Ryckewaert A, Nobili F, Gindre FA, Rambaud J, Duncan A, Berthiller J, Bacchetta J, Sellier-Leclerc AL. Cardiac involvement in pediatric hemolytic uremic syndrome. Pediatr Nephrol 2022; 37:3215-3221. [PMID: 35286451 DOI: 10.1007/s00467-022-05427-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cardiac involvement is a known but rare complication of pediatric hemolytic uremic syndrome (HUS). We conducted a nationwide observational, retrospective case-control study describing factors associated with the occurrence of myocarditis among HUS patients. METHODS Cases were defined as hospitalized children affected by any form of HUS with co-existent myocarditis in 8 French Pediatric Intensive Care Units (PICU) between January 2007 and December 2018. Control subjects were children, consecutively admitted with any form of HUS without coexistent myocarditis, at a single PICU in Lyon, France, during the same time period. RESULTS A total of 20 cases of myocarditis were reported among 8 PICUs, with a mean age of 34.3 ± 31.9 months; 66 controls were identified. There were no differences between the two groups concerning the season and the typical, Shiga toxin-producing Escherichia coli (STEC-HUS), or atypical HUS (aHUS). Maximal leukocyte count was higher in the myocarditis group (29.1 ± 16.3G/L versus 21.0 ± 9.9G/L, p = 0.04). The median time between admission and first cardiac symptoms was of 3 days (range 0-19 days), and 4 patients displayed myocarditis at admission. The fatality rate in the myocarditis group was higher than in the control group (40.0% versus 1.5%, p < 0.001). Thirteen (65%) children from the myocarditis group received platelet transfusion compared to 19 (29%) in the control group (p = 0.03). CONCLUSION Our study confirms that myocarditis is potentially lethal and identifies higher leukocyte count and platelet transfusion as possible risk factors of myocarditis. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Corentin Tanné
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France.,Service de Pédiatrie Et Néonatalogie, Hôpitaux du Pays du Mont Blanc, Sallanches, France
| | - Etienne Javouhey
- Pediatric Intensive Care Unit, Hôpital Femme Mère Enfants, Hospices Civils of Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, Centres de Référence MARHEA Et MAT, Hôpital Necker-Enfants Maladies, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut IMAGINE, INSERM U1163, Université de Paris, Paris, France
| | - Morgan Recher
- CHU Lille, Department of Paediatric Intensive Care Unit, Jeanne de Flandre Hospital, 59000, Lille, France
| | | | - Catherine Monet-Didailler
- Service de Pédiatrie, Unité de Néphrologie Pédiatrique, CHU de Bordeaux, France.,Service de Pédiatrie, Centre Hospitalier de La Côte Basque, Bayonne, France
| | | | | | | | | | - Jérôme Rambaud
- Service de Réanimation Pédiatrique Et Néonatal, Hôpital Armand-Trousseau, assistance publique des Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Anita Duncan
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France
| | - Julien Berthiller
- Service d'Epidémiologie Et de Recherche Clinique. Pôle de Santé Publique Des Hospices Civils de Lyon, Lyon, France
| | - Justine Bacchetta
- Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France.,Université de Lyon, Lyon, France
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Abstract
Hemolytic uremic syndrome is characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney failure. Most cases are caused by Shiga-toxin-producing bacteria, especially Escherichia coli. Transmission occurs through ground beef and unpasteurized milk. STEC-HUS is the main cause of acute renal failure in children. Management remains supportive. Immediate outcome is most often. Atypical HUS represents about 5% of cases, has a relapsing course with more than half of the patients progressing to end-stage kidney failure. Most cases are due to variants in complement regulators of the alternative pathway. Complement inhibitors, such as eculizumab, have considerably improved the prognosis.
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Affiliation(s)
- Olivia Boyer
- Pediatric Nephrology, Necker Enfants Malades Hospital, Université Paris Cité, France; Néphrologie Pédiatrique, Hôpital Necker, 149 Rue de Sèvres, Paris 75015, France
| | - Patrick Niaudet
- Pediatric Nephrology, Necker Enfants Malades Hospital, Université Paris Cité, France.
