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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.
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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
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Torra R. Kidney Health Matters: A Global Imperative for Public Health. Nephrol Dial Transplant 2024:gfae083. [PMID: 38578651 DOI: 10.1093/ndt/gfae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert. Institut de Recerca Sant Pau (IR-Sant Pau). RICORS40. Department of Medicine, Universitat Autonoma de Barcelona (UAB). Barcelona, Spain
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Stevens KI, Mallamaci F, Ortiz A, Bover J, Delanaye P, Torra R, Cozzolino M. 'The forgotten sex': gender disparities in kidney disease. Clin Kidney J 2024; 17:sfad102. [PMID: 38628911 PMCID: PMC11019306 DOI: 10.1093/ckj/sfad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 04/19/2024] Open
Affiliation(s)
- Kate I Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Francesca Mallamaci
- Nefrologia and CNR Unit, Grande Ospedale Metropolitano Reggio Calabria, Italy
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz- UAM, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias I Pujol, Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
| | - Roser Torra
- Inherited Kidney Disorders, Department of Nephrology, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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4
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Bais T, Meijer E, Kramers BJ, Vart P, Vervloet M, Salih M, Bammens B, Demoulin N, Todorova P, Müller RU, Halbritter J, Paliege A, Gall ECL, Knebelmann B, Torra R, Ong ACM, Karet Frankl FE, Gansevoort RT. HYDROchlorothiazide versus placebo to PROTECT polycystic kidney disease patients and improve their quality of life: study protocol and rationale for the HYDRO-PROTECT randomized controlled trial. Trials 2024; 25:120. [PMID: 38355627 PMCID: PMC10865620 DOI: 10.1186/s13063-024-07952-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) leads to progressive renal cyst formation and loss of kidney function in most patients. Vasopressin 2 receptor antagonists (V2RA) like tolvaptan are currently the only available renoprotective agents for rapidly progressive ADPKD. However, aquaretic side effects substantially limit their tolerability and therapeutic potential. In a preliminary clinical study, the addition of hydrochlorothiazide (HCT) to tolvaptan decreased 24-h urinary volume and appeared to increase renoprotective efficacy. The HYDRO-PROTECT study will investigate the long-term effect of co-treatment with HCT on tolvaptan efficacy (rate of kidney function decline) and tolerability (aquaresis and quality of life) in patients with ADPKD. METHODS The HYDRO-PROTECT study is an investigator-initiated, multicenter, double-blind, placebo-controlled, randomized clinical trial. The study is powered to enroll 300 rapidly progressive patients with ADPKD aged ≥ 18 years, with an eGFR of > 25 mL/min/1.73 m2, and on stable treatment with the highest tolerated dose of tolvaptan in routine clinical care. Patients will be randomly assigned (1:1) to daily oral HCT 25 mg or matching placebo treatment for 156 weeks, in addition to standard care. OUTCOMES The primary study outcome is the rate of kidney function decline (expressed as eGFR slope, in mL/min/1.73 m2 per year) in HCT versus placebo-treated patients, calculated by linear mixed model analysis using all available creatinine values from week 12 until the end of treatment. Secondary outcomes include changes in quality-of-life questionnaire scores (TIPS, ADPKD-UIS, EQ-5D-5L, SF-12) and changes in 24-h urine volume. CONCLUSION The HYDRO-PROTECT study will demonstrate whether co-treatment with HCT can improve the renoprotective efficacy and tolerability of tolvaptan in patients with ADPKD.
