1
|
Gosselink ME, Snoek R, Cerkauskaite-Kerpauskiene A, van Bakel SPJ, Vollenberg R, Groen H, Cerkauskiene R, Miglinas M, Attini R, Tory K, Claes KJ, van Calsteren K, Servais A, de Jong MFC, Gillion V, Vogt L, Mastrangelo A, Furlano M, Torra R, Bramham K, Wiles K, Ralston ER, Hall M, Liu L, Hladunewich MA, Lely AT, van Eerde AM. Reassuring pregnancy outcomes in women with mild COL4A3-5-related disease (Alport syndrome) and genetic type of disease can aid personalized counseling. Kidney Int 2024; 105:1088-1099. [PMID: 38382843 DOI: 10.1016/j.kint.2024.01.034] [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: 02/25/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Abstract
Individualized pre-pregnancy counseling and antenatal care for women with chronic kidney disease (CKD) require disease-specific data. Here, we investigated pregnancy outcomes and long-term kidney function in women with COL4A3-5 related disease (Alport Syndrome, (AS)) in a large multicenter cohort. The ALPART-network (mAternaL and fetal PregnAncy outcomes of women with AlpoRT syndrome), an international collaboration of 17 centers, retrospectively investigated COL4A3-5 related disease pregnancies after the 20th week. Outcomes were stratified per inheritance pattern (X-Linked AS (XLAS)), Autosomal Dominant AS (ADAS), or Autosomal Recessive AS (ARAS)). The influence of pregnancy on estimated glomerular filtration rate (eGFR)-slope was assessed in 192 pregnancies encompassing 116 women (121 with XLAS, 47 with ADAS, and 12 with ARAS). Median eGFR pre-pregnancy was over 90ml/min/1.73m2. Neonatal outcomes were favorable: 100% live births, median gestational age 39.0 weeks and mean birth weight 3135 grams. Gestational hypertension occurred during 23% of pregnancies (reference: 'general' CKD G1-G2 pregnancies incidence is 4-20%) and preeclampsia in 20%. The mean eGFR declined after pregnancy but remained within normal range (over 90ml/min/1.73m2). Pregnancy did not significantly affect eGFR-slope (pre-pregnancy β=-1.030, post-pregnancy β=-1.349). ARAS-pregnancies demonstrated less favorable outcomes (early preterm birth incidence 3/11 (27%)). ARAS was a significant independent predictor for lower birth weight and shorter duration of pregnancy, next to the classic predictors (pre-pregnancy kidney function, proteinuria, and chronic hypertension) though missing proteinuria values and the small ARAS-sample hindered analysis. This is the largest study to date on AS and pregnancy with reassuring results for mild AS, though inheritance patterns could be considered in counseling next to classic risk factors. Thus, our findings support personalized reproductive care and highlight the importance of investigating kidney disease-specific pregnancy outcomes.
Collapse
Affiliation(s)
- Margriet E Gosselink
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Rozemarijn Snoek
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Agne Cerkauskaite-Kerpauskiene
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sophie P J van Bakel
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Renee Vollenberg
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rimante Cerkauskiene
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Miglinas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rossella Attini
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy
| | - Kálmán Tory
- MTA-SE Lendulet Nephrogenetic Laboratory, Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Kathleen J Claes
- Department of Nephrology, University Hospital Leuven, Leuven, Belgium
| | - Kristel van Calsteren
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - Aude Servais
- Department of Nephrology and Transplantation, Necker Enfants Maladies University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Margriet F C de Jong
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Valentine Gillion
- Department of Nephrology, Cliniques Universitaires Saint-Luc (Université Catholique de Louvain), Brussels, Belgium
| | - Liffert Vogt
- Section Nephrology, Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Furlano
- Department of Nephrology, Inherited Kidney Diseases, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau Universitat Autònoma de Barcelona, RICORS2040 (Kidney Disease), Barcelona, Spain
| | - Roser Torra
- Department of Nephrology, Inherited Kidney Diseases, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau Universitat Autònoma de Barcelona, RICORS2040 (Kidney Disease), Barcelona, Spain
| | - Kate Bramham
- Department of Women and Children's Health, King's College London, London, UK
| | - Kate Wiles
- Department of Women and Children, Barts National Health Service Trust and Queen Mary University of London, London, UK
| | - Elizabeth R Ralston
- Department of Women and Children's Health, King's College London, London, UK
| | - Matthew Hall
- Department of Nephrology, Nottingham University Hospitals, Nottingham, UK
| | - Lisa Liu
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - A Titia Lely
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | |
Collapse
|
2
|
Savige J, Storey H, Watson E, Hertz JM, Deltas C, Renieri A, Mari F, Hilbert P, Plevova P, Byers P, Cerkauskaite A, Gregory M, Cerkauskiene R, Ljubanovic DG, Becherucci F, Errichiello C, Massella L, Aiello V, Lennon R, Hopkinson L, Koziell A, Lungu A, Rothe HM, Hoefele J, Zacchia M, Martic TN, Gupta A, van Eerde A, Gear S, Landini S, Palazzo V, Al-Rabadi L, Claes K, Corveleyn A, Van Hoof E, van Geel M, Williams M, Ashton E, Belge H, Ars E, Bierzynska A, Gangemi C, Lipska-Ziętkiewicz BS. Correction: Consensus statement on standards and guidelines for the molecular diagnostics of Alport syndrome: refining the ACMG criteria. Eur J Hum Genet 2024; 32:132. [PMID: 36721056 PMCID: PMC10772080 DOI: 10.1038/s41431-023-01288-x] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Judy Savige
- Department of Medicine (MH and NH), The University of Melbourne, Parkville, VIC, Australia.
| | - Helen Storey
- Molecular Genetics, Viapath Laboratories, Guy's Hospital, London, UK
| | - Elizabeth Watson
- Elizabeth Watson, South West Genomic Laboratory Hub, North Bristol Trust, Bristol, UK
| | - Jens Michael Hertz
- Jens Michael Hertz, Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Constantinos Deltas
- Center of Excellence in Biobanking and Biomedical Research and Molecule Medicine Center, University of Cyprus, Nicosia, Cyprus
| | | | - Francesca Mari
- Institute de Pathologie et de Genetique ASBL, Departement de Biologie Moleculaire, Gosselies, Belgium
| | - Pascale Hilbert
- Institute de Pathologie et de Genetique ASBL, Departement de Biologie Moleculaire, Gosselies, Belgium
| | - Pavlina Plevova
- Department of Medical Genetics, and Department of Biomedical Sciences, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Peter Byers
- Departments of Pathology and Medicine (Medical Genetics), University of Washington, Seattle, WA, USA
| | - Agne Cerkauskaite
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Martin Gregory
- Division of Nephrology, Department of Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Rimante Cerkauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Danica Galesic Ljubanovic
- Department of Pathology, University of Zagreb, School of Medicine, Dubrava University Hospital, Zagreb, Croatia
| | | | | | - Laura Massella
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Louise Hopkinson
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Ania Koziell
- School of Immunology and Microbial Sciences, Faculty of Life Sciences, King's College London, London, UK
| | - Adrian Lungu
- Fundeni Clinical Institute, Pediatric Nephrology Department, Bucharest, Romania
| | | | - Julia Hoefele
- Institute of Human Genetics, Technical University of Munich, München, Germany
| | | | | | | | - Albertien van Eerde
- Departments of Genetics and Center for Molecular Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - Samuela Landini
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Viviana Palazzo
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Laith Al-Rabadi
- Health Sciences Centre, University of UTAH, Salt Lake City, UT, USA
| | - Kathleen Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Anniek Corveleyn
- Center for Human Genetics, University Hospitals and KU Leuven, Leuven, Belgium
| | - Evelien Van Hoof
- Center for Human Genetics, University Hospitals and KU Leuven, Leuven, Belgium
| | - Micheel van Geel
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maggie Williams
- Bristol Genetics Laboratory Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Emma Ashton
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital, London, UK
| | - Hendica Belge
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisabeth Ars
- Inherited Kidney Disorders, Fundacio Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Concetta Gangemi
- Division of Nephrology and Dialysis, University Hospital of Verona, Verona, Italy
| | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Almeida LS, Pereira C, Aanicai R, Schröder S, Bochinski T, Kaune A, Urzi A, Spohr TCLS, Viceconte N, Oppermann S, Alasel M, Ebadat S, Iftikhar S, Jasinge E, Elsayed SM, Tomoum H, Marzouk I, Jalan AB, Cerkauskaite A, Cerkauskiene R, Tkemaladze T, Nadeem AM, El Din Mahmoud IG, Mossad FA, Kamel M, Selim LA, Cheema HA, Paknia O, Cozma C, Juaristi-Manrique C, Guatibonza-Moreno P, Böttcher T, Vogel F, Pinto-Basto J, Bertoli-Avella A, Bauer P. An integrated multiomic approach as an excellent tool for the diagnosis of metabolic diseases: our first 3720 patients. Eur J Hum Genet 2022; 30:1029-1035. [PMID: 35614200 PMCID: PMC9437014 DOI: 10.1038/s41431-022-01119-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Abstract
To present our experience using a multiomic approach, which integrates genetic and biochemical testing as a first-line diagnostic tool for patients with inherited metabolic disorders (IMDs). A cohort of 3720 patients from 62 countries was tested using a panel including 206 genes with single nucleotide and copy number variant (SNV/CNV) detection, followed by semi-automatic variant filtering and reflex biochemical testing (25 assays). In 1389 patients (37%), a genetic diagnosis was achieved. Within this cohort, the highest diagnostic yield was obtained for patients from Asia (57.5%, mainly from Pakistan). Overall, 701 pathogenic/likely pathogenic unique SNVs and 40 CNVs were identified. In 620 patients, the result of the biochemical tests guided variant classification and reporting. Top five diagnosed diseases were: Gaucher disease, Niemann-Pick disease type A/B, phenylketonuria, mucopolysaccharidosis type I, and Wilson disease. We show that integrated genetic and biochemical testing facilitated the decision on clinical relevance of the variants and led to a high diagnostic yield (37%), which is comparable to exome/genome sequencing. More importantly, up to 43% of these patients (n = 610) could benefit from medical treatments (e.g., enzyme replacement therapy). This multiomic approach constitutes a unique and highly effective tool for the genetic diagnosis of IMDs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Solaf M Elsayed
- Medical Genetics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hoda Tomoum
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Iman Marzouk
- Alexandria University Children Hospital, Alexandria, Egypt
| | - Anil B Jalan
- Navi Mumbai Institute of Research In Mental And Neurological Handicap (NIRMAN) / Pediatric Geneticist, Navi Mumbai, India
| | | | | | - Tinatin Tkemaladze
- Department of Molecular and Medical Genetics, Tbilisi State Medical University, Tbilisi, Georgia
| | - Anjum Muhammad Nadeem
- Pediatric Gastroenterology, Hepatology and Nutrition, the Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Iman Gamal El Din Mahmoud
- Cairo University Children Hospital (Abu El Reesh Children's Hospital), Metabolic, Neurology, Cairo, Egypt
| | - Fawzia Amer Mossad
- Cairo University Children Hospital (Abu El Reesh Children's Hospital), Metabolic, Neurology, Cairo, Egypt
| | - Mona Kamel
- Cairo University Children Hospital (Abu El Reesh Children's Hospital), Metabolic, Neurology, Cairo, Egypt
| | - Laila Abdel Selim
- Cairo University Children Hospital (Abu El Reesh Children's Hospital), Metabolic, Neurology, Cairo, Egypt
| | - Huma Arshad Cheema
- Pediatric Gastroenterology, Hepatology and Nutrition, the Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | | | | | | | | | | | | | | | | | - Peter Bauer
- CENTOGENE GmbH, 18055, Rostock, Germany.,Department of Oncology, University Medical Center Rostock, Rostock, Germany
| |
Collapse
|
6
|
Navickaite M, Janonytė K, Cerkauskiene R, Miglinas M, Cerkauskaite A. MO021: Alport syndrome manifestation in twins. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac062.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Alport syndrome (AS) is a hereditary renal disease characterized by progressive loss of kidney function and often accompanied by sensorineural hearing loss and ocular abnormalities [1]. The variety of symptoms and their severity is closely associated with mode of inheritance, type of mutation, as well as the sex of the patient [2]. In cases of twins with Alport syndrome, genotype–phenotype manifestation shows a large intrafamilial heterogeneity, although only few reports have been published. In this case series, we describe three different manifestations of three unrelated families with AS with twin pattern.