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38
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Boyer O, Trautmann A, Haffner D, Vivarelli M. Steroid-sensitive nephrotic syndrome in children. Nephrol Dial Transplant 2022; 38:1123-1126. [PMID: 36455815 DOI: 10.1093/ndt/gfac314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence du syndrome néphrotique idiopathique de l'enfant et de l'adulte, Hôpital Necker - Enfants Malades, APHP.Centre, Inserm U1163, Institut Imagine, Université Paris Cité , Paris , France
| | - Agnes Trautmann
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg , Heidelberg , Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hannover and Center for Rare Diseases, Hannover Medical School , Hannover , Germany
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS , Rome , Italy
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Burballa C, Cantero-Recasens G, Prikhodina L, Lugani F, Schlingmann K, Ananin PV, Besouw M, Bockenhauer D, Madariaga L, Bertholet-Thomas A, Taroni F, Parolin M, Conlon P, Delprete D, Chauveau D, Koster-Kamphuis L, Fila M, Pasini A, Castro I, Colussi G, Gil M, Mohidin B, Wlodkowski T, Schaefer F, Ariceta G, Bacchetta J, Paglialonga F, Murer L, Andersone I, Sayer JA, Boyer O, Levart TK, Rus R, Paripović D, Gonzalez ER, Nieto F, Zieg J, Caballero JÁ, Vara J, Keijzer-Veen M, Ferraro PM, Gonzalez R, Rotaeche RMS, Fenoglio R, Ballesteros SS, Lobo ST, Ghuysen MS, Ordóñez Álvarez FA, Vandyck M, Rosenberg M, Thorsteinsdottir H, Tasic V, Bayram MT, Mir S, Costea GC, Yildiz N, Lumbreras J, Yel S, Cerkauskiene R, La Manna A, Elhassan E, Ciurli F, Meseguer A, Duran M. Clinical and genetic characteristics of Dent's Disease type 1 in Europe. Nephrol Dial Transplant 2022; 38:1497-1507. [DOI: 10.1093/ndt/gfac310] [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: 07/30/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Background
Dent's disease type 1 (DD1) is a rare X-linked nephropathy caused by CLCN5 mutations, characterized by proximal tubule dysfunction, including low-molecular-weight proteinuria (LMWP), hypercalciuria, nephrolithiasis-nephrocalcinosis, progressive chronic kidney disease (CKD) and kidney failure (KF). Current management is symptomatic and does not prevent disease progression. Here we describe the contemporary DD1 picture across Europe to highlight its unmet needs.
Methods
A physician-based anonymous international e-survey supported by several European Nephrology Networks/Societies was conducted. Questions focused on DD1 clinical features, diagnostic procedure and mutation spectrum.
Results
Two-hundred seven DD1 male patients were reported, being clinical data available for 163 with confirmed CLCN5 mutations. Proteinuria was the most common leading manifestation (49.1%). During follow-up, all patients showed LMWP, 66.4% nephrocalcinosis, 44.4% hypercalciuria and 26.4% nephrolithiasis. After 5.5 years, ∼50% of patients presented renal dysfunction, 20.7% developed CKD ≥ 3, and 11.1% KF. At last visit, hypercalciuria was more frequent in pediatric patients than in adults (73.4% vs. 19.0%). Conversely, nephrolithiasis, nephrocalcinosis and renal dysfunction were more prominent in adults. Furthermore, CKD progressed with age. Despite no clear phenotype/genotype correlation was observed, decreased glomerular filtration rate was more frequent in subjects with CLCN5 mutations affecting the pore or CBS domains compared to those with early-stop mutations.
Conclusions
Results from this large DD1 cohort confirm previous findings and provide new insights regarding age and genotype impact on CKD progression. Our data strongly support that DD1 should be considered in male patients with CKD, nephrocalcinosis/hypercalciuria and non-nephrotic proteinuria and provide additional support for new research opportunities.