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Affiliation(s)
- Thomas Bais
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Esther Meijer
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart J Kramers
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marc Vervloet
- Department of Nephrology, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mahdi Salih
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bert Bammens
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Demoulin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Polina Todorova
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department 2 for Internal Medicine, Cologne, Germany
| | - Roman-Ulrich Müller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department 2 for Internal Medicine, Cologne, Germany
| | - Jan Halbritter
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Paliege
- Department of Nephrology, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Emilie Cornec-Le Gall
- University Brest, Inserm, UMR 1078, GGB, Brest, 29609, France
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, CHRU Brest, Brest, 29609, France
| | - Bertrand Knebelmann
- Department of Nephrology, Necker-Enfants Malades Hospital AP-HP, Paris, France
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Albert C M Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Fiona E Karet Frankl
- Department of Medical Genetics and Division of Renal Medicine, University of Cambridge, Cambridge, UK
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
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Furlano M, Pilco-Teran M, Pybus M, Martínez V, Aza-Carmona M, Rius A, Pérez-Gomez V, Berná G, Mazo J, Hernández J, Fayos L, Viera E, Gich I, Vergara Pérez H, Gomá Garcés E, Albero Dolon JL, Ars E, Torra R. Increased prevalence of Kidney cysts in individuals carrying heterozygous COL4A3 or COL4A4 pathogenic variants. Nephrol Dial Transplant 2024:gfae031. [PMID: 38317457 DOI: 10.1093/ndt/gfae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Clinical variability among individuals with heterozygous pathogenic/likely pathogenic (P/LP) variants in the COL4A3/COL4A4 genes (also called autosomal dominant Alport syndrome or COL4A3/COL4A4 related disorder) is huge; many individuals are asymptomatic or show microhematuria, while others may develop proteinuria and chronic kidney disease (CKD). The prevalence of simple kidney cysts (KC) in the general population varies according to age, and patients with advanced CKD are prone to have them. A possible association between heterozygous COL4A3, COL4A4, and COL4A5 P/LP variants and KC has been described in small cohorts. The presence of KC in a multicenter cohort of individuals with heterozygous P/LP variants in the COL4A3/COL4A4 genes is assessed in this study. METHODS We evaluated the presence of KC by ultrasound in 157 individuals with P/LP variants in COL4A3 (40.7%) or COL4A4 (53.5%) without kidney replacement therapy. The association between presence of KC and age, proteinuria, eGFR, and causative gene was analyzed. Prevalence of KC was compared with historical case series in the general population. RESULTS Half of the individuals with P/LP variants in COL4A3/COL4A4 showed KC, which is a significantly higher percentage than in the general population. Only 3.8% (6/157) had cystic nephromegaly. Age and eGFR showed an association with the presence of KC (p<0.001). No association was found between KC and proteinuria, sex, or causative gene. CONCLUSIONS Individuals with COL4A3/COL4A4 P/LP variants are prone to develop KC more frequently than the general population, and their presence is related to age and to eGFR. Neither proteinuria, sex nor the causative gene influences the presence of KC in these individuals.
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Affiliation(s)
- Mónica Furlano
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert. Institut de Recerca Sant Pau. Department of Medicine, Universitat Autonoma de Barcelona (UAB), Spain
| | - Melissa Pilco-Teran
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert. Institut de Recerca Sant Pau. Department of Medicine, Universitat Autonoma de Barcelona (UAB), Spain
| | - Marc Pybus
- Molecular Biology Laboratory, Fundació Puigvert. Institut de Recerca Sant Pau, Spain
| | - Víctor Martínez
- Nephrology Department, Hospital Universitario Virgen de la Arrixaca, Spain
| | - Miriam Aza-Carmona
- Molecular Biology Laboratory, Fundació Puigvert. Institut de Recerca Sant Pau, Spain
| | - Asunción Rius
- Nephrology Department, Hospital General Universitario de Castellón, Spain
| | | | | | - Jaime Mazo
- Nephrology Department, Hospital de Valdecilla, Santander, Spain
| | | | | | | | - Ignasi Gich
- Biostatistics Department Institut d'Investigacions Biomèdiques (IIB-Sant Pau), Spain
| | - Hugo Vergara Pérez
- Nephrology Department, Hospital General Universitario de Castellón, Spain
| | | | | | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert. Institut de Recerca Sant Pau, Spain
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert. Institut de Recerca Sant Pau. Department of Medicine, Universitat Autonoma de Barcelona (UAB), Spain
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6
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Torra R, Kronbichler A, Bajema IM. Replacing a kidney biopsy by exome sequencing in undetermined kidney diseases-not yet ready for prime time! Clin Kidney J 2024; 17:sfad250. [PMID: 38186890 PMCID: PMC10768749 DOI: 10.1093/ckj/sfad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut d'Investigacions Biomèdiques (IIB-Sant Pau), Department of Medicine, Universitat Autonoma de Barcelona (UAB), Spain
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Ingeborg M Bajema
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
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7
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Lomonte C, Rossini M, Ibeas J, Forcella M, Ponikvar JB, Gallieni M, Russo R, Goumenos D, Tesar V, Hruskova Z, Roelofs J, Florquin S, Snoeijs M, Giusto A, Shemesh D, Rotmans J, Torra R, Wanner C, Gesualdo L. Nephrology Partnership for Advancing Technology in Healthcare (N-PATH) program: the teachers' perspective. Clin Kidney J 2024; 17:sfad299. [PMID: 38213498 PMCID: PMC10783234 DOI: 10.1093/ckj/sfad299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