METHOD
Molecular analysis by next-generation sequencing was performed on individuals with suspected AS in Vilnius University Hospital Santaros Klinikos. Only patients with confirmed pathogenic AS variants and presence of the twin sibling were included in this study. Clinical, genetic, and laboratory data were reviewed and compared among the siblings and their family members.
RESULTS
Case 1: Two heterozygous twin sisters with two compound heterozygous pathogenic variants c.4702C > T and c.3247G > C in COL4A3 gene led to autosomal recessive AS. The first sister with a history of nephritis from a childhood reached kidney failure at the age of 33. Further investigations revealed mild bilateral sensorineural hearing loss and no ocular lesions. Her 33-year-old heterozygous twin sister had a similar past history consisting of hematuria since the age of 5 and preeclampsia during her first pregnancy at the age of 30. However, at the age of 33, this patient still had preserved kidney function with eGFR >45 mL/min/1.73 m3. She also suffered by mild bilateral hearing loss while no ocular abnormalities were found.
Case 2: Heterozygous pathogenic variant c.2623G > A in COL4A5 gene in female heterozygous twin and her relatives (her mother, son and granddaughter) led to X-linked AS while her twin brother was born healthy. The 51-year-old female’s medical history revealed hematuria since 7 years of age. Her kidney function gradually declined and the patient reached kidney failure at the age of 43 years. Family screening showed a history of kidney disease. Her mother developed hematuria and proteinuria at the age of 20 years and kidney failure at 60 years. The patient's son reached kidney failure at his 20s and he also had bilateral sensorineural hearing loss and typical ocular lesions. Her granddaughter has experienced persistent hematuria and proteinuria since 2 months old, but no extrarenal manifestations were discovered.
Case 3: Two heterozygous twin brothers with heterozygous pathogenic variant c.593G > T in COL4A3 gene led to autosomal dominant AS. A 53-year-old male has experienced persistent hematuria and proteinuria since the age of 26. At the age of 53, kidney biopsy was performed where FSGS, thin and split glomerular basement membrane were observed. Further examination showed mild bilateral sensorineural hearing loss and no ocular abnormalities. Family screening revealed that multiple family members had a history of kidney disease. Patient's 55-year-old twin brother experienced persistent hematuria since early adulthood; however, he did not show any signs of hearing loss or ocular abnormalities. Elder brother demonstrated hematuria as well. The patient's deceased father reached kidney failure at the age of 69; however, no hearing abnormalities were found.
CONCLUSION
Observing genotype–phenotype manifestations suggest that some pathogenic variants demonstrate intrafamilial phenotypic variability. Therefore, despite having identical mutations, twins can manifest AS differently.
Collapse
Affiliation(s)
| | | | - Rimante Cerkauskiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Marius Miglinas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Agne Cerkauskaite
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
7
|
Bartosova M, Zhang C, Herzog R, Bernardor J, Wetzel C, Marinovic I, Du Z, Damgov I, Schaefer B, Melk A, Klaus G, Cerkauskiene R, Arbeiter K, Peters V, Kratochwill K, Peter Schmitt C. MO465: Molecular Mechanisms of Vascular Ageing in Children With Chronic Kidney Disease. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac070.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Paediatric patients with chronic kidney disease (CKD) develop significant atherosclerosis and vascular calcifications until early adulthood. Largely devoid of confounding lifestyle related factors and underlying disease mostly limited to congenital abnormalities of the kidneys and urinary tract, these patients provide highly sensitive and specific information on early CKD-induced molecular mechanisms of vascular disease and on putative therapeutic targets.
METHOD
Standardized omental and parietal peritoneal tissue samples from 95 non-CKD individuals [median age 9.2 (interquartile range, IQR 15), 110 children with CKD5 (median age 8.6 (IQR 12)] underwent digital histomorphometry. Omental arterioles microdissected from surrounding fat tissue underwent whole-exome and proteome analyses, followed by gene set enrichment and Ingenuity pathway analysis. Vascular calcification pathway analysis was performed for 370 biological processes and molecular functions associated with vascular calcification extracted from Gene Ontology database. Key regulated pathways were validated by quantitative immunostaining. The effects of uraemic toxins on endothelial integrity were studied in vitro in human umbilical arterial and vein endothelial cells in Transwells.
RESULTS
Lumen to vessel diameter (L/V) ratio was reduced in patients with CKD5. Parietal peritoneal arteriole L/V ratio was 0.54 (0.2) versus 0.63 (0.1) in non-CKD controls, omental arteriole L/V ratio 0.58 (0.1) versus 0.76 (0.1) in controls (both P < 0.001), indicating significant CKD5 related vascular disease. These findings were independent of underlying disease entities and gender. The parietal peritoneal submesothelial space exhibited infiltration of single CD45 positive lymphocytes, mesothelial cells which had undergone epithelial-to-mesenchymal-transition, and isolated peritoneal fibrin deposits. Submesothelial TGF-ß induced pSMAD was 4-fold increased and IL-17A 2-fold, while VEGF was not different compared to non-CKD controls.
Gene set enrichment analysis of omental arteriolar multi-omics identified enrichment of pathways including telomere extension by telomerase, chromatin histone methylation, actin cytoskeleton, integrin- and tight junction signaling, and focal adhesion in children with CKD5 children compared to controls (P < 0.05). Vascular calcification pathway analysis identified 16/370 pathways significantly enriched on arteriolar transcriptome (P < 0.01), related to Wnt signalling, extracellular matrix organization, complement activation, autophagy and ossification. Applying the same threshold on proteome level, 10 calcification-related arteriolar pathways were identified and included DNA damage, fatty acid metabolism, calcium ion binding, extracellular matrix organization and complement activation.
In independent age-matched cohorts, CKD5 children had shorter endothelial telomere and less endothelial methylated histone 3. The endothelial complement system was activated and arteriolar actin cytoskeleton interacting proteins gamma actin and profilin-1 were reduced in CKD5, cofilin-1 remained unchanged. In vitro, methylglyoxal and 3.4-di-deoxyglucosone-3-ene reduced transendothelial resistance, increased endothelial monolayer permeability and induced cytoskeleton disassembly (zonula occludens-1 and F-actin). These effects were prevented by co-incubation with anserine, 3-methylhistidine and alanyl-glutamine, but not by carnosine, L-histidine, 1-methylhistidine and methyl-alanyl.
CONCLUSION
CKD5 results in major vascular ageing already in early childhood. Multi-omics analysis of omental arterioles identified specific mechanisms of CKD-induced vascular ageing and of vascular calcification. Endothelial cell barrier integrity is impaired, and in vitro reversed by specific dipeptides.
Collapse
Affiliation(s)
- Maria Bartosova
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Conghui Zhang
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rebecca Herzog
- Division of Paediatric Nephrology and Gastroenterology, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Medical University of Vienna, Department of Paediatrics and Adolescent Medicine, Vienna, Austria
| | - Julie Bernardor
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
- INSERM UMR S1033 Research Unit, Lyon, France
- Paediatric Nephrology Unit, CHU de Nice, Hôpital Archet, Nice, France
| | - Charlotte Wetzel
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Iva Marinovic
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Zhiwei Du
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Ivan Damgov
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Betti Schaefer
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover, Germany
| | - Guenter Klaus
- KfH Pediatric Kidney Centre, Department of Paediatric Nephrology, University of Marburg, Marburg, Germany
| | - Rimante Cerkauskiene
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Clinic of Children's Diseases, Vilnius, Lithuania
| | - Klaus Arbeiter
- Medical University Vienna, Department of Paediatrics and Adolescent Medicine, Vienna, Austria
| | - Verena Peters
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Klaus Kratochwill
- Division of Paediatric Nephrology and Gastroenterology, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Medical University of Vienna, Department of Paediatrics and Adolescent Medicine, Vienna, Austria
| | - Claus Peter Schmitt
- Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
8
|
Cerkauskaite A, Savige J, Janonyte K, Jeremiciute I, Miglinas M, Kazenaite E, Laurinavicius A, Strupaite-Sileikiene R, Vainutiene V, Burnyte B, Jankauskiene A, Rolfs A, Bauer P, Schröder S, Cerkauskiene R. Identification of 27 Novel Variants in Genes COL4A3, COL4A4, and COL4A5 in Lithuanian Families With Alport Syndrome. Front Med (Lausanne) 2022; 9:859521. [PMID: 35419377 PMCID: PMC8995700 DOI: 10.3389/fmed.2022.859521] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Alport syndrome (AS) is an inherited disorder characterized by hematuria, proteinuria, and kidney function impairment, and frequently associated with extrarenal manifestations. Pathogenic variants in COL4A5 usually cause X-linked Alport syndrome (XLAS), whereas those in the COL4A3 or COL4A4 genes are associated with autosomal dominant (AD) or recessive (AR) inheritance. To date, more than 3000 different disease-causing variants in COL4A5, COL4A3, and COL4A4 have been identified. The aim of this study was to evaluate the clinical and genetic spectrum of individuals with novel, pathogenic or likely pathogenic variants in the COL4A3-A5 genes in a previously unstudied cohort. Methods In this study molecular analysis by next generation sequencing (NGS) was performed on individuals from a Lithuanian cohort, with suspected AS. The presence of AS was assessed by reviewing clinical evidence of hematuria, proteinuria, chronic kidney disease (CKD), kidney failure (KF), a family history of AS or persistent hematuria, and specific histological lesions in the kidney biopsy such as thinning or lamellation of the glomerular basement membrane (GBM). Clinical, genetic, laboratory, and pathology data were reviewed. The novelty of the COL4A3-A5 variants was confirmed in the genetic variant databases (Centogene, Franklin, ClinVar, Varsome, InterVar). Only undescribed variants were included in this study. Results Molecular testing of 171 suspected individuals led to the detection of 99 individuals with 44 disease causing variants including 27, previously undescribed changes, with the frequency of 9/27 (33,3%) in genes COL4A5, COL4A3 and COL4A4 equally. Three individuals were determined as having digenic AS causing variants: one in COL4A3 and COL4A4, two in COL4A4 and COL4A5. The most prevalent alterations in genes COL4A3-5 were missense variants (n = 19), while splice site, frameshift, unknown variant and stop codon changes were detected more in genes COL4A4 and COL4A5 and accounted for 3, 3, 1 and 1 of all novel variants, respectively. Conclusion Genotype-phenotype correlation analysis suggested that some variants demonstrated intra-familial phenotypic variability. These novel variants represented more than half of all the variants found in a cohort of 171 individuals from 109 unrelated families who underwent testing. Our study expands the knowledge of the genetic and phenotypic spectrum for AS.