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Affiliation(s)
- Carla Burballa
- Vall d'Hebron University Hospital (HUVH) - Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
| | - Gerard Cantero-Recasens
- Vall d'Hebron University Hospital (HUVH) - Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
| | - Larisa Prikhodina
- Veltishev Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University , Moscow , Russia
| | | | | | - Petr V Ananin
- Scientific Centre of Children Health 2 , Moscow , Russia
| | | | - Detlef Bockenhauer
- UCL Division of Medicine and Great Ormond Street Hospital , London , United Kingdom
| | - Leire Madariaga
- Hospital Universitario Cruces, Biocruces-Bizkaia, UPV/EHU , Barakaldo , Spain
| | | | - Francesca Taroni
- Pediatric Nephrology Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Mattia Parolin
- Nefrologia Pediatrica, Dialisi e Trapianto, Università di Padova , Italy
| | | | | | | | - Linda Koster-Kamphuis
- Amalia Children's Hospital, Radboud University Medical Center , Nijmegen , the Netherlands
| | - Marc Fila
- Arnaud de Villeneuve , Montpellier , France
| | - Andrea Pasini
- Azienda Ospedaliero-Universitaria Santorsola-Malpighi Bologna , Italy
| | - Isabel Castro
- Complexo Hospitalario de Pontevedra , Pontevedra , Spain
| | | | - Marta Gil
- Hospital Universitario Santiago de Compostela , Santiago de Compostela , Spain
| | | | | | | | - Gema Ariceta
- Vall d'Hebron University Hospital (HUVH) - Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
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de Truchis C, Bouazza N, Foissac F, Charbit M, Dehoux L, Lui G, Ribot M, Briand N, Zheng Y, Tréluyer JM, Boyer O. Prednisolone pharmacokinetics after oral prednisone administration in paediatric patients with kidney transplant. Br J Clin Pharmacol 2022; 89:1532-1540. [PMID: 36510685 DOI: 10.1111/bcp.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Glucocorticoids are 1 of the primary treatments in paediatric kidney transplantation. The aims of this study were: (i) to build a population pharmacokinetics (PPK) model of free prednisolone, which is the active form of prednisone, in paediatric kidney transplant recipients; (ii) to identify covariates accounting for interindividual variability (IIV) of pharmacokinetics (PK) parameters; and (iii) to investigate drug exposure-safety relationships. METHODS Ninety-seven samples were obtained from 39 paediatric kidney transplant recipients (aged 3.4-17.2 years) in order to investigate prednisone PPK. We selected children receiving oral prednisone as part of their immunosuppressive regimen. A PPK analysis was performed using Monolix. RESULTS A 1-compartment model best described prednisolone concentrations. Large IIV was observed as prednisolone was undetectable at H12 in some patients but could still be detected at H24 in others. Both bodyweight and ciclosporin cotreatment influenced the PK. The clearance (CLU ) and volume of distribution of free prednisolone allometrically scaled to 70 kg were 27.6 L/h and 101 L. Ciclosporin cotreatment decreased CLU by 67%. High blood pressure and new onset diabetes after transplantation were associated with daily free prednisolone exposure. CONCLUSION This study is the first analysis of prednisolone PPK in kidney-transplanted children. Some of the IIV in the PK parameters was explained by bodyweight and ciclosporin cotreatment. These data suggest that dose adjustment is required after identifying variability factors to optimize efficacy and limit side effects. The use of therapeutic drug monitoring in kidney-transplanted children may be useful, especially with respect to safety issues.
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Affiliation(s)
- Camille de Truchis
- Service de Néphrologie Pédiatrique, CRMR MARHEA, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Naïm Bouazza
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France.,Unité de Recherche Clinique, Université de Paris Necker/Cochin, Hôpital Tarnier, Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Frantz Foissac
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France.,Unité de Recherche Clinique, Université de Paris Necker/Cochin, Hôpital Tarnier, Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France
| | - Marina Charbit
- Service de Néphrologie Pédiatrique, CRMR MARHEA, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Laurène Dehoux
- Service de Néphrologie Pédiatrique, CRMR MARHEA, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gabrielle Lui
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Mégane Ribot
- Unité de Recherche Clinique, Université de Paris Necker/Cochin, Hôpital Tarnier, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Nelly Briand
- Unité de Recherche Clinique, Université de Paris Necker/Cochin, Hôpital Tarnier, Paris, France
| | - Yi Zheng
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Jean-Marc Tréluyer
- EA 7323, Université Paris Cité, Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Paris, France.,Unité de Recherche Clinique, Université de Paris Necker/Cochin, Hôpital Tarnier, Paris, France.,CIC-1419 Inserm, Cochin-Necker, Paris, France.,Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Groupe Hospitalier Paris Centre, Paris, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, CRMR MARHEA, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Unité INSERM U1163, Institut Imagine, Paris, France
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Pardinhas C, Filipe R, Vergnaud P, Grapin M, Ferrière E, Jamet A, Fourgeaud J, Da Rocha N, Pérot P, Boyer O, Rabant M, Van Huyen JPD, Isnard P. Renal arcuate vein thrombosis-induced acute kidney injury: a rare multiple-Hit-mediated disease. Clin Kidney J 2022; 16:367-373. [PMID: 36755840 PMCID: PMC9900575 DOI: 10.1093/ckj/sfac244] [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: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Renal arcuate vein thrombosis (RAVT) is a rare and recently recognized cause of acute kidney injury (AKI) in young adults. However, the precise incidence and underlying pathophysiologic mechanisms leading to AKI in these patients remain elusive. Methods This study included all patients who underwent a kidney biopsy over a 40-month period sent to the pathology department of Necker-Enfants Malades Hospital, with evidence of RAVT. We performed coagulation tests, genetic testing for thrombophilia, complete urine toxicologic screening and kidney metagenomic sequencing to identify an underlying cause of thrombosis. Results We report five pediatric cases of RAVT discovered on kidney biopsy performed in the setting of unexplained AKI. Investigations did not reveal an underlying cause of thrombosis but only a significant nonsteroidal anti-inflammatory drugs (NSAIDs) use was reported in 4/5 patients, supporting a potential link between NSAIDs use and RAVT. By performing metagenomic sequencing on kidney biopsy samples, we detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the kidney of one patient. These results suggest that systemic SARS-CoV-2 infection may also be a key contributing factor of renal thrombosis, particularly by inducing potential endothelial disruption. Conclusions In conclusion, RAVT-induced AKI appears to be a multiple hit-mediated disease in which NSAIDs consumption and viral infection such as SARS-CoV-2 may be crucial contributing factors. These findings may have significant public health implications given the prevalence of NSAIDs use in the general population. Increased awareness and additional study of future cases may lead to a better understanding of this rare cause of AKI in children and young adults.