The N-PATH (Nephrology Partnership for Advancing Technology in Healthcare) program concluded with the 60th European Renal Association 2023 Congress in Milan, Italy. This collaborative initiative aimed to provide advanced training in interventional nephrology to young European nephrologists. Funded by Erasmus+ Knowledge Alliance, N-PATH addressed the global burden of chronic kidney disease (CKD) and the shortage of nephrologists. CKD affects >850 million people worldwide, yet nephrology struggles to attract medical talent, leading to unfilled positions in residency programs. To address this, N-PATH focused on enhancing nephrology education through four specialized modules: renal expert in renal pathology (ReMAP), renal expert in vascular access (ReVAC), renal expert in medical ultrasound (ReMUS) and renal expert in peritoneal dialysis (RePED). ReMAP emphasized the importance of kidney biopsy in nephrology diagnosis and treatment, providing theoretical knowledge and hands-on training. ReVAC centred on vascular access in haemodialysis, teaching trainees about different access types, placement techniques and managing complications. ReMUS recognized the significance of ultrasound in nephrology, promoting interdisciplinary collaboration and preparing nephrologists for comprehensive patient care. RePED addressed chronic peritoneal dialysis, offering comprehensive training in patient selection, prescription, monitoring, complications and surgical techniques for catheter insertion. Overall, N-PATH's strategy involved collaborative networks, hands-on training, mentorship, an interdisciplinary approach and the integration of emerging technologies. By bridging the gap between theoretical knowledge and practical skills, N-PATH aimed to revitalize interest in nephrology and prepare proficient nephrologists to tackle the challenges of kidney diseases. In conclusion, the N-PATH program aimed to address the shortage of nephrologists and improve the quality of nephrology care in Europe. By providing specialized training, fostering collaboration and promoting patient-centred care, N-PATH aimed to inspire future nephrology professionals to meet the growing healthcare demands related to kidney diseases and elevate the specialty's status within the medical community.
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Affiliation(s)
- Carlo Lomonte
- Nephrology Unit, “F. Miulli” General Hospital, Acquaviva delle fonti, Bari, Italy
| | - Michele Rossini
- Renal, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari, Bari, Italy
| | - Jose Ibeas
- Nephrology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Mauro Forcella
- Department of Nephrology, University Hospital “Ospedali Riuniti”, Foggia, Italy
| | - Jadranka Buturovic Ponikvar
- Department of Nephrology, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy
| | - Roberto Russo
- Renal, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari, Bari, Italy
| | - Dimitrios Goumenos
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, Patras, Greece
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdenka Hruskova
- Department of Nephrology, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Joris Roelofs
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sandrine Florquin
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Maarten Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Antonio Giusto
- Renal, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari, Bari, Italy
| | - David Shemesh
- Vascular Access Society, Department of Surgery and Hemodialysis Access Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Joris Rotmans
- Vascular Access Society, Leiden University Medical Center, Leiden, The Netherlands
| | - Roser Torra
- European Renal Association, Nephrology Department, Fundació Puigvert, Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christoph Wanner
- European Renal Association, University of Würzburg, Department of Clinical Research and Epidemiology, Würzburg, Germany and University of Oxford, Nuffield Department of Population Health, CTSU, Oxford, UK
| | - Loreto Gesualdo
- Renal, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari, Bari, Italy
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8
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Daga S, Ding J, Deltas C, Savige J, Lipska-Ziętkiewicz BS, Hoefele J, Flinter F, Gale DP, Aksenova M, Kai H, Perin L, Barua M, Torra R, Miner JH, Massella L, Ljubanović DG, Lennon R, Weinstock AB, Knebelmann B, Cerkauskaite A, Gear S, Gross O, Turner AN, Baldassarri M, Pinto AM, Renieri A. Correction: The 2019 and 2021 International workshops on Alport syndrome. Eur J Hum Genet 2024; 32:130. [PMID: 36690832 PMCID: PMC10772067 DOI: 10.1038/s41431-023-01286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Sergio Daga
- Medical Genetics, University of Siena, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Jie Ding
- Peking University First Hospital, Beijing, China
| | - Constantinos Deltas
- Biobank.cy Center of Excellence in Biobanking and Biomedical Research and University of Cyprus Medical School, Nicosia, Cyprus
| | - Judy Savige
- Department of Medicine, Melbourne and Northern Health, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Beata S Lipska-Ziętkiewicz
- Rare Diseases Centre, Clinical Genetics Unit, Department of Biology and Medical Genetics, Medical University of Gdańsk, Gdansk, Poland
| | - Julia Hoefele
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Frances Flinter
- Department of Clinical Genetics, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Daniel P Gale
- Department of Renal Medicine, University College London, London, UK
- Rare Renal Disease Registry, UK Renal Registry, Bristol, UK
| | - Marina Aksenova
- Y. Veltischev Research and Clinical Institute for Pediatrics at the Pirogov Russian National Research Medical University, Taldomskaya Street, 2, Moscow, 125412, Russia