Collapse
Affiliation(s)
- Agne Cerkauskaite
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Judy Savige
- Department of Medicine (Melbourne Health and Northern Health), Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | | | | | - Marius Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Edita Kazenaite
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arvydas Laurinavicius
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Vija Vainutiene
- Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Birute Burnyte
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Augustina Jankauskiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arndt Rolfs
- Albrecht Kossel Institute for Neuroregeneration, University of Rostock, Rostock, Germany
| | | | | | - Rimante Cerkauskiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
9
|
Tylki-Szymańska A, Almássy Z, Christophidou-Anastasiadou V, Avdjieva-Tzavella D, Barisic I, Cerkauskiene R, Cuturilo G, Djiordjevic M, Gucev Z, Hlavata A, Kieć-Wilk B, Magner M, Pecin I, Plaiasu V, Samardzic M, Zafeiriou D, Zaganas I, Lampe C. The landscape of Mucopolysaccharidosis in Southern and Eastern European countries: a survey from 19 specialistic centers. Orphanet J Rare Dis 2022; 17:136. [PMID: 35331284 PMCID: PMC8943501 DOI: 10.1186/s13023-022-02285-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/13/2022] [Indexed: 01/20/2023] Open
Abstract
Background Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders caused by defects in genes coding for different lysosomal enzymes which degrade glycosaminoglycans. Impaired lysosomal degradation causes cell dysfunction leading to progressive multiorgan involvement, disabling consequences and poor life expectancy. Enzyme replacement therapy (ERT) is now available for most MPS types, offering beneficial effects on disease progression and improving quality of life of patients. The landscape of MPS in Europe is not completely described and studies on availability of treatment show that ERT is not adequately implemented, particularly in Southern and Eastern Europe. In this study we performed a survey analysis in main specialist centers in Southern and Eastern European countries, to outline the picture of disease management in the region and understand ERT implementation. Since the considerable number of MPS IVA patients in the region, particularly adults, the study mainly focused on MPS IVA management and treatment. Results 19 experts from 14 Southern and Eastern European countries in total responded to the survey. Results outlined a picture of MPS management in the region, with a high number of MPS patients managed in the centers and a high level of care. MPS II was the most prevalent followed by MPS IVA, with a particular high number of adult patients. The study particularly focused on management and treatment of MPS IVA patients. Adherence to current European Guidelines for follow-up of MPS IVA patients is generally adequate, although some important assessments are reported as difficult due to the lack of MPS skilled specialists. Availability of ERT in Southern and Eastern European countries is generally in line with other European regions, even though regulatory, organizational and reimbursement constrains are demanding. Conclusions The landscape of MPS in Southern and Eastern European countries is generally comparable to that of other European regions, regarding epidemiology, treatment accessibility and follow up difficulties. However, issues limiting ERT availability and reimbursement should be simplified, to start treatment as early as possible and make it available for more patients. Besides, educational programs dedicated to specialists should be implemented, particularly for pediatricians, clinical geneticists, surgeons, anesthesiologists and neurologists.
Collapse
Affiliation(s)
- Anna Tylki-Szymańska
- Department of Pediatric Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Zsuzsanna Almássy
- Department of Toxicology and Metabolic Diseases, Heim Pal Children's Hospital Budapest, Budapest, Hungary
| | | | | | - Ingeborg Barisic
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
| | - Rimante Cerkauskiene
- Clinic of Paediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Goran Cuturilo
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,University Children's Hospital, Belgrade, Serbia
| | - Maja Djiordjevic
- Mother and Child Health Care Institute of Serbia, Medical University of Belgrade, Belgrade, Serbia
| | - Zoran Gucev
- University Children's Hospital, Skopje, North Macedonia
| | - Anna Hlavata
- National Institute of Children's Diseases, Department of Paediatrics, Medical Faculty Comenius University, Centre for Inherited Metabolic Disorders, Bratislava, Slovakia
| | - Beata Kieć-Wilk
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Martin Magner
- Department of Paediatrics, University Thomayer Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Pediatrics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Pecin
- University Hospital Centre Zagreb, Department of Internal Medicine, Division of Metabolic Diseases, Zagreb School of Medicine, Zagreb, Croatia
| | - Vasilica Plaiasu
- Regional Centre of Medical Genetics, INSMC Alessandrescu-Rusescu, Bucharest, Romania
| | - Mira Samardzic
- Institute for Sick Children, Department of Pediatric Endocrinology and Metabolism, Medical School, University of Montenegro, Podgorica, Montenegro
| | - Dimitrios Zafeiriou
- First Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Ioannis Zaganas
- Neurogenetics Laboratory, Neurology Department, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Christina Lampe
- Department of Child Neurology, Epileptology and Social Pediatrics, Centre for Rare Diseases, University of Giessen, Standort Giessen, Feulgenstr. 12, 35389, Giessen, Germany.
| |
Collapse
|
10
|
Savige J, Lipska-Zietkiewicz BS, Watson E, Hertz JM, Deltas C, Mari F, Hilbert P, Plevova P, Byers P, Cerkauskaite A, Gregory M, Cerkauskiene R, Ljubanovic DG, Becherucci F, Errichiello C, Massella L, Aiello V, Lennon R, Hopkinson L, Koziell A, Lungu A, Rothe HM, Hoefele J, Zacchia M, Martic TN, Gupta A, van Eerde A, Gear S, Landini S, Palazzo V, al-Rabadi L, Claes K, Corveleyn A, Van Hoof E, van Geel M, Williams M, Ashton E, Belge H, Ars E, Bierzynska A, Gangemi C, Renieri A, Storey H, Flinter F. Guidelines for Genetic Testing and Management of Alport Syndrome. Clin J Am Soc Nephrol 2022; 17:143-154. [PMID: 34930753 PMCID: PMC8763160 DOI: 10.2215/cjn.04230321] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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] [Indexed: 02/06/2023]
Abstract
Genetic testing for pathogenic COL4A3-5 variants is usually undertaken to investigate the cause of persistent hematuria, especially with a family history of hematuria or kidney function impairment. Alport syndrome experts now advocate genetic testing for persistent hematuria, even when a heterozygous pathogenic COL4A3 or COL4A4 is suspected, and cascade testing of their first-degree family members because of their risk of impaired kidney function. The experts recommend too that COL4A3 or COL4A4 heterozygotes do not act as kidney donors. Testing for variants in the COL4A3-COL4A5 genes should also be performed for persistent proteinuria and steroid-resistant nephrotic syndrome due to suspected inherited FSGS and for familial IgA glomerulonephritis and kidney failure of unknown cause.
Collapse
Affiliation(s)
- Judy Savige
- Department of Medicine (Melbourne Health and Northern Health), The University of Melbourne, Parkville, Victoria, Australia
| | | | - Elizabeth Watson
- South West Genetic Laboratory Hub, North Bristol Trust, Bristol, United Kingdom
| | - Jens Michael Hertz
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Constantinos Deltas
- Center of Excellence in Biobanking and Biomedical Research, University of Cyprus Medical School, Nicosia, Cyprus
| | - Francesca Mari
- Department of Medical Biotechnology, Medical Genetics, University of Siena, Siena, Italy
| | - Pascale Hilbert
- Departement de Biologie Moleculaire, Institute de Pathologie et de Genetique, Gosselies, Belgium
| | - Pavlina Plevova
- Department of Medical Genetics, University Hospital of Ostrava, Ostrava, Czech Republic
- Department of Biomedical Sciences, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Peter Byers
- Department of Pathology, University of Washington, Seattle, Washington
- Department of Medicine (Medical Genetics), University of Washington, Seattle, Washington
| | - Agne Cerkauskaite
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Martin Gregory
- Division of Nephrology, Department of Medicine, University of Utah Health, Salt Lake City, Utah
| | - Rimante Cerkauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Danica Galesic Ljubanovic
- Department of Pathology, University of Zagreb, School of Medicine, Dubrava University Hospital, Zagreb, Croatia
| | | | | | - Laura Massella
- Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine, Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Louise Hopkinson
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Ania Koziell
- School of Immunology and Microbial Sciences, Faculty of Life Sciences, King's College London, London, United Kingdom
| | - Adrian Lungu
- Pediatric Nephrology Department, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Julia Hoefele
- Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | | | | | - Asheeta Gupta
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | | | | | - Samuela Landini
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Viviana Palazzo
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Laith al-Rabadi
- Health Sciences Centre, University of Utah, Salt Lake City, Utah
| | - Kathleen Claes
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anniek Corveleyn
- Center for Human Genetics, University Hospitals and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Evelien Van Hoof
- Center for Human Genetics, University Hospitals and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Micheel van Geel
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maggie Williams
- Bristol Genetics Laboratory Pathology Sciences, Southmead Hospital, Southmead, United Kingdom
| | - Emma Ashton
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital, London, United Kingdom
| | - Hendica Belge
- Institut de Pathologie et de Génétique, Center for Human Genetics, Gosselies, Belgium
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundacio Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autonoma de Barcelona, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Agnieszka Bierzynska
- Bristol Renal Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Concetta Gangemi
- Division of Nephrology and Dialysis, University Hospital of Verona, Verona, Italy
| | - Alessandra Renieri
- Department of Medical Biotechnology, Medical Genetics, University of Siena, Siena, Italy
| | - Helen Storey
- Molecular Genetics, Viapath Laboratories, Guy’s Hospital, London, United Kingdom
| | - Frances Flinter
- Department of Clinical Genetics, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
| |
Collapse
|
11
|
Gabartaite D, Skiauteryte E, Aliosaitiene U, Petrulioniene Z, Rinkuniene E, Dzenkeviciute V, Petrulionyte E, Barysiene J, Cerkauskiene R. Distribution of serum cholesterol values between men and women with familial hypercholesterolaemia (FH) in Lithuania. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Gabartaite D, Skiauteryte E, Aliosaitiene U, Petrulioniene Z, Rinkuniene E, Dzenkeviciute V, Petrulionyte E, Barysiene J, Cerkauskiene R. Characteristics of echocardiography parameters in patients with familial hypercholesterolaemia (FH) in Lithuania. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Savige J, Storey H, Watson E, Hertz JM, Deltas C, Renieri A, Mari F, Hilbert P, Plevova P, Byers P, Cerkauskaite A, Gregory M, Cerkauskiene R, Ljubanovic DG, Becherucci F, Errichiello C, Massella L, Aiello V, Lennon R, Hopkinson L, Koziell A, Lungu A, Rothe HM, Hoefele J, Zacchia M, Martic TN, Gupta A, van Eerde A, Gear S, Landini S, Palazzo V, al-Rabadi L, Claes K, Corveleyn A, Van Hoof E, van Geel M, Williams M, Ashton E, Belge H, Ars E, Bierzynska A, Gangemi C, Lipska-Ziętkiewicz BS. Consensus statement on standards and guidelines for the molecular diagnostics of Alport syndrome: refining the ACMG criteria. Eur J Hum Genet 2021; 29:1186-1197. [PMID: 33854215 PMCID: PMC8384871 DOI: 10.1038/s41431-021-00858-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 07/16/2020] [Revised: 02/13/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
The recent Chandos House meeting of the Alport Variant Collaborative extended the indications for screening for pathogenic variants in the COL4A5, COL4A3 and COL4A4 genes beyond the classical Alport phenotype (haematuria, renal failure; family history of haematuria or renal failure) to include persistent proteinuria, steroid-resistant nephrotic syndrome, focal and segmental glomerulosclerosis (FSGS), familial IgA glomerulonephritis and end-stage kidney failure without an obvious cause. The meeting refined the ACMG criteria for variant assessment for the Alport genes (COL4A3-5). It identified 'mutational hotspots' (PM1) in the collagen IV α5, α3 and α4 chains including position 1 Glycine residues in the Gly-X-Y repeats in the intermediate collagenous domains; and Cysteine residues in the carboxy non-collagenous domain (PP3). It considered that 'well-established' functional assays (PS3, BS3) were still mainly research tools but sequencing and minigene assays were commonly used to confirm splicing variants. It was not possible to define the Minor Allele Frequency (MAF) threshold above which variants were considered Benign (BA1, BS1), because of the different modes of inheritances of Alport syndrome, and the occurrence of hypomorphic variants (often Glycine adjacent to a non-collagenous interruption) and local founder effects. Heterozygous COL4A3 and COL4A4 variants were common 'incidental' findings also present in normal reference databases. The recognition and interpretation of hypomorphic variants in the COL4A3-COL4A5 genes remains a challenge.