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Affiliation(s)
| | | | - Paul Vergnaud
- Department of Pediatric Nephrology, CRMR MARHEA, Institut Imagine, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Mathilde Grapin
- Department of Pediatric Nephrology, CRMR MARHEA, Institut Imagine, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Elsa Ferrière
- Department of Nephrology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Anne Jamet
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, AP-HP, Paris Cité University, Paris, France
| | - Jacques Fourgeaud
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, AP-HP, Paris Cité University, Paris, France
| | - Nicolas Da Rocha
- Pasteur Institut, Paris Cité University, Pathogen Discovery Laboratory, Paris, France
| | - Philippe Pérot
- Pasteur Institut, Paris Cité University, The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, CRMR MARHEA, Institut Imagine, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France
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Berthaud R, Heidet L, Oualha M, Brat R, Talmud D, Garaix F, Rabant M, Frémeaux-Bacchi V, Antignac C, Boyer O, Dorval G. Atypical severe early-onset nephrotic syndrome: Questions. Pediatr Nephrol 2022; 37:2635-2636. [PMID: 35507145 DOI: 10.1007/s00467-022-05521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Romain Berthaud
- APHP, Service de Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France.
| | - Laurence Heidet
- APHP, Service de Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
| | - Mehdi Oualha
- APHP, Service de Réanimation, Surveillance Continue Médico-Chirurgicales Et SMUR Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Roselyne Brat
- Service de Réanimation Et Médecine Néonatales, Centre Hospitalier Régional d'Orléans, 45000, Orléans, France
| | - Déborah Talmud
- Département de Pédiatrie, Centre Hospitalier Régional d'Orléans, 45000, Orléans, France
| | - Florentine Garaix
- Service de Pédiatrie Multidisciplinaire, Hôpital de La Timone, Marseille, France
| | - Marion Rabant
- APHP, Service d'Anatomie Pathologique, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | | | - Corinne Antignac
- APHP, Service de Génétique Moléculaire, Institut Imagine, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
| | - Olivia Boyer
- APHP, Service de Néphrologie Pédiatrique, Institut Imagine, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
| | - Guillaume Dorval
- APHP, Service de Génétique Moléculaire, Institut Imagine, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
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Berthaud R, Heidet L, Oualha M, Brat R, Talmud D, Garaix F, Rabant M, Frémeaux-Bacchi V, Antignac C, Boyer O, Dorval G. Atypical severe early-onset nephrotic syndrome: Answers. Pediatr Nephrol 2022; 37:2637-2642. [PMID: 35507148 DOI: 10.1007/s00467-022-05537-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Romain Berthaud
- APHP, Service de Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France.
| | - Laurence Heidet
- APHP, Service de Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Mehdi Oualha
- APHP, Service de Réanimation, Surveillance Continue Médico-Chirurgicales Et SMUR Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Roselyne Brat
- Service de Réanimation Et Médecine Néonatales, Centre Hospitalier Régional d'Orléans, 45000, Orléans, France
| | - Déborah Talmud
- Département de Pédiatrie, Centre Hospitalier Régional d'Orléans, 45000, Orléans, France
| | - Florentine Garaix
- Service de Pédiatrie Multidisciplinaire, Hôpital de La Timone, Marseille, France
| | - Marion Rabant
- APHP, Service d'Anatomie Pathologique, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | | | - Corinne Antignac
- APHP, Service de Génétique Moléculaire, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Institut Imagine, Université Paris Cité, 75015, Paris, France
| | - Olivia Boyer
- APHP, Service de Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Institut Imagine, Université Paris Cité, 75015, Paris, France
| | - Guillaume Dorval
- APHP, Service de Génétique Moléculaire, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Institut Imagine, Université Paris Cité, 75015, Paris, France
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Boyer O, Manso-Silván MA, Joukoff S, Berthaud R, Guittet C. Improved growth of a child with primary distal renal tubular acidosis after switching from a conventional alkalizing treatment to a new prolonged-release formulation containing potassium citrate and potassium bicarbonate: lessons for the clinical nephrologist. J Nephrol 2022; 35:2119-2122. [PMID: 35357683 PMCID: PMC9584875 DOI: 10.1007/s40620-022-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/05/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Olivia Boyer
- Néphrologie Pédiatrique, Centre de référence MARHEA, AP-HP, Hôpital Necker-Enfants Malades, INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France.