| | - Hirofumi Kai
- Department of Molecular Medicine, Kumamoto University, Kumamoto, Japan
| | - Laura Perin
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics in Urology, Saban Research Institute, Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Moumita Barua
- Toronto General Hospital, Toronto General Research Institute, University of Toronto, Toronto, ON, Canada
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, IIB-Sant Pau, Medicine Department, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jeff H Miner
- Division of Nephrology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Laura Massella
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Danica Galešić Ljubanović
- University of Zagreb School of Medicine, Department of Pathology and Department of Nephropathology and Electron Microscopy Dubrava University Hospital, Zagreb, Croatia
| | - 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 Academic Health Science Centre, Manchester, UK
| | | | - Bertrand Knebelmann
- Nephrology Department, Reference Center for Inherited Kidney Diseases (MARHEA), APHP, Necker Hospital, Paris University, Paris, France
| | - Agne Cerkauskaite
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Oliver Gross
- Department of Nephrology and Rheumatology, University Medicine Goettingen, Gottingen, Germany
| | - A Neil Turner
- Centre for Inflammation, University of Edinburgh, Edinburgh, UK
| | - Margherita Baldassarri
- Medical Genetics, University of Siena, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Anna Maria Pinto
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy.
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy.
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
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9
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Jankowska M, Soler MJ, Stevens KI, Torra R. Why do we keep ignoring sex in kidney disease? Clin Kidney J 2023; 16:2327-2335. [PMID: 38046033 PMCID: PMC10689162 DOI: 10.1093/ckj/sfad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 12/05/2023] Open
Abstract
Throughout the history of nephrology, little attention has been paid to the sex and gender differences in kidney disease. This lack of awareness prevents optimal diagnosis and management of kidney disease. In today's world of precision medicine, it is imperative to appreciate the differential factors regarding gender and kidney disease. This editorial summarizes the up-to-date literature regarding sex and gender differences in kidney disease and considers areas where knowledge is incomplete and where further research is needed. We address sex-specific effects on chronic kidney disease epidemiology; risks of dialysis underdosing and medication overdosing in women; unexplained loss of female sex advantage in life expectancy during dialysis, and impact of sex on diagnosis and management of genetic kidney disease. We also aim to highlight the impact of gender on kidney health and raise awareness of disparities that may be faced by women, and transgender and gender-diverse persons when a male-model approach is used by healthcare systems. By understanding the link between sex and kidney disease, kidney specialists can improve the care and outcomes of their patients. In addition, research on this topic can inform the development of targeted prevention and intervention strategies that address the specific needs and risk factors of different populations.
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Affiliation(s)
- Magdalena Jankowska
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - María José Soler
- Department of Nephrology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Nephrology and Transplantation Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Kate I Stevens
- The Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
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10
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Fayos De Arizón L, Viera ER, Pilco M, Perera A, De Maeztu G, Nicolau A, Furlano M, Torra R. Artificial intelligence: a new field of knowledge for nephrologists? Clin Kidney J 2023; 16:2314-2326. [PMID: 38046016 PMCID: PMC10689169 DOI: 10.1093/ckj/sfad182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 12/05/2023] Open
Abstract
Artificial intelligence (AI) is a science that involves creating machines that can imitate human intelligence and learn. AI is ubiquitous in our daily lives, from search engines like Google to home assistants like Alexa and, more recently, OpenAI with its chatbot. AI can improve clinical care and research, but its use requires a solid understanding of its fundamentals, the promises and perils of algorithmic fairness, the barriers and solutions to its clinical implementation, and the pathways to developing an AI-competent workforce. The potential of AI in the field of nephrology is vast, particularly in the areas of diagnosis, treatment and prediction. One of the most significant advantages of AI is the ability to improve diagnostic accuracy. Machine learning algorithms can be trained to recognize patterns in patient data, including lab results, imaging and medical history, in order to identify early signs of kidney disease and thereby allow timely diagnoses and prompt initiation of treatment plans that can improve outcomes for patients. In short, AI holds the promise of advancing personalized medicine to new levels. While AI has tremendous potential, there are also significant challenges to its implementation, including data access and quality, data privacy and security, bias, trustworthiness, computing power, AI integration and legal issues. The European Commission's proposed regulatory framework for AI technology will play a significant role in ensuring the safe and ethical implementation of these technologies in the healthcare industry. Training nephrologists in the fundamentals of AI is imperative because traditionally, decision-making pertaining to the diagnosis, prognosis and treatment of renal patients has relied on ingrained practices, whereas AI serves as a powerful tool for swiftly and confidently synthesizing this information.