Collapse
Affiliation(s)
- Judy Savige
- grid.1008.90000 0001 2179 088XDepartment of Medicine (MH and NH), The University of Melbourne, Parkville, VIC Australia
| | - Helen Storey
- grid.239826.40000 0004 0391 895XMolecular Genetics, Viapath Laboratories, Guy’s Hospital, London, UK
| | - Elizabeth Watson
- Elizabeth Watson, South West Genomic Laboratory Hub, North Bristol Trust, Bristol, UK
| | - Jens Michael Hertz
- grid.7143.10000 0004 0512 5013Jens Michael Hertz, Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Constantinos Deltas
- grid.6603.30000000121167908Center of Excellence in Biobanking and Biomedical Research and Molecule Medicine Center, University of Cyprus, Nicosia, Cyprus
| | - Alessandra Renieri
- grid.9024.f0000 0004 1757 4641Medical Genetics, University of Siena, Siena, Italy
| | - Francesca Mari
- Institute de Pathologie et de Genetique ASBL, Departement de Biologie Moleculaire, Gosselies, Belgium
| | - Pascale Hilbert
- Institute de Pathologie et de Genetique ASBL, Departement de Biologie Moleculaire, Gosselies, Belgium
| | - Pavlina Plevova
- grid.412727.50000 0004 0609 0692Department of Medical Genetics, and Department of Biomedical Sciences, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Peter Byers
- grid.34477.330000000122986657Departments of Pathology and Medicine (Medical Genetics), University of Washington, Seattle, WA USA
| | - Agne Cerkauskaite
- grid.6441.70000 0001 2243 2806Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Martin Gregory
- grid.223827.e0000 0001 2193 0096Division of Nephrology, Department of Medicine, University of Utah Health, Salt Lake City, UT USA
| | - Rimante Cerkauskiene
- grid.6441.70000 0001 2243 2806Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Danica Galesic Ljubanovic
- grid.412095.b0000 0004 0631 385XDepartment of Pathology, University of Zagreb, School of Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Francesca Becherucci
- grid.411477.00000 0004 1759 0844Nephrology Unit and Meyer Children’s University Hospital, Firenze, Italy
| | - Carmela Errichiello
- grid.411477.00000 0004 1759 0844Nephrology Unit and Meyer Children’s University Hospital, Firenze, Italy
| | - Laura Massella
- grid.414125.70000 0001 0727 6809Division of Nephrology and Dialysis, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valeria Aiello
- grid.6292.f0000 0004 1757 1758Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rachel Lennon
- grid.5379.80000000121662407Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Louise Hopkinson
- grid.5379.80000000121662407Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Ania Koziell
- grid.13097.3c0000 0001 2322 6764School of Immunology and Microbial Sciences, Faculty of Life Sciences, King’s College London, London, UK
| | - Adrian Lungu
- grid.415180.90000 0004 0540 9980Fundeni Clinical Institute, Pediatric Nephrology Department, Bucharest, Romania
| | | | - Julia Hoefele
- grid.6936.a0000000123222966Institute of Human Genetics, Technical University of Munich, München, Germany
| | | | - Tamara Nikuseva Martic
- grid.4808.40000 0001 0657 4636Department of Biology, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Asheeta Gupta
- grid.415246.00000 0004 0399 7272Birmingham Children’s Hospital, Birmingham, UK
| | - Albertien van Eerde
- grid.5477.10000000120346234Departments of Genetics and Center for Molecular Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - Samuela Landini
- grid.8404.80000 0004 1757 2304Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Viviana Palazzo
- grid.411477.00000 0004 1759 0844Medical Genetics Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Laith al-Rabadi
- grid.223827.e0000 0001 2193 0096Health Sciences Centre, University of UTAH, Salt Lake City, UT USA
| | - Kathleen Claes
- grid.410569.f0000 0004 0626 3338Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Anniek Corveleyn
- grid.410569.f0000 0004 0626 3338Center for Human Genetics, University Hospitals and KU Leuven, Leuven, Belgium
| | - Evelien Van Hoof
- grid.410569.f0000 0004 0626 3338Center for Human Genetics, University Hospitals and KU Leuven, Leuven, Belgium
| | - Micheel van Geel
- grid.412966.e0000 0004 0480 1382Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maggie Williams
- grid.416201.00000 0004 0417 1173Bristol Genetics Laboratory Pathology Sciences, Southmead Hospital, Bristol, UK
| | - Emma Ashton
- grid.420468.cNorth East Thames Regional Genetics Laboratory, Great Ormond Street Hospital, London, UK
| | - Hendica Belge
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisabeth Ars
- grid.7080.f0000 0001 2296 0625Inherited Kidney Disorders, Fundacio Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Agnieszka Bierzynska
- grid.5337.20000 0004 1936 7603Bristol Renal Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Concetta Gangemi
- grid.411475.20000 0004 1756 948XDivision of Nephrology and Dialysis, University Hospital of Verona, Verona, Italy
| | - Beata S. Lipska-Ziętkiewicz
- grid.11451.300000 0001 0531 3426Centre for Rare Diseases, and Clinical Genetics Unit, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
14
|
Sutkus V, Petrulioniene Z, Kinčinienė O, Černiauskienė V, Skiauteryte E, Aliosaitiene U, Stulginskaitė P, Rolfs A, Cerkauskiene R. Primordial prevention of cardiovascular diseases in Lithuania: Pediatric dyslipidemia and cascade screening of large risk families. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Zhang C, Bartosova M, Schaefer B, Herzog R, Cerkauskiene R, Vondrak K, Oh J, Klaus G, Zaloszyc A, Ariceta Iraola MG, Ranchin B, Bayazit AK, Testa S, Taylan C, Vande Walle J, YAP YOKCHIN, Büscher R, Drozd D, Zarogiannis SG, Kratochwill K, Schmitt C. FC 102PD INDUCED ARTERIOLAR AND PERITONEAL PATHOMECHANISMS ARE PARTIALLY REVERSED AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab135.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Due to the unphysiological composition of PD fluids, chronic peritoneal dialysis (PD) induces progressive peritoneal fibrosis, hypervascularization, and vasculopathy. The evolution of the PD membrane and vasculopathy following kidney transplantation (KTx) is largely unknown.
Method
Arteriolar and peritoneal tissues were obtained from 107 children with chronic kidney disease (CKD5), 72 children on PD (treated with neutral pH PD fluids, with low glucose degradation product content, GDP) and 21 children, who underwent KTx 4-5 weeks after a median 21 months of PD. Specimen underwent standardized digital quantitative histomorphometry. Molecular mechanisms were studied in omental arterioles microdissected from surrounding fat by multi-omics followed by Gene Set Enrichment Analysis (GSEA); key findings were validated in parietal tissues of independent, matched cohorts by quantitative immunohistochemistry (n=15/group).
Results
Arteriolar transcriptome and proteome GSEA revealed suppression of leucocyte migration and T-cell activation / secretory pathways regulation, of sprouting angiogenesis biological processes and of epithelial proliferation and cell cycle after KTx as compared to PD. Lipid / fatty acid metabolism, autophagy and ATP synthesis pathways were activated.
Transcriptome analysis including KTx, PD and CKD5 specifically attributed regulation of arteriolar lipid and fatty acid metabolism to transplantation and comprised 140 transcripts; their regulation was confirmed on the proteome level. Hub gene fatty acid synthase was identified by protein interaction analysis (string-db.org). 15 arteriolar genes activated by PD were inactivated after KTx and included glucose metabolisms and cytoskeleton related transcripts. 24 transcripts and 10 corresponding proteins induced by PD were still active after KTx and associated with biological processes related to TGF-ß signaling, fibrosis and mineral absorption.
In line with arteriolar multi-omics findings, peritoneal hypervascularization induced by chronic PD was reversed after Tx to CKD5 level. CD45 positive tissue infiltrating leucocytes count was reduced by 40% and was independently associated with microvessel density in multivariable analysis including PD vintage, daily GDP exposure and recent KTx. Peritoneal lymphatic vessel density, submesothelial thickness, activated fibroblast, fibrin deposit, macrophage and EMT cell counts remained unchanged after KTx compared to PD. Arteriolar lumen to vessel ratios (a marker of vasculopathy) were similar in both groups.
Vessel-homeostasis-related proteins in independent, matched cohorts demonstrated increased caspase-3 abundance in peritoneal arterioles after KTx. Arteriolar VEGF-A, thrombospondin, angiopoietin1/2, and hypoxia-inducible factor-1 (HIF-1a) were unchanged, while submesothelial HIF-1a and angiopoietin1/2 were decreased after Tx, favoring vessel maturation. The abundance of the key driver of fibrosis, TGF-ß-effector pSMAD2/3, was unchanged in the peritoneum and arterioles after Tx.
Conclusion
Our multi-omics analyses of fat covered omental arterioles, not directly exposed to PD fluids, demonstrate inhibition of PD induced immune response and angiogenesis pathways, of glucose metabolism and cytoskeleton regulation to levels similar as seen in children with CKD5. Arteriolar lipid and fatty acid metabolism is selectively altered after KTx. Reversal of low GDP PD induced hypervascularization and inflammation of the parietal peritoneum after KTx, mirror molecular changes in omental arterioles, while profibrotic activity persists after KTx in omental arterioles and in the parietal peritoneum.