| | | | | | - Romain Berthaud
- Néphrologie Pédiatrique, Centre de référence MARHEA, AP-HP, Hôpital Necker-Enfants Malades, INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France
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Dello Strologo L, Spada M, Vici CD, Atti MCD, Rheault M, Bjerre AK, Boyer O, Calvo PL, D'Antiga L, Harshman LA, Hörster F, Kölker S, Jahnukainen T, Knops N, Krug P, Krupka K, Lee A, Levtchenko E, Marks SD, Stojanovic J, Martelli L, Mazariegos G, Montini G, Shenoy M, Sidhu S, Spada M, Tangeras T, Testa S, Vijay S, Wac K, Wennberg L, Concepcion W, Garbade SF, Tönshoff B. Renal outcome and plasma methylmalonic acid levels after isolated or combined liver or kidney transplantation in patients with methylmalonic acidemia: A multicenter analysis. Mol Genet Metab 2022; 137:265-272. [PMID: 36240580 DOI: 10.1016/j.ymgme.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Methylmalonic acidemia (MMAemia) is characterized by accumulation of methylmalonic acid (MMA) in all body tissues. To minimize disease-related complications, isolated kidney (KTx), liver (LTx) or combined liver-kidney transplantation (LKTx) have been suggested. However, the impact of these different transplant strategies on outcome are unclear. METHODS In this multicenter retrospective observational study, we compared plasma MMA levels and estimated glomerular filtration rate (eGFR) data of 83 patients. Sixty-eight patients (82%) had a mut0-type MMAemia, one patient had a mut--type MMAemia, and seven (7.3%) had an inherited defect in cobalamin metabolism (cblA- or cblB-type MMAemia). Median observation period was 3.7 years (0-15.1 years). RESULTS Twenty-six (31%) patients underwent KTx, 24 (29%) LTx and 33 (40%) LKTx. Posttransplant, mean plasma MMA concentration significantly decreased in all three cohorts; but at month 12, plasma MMA in KTx (1372 ± 1101 μmol/L) was 7.8-fold higher than in LTx (176 ± 103 μmol/L; P < 0.001) and 6.4-fold higher than in LKTx (215 ± 110 μmol/L; P < 0.001). Comparable data were observed at month 24. At time of transplantation, mean eGFR in KTx was 18.1 ± 24.3 mL/min/1.73 m2, in LTx 99.8 ± 29.9 mL/min/1.73 m2, and in LKTx 31.5 ± 21.2 mL/min/1.73 m2. At month 12 posttransplant, mean eGFR in KTx (62.3 ± 30.3 mL/min/1.73 m2) was 33.4% lower than in LTx (93.5 ± 18.3 mL/min/1.73 m2; P = 0.0053) and 25.4% lower than in LKTx (83.5 ± 26.9 mL/min/1.73 m2; P = 0.0403). CONCLUSIONS In patients with isolated MMAemia, LTx and LKTx lead to markedly lower plasma MMA levels during the first 2 years posttransplant than KTx and are associated with a better preservation of kidney function. LTx should therefore be part of the transplant strategy in MMAemia.
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Affiliation(s)
| | - Marco Spada
- Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | | | | | - Anna Kristina Bjerre
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Olivia Boyer
- Hopital Necker - Enfant Malades, MARHEA, Institut Imagine, Université Paris Cité, Paris, France
| | | | - Lorenzo D'Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Friederike Hörster
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Stefan Kölker
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital Helsinki, Finland
| | - Noël Knops
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & University of Leuven, Belgium
| | - Pauline Krug
- Hopital Necker - Enfant Malades, MARHEA, Institut Imagine, Université Paris Cité, Paris, France
| | - Kai Krupka
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Angela Lee
- Division of Transplantation, Stanford University School of Medicine, USA
| | - Elena Levtchenko
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & University of Leuven, Belgium
| | - Stephen D Marks
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Jelena Stojanovic
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Laura Martelli
- Paediatric Hepatology, Gastroenterology and Transplantation Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - George Mazariegos
- Pediatric Transplant Surgery, UPMC Children's Hospital of Pittsburgh, USA
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Mohan Shenoy
- Pediatric Nephrology, Royal Manchester Children's Hospital, UK
| | - Sangeet Sidhu
- Pediatric Nephrology, Royal Manchester Children's Hospital, UK
| | - Marco Spada
- Department of Pediatrics, University of Torino, Turin, Italy
| | - Trine Tangeras
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Sara Testa
- Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan, Italy
| | - Suresh Vijay
- Pediatrics, Birmingham Children's Hospital NHS Foundation Trust, UK
| | - Katarzyna Wac
- Division of Transplantation, Stanford University School of Medicine, USA
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital Stockholm, Sweden
| | - Waldo Concepcion
- Division of Transplantation, Stanford University School of Medicine, USA
| | - Sven F Garbade
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany.