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Affiliation(s)
- Leonor Fayos De Arizón
- Nephrology Department, Fundació Puigvert; Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau); Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elizabeth R Viera
- Nephrology Department, Fundació Puigvert; Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau); Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Melissa Pilco
- Nephrology Department, Fundació Puigvert; Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau); Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandre Perera
- Center for Biomedical Engineering Research (CREB), Universitat Politècnica de Barcelona (UPC), Barcelona, Spain; Networking Biomedical Research Centre in the subject area of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | | | - Monica Furlano
- Nephrology Department, Fundació Puigvert; Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau); Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roser Torra
- Nephrology Department, Fundació Puigvert; Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau); Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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11
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Bichet DG, Hopkin RJ, Aguiar P, Allam SR, Chien YH, Giugliani R, Kallish S, Kineen S, Lidove O, Niu DM, Olivotto I, Politei J, Rakoski P, Torra R, Tøndel C, Hughes DA. Consensus recommendations for the treatment and management of patients with Fabry disease on migalastat: a modified Delphi study. Front Med (Lausanne) 2023; 10:1220637. [PMID: 37727761 PMCID: PMC10505750 DOI: 10.3389/fmed.2023.1220637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/13/2023] [Indexed: 09/21/2023] Open
Abstract
Objective Fabry disease is a progressive disorder caused by deficiency of the α-galactosidase A enzyme (α-Gal A), leading to multisystemic organ damage with heterogenous clinical presentation. The addition of the oral chaperone therapy migalastat to the available treatment options for Fabry disease is not yet universally reflected in all treatment guidelines. These consensus recommendations are intended to provide guidance for the treatment and monitoring of patients with Fabry disease receiving migalastat. Methods A modified Delphi process was conducted to determine consensus on treatment decisions and monitoring of patients with Fabry disease receiving migalastat. The multidisciplinary panel comprised 14 expert physicians across nine specialties and two patients with Fabry disease. Two rounds of Delphi surveys were completed and recommendations on the use of biomarkers, multidisciplinary monitoring, and treatment decisions were generated based on statements that reached consensus. Results The expert panel reached consensus agreement on 49 of 54 statements, including 16 that reached consensus in round 1. Statements that reached consensus agreement are summarized in recommendations for migalastat treatment and monitoring, including baseline and follow-up assessments and frequency. All patients with Fabry disease and an amenable mutation may initiate migalastat treatment if they have evidence of Fabry-related symptoms and/or organ involvement. Treatment decisions should include holistic assessment of the patient, considering clinical symptoms and organ involvement as well as patient-reported outcomes and patient preference. The reliability of α-Gal A and globotriaosylsphingosine as pharmacodynamic response biomarkers remains unclear. Conclusion These recommendations build on previously published guidelines to highlight the importance of holistic, multidisciplinary monitoring for patients with Fabry disease receiving migalastat, in addition to shared decision-making regarding treatments and monitoring throughout the patient journey. GRAPHICAL ABSTRACT.