Collapse
Affiliation(s)
- Conghui Zhang
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Maria Bartosova
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Betti Schaefer
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Rebecca Herzog
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | | | - Karel Vondrak
- University Hospital Motol, Department of Pediatrics, Prague, Czech Republic
| | - Jun Oh
- University Medical Center Hamburg-Eppendorf, Department of Pediatric Nephrology, University Children's Medical Clinic, Germany
| | - Günter Klaus
- University Hospital of Giessen and Marburg, KfH Pediatric Kidney Center, Marburg, Germany
| | - Ariane Zaloszyc
- University Hospital of Strasbourg, Department of Pediatrics 1, Strasbourg, France
| | | | - Bruno Ranchin
- Hôpital Femme Mere Enfant, Service de Néphrologie Pédiatrique, lyon, France
| | | | - Sara Testa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology and Dialysis Unit, Milano, Italy
| | - Christina Taylan
- University Hospital of Cologne, Pediatric Nephrology, Children‘s and Adolescent’s Hospital, Germany
| | - Johan Vande Walle
- Ghent University Hospital, Pediatric Nephrology, Department of Pediatrics, Belgium
| | - YOKCHIN YAP
- Hospital Kuala Lumpur, Department of Pediatrics, Malaysia
| | - Rainer Büscher
- University Children`s Hospital, Pediatric Nephrology, Essen, Germany
| | - Dorota Drozd
- Jagiellonian University Medical College, Krakow, Poland
| | - Sotirios G Zarogiannis
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Germany
- University of Thessaly, Department of Physiology, Faculty of Medicine, Larissa, Greece
| | - Klaus Kratochwill
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | - Claus Schmitt
- University of Heidelberg, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| |
Collapse
|
16
|
Servais A, Thomas K, Dello Strologo L, Sayer JA, Bekri S, Bertholet-Thomas A, Bultitude M, Capolongo G, Cerkauskiene R, Daudon M, Doizi S, Gillion V, Gràcia-Garcia S, Halbritter J, Heidet L, van den Heijkant M, Lemoine S, Knebelmann B, Emma F, Levtchenko E. Cystinuria: clinical practice recommendation. Kidney Int 2020; 99:48-58. [PMID: 32918941 DOI: 10.1016/j.kint.2020.06.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 03/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Cystinuria (OMIM 220100) is an autosomal recessive hereditary disorder in which high urinary cystine excretion leads to the formation of cystine stones because of the low solubility of cystine at normal urinary pH. We developed clinical practice recommendation for diagnosis, surgical and medical treatment, and follow-up of patients with cystinuria. Elaboration of these clinical practice recommendations spanned from June 2018 to December 2019 with a consensus conference in January 2019. Selected topic areas were chosen by the co-chairs of the conference. Working groups focusing on specific topics were formed. Group members performed systematic literature review using MEDLINE, drafted the statements, and discussed them. They included geneticists, medical biochemists, pediatric and adult nephrologists, pediatric and adult urologists experts in cystinuria, and the Metabolic Nephropathy Joint Working Group of the European Reference Network for Rare Kidney Diseases (ERKNet) and eUROGEN members. Overall 20 statements were produced to provide guidance on diagnosis, genetic analysis, imaging techniques, surgical treatment (indication and modalities), conservative treatment (hydration, dietetic, alkalinization, and cystine-binding drugs), follow-up, self-monitoring, complications (renal failure and hypertension), and impact on quality of life. Because of the rarity of the disease and the poor level of evidence in the literature, these statements could not be graded. This clinical practice recommendation provides guidance on all aspects of the management of both adults and children with cystinuria, including diagnosis, surgery, and medical treatment.
Collapse
Affiliation(s)
- 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, Paris, France.
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luca Dello Strologo
- Renal Transplant Clinic, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle upon Tyne, UK; The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen, France
| | - Aurelia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares, Filière ORKID, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Lyon, France
| | | | - Giovanna Capolongo
- Unit of Nephrology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Michel Daudon
- UMR S 1155 and Physiology Unit, AP-HP, Hôpital Tenon, Sorbonne Université and INSERM, Paris, France
| | - Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Service d'Urologie, Hôpital Tenon, AP-HP, Paris, France
| | - Valentine Gillion
- Département de Néphrologie adulte, Cliniques universitaires Saint Luc, Bruxelles, Belgium
| | - Silvia Gràcia-Garcia
- Laboratory of Renal Lithiasis, Clinical Laboratories, Fundació Puigvert, Barcelona, Spain
| | - Jan Halbritter
- Division of Nephrology, Department of Endocrinology, Nephrology, and Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Laurence Heidet
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | - Marleen van den Heijkant
- Pediatric Renal Center, University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandrine Lemoine
- Nephrology and Renal Function Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
| | - Bertrand Knebelmann
- Nephrology and Transplantation Department, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, Paris, France
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Elena Levtchenko
- Division of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | | |
Collapse
|
17
|
CERKAUSKAITE A, Cerkauskiene R, Miglinas M. SAT-438 DEVELOPMENT AND VALIDATION OF CASE-FINDING ALGORITHMS FOR THE IDENTIFICATION OF PATIENTS WITH FABRY DISEASE. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
18
|
Kutkiene S, Petrulioniene Z, Laucevicius A, Cerkauskiene R, Staigyte J, Saulyte A, Petrulionyte E, Gargalskaite U, Skiauteryte E, Matuzeviciene G, Kovaite M, Rinkuniene E. Lipid profile evaluation and severe hypercholesterolaemia screening in the middle-aged population according to nationwide primary prevention programme in Lithuania. Atherosclerosis 2019; 277:267-272. [PMID: 30270057 DOI: 10.1016/j.atherosclerosis.2018.06.008] [Citation(s) in RCA: 5] [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: 03/31/2018] [Revised: 05/29/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) is a major cause of premature death in Lithuania where abnormal lipid levels are very common among middle-aged adults. The aim of this study was to evaluate lipid profile in middle-aged Lithuanians and perform population-based severe hypercholesterolaemia (SH) screening. METHODS This study included men aged 40-54 and women aged 50-64 years without overt CVD, participating in the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme during the period 2009-2016. Lipidograms of 92,373 adults (58.4% women and 41.6% men) included in the database were analysed and screening for SH was performed. RESULTS The mean levels of total cholesterol, LDL cholesterol (LDL-C) and triglycerides (TG) among participants were 6.08 mmol/l, 3.87 mmol/l, and 1.59 mmol/l, respectively. Any type of dyslipidaemia was present in 89.7%, and severe dyslipidaemia in 13.4% of the study population. 80.2% of adults without overt CVD had LDL-C ≥3 mmol/l. SH (LDL-C ≥6 mmol/l) was detected in 3.2% of study participants. Prevalence of SH decreased from 2.91% to 2.82% during the period 2009-2016 (p for trend = 0.003). LDL-C ≥6.5 mmol/l was observed in 1.5% of subjects while both LDL-C ≥6.5 mmol/l, and TG ≤ 1.7 mmol/l was found in 0.6% of subjects. CONCLUSIONS SH was present in 3.2% of the middle-aged population without overt CVD. Slightly decreasing prevalence of SH was observed during the period 2009-2016 in Lithuania. Likely phenotypic familial hypercholesterolaemia was observed in 1.5% of middle-aged Lithuanians. Further clinical and genetic evaluation of people with SH is needed to detect familial forms of SH.
Collapse
Affiliation(s)
- Sandra Kutkiene
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Santariskiu str. 2, LT-08661, Vilnius, Lithuania; Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania.
| | - Zaneta Petrulioniene
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Santariskiu str. 2, LT-08661, Vilnius, Lithuania; Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania
| | - Aleksandras Laucevicius
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Santariskiu str. 2, LT-08661, Vilnius, Lithuania; Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania
| | - Rimante Cerkauskiene
- Children's Hospital, Vilnius University Hospital Santaros Klinikos, Santariskiu str. 7, LT-08406, Vilnius, Lithuania; Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Justina Staigyte
- Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Akvile Saulyte
- Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Emilija Petrulionyte
- Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Urte Gargalskaite
- Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania
| | - Egle Skiauteryte
- Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania
| | - Gabija Matuzeviciene
- Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania
| | - Milda Kovaite
- Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania
| | - Egidija Rinkuniene
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Santariskiu str. 2, LT-08661, Vilnius, Lithuania; Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania
| |
Collapse
|
19
|
Schaefer B, Bartosova M, Macher-Goeppinger S, Sallay P, Vörös P, Ranchin B, Vondrak K, Ariceta G, Zaloszyc A, Bayazit AK, Querfeld U, Cerkauskiene R, Testa S, Taylan C, VandeWalle J, Yap Y, Krmar RT, Büscher R, Mühlig AK, Drozdz D, Caliskan S, Lasitschka F, Fathallah-Shaykh S, Verrina E, Klaus G, Arbeiter K, Bhayadia R, Melk A, Romero P, Warady BA, Schaefer F, Ujszaszi A, Schmitt CP. Neutral pH and low-glucose degradation product dialysis fluids induce major early alterations of the peritoneal membrane in children on peritoneal dialysis. Kidney Int 2019; 94:419-429. [PMID: 29776755 DOI: 10.1016/j.kint.2018.02.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 12/05/2017] [Revised: 01/22/2018] [Accepted: 02/08/2018] [Indexed: 01/11/2023]
Abstract
The effect of peritoneal dialysates with low-glucose degradation products on peritoneal membrane morphology is largely unknown, with functional relevancy predominantly derived from experimental studies. To investigate this, we performed automated quantitative histomorphometry and molecular analyses on 256 standardized peritoneal and 172 omental specimens from 56 children with normal renal function, 90 children with end-stage kidney disease at time of catheter insertion, and 82 children undergoing peritoneal dialysis using dialysates with low-glucose degradation products. Follow-up biopsies were obtained from 24 children after a median peritoneal dialysis of 13 months. Prior to dialysis, mild parietal peritoneal inflammation, epithelial-mesenchymal transition and vasculopathy were present. After up to six and 12 months of peritoneal dialysis, blood microvessel density was 110 and 93% higher, endothelial surface area per peritoneal volume 137 and 95% greater, and submesothelial thickness 23 and 58% greater, respectively. Subsequent peritoneal changes were less pronounced. Mesothelial cell coverage was lower and vasculopathy advanced, whereas lymphatic vessel density was unchanged. Morphological changes were accompanied by early fibroblast activation, leukocyte and macrophage infiltration, diffuse podoplanin presence, epithelial mesenchymal transdifferentiation, and by increased proangiogenic and profibrotic cytokine abundance. These transformative changes were confirmed by intraindividual comparisons. Peritoneal microvascular density correlated with peritoneal small-molecular transport function by uni- and multivariate analysis. Thus, in children on peritoneal dialysis neutral pH dialysates containing low-glucose degradation products induce early peritoneal inflammation, fibroblast activation, epithelial-mesenchymal transition and marked angiogenesis, which determines the PD membrane transport function.