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Innocenti S, Bernardi S, Prévot M, Saldmann A, Tusseau M, Belot A, Duong Van Huyen JP, Boyer O. Diagnostic dilemma in a 3-year-old girl with acute nephritic syndrome and hematologic abnormalities: Questions. Pediatr Nephrol 2022:10.1007/s00467-022-05733-9. [PMID: 36251072 DOI: 10.1007/s00467-022-05733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Samantha Innocenti
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France.
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy.
| | - Silvia Bernardi
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
- School of Nephrology, Università Degli Studi Di Milano, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maud Prévot
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
| | - Antonin Saldmann
- Immunology Department, Hopital Européen Georges Pompidou, APHP, Paris Cité University, Paris, France
| | - Maud Tusseau
- Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard, Lyon 1, Centre National de La Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology Department, Hôpital Femme Mère Enfant, CRMR RAISE, Hospices Civils de Lyon, Bron, France
- The International Center of Research in Infectiology, Lyon University, INSERM U1111, CNRS UMR 5308, ENS, UCBL, Lyon, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
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47
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Innocenti S, Bernardi S, Prévot M, Saldmann A, Tusseau M, Belot A, Duong Van Huyen JP, Boyer O. Diagnostic dilemma in a 3-year-old girl with acute nephritic syndrome and hematologic abnormalities: Answers. Pediatr Nephrol 2022:10.1007/s00467-022-05752-6. [PMID: 36251071 DOI: 10.1007/s00467-022-05752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Samantha Innocenti
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France.
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy.
| | - Silvia Bernardi
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
- School of Nephrology, Università Degli Studi Di Milano, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maud Prévot
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
| | - Antonin Saldmann
- Immunology Department, Hopital Européen Georges Pompidou, APHP, Cité University, Paris, Paris, France
| | - Maud Tusseau
- Centre International de Recherche en Infectiologie, UMR5308, Univ Lyon Université Claude Bernard Centre National de La Recherche Scientifique ENS de Lyon, Lyon 1, U1111, InsermLyon, France
| | - Alexandre Belot
- Pediatric Nephrology, Dermatology Department, Hôpital Femme Mère Enfant, CRMR RAISE, Hospices Civils de Lyon, Rheumatology Bron, France
- The International Center of Research in Infectiology, UMR 5308, Lyon University CNRSENS, UCBL, INSERM U1111, Lyon, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Cité University, Paris, Paris, France
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
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Chauvet S, Hauer JJ, Petitprez F, Rabant M, Martins PV, Baudouin V, Delmas Y, Jourde-Chiche N, Cez A, Ribes D, Cloarec S, Servais A, Zaidan M, Daugas E, Delahousse M, Wynckel A, Ryckewaert A, Sellier-Leclerc AL, Boyer O, Thervet E, Karras A, Smith RJH, Frémeaux-Bacchi V. Results from a nationwide retrospective cohort measure the impact of C3 and soluble C5b-9 levels on kidney outcomes in C3 glomerulopathy. Kidney Int 2022; 102:904-916. [PMID: 35752323 PMCID: PMC10588728 DOI: 10.1016/j.kint.2022.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/14/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
C3 glomerulopathy (C3G) is a rare complement-mediated disease. Specific treatments are not yet available and factors predictive of kidney survival such as age, kidney function and proteinuria are not specific to C3G. The prognostic value of biomarkers of complement activation, which are pathognomonic of the diseases, remains unknown. In a large cohort of 165 patients from the French National registry, we retrospectively assess the prognostic value of C3, soluble C5b-9 (sC5b-9), C3 nephritic factor, and rare disease-predicting variants in complement genes in predicting clinical outcome of patients. By multivariate analysis age (adult onset), reduced kidney function (defined by estimated glomerular filtration rate under 60ml/min) and presence of rare disease-predicting variants in complement genes predicted risk of progression to kidney failure. Moreover, by multivariate analysis, normal C3/high sC5b-9 levels or low C3/normal sC5b-9 levels remained independently associated with a worse kidney prognosis, with the relative risk 3.7- and 8-times higher, respectively. Subgroup analysis indicated that the complement biomarker profiles independently correlated to kidney prognosis in patients with adult but not pediatric onset. In this subgroup, we showed that profiles of biomarkers C3 and/or sC5b-9 correlated with intra glomerular inflammation and may explain kidney outcomes. In children, only the presence of rare disease-predicting variants correlated with kidney survival. Thus, in an adult population, we propose a three-point C3G prognostic score based on biomarker profiles at risk, estimated glomerular filtration rate at presentation and genetic findings, which may help stratify adult patients into subgroups that require close monitoring and more aggressive therapy.