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Affiliation(s)
- Daniel G. Bichet
- Department of Medicine, Pharmacology and Physiology, Hôpital du Sacré-Coeur, University of Montréal, Montreal, QC, Canada
| | - Robert J. Hopkin
- Department of Pediatrics, Division of Human Genetics, University of Cincinnati College of Medicine, and Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Patrício Aguiar
- Inborn Errors of Metabolism Reference Center, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Sridhar R. Allam
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX, United States
- Tarrant Nephrology Associates/PPG Health, Fort Worth, TX, United States
| | - Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Roberto Giugliani
- Postgraduate Program in Genetics and Molecular Biology (PPGBM) at Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- BioDiscovery Laboratory at Hospital de Clinicas de Porto Alegre (HCPA), National Institute of Population Medical Genetics (INAGEMP), DASA, Casa dos Raros, Porto Alegre, Brazil
| | - Staci Kallish
- Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Olivier Lidove
- Department of Internal Medicine-Rheumatology, Croix Saint Simon Hospital, Paris, France
- French Network of Inherited Metabolic Disorders (G2m), France
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, Meyer University Children’s Hospital, Florence, Italy
| | - Juan Politei
- Department of Neurology, Fundacion Para el Estudio de Enfermedades Neurometabolicas (FESEN), Buenos Aires, Argentina
| | | | - Roser Torra
- Inherited Kidney Disorders, Department of Nephrology, Fundació Puigvert, Institut d’Investigació Biomèdica Sant Pau (IIB-SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Camilla Tøndel
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Derralynn A. Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
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12
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Hughes DA, Bichet DG, Giugliani R, Hopkin RJ, Krusinska E, Nicholls K, Olivotto I, Feldt-Rasmussen U, Sakai N, Skuban N, Sunder-Plassmann G, Torra R, Wilcox WR. Long-term multisystemic efficacy of migalastat on Fabry-associated clinical events, including renal, cardiac and cerebrovascular outcomes. J Med Genet 2023; 60:722-731. [PMID: 36543533 PMCID: PMC10359570 DOI: 10.1136/jmg-2022-108669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fabry disease is a rare, multisystemic disorder caused by GLA gene variants that lead to alpha galactosidase A deficiency, resulting in accumulation of glycosphingolipids and cellular dysfunction. Fabry-associated clinical events (FACEs) cause significant morbidity and mortality, yet the long-term effect of Fabry therapies on FACE incidence remains unclear. METHODS This posthoc analysis evaluated incidence of FACEs (as a composite outcome and separately for renal, cardiac and cerebrovascular events) in 97 enzyme replacement therapy (ERT)-naïve and ERT-experienced adults with Fabry disease and amenable GLA variants who were treated with migalastat for up to 8.6 years (median: 5 years) in Phase III clinical trials of migalastat. Associations between baseline characteristics and incidence of FACEs were also evaluated. RESULTS During long-term migalastat treatment, 17 patients (17.5%) experienced 22 FACEs and there were no deaths. The incidence rate of FACEs was 48.3 events per 1000 patient-years overall. Numerically higher incidence rates were observed in men versus women, patients aged >40 years versus younger patients, ERT-naïve versus ERT-experienced patients and men with the classic phenotype versus men and women with all other phenotypes. There was no statistically significant difference in time to first FACE when analysed by patient sex, phenotype, prior treatment status or age. Lower baseline estimated glomerular filtration rate (eGFR) was associated with an increased risk of FACEs across patient populations. CONCLUSIONS The overall incidence of FACEs for patients during long-term treatment with migalastat compared favourably with historic reports involving ERT. Lower baseline eGFR was a significant predictor of FACEs.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Daniel G Bichet
- Hôpital du Sacré Coeur, University of Montréal, Montréal, Quebec, Canada
| | - Roberto Giugliani
- Medical Genetics Service, HCPA, Department of Genetics, UFRGS, DASA and INAGEMP, Porto Alegre, Brazil
| | - Robert J Hopkin
- Division of Human Genetics, College of Medicine, Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio, USA
| | - Eva Krusinska
- Clinical Development, Amicus Therapeutics Inc, Philadelphia, Pennsylvania, USA
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Norio Sakai
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nina Skuban
- Clinical Development, Amicus Therapeutics Inc, Philadelphia, Pennsylvania, USA
| | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Roser Torra
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - William R Wilcox
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
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13
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Ortiz A, Ars E, Bernis C, Fraga G, Furlano M, Martínez V, Martins J, Pérez-Gómez MV, Rodríguez-Pérez JC, Sans L, Torra R. Reply to Comments on the SENefro Consensus Document on Autosomal Dominant Polycystic Kidney Disease. Nefrologia 2023; 43:152-153. [PMID: 37217372 DOI: 10.1016/j.nefroe.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 05/24/2023] Open
Affiliation(s)
- Alberto Ortiz
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, RICORS2040, Madrid, Spain
| | - Elisabet Ars
- Laboratorio de Biología Molecular, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Carmen Bernis
- Servicio de Nefrología, Hospital de la Princesa, Instituto de Investigación Carlos III, Madrid, Spain
| | - Gloria Fraga
- Sección de Nefrología Pediátrica, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mónica Furlano
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), Barcelona, Spain
| | - Víctor Martínez
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Judith Martins
- Servicio de Nefrología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, Spain
| | - Maria Vanessa Pérez-Gómez
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, RICORS2040, Madrid, Spain
| | - José Carlos Rodríguez-Pérez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Spain
| | - Laia Sans
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Roser Torra
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), Barcelona, Spain.