Collapse
Affiliation(s)
- Betti Schaefer
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany
| | - Maria Bartosova
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany
| | | | - Peter Sallay
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Vörös
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Bruno Ranchin
- Service de Néphrologie Pédiatrique, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
| | - Karel Vondrak
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | - Gema Ariceta
- Pediatric Nephrology, Hospital Universitario Vall d' Hebrón, Universitat Autonoma, Barcelona, Barcelona, Spain
| | - Ariane Zaloszyc
- Department of Pediatrics 1, University Hospital of Strasbourg, Strasbourg, France
| | - Aysun K Bayazit
- Department of Pediatric Nephrology Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Uwe Querfeld
- Department of Pediatrics, Division of Nephrology, University of Charité, Berlin, Germany
| | - Rimante Cerkauskiene
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Clinic of Children's Diseases, Lithuania
| | - Sara Testa
- Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Christina Taylan
- Pediatric Nephrology, Children's and Adolescent's Hospital, University Hospital of Cologne, Germany
| | - Johan VandeWalle
- Pediatric Nephrology, Utopaed, Department of Pediatrics, Ghent University Hospital, Belgium
| | - YokChin Yap
- Department of Pediatrics, Hospital Kuala Lumpur, Malaysia
| | - Rafael T Krmar
- Division of Pediatrics, Department for Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Rainer Büscher
- Pediatric Nephrology, University Children's Hospital, Essen, Germany
| | - Anne K Mühlig
- Department of Pediatric Nephrology, University Children's Medical Clinic, University Medical Center Hamburg-Eppendorf, Germany
| | - Dorota Drozdz
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Salim Caliskan
- Department of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Felix Lasitschka
- Department of General Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Sahar Fathallah-Shaykh
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Enrico Verrina
- Dialysis Unit, Pediatric Nephrology and Dialysis Division, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Günter Klaus
- KfH Pediatric Kidney Center, Department of Pediatric Nephrology, University of Marburg, Marburg, Germany
| | - Klaus Arbeiter
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Austria
| | - Raj Bhayadia
- Department of Pediatric Nephrology, Hepatology and Metabolic Diseases, Children's Hospital, Hannover Medical School, Germany
| | - Anette Melk
- Department of Pediatric Nephrology, Hepatology and Metabolic Diseases, Children's Hospital, Hannover Medical School, Germany
| | - Philipp Romero
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University of Heidelberg
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany
| | - Akos Ujszaszi
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany
| | - Claus Peter Schmitt
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany.
| |
Collapse
|
20
|
Bartosova M, Schaefer B, Vondrak K, Sallay P, Taylan C, Cerkauskiene R, Dzierzega M, Milosevski-Lomic G, Büscher R, Zaloszyc A, Romero P, Lasitschka F, Warady BA, Schaefer F, Ujszaszi A, Schmitt CP. Peritoneal Dialysis Vintage and Glucose Exposure but Not Peritonitis Episodes Drive Peritoneal Membrane Transformation During the First Years of PD. Front Physiol 2019; 10:356. [PMID: 31001140 PMCID: PMC6455046 DOI: 10.3389/fphys.2019.00356] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/14/2019] [Indexed: 01/26/2023] Open
Abstract
The impact of peritoneal dialysis (PD) associated peritonitis on peritoneal membrane integrity is incompletely understood. Children are particularly suited to address this question, since they are largely devoid of preexisting tissue damage and life-style related alterations. Within the International Peritoneal Biobank, 85 standardized parietal peritoneal tissue samples were obtained from 82 children on neutral pH PD fluids with low glucose degradation product (GDP) content. 37 patients had a history of peritonitis and 16 of the 37 had two or more episodes. Time interval between tissue sampling and the last peritonitis episode was 9 (4, 36) weeks. Tissue specimen underwent digital imaging and molecular analyses. Patients with and without peritonitis were on PD for 21.0 (12.0, 36.0) and 12.8 (7.3, 27.0) months (p = 0.053), respectively. They did not differ in anthropometric or histomorphometric parameters [mesothelial coverage, submesothelial fibrosis, blood, and lymphatic vascularization, leukocyte, macrophage and activated fibroblast counts, epithelial-mesenchymal transition (EMT), podoplanin positivity and vasculopathy]. VEGF and TGF-ß induced pSMAD abundance were similar. Similar findings were also obtained after matching for age and PD vintage and a subgroup analysis according to time since last peritonitis (<3, <6, >6 months). In patients with more than 24 months of PD vintage, submesothelial thickness, vessel number per mmm section length and ASMA fibroblast positivity were higher in patients with peritonitis history; only the difference in ASMA positivity persisted in multivariable analyses. While PD duration and EMT were independently associated with submesothelial thickness, and glucose exposure and EMT with peritoneal vessel density in the combined groups, submesothelial thickness was independently associated with EMT in the peritonitis free patients, and with duration of PD in patients with previous peritonitis. This detailed analysis of the peritoneal membrane in pediatric patients on PD with neutral pH, low GDP fluids, does not support the notion of a consistent long-term impact of peritonitis episodes on peritoneal membrane ultrastructure, on inflammatory and fibrotic cell activity and EMT. Peritoneal alterations are mainly driven by PD duration, dialytic glucose exposure, and associated EMT.
Collapse
Affiliation(s)
- Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Betti Schaefer
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Karel Vondrak
- Department of Pediatrics, Motol University Hospital, Prague, Czechia
| | - Peter Sallay
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Christina Taylan
- Pediatric Nephrology, Children's and Adolescent's Hospital, University Hospital of Cologne, Cologne, Germany
| | | | - Maria Dzierzega
- Department of Pediatric Emergency, Medicine University Hospital, Polish-American Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | | | - Rainer Büscher
- Pediatric Nephrology, University Children's Hospital, Essen, Germany
| | - Ariane Zaloszyc
- Department of Pediatrics 1, Strasbourg University Hospital, Strasbourg, France
| | - Philipp Romero
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Lasitschka
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Franz Schaefer
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Akos Ujszaszi
- Division of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
21
|
Petrulioniene Z, Gargalskaite U, Kutkiene S, Staigyte J, Cerkauskiene R, Laucevicius A. Establishing a national screening programme for familial hypercholesterolaemia in Lithuania. Atherosclerosis 2018; 277:407-412. [DOI: 10.1016/j.atherosclerosis.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/15/2018] [Accepted: 06/07/2018] [Indexed: 12/27/2022]
|
22
|
Jonuskaite D, Kalibatas P, Praninskiene R, Zalubiene A, Jucaite A, Cerkauskiene R. Adolescent with acute psychosis due to anti-N-methyl-D-aspartate receptor encephalitis: successful recovery. Scand J Child Adolesc Psychiatr Psychol 2017. [DOI: 10.21307/sjcapp-2017-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a relatively new autoimmune disorder of the central nervous system. We report the first case of anti-NMDAR autoimmune encephalitis combined with anti-voltage-gated potassium channel (anti-VGKC) antibodies in Lithuania in a 16-year-old girl. The patient was admitted to psychiatry unit because of an acute psychotic episode. She was unsuccessfully treated with antipsychotics, and electroconvulsive therapy was initiated because of her rapidly deteriorating condition. Electroconvulsive therapy improved the patient’s condition even before the initiation of immunomodulatory therapy. The abrupt onset, atypical and severe course of psychosis, poor response to antipsychotic treatment, and signs of flu-like prodromal period led to the search of non-psychiatric causes. Although with considerable delay, she was screened for an autoimmune encephalitis. Positive anti-NMDA receptor antibodies were found in the cerebrospinal fluid, but not in serum. In addition, serum was found positive for antinuclear antibodies and anti-VGKC antibodies but negative for CASPR2 and LGI1 antibodies. The girl was treated with intravenous immunoglobulin and methylprednisolone with satisfactory response, although infrequent orofacial movements, emotional lability, and learning deficits remained upon discharge. The reported case suggests that multiple antibodies could be present, and that electroconvulsive therapy may have a role in symptomatic treatment of autoimmune encephalitis.
Collapse
Affiliation(s)
- Dovile Jonuskaite
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Paulius Kalibatas
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Ruta Praninskiene
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Asta Zalubiene
- University Dep. of Child and Adolescent Psychiatry, Republican Vilnius Psychiatry Hospital , Vilnius , Lithuania
| | - Aurelija Jucaite
- Dep. of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Rimante Cerkauskiene
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| |
Collapse
|
23
|
Dulz S, Bigdon E, Atiskova Y, Schuettauf F, Cerkauskiene R, Oh J, Brinkert F. Genotype–phenotype variability of retinal manifestation in primary hyperoxaluria type 1. Ophthalmic Genet 2017; 39:275-277. [DOI: 10.1080/13816810.2017.1413660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E. Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y. Atiskova
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F. Schuettauf
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R. Cerkauskiene
- Children’s Clinic, Vilnius University Faculty of Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - J. Oh
- Department of Pediatrics, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F. Brinkert
- Department of Pediatrics, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
24
|
Juozapaite S, Cerkauskiene R, Laurinavicius A, Jankauskiene A. The impact of IgM deposits on the outcome of Nephrotic syndrome in children. BMC Nephrol 2017; 18:260. [PMID: 28774288 PMCID: PMC5543753 DOI: 10.1186/s12882-017-0674-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 07/19/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The significance of IgM deposits in glomerular mesangium has been controversial since they were first described due to the variations in the both the definitions used and described impact on clinical outcome. The aim of our study was to evaluate the significance of the IgM deposits in the glomerular mesangium for outcomes of nephrotic syndrome (NS) in children. METHODS Forty-five children with NS who underwent renal biopsy at tertiary pediatric hospital from January 1st, 2000 to December 31st, 2015 and the pathology diagnosis of minimal change disease, focal segmental glomerulosclerosis and mesangial hypercellularity (MH) were retrospectively analyzed. IgM positivity was defined as ≥1+ imunofluorescence with predominantly mesangial distribution. The patients were stratified into IgM-positive (n = 18) and IgM-negative (n = 27). RESULTS At the end of the median follow-up 4.5 years (range 0.17-13.14), the IgM-positive group was represented by 11 patients (61.1%) in remission, 3 patients (16.7%) with active disease and normal kidney function, 2 (11.1%) patients with active disease and impaired kidney function, 2 (11.1%) patients on renal replacement therapy. Accordingly, the IgM-negative group included 13 patients (48.1%) in remission, 12 (44.4%) with active disease and normal kidney function, 1 (3.7%) with active disease and impaired kidney function, 1 (3.7%) on renal replacement therapy, with no statistical significance between groups (p = 0.186). CONCLUSIONS This study did not reveal significant differences of the disease outcomes between IgM-positive and IgM-negative groups.
Collapse
Affiliation(s)
- Sandra Juozapaite
- Institute of Clinical Medicine, Faculty of medicine, Vilnius University, M.K.Ciurlionio srt. 21, 03101, Vilnius, Lithuania.
| | - Rimante Cerkauskiene
- Institute of Clinical Medicine, Faculty of medicine, Vilnius University, M.K.Ciurlionio srt. 21, 03101, Vilnius, Lithuania
| | - Arvydas Laurinavicius
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,National Center of Pathology, affiliate of Vilnius University Hospital Santariskiu Clinics, P. Baublio str. 5, 08406, Vilnius, Lithuania
| | - Augustina Jankauskiene
- Institute of Clinical Medicine, Faculty of medicine, Vilnius University, M.K.Ciurlionio srt. 21, 03101, Vilnius, Lithuania
| |
Collapse
|
25
|
Urbonas V, Sadauskaite J, Cerkauskiene R, Kaminskas A, Mäki M, Kurppa K. Population-Based Screening for Selective Immunoglobulin A (IgA) Deficiency in Lithuanian Children Using a Rapid Antibody-Based Fingertip Test. Med Sci Monit 2016; 22:4773-4778. [PMID: 27920422 PMCID: PMC5144930 DOI: 10.12659/msm.898269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/24/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Selective immunoglobulin A (IgA) deficiency is the most common inherited immunodeficiency disorder worldwide. An early diagnosis is advocated because of the increased risk of infections, autoimmune diseases, and allergic reactions. We investigated the usefulness of a rapid point-of-care test in detecting for IgA deficiency in a population with a previously unknown prevalence. MATERIAL AND METHODS Altogether, 1000 children aged 11-13 years from randomly selected Lithuanian schools were enrolled. A point-of-care test with a fingertip sample was used to screen for the presence of IgA deficiency in children whose parents gave consent. Those with suspected IgA deficiency were referred to hospital for further clinical examination and confirmation of the diagnosis. In addition, their medical histories were compared with those of 30 age- and sex-matched healthy controls. RESULTS IgA deficiency was suspected in one girl and in three boys on the basis of the rapid test, and the diagnosis was confirmed for all four cases (prevalence 0.4%, 95% confidence interval 0.16-1.02%). There was no difference in disease history or complications between IgA-deficient children and healthy controls. CONCLUSIONS The rapid antibody test is a practical and accurate method to diagnose selective IgA deficiency in children. The prevalence of IgA deficiency among Lithuanian schoolchildren is 1:250.