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Affiliation(s)
- Sophie Chauvet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMRS1138, Centre de Recherche des Cordeliers, Team "Inflammation, Complement and cancer", Paris, France; Paris Cité University, Paris, France.
| | - Jill J Hauer
- Molecular Otolaryngology and Renal Research Laboratories, University of Iowa, Iowa City, Iowa, USA
| | - Florent Petitprez
- Programme Cartes d'Identités des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France
| | - Marion Rabant
- Department of Renal Pathology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Paula Vieira Martins
- Department of Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Baudouin
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Yahsou Delmas
- Department of Nephrology, CH Bordeaux, Bordeaux, France
| | | | - Alexandre Cez
- Department of Nephrology, Tenon Hospital, Assistance Publique-hopitaux de Paris, Paris, France
| | - David Ribes
- Department of Nephrology, CHU Toulouse, Toulouse, France
| | - Sylvie Cloarec
- Department of Pediatric Nephrology, CHU Tours, Tours, France
| | - Aude Servais
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Mohamad Zaidan
- Department of Nephrology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Eric Daugas
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Department of Nephrology, Paris, France
| | | | | | | | | | - Olivia Boyer
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Department of Pediatric Nephrology, Paris, France
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, University of Iowa, Iowa City, Iowa, USA
| | - Véronique Frémeaux-Bacchi
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Team "Inflammation, Complement and cancer", Paris, France; Department of Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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49
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Cébron C, Godron-Dubrasquet A, Aladjidi N, Roussey G, Boyer O, Avramescu M, Baudouin V, Terzic J, Allain-Launay E, Rieux-Laucat F, Decramer S, Simon T, Harambat J. Benign and malignant proliferation in idiopathic nephrotic syndrome: a French cohort study. Pediatr Nephrol 2022; 37:1837-1843. [PMID: 35006357 DOI: 10.1007/s00467-021-05386-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/03/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There seems to be a possible link between nephrotic syndrome (NS) and lymphoproliferative syndrome, but it remains poorly understood. METHODS This multicentric and retrospective study focuses on children, who developed idiopathic NS and malignant or benign proliferation between 2000 and 2021. RESULTS Eleven patients were included, with a median age of 4 years. Only one had a steroid-resistant nephrotic syndrome (SRNS). The maintenance therapy before the proliferation was in majority tacrolimus or mycophenolate mofetil (MMF), but three patients did not receive treatments. The proliferation was mainly a Hodgkin's lymphoma (45%) or a lymphoproliferative disease (36%), in a median time after the NS of two years. Viruses were found in seven cases (EBV in five cases and HHV-8 in two). CONCLUSION The association between proliferative syndrome and idiopathic NS may not be fortuitous, possibly with a common lymphocytic disturbance. Genetic analyses could improve the comprehension of these manifestations in the future. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Clara Cébron
- Department of Pediatric Internal Medicine, Rheumatology and Nephrology, Centre De Référence Des Maladies Rénales Rares du Sud-Ouest, SoRare, Toulouse University Hospital, Toulouse, France
- Pediatric Department, Grenoble University Hospital, Grenoble, France
| | - Astrid Godron-Dubrasquet
- Department of Pediatrics, Pediatric Nephrology Unit, Centre De Référence Des Maladies Rénales Rares du Sud-Ouest, SoRare, Bordeaux University Hospital, Bordeaux, France
| | - Nathalie Aladjidi
- Department of Pediatrics, Pediatric Oncology Hematology Unit, Bordeaux University Hospital, Bordeaux, France
| | | | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Imagine Institute, Paris University, Necker Hospital, APHP, Paris, France
| | - Marina Avramescu
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Imagine Institute, Paris University, Necker Hospital, APHP, Paris, France
| | - Veronique Baudouin
- Department of Pediatric Nephrology, Robert Debré Hospital, APHP, Paris, France
| | - Joelle Terzic
- Department of Pediatric Nephrology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Frédéric Rieux-Laucat
- Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM, UMR 1163, Université de Paris, Paris, France
| | - Stéphane Decramer
- Department of Pediatric Internal Medicine, Rheumatology and Nephrology, Centre De Référence Des Maladies Rénales Rares du Sud-Ouest, SoRare, Toulouse University Hospital, Toulouse, France
- Centre De Référence Des Maladies Rénales Rares du Sud-Ouest, SoRare, Membre du réseau européen ERKNet, Toulouse, France
- INSERM U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France
| | - Thomas Simon
- Department of Pediatric Internal Medicine, Rheumatology and Nephrology, Centre De Référence Des Maladies Rénales Rares du Sud-Ouest, SoRare, Toulouse University Hospital, Toulouse, France.