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14
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Warady BA, Pergola PE, Agarwal R, Andreoli S, Appel GB, Bangalore S, Block GA, Chapman AB, Chin MP, Gibson KL, Goldsberry A, Iijima K, Inker LA, Kashtan CE, Knebelmann B, Mariani LH, Meyer CJ, Nozu K, O’Grady M, Rheault MN, Silva AL, Stenvinkel P, Torra R, Chertow GM. Effects of Bardoxolone Methyl in Alport Syndrome. Clin J Am Soc Nephrol 2022; 17:1763-1774. [PMID: 36411058 PMCID: PMC9718021 DOI: 10.2215/cjn.02400222] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Alport syndrome is an inherited disease characterized by progressive loss of kidney function. We aimed to evaluate the safety and efficacy of bardoxolone methyl in patients with Alport syndrome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We randomly assigned patients with Alport syndrome, ages 12-70 years and eGFR 30-90 ml/min per 1.73 m2, to bardoxolone methyl (n=77) or placebo (n=80). Primary efficacy end points were change from baseline in eGFR at weeks 48 and 100. Key secondary efficacy end points were change from baseline in eGFR at weeks 52 and 104, after an intended 4 weeks off treatment. Safety was assessed by monitoring for adverse events and change from baseline in vital signs, 12-lead electrocardiograms, laboratory measurements (including, but not limited to, aminotransferases, urinary albumin-creatinine ratio, magnesium, and B-type natriuretic peptide), and body weight. RESULTS Patients randomized to bardoxolone methyl experienced preservation in eGFR relative to placebo at 48 and 100 weeks (between-group differences: 9.2 [97.5% confidence interval, 5.1 to 13.4; P<0.001] and 7.4 [95% confidence interval, 3.1 to 11.7; P=0.0008] ml/min per 1.73 m2, respectively). After a 4-week off-treatment period, corresponding mean differences in eGFR were 5.4 (97.5% confidence interval, 1.8 to 9.1; P<0.001) and 4.4 (95% confidence interval, 0.7 to 8.1; P=0.02) ml/min per 1.73 m2 at 52 and 104 weeks, respectively. In a post hoc analysis with no imputation of missing eGFR data, the difference at week 104 was not statistically significant (1.5 [95% confidence interval, -1.9 to 4.9] ml/min per 1.73 m2). Discontinuations from treatment were more frequent among patients randomized to bardoxolone methyl; most discontinuations were due to protocol-specified criteria being met for increases in serum transaminases. Serious adverse events were more frequent among patients randomized to placebo. Three patients in each group developed kidney failure. CONCLUSIONS In adolescent and adult patients with Alport syndrome receiving standard of care, treatment with bardoxolone methyl resulted in preservation in eGFR relative to placebo after a 2-year study period; off-treatment results using all available data were not significantly different. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER A Phase 2/3 Trial of the Efficacy and Safety of Bardoxolone Methyl in Patients with Alport Syndrome - CARDINAL (CARDINAL), NCT03019185.
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Affiliation(s)
- Bradley A. Warady
- Division of Nephrology, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | | | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
| | - Sharon Andreoli
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gerald B. Appel
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Sripal Bangalore
- Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York
| | - Geoffrey A. Block
- Department of Clinical Research and Medical Affairs, US Renal Care, Inc., Plano, Texas
| | | | | | - Keisha L. Gibson
- University of North Carolina Kidney Center at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Lesley A. Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Clifford E. Kashtan
- Division of Pediatric Nephrology, Department of Pediatrics, Alport Syndrome Treatments and Outcomes Registry, University of Minnesota Medical School and Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Bertrand Knebelmann
- Department of Nephrology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Citè, Paris, France
| | - Laura H. Mariani
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Michelle N. Rheault
- Division of Pediatric Nephrology, Department of Pediatrics, Alport Syndrome Treatments and Outcomes Registry, University of Minnesota Medical School and Masonic Children’s Hospital, Minneapolis, Minnesota
| | | | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Roser Torra
- Inherited Kidney Disorders, Nephrology Department, Fundacio Puigvert, IIB Sant Pau, REDINREN (Instituto de Investigacion Carlos III), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Glenn M. Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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15
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Martínez V, Furlano M, Sans L, Pulido L, García R, Pérez-Gómez MV, Sánchez-Rodríguez J, Blasco M, Castro-Alonso C, Fernández-Fresnedo G, Robles NR, Valenzuela MP, Naranjo J, Martín N, Pilco M, Agraz-Pamplona I, González-Rodríguez JD, Panizo N, Fraga G, Fernández L, López MT, Dall´Anese C, Ortiz A, Torra R, Marcas L, Rius A, Tomás P, García L, Luna E, Martín MA, Íñigo P, Martins J, Ramos F, García R, del Río García L, del Carmen Merino M, Fernández-Reyes MJ, Madariaga L, Canal C, Martínez AM, Echarri R, Bouarich H, Cabezas A. Autosomal Dominant Polycystic Kidney Disease in Young Adults. Clin Kidney J 2022. [DOI: 10.1093/ckj/sfac251] [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: 12/03/2022] Open
Abstract
Abstract
Background
The clinical manifestations of autosomal dominant polycystic kidney disease (ADPKD) usually appear in adulthood, however pediatric series report a high morbidity. The objective of the study was to analyze the clinical characteristics of young ADPKD adults.