Collapse
Affiliation(s)
- Vaidotas Urbonas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Children’s Hospital, Vilnius University Hospital, Vilnius, Lithuania
| | | | - Rimante Cerkauskiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Children’s Hospital, Vilnius University Hospital, Vilnius, Lithuania
| | | | - Markku Mäki
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Kalle Kurppa
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| |
Collapse
|
26
|
Burkhardt D, Bartosova M, Schaefer B, Grabe N, Lahrmann B, Nasser H, Freise C, Schneider A, Lingnau A, Degenhardt P, Ranchin B, Sallay P, Cerkauskiene R, Malina M, Ariceta G, Schmitt CP, Querfeld U. Reduced Microvascular Density in Omental Biopsies of Children with Chronic Kidney Disease. PLoS One 2016; 11:e0166050. [PMID: 27846250 PMCID: PMC5113061 DOI: 10.1371/journal.pone.0166050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/21/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of "uremic microangiopathy", we have measured microvascular density in biopsies of the omentum of children with CKD. PATIENTS AND METHODS Omental tissue was collected from 32 healthy children (0-18 years) undergoing elective abdominal surgery and from 23 age-matched cases with stage 5 CKD at the time of catheter insertion for initiation of peritoneal dialysis. Biopsies were analyzed by independent observers using either a manual or an automated imaging system for the assessment of microvascular density. Quantitative immunohistochemistry was performed for markers of autophagy and apoptosis, and for the abundance of the angiogenesis-regulating proteins VEGF-A, VEGF-R2, Angpt1 and Angpt2. RESULTS Microvascular density was significantly reduced in uremic children compared to healthy controls, both by manual imaging with a digital microscope (median surface area 0.61% vs. 0.95%, p<0.0021 and by automated quantification (total microvascular surface area 0.89% vs. 1.17% p = 0.01). Density measured by manual imaging was significantly associated with age, height, weight and body surface area in CKD patients and healthy controls. In multivariate analysis, age and serum creatinine level were the only independent, significant predictors of microvascular density (r2 = 0.73). There was no immunohistochemical evidence for apoptosis or autophagy. Quantitative staining showed similar expression levels of the angiogenesis regulators VEGF-A, VEGF-receptor 2 and Angpt1 (p = 0.11), but Angpt2 was significantly lower in CKD children (p = 0.01). CONCLUSIONS Microvascular density is profoundly reduced in omental biopsies of children with stage 5 CKD and associated with diminished Angpt2 signaling. Microvascular rarefaction could be an early systemic manifestation of CKD-induced cardiovascular disease.
Collapse
Affiliation(s)
- Dorothea Burkhardt
- Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Betti Schaefer
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Niels Grabe
- Bioquant, Hamamatsu Tissue Imaging and Analysis (TIGA) Center, University of Heidelberg, Heidelberg, Germany
| | - Bernd Lahrmann
- Bioquant, Hamamatsu Tissue Imaging and Analysis (TIGA) Center, University of Heidelberg, Heidelberg, Germany
| | - Hamoud Nasser
- Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Freise
- Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Schneider
- Department of Pediatric Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Lingnau
- Department of Pediatric Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Degenhardt
- Department of Pediatric Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Pediatric Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Bruno Ranchin
- Hospices Civils de Lyon, Service de Nephrologie Pediatrique and Epicime-Centre d’Investigation Clinique 1407, Hopital Femme Mere Enfant, Lyon, France
| | - Peter Sallay
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Rimante Cerkauskiene
- Coordinating Centre for Children’s Rare Diseases, Children´s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Michal Malina
- Department of Pediatrics, Second Faculty of Medicine, Charles University-Prague, Prague 5, Czech Republic
| | - Gema Ariceta
- Servicio de Nefrología Pediátrica, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Uwe Querfeld
- Department of Pediatric Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Cardiovascular Research, Charité Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| |
Collapse
|
27
|
Raistenskis J, Sidlauskiene A, Cerkauskiene R, Burokiene S, Strukcinskiene B, Buckus R. Physical Activity and Sedentary Screen Time in Obese and Overweight Children Living in Different Environments. Cent Eur J Public Health 2016; 23 Suppl:S37-43. [PMID: 26849542 DOI: 10.21101/cejph.a4184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/14/2014] [Accepted: 03/15/2015] [Indexed: 11/15/2022]
Abstract
AIM To assess the relationship of children's physical activity and sedentary screen time with overweight and obesity in children living in different environments (town and city) in Lithuania. METHODS An analysis of anthropometric data from 532 children living in town and city areas was performed. A youth physical activity questionnaire (YPAQ) was conducted to evaluate physical activity and sedentary screen time. RESULTS The prevalence of overweight and obesity among the children was 25.5% in the town and 18.6% in the city. Children living in the town on average engaged 9.3 min/day less in moderate to vigorous physical activity (p=0.050) and had 33.2 MET-min/day lower energy expenditure than children living in the city. Sedentary screen time was extremely high on weekends in both town and city children. CONCLUSIONS A higher prevalence of overweight and obesity and a lower amount of moderate-to-vigorous physical activity was found in children living in the town compared to children living in the city.
Collapse
Affiliation(s)
- Juozas Raistenskis
- Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aurelija Sidlauskiene
- Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rimante Cerkauskiene
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuani
| | - Sigita Burokiene
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuani
| | | | - Raimondas Buckus
- Public Health Institute, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
28
|
Dufek S, Holtta T, Fischbach M, Ariceta G, Jankauskiene A, Cerkauskiene R, Schmitt CP, Schaefer B, Aufricht C, Wright E, Stefanidis CJ, Ekim M, Bakkaloglu S, Klaus G, Zurowska A, Vondrak K, Vande Walle J, Edefonti A, Shroff R. Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis-A survey from the European Paediatric Dialysis Working Group. Pediatr Nephrol 2015; 30:2021-7. [PMID: 26054713 DOI: 10.1007/s00467-015-3137-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 04/22/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pleural or pericardial effusions secondary to pleuro-peritoneal fistula (PPF) and pericardio-peritoneal fistula (PcPF) are rare but serious complications of peritoneal dialysis (PD). METHODS We conducted a 10-year survey across all participating centres in the European Paediatric Dialysis Working Group to review the incidence, diagnostic techniques, therapeutic options and outcome of children on chronic PD with PPF and/or PcPF. RESULTS Of 1506 children on PD there were ten cases (8 of PPF, 1 each of PcPF and PPF + PcPF), with a prevalence of 0.66%. The median age at presentation was 1.5 [inter-quartile range (IQR) 0.4-2.4] years, and nine children were <3 years. The time on PD before onset of symptoms was 4.3 (IQR 1.3-19.8) months. Eight children had herniae and seven had abdominal surgery in the preceding 4 weeks. Symptoms at presentation were respiratory distress, reduced ultrafiltration and tachycardia. PD was stopped in all children; three were managed conservatively and thoracocentesis was performed in seven (with pleurodesis in 3). PD was restarted in only three children, in two of them with success. CONCLUSION In conclusion, PPF and PcPF are rare in children on chronic PD, but are associated with significant morbidity, requiring a change of dialysis modality in all cases. Risk factors for PPF development include age of <3 years, herniae and recent abdominal surgery.
Collapse
Affiliation(s)
- Stephanie Dufek
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | - Tuula Holtta
- Renal Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | | | - Gema Ariceta
- Renal Unit, Hospital Cruces, Barakaldo, Vizcaya, Spain.
| | | | | | - Claus Peter Schmitt
- Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany.
| | - Betti Schaefer
- Renal Unit, Center for Pediatric & Adolescent Medicine, Heidelberg, Germany.
| | | | - Elizabeth Wright
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | | | - Mesiha Ekim
- Renal Unit, Ankara University Hospital, Ankara, Turkey.
| | | | - Günter Klaus
- Renal Unit, KfH Pediatric Kidney Center, Marburg, Germany.
| | | | - Karel Vondrak
- Renal Unit, University Hospital Motol, Prague, Czech Republic.
| | | | - Alberto Edefonti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Rukshana Shroff
- Renal Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | | |
Collapse
|
29
|
Cerkauskaite A, Miglinas M, Praninskiene R, Anysko S, Burokiene S, Cerkauskiene R. SP020RENAL MANIFESTATION OF TUBEROUS SCLEROSIS COMPLEX. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv187.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Harambat J, van Stralen KJ, Espinosa L, Groothoff JW, Hulton SA, Cerkauskiene R, Schaefer F, Verrina E, Jager KJ, Cochat P. Characteristics and outcomes of children with primary oxalosis requiring renal replacement therapy. Clin J Am Soc Nephrol 2012. [PMID: 22223608 DOI: 10.2215/cjn.07430711]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Primary hyperoxaluria (PH) as a cause of ESRD in children is believed to have poor outcomes. Data on management and outcomes of these children remain scarce. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study included patients aged <19 years who started renal replacement therapy (RRT) between 1979 and 2009 from 31 countries providing data to a large European registry. RESULTS Of 9247 incident patients receiving RRT, 100 patients had PH. PH children were significantly younger than non-PH children at the start of RRT. The median age at RRT of PH children decreased from 9.8 years in 1979-1989 to 1.5 years in 2000-2009. Survival was 86%, 79%, and 76% among PH patients at 1, 3, and 5 years after the start of RRT, compared with 97%, 94%, and 92% in non-PH patients, resulting in a three-fold increased risk of death over non-PH patients. PH and non-PH patient survival improved over time. Sixty-eight PH children received a first kidney (n=13) or liver-kidney transplantation (n=55). Although the comparison was hampered by the lower number of kidney transplantations primarily derived from the earlier era of RRT, kidney graft survival in PH patients was 82%, 79%, and 76% at 1, 3, and 5 years for liver-kidney transplantation and 46%, 28%, and 14% at 1, 3, and 5 years for kidney transplantation alone, compared with 95%, 90%, and 85% in non-PH patients. CONCLUSIONS The outcomes of PH children with ESRD are still poorer than in non-PH children but have substantially improved over time.