- Centre De Référence Des Maladies Rénales Rares du Sud-Ouest, SoRare, Membre du réseau européen ERKNet, Toulouse, France.
| | - Jérôme Harambat
- Department of Pediatrics, Pediatric Nephrology Unit, Centre De Référence Des Maladies Rénales Rares du Sud-Ouest, SoRare, Bordeaux University Hospital, Bordeaux, France
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50
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Drovandi S, Lugani F, Boyer O, La Porta E, Giordano P, Hummel A, Knebelmann B, Cornet J, Baujat G, Lipska-Ziętkiewicz BS, Ghiggeri GM, Caridi G, Angeletti A. Multicentric Carpotarsal Osteolysis Syndrome Associated Nephropathy: Novel Variants of MAFB Gene and Literature Review. J Clin Med 2022; 11:jcm11154423. [PMID: 35956038 PMCID: PMC9369440 DOI: 10.3390/jcm11154423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
Multicentric carpo-tarsal osteolysis (MCTO) is a rare osteolysis syndrome mainly involving carpal and tarsal bones usually presenting in early childhood. MCTO has autosomal dominant inheritance with heterozygous mutation in the MAFB gene. The skeletal disorder is often associated with chronic kidney disease. Data on clinical characterization and best treatment option of MCTO-associated nephropathy are scarce and mostly limited to case reports. With the aim to better define the phenotype and long-term outcomes of MCTO-associated nephropathy, we launched an online survey through the Workgroup for hereditary glomerulopathies of the European Rare Kidney Disease Network (ERKNet). Overall, we collected clinical and genetic data of 54 MCTO patients, of which 42 previously described and 12 new patients. We observed a high rate of kidney involvement (70%), early age of kidney disease onset, nephrotic-range proteinuria, and a kidney survival around of 40% at long-term follow-up. Our finding confirmed the heterogeneity of clinical manifestations and widen the spectrum of phenotypes resulting from MCTO-associated nephropathy. Furthermore, we report the first case of complete remission after treatment with cyclosporine A. We demonstrated that multidisciplinary care is essential for MCTO patients and early referral to nephrologists is therefore warranted to facilitate prompt treatment.
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Affiliation(s)
- Stefania Drovandi
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.D.); (E.L.P.); (P.G.); (G.M.G.)
| | - Francesca Lugani
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (F.L.); (G.C.)
| | - Olivia Boyer
- PHP, Service de Néphrologie Pédiatrique, Institut Imagine, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015 Paris, France; (O.B.); (A.H.)
| | - Edoardo La Porta
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.D.); (E.L.P.); (P.G.); (G.M.G.)
| | - Paolo Giordano
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.D.); (E.L.P.); (P.G.); (G.M.G.)
| | - Aurélie Hummel
- PHP, Service de Néphrologie Pédiatrique, Institut Imagine, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Université Paris Cité, 75015 Paris, France; (O.B.); (A.H.)
| | - Bertrand Knebelmann
- Nephrology Department, Reference Center for Inherited Kidney Diseases (MARHEA), APHP, Necker Hospital, Paris University, 75015 Paris, France; (B.K.); (J.C.)
| | - Joséphine Cornet
- Nephrology Department, Reference Center for Inherited Kidney Diseases (MARHEA), APHP, Necker Hospital, Paris University, 75015 Paris, France; (B.K.); (J.C.)
| | - Genevieve Baujat
- Reference Centre for Constitutional Bone Diseases, Laboratory of Osteochondrodysplasia, INSERM UMR 1163, Imagine Institute, Université de Paris, 75015 Paris, France;
| | - Beata S. Lipska-Ziętkiewicz
- Rare Diseases Centre, Medical University of Gdansk, 80-210 Gdansk, Poland;
- Department of Biology and Medical Genetics, Clinical Genetics Unit, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.D.); (E.L.P.); (P.G.); (G.M.G.)
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (F.L.); (G.C.)
| | - Gianluca Caridi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (F.L.); (G.C.)
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (S.D.); (E.L.P.); (P.G.); (G.M.G.)
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (F.L.); (G.C.)
- Correspondence:
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