Methods
Family history, hypertension, albuminuria, eGFR and imaging tests were examined in 346 young adults (18-30 years) out of 2580 patients in the Spanish ADPKD registry (REPQRAD). A literature review searched for reports on hypertension in series with more than 50 young (age <30 years) ADPKD patients.
Results
The mean age of this young adult cohort was 25.24 (SD 3.72) years. The mean age at diagnosis of hypertension was 21.15 (SD 4.62) years, while in the overall REPQRAD population was 37.6 years. The prevalence of hypertension was 28.03% and increased with age (18 to 24 years: 16.8%, 25 to 30 years: 36.8%). Although prevalence was lower in women than in men, the age at onset of hypertension (21 years) was similar in both sexes. Mean eGFR was 108 (SD 21) ml/min/1.73m2, 38.0% had liver cysts and 3.45% of those studied had intracranial aneurysms. In multivariate analyses, hematuria episodes and kidney length were independent predictors of hypertension (AUC 0.75). The prevalence of hypertension in 22 pediatric cohorts was 20-40%, but no literature reports on hypertension in young ADPKD adults were found.
Conclusions
Young adults present non-negligible ADPKD-related morbidity. This supports the need for a thorough assessment of young adults at risk of ADPKD that allows early diagnosis and treatment of hypertension.
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Affiliation(s)
- Víctor Martínez
- Nephrology Department, Hospital Universitario Virgen de la Arrixaca , Murcia , Spain
| | - Mónica Furlano
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU)
| | - Laia Sans
- Nephrology Department, Hospital del Mar , Barcelona , Spain
| | - Lissett Pulido
- Nephrology Department, Hospital Universitario Joan XXIII , Tarragona , Spain
| | - Rebeca García
- Nephrology Department, Hospital La Mancha-Centro , Alcázar de San Juan, Spain
| | - Mara Vanessa Pérez-Gómez
- Nephrology Department, IIS-Fundación Jiménez Diaz, Universidad Autónoma de Madrid , IRSIN, RICORS40, Madrid , Spain
| | - Jinny Sánchez-Rodríguez
- Nephrology Department, IIS-Fundación Jiménez Diaz, Universidad Autónoma de Madrid , IRSIN, RICORS40, Madrid , Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Institute of Biomedical Research August Pi i Sunyer (IDIPABS), University of Barcelona , Barcelona , Spain
| | | | | | | | | | - Javier Naranjo
- Nephrology Department, Hospital Universitario Puerta del Mar , Cádiz, Spain
| | - Nadia Martín
- Nephrology Department, Hospital Universitari de Girona Dr. Josep Trueta , Gerona, Spain
| | - Melissa Pilco
- Nephrology Department, Hospital Universitari de Girona Dr. Josep Trueta , Gerona, Spain
| | | | | | - Nayara Panizo
- Nephrology Department, Hospital Universitari i Politècnic la Fe , Valencia , Spain
| | - Gloria Fraga
- Pediatric Nephrology Department, Hospital Santa Creu i Sant Pau , Barcelona , Spain
| | - Loreto Fernández
- Nephrology Department, Hospital Príncipe de Asturias , Alcalá de Henares, Spain
| | | | | | - Alberto Ortiz
- Nephrology Department, IIS-Fundación Jiménez Diaz, Universidad Autónoma de