Collapse
Affiliation(s)
- Jérôme Harambat
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Harambat J, van Stralen KJ, Espinosa L, Groothoff JW, Hulton SA, Cerkauskiene R, Schaefer F, Verrina E, Jager KJ, Cochat P. Characteristics and outcomes of children with primary oxalosis requiring renal replacement therapy. Clin J Am Soc Nephrol 2012; 7:458-65. [PMID: 22223608 DOI: 10.2215/cjn.07430711] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Primary hyperoxaluria (PH) as a cause of ESRD in children is believed to have poor outcomes. Data on management and outcomes of these children remain scarce. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study included patients aged <19 years who started renal replacement therapy (RRT) between 1979 and 2009 from 31 countries providing data to a large European registry. RESULTS Of 9247 incident patients receiving RRT, 100 patients had PH. PH children were significantly younger than non-PH children at the start of RRT. The median age at RRT of PH children decreased from 9.8 years in 1979-1989 to 1.5 years in 2000-2009. Survival was 86%, 79%, and 76% among PH patients at 1, 3, and 5 years after the start of RRT, compared with 97%, 94%, and 92% in non-PH patients, resulting in a three-fold increased risk of death over non-PH patients. PH and non-PH patient survival improved over time. Sixty-eight PH children received a first kidney (n=13) or liver-kidney transplantation (n=55). Although the comparison was hampered by the lower number of kidney transplantations primarily derived from the earlier era of RRT, kidney graft survival in PH patients was 82%, 79%, and 76% at 1, 3, and 5 years for liver-kidney transplantation and 46%, 28%, and 14% at 1, 3, and 5 years for kidney transplantation alone, compared with 95%, 90%, and 85% in non-PH patients. CONCLUSIONS The outcomes of PH children with ESRD are still poorer than in non-PH children but have substantially improved over time.
Collapse
Affiliation(s)
- Jérôme Harambat
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Baciulis V, Eitutiene G, Cerkauskiene R, Baciuliene E, Jankauskiene A, Mieliauskaite E. [Long-term Cefadroxil prophylaxis in children with recurrent urinary tract infections]. MEDICINA (KAUNAS, LITHUANIA) 2008; 39 Suppl 1:59-63. [PMID: 12761422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The aim of the study was to evaluate the efficacy and safety of low-dose, long-term cefadroxil prophylaxis in preventing recurrent urinary tract infections in children. A prospective, randomized trial in 33 children (32 female, 1 male) aged 2-14 years (mean 8.1+/-2.8) was conducted. Children with recurrent urinary tract infections were commenced to six-month prophylaxis with cefadroxil at the dosage of 12.5-15.0 mg/kg at bedtime administered every night (group I, n=15) or alternate night (group II, n=18). Escherichia coli was the most frequently isolated agent (90.9%), followed by Proteus mirabilis (3.0%) and Klebsiella oxytoca (3.0%) and Staphylococcus epidermidis (3.0%). Cefadroxil prophylaxis was effective in 80% of patients in group I and in 78% patients in group II. Reinfection occurred in 3/15 (20%) patients in-group I and in 4/18 (22.2%) patients in-group II (odds ratio--1.14; 95% confidence interval--0.16-8.3). The difference of reinfection rate between the groups was not significant (p=0.88). The rate of day- and night-time wetting in both groups before prophylaxis of urinary tract infections was high. It decreased significantly at the end of prophylactic treatment with cefadroxil (from 42.4% to 9.1% and from 39.4% to 6.1% respectively). Mild adverse reaction (nausea) was observed in 1/33 patient. In conclusion our study shows that cefadroxil is an effective, well-tolerated and safe agent in the urinary tract infections prophylaxis. Prophylaxis of recurrent urinary tract infections in children with cefadroxil on alternate night regimen might reduce the cost of the treatment.
Collapse
|
33
|
Baciulis V, Jankauskiene A, Cerkauskiene R. [Incidence of peritonitis and catheter exit site infection in children undergoing automatic continuous cyclic peritoneal dialysis]. Medicina (Kaunas) 2008; 39 Suppl 1:70-4. [PMID: 12761424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The aim of this study was to find out the clinical aspects of peritonitis and catheter exit site infection in children undergoing continuous cyclic peritoneal dialysis. The incidence of peritonitis and catheter related infections were reviewed in 8 children on continuous cyclic peritoneal dialysis over a mean period of 14.9+/-15.8 months. Peritonitis occurred in 4 children. There were 14 episodes of peritonitis. The mean time from starting dialysis to the first episode of peritonitis was 1.9+/-1.0 months. The incidence of peritonitis was 1 episode in 9 treatment months. Gram-negative organisms (Enterococcus spp.) were responsible for the majority of episodes (35.7%) of peritonitis and gram-positive bacteria mainly caused the catheter exit site infections (Staphylococcus epidermidis). The incidence of catheter exit site infection was one episode in 8 treatment months. Recurrent peritonitis was present in 1 case. Most patients with dialysis-related peritonitis and catheter exit site infection responded to antibiotic therapy. Catheter was replaced in 2 patients. The mortality rate was 2 out of 8 patients but none of the deaths were related to peritonitis. Patients with exit site infection had 7 times higher risk than those without developing peritonitis.
Collapse
|
34
|
Cerkauskiene R, Kaminskas A, Kaltenis P, Vitkus D. [Influence of omega-3 fatty acids on lipid metabolism in children with steroid sensitive nephrotic syndrome]. MEDICINA (KAUNAS, LITHUANIA) 2008; 39 Suppl 1:82-7. [PMID: 12761426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Changes in lipid metabolism is one of the most important features of steroid sensitive nephrotic syndrome. Increased serum lipid level not always is connected with disease activity and sometimes may persist for long time, especially in frequently relapsing nephrotic syndrome. Hyperlipidemia and dyslipidemia are connected with cardiovascular diseases and development of glomerulosclerosis. Omega-3 (omega-3) polyunsaturated fatty acids have positive influence on lipid metabolism, diminishing hypercoagulation and a risk of cardiovascular diseases. The aim of this study was to examine influence of omega-3 polyunsaturated fatty acids on lipid disturbances in children with steroid sensitive nephrotic syndrome. Forty-eight patients were included in the study; 24 of them were treated with prednisolone (control group) and 24 were treated with prednisolone and fish oil (6 mg/day) along with symptomatic therapies. Serum lipid profile and spectrum of fatty acids before treatment and three months after start of the treatment were evaluated. Before treatment, contents of serum fatty acids and lipids did not differ between the groups. The study showed decrease in serum triglycerides (p<0.06) and omega-6 polyunsaturated fatty acids (p<0.02), increase in concentration of omega-3 polyunsaturated fatty acids and the ratio of 20:5 omega-3/20: omega-6 (eicosapentaenoic/arachidonic acids) (p<0.001). Cholesterol, HDL-Ch, LDL-Ch concentrations did not change under the treatment with fish oil. We conclude that fish oil might be useful as an agent normalising lipid metabolism in children with steroid sensitive nephrotic syndrome.
Collapse
Affiliation(s)
- Rimante Cerkauskiene
- Center of Pediatrics, Vilnius University Children's Hospital, Vilnius, Lithuania.
| | | | | | | |
Collapse
|
35
|
Pundziene B, Masalskiene J, Jankauskiene A, Cerkauskiene R, Aleksyniene V, Dobiliene D, Rudaitis S. [Etiology, prevalence of chronic renal failure and growth retardation in Lithuanian children]. Medicina (Kaunas) 2007; 43 Suppl 1:11-5. [PMID: 17551270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of the study was to evaluate the causes, prevalence, and grades of chronic renal failure in Lithuanian children and to assess its influence on children's growth. The study was performed in Vilnius University Children's Hospital and Clinic of Children's Diseases, Kaunas University of Medicine. By March 31, 2006, 65 children with chronic renal failure had been registered. The prevalence was 88.3 cases per million children. The mean age was 10.8+/-4.9 years. The leading causes of chronic renal failure were congenital diseases (37%) and obstruction with interstitial nephritis (33.8%). At presentation, 23 (35.40%) children had mild, 17 (26.15%) had moderate, 9 (23.85%) had severe renal failure, and 16 (24.6%) had end-stage renal disease. Fourteen (21.54%) children were below the third percentile in height for their age. Growth failure was observed in one (4.35%) child with Grade 1 renal failure. The deterioration of renal function had a significant influence on growth impairment, and 13 (30.95%) children with glomerular filtration rate of less than 60 mL/min/1.73 m2 and 7 (43.75%) with end-stage renal disease had a height below the third percentile. Growth retardation as one of the symptoms of impairment of children's physical development depends on the severity of renal function.
Collapse
Affiliation(s)
- Birute Pundziene
- 1st Department of Children's Diseases, Kaunas University of Medicine, Kaunas, Lithuania.
| | | | | | | | | | | | | |
Collapse
|
36
|
Cerkauskiene R, Kaltenis P. Comparative study of prednisolone alone and prednisolone plus fusidic acid in the treatment of children with steroid-responsive nephrotic syndrome. Medicina (Kaunas) 2005; 41 Suppl 1:26-30. [PMID: 15901972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND There are several reports in the literature indicating that fusidic acid owns functions similar to those of cyclosporin. As cyclosporin has effectively been used in frequently relapsing steroid-responsive nephrotic syndrome we carried out this study to determine whether fusidic acid used along with prednisolone diminishes rate of steroid-responsive nephrotic syndrome relapses in children. PATIENTS AND METHODS The patients were randomly allocated to receive either prednisolone alone or prednisolone plus fusidic acid for two months in standard doses. In the cases of relapses the treatment was changed to the comparative treatment method. Altogether 18 children (12 boys and 6 girls) aged 1.3 to 13.2 years entered the study. Thirteen of them were treated by either method on different occasions, four patients were treated with prednisolone only, and one child was treated with prednisolone plus fusidic acid only. Thus, there were 17 evaluable treatment courses with prednisolone alone and 14 courses with prednisolone plus fusidic acid. The patients were followed-up as long as the remission lasted. RESULTS There was prompt and complete response under the influence of both treatment methods. However, relapses occurred in all the patients irrespective of the mode of treatment. Mean duration of remissions did not differ significantly between the study groups (17.8+/-20.4 weeks in the prednisolone group and 18.3+/-23.9 weeks in the prednisolone plus fusidic acid group; p>0.05). There were no statistically significant differences in laboratory parameters reflecting therapeutic efficacy in the comparative treatment groups, too. CONCLUSION Thus, it was not revealed any remission-sustaining efficacy of fusidic acid used in standard doses for two months along with prednisolone in children with frequently relapsing steroid-responsive nephrotic syndrome.
Collapse
Affiliation(s)
- Rimante Cerkauskiene
- Department of Pediatrics, Vilnius University Children's Hospital, Santariskiu 4, 08406 Vilnius, Lithuania.
| | | |
Collapse
|
37
|
Kaltenis P, Cerkauskiene R, Pundziene B. [Hemolytic-uremic syndrome in Lithuania over the period 1990-2004]. Medicina (Kaunas) 2005; 41 Suppl 1:12-5. [PMID: 15901969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
More than 80 cases of the hemolytic-uremic syndrome were registered in Lithuania over the period 1990-2004. The incidence of this syndrome fluctuated annually; higher incidence rates were observed in 1990-1993, 1998-1999 and 2003-2004, however, there was no overall increase in morbidity over the 15-year period. Most cases occurred in the first two years of life; besides, girls suffered slightly more often than boys. At least in 80% of cases the illness was typical, i.e. was associated with diarrhea. In general, the data correspond to the findings of other scientists.
Collapse
Affiliation(s)
- Petras Kaltenis
- Clinic of Children's Diseases, Vilnius University, Santariskiu 4, 08406 Vilnius, Lithuania.
| | | | | |
Collapse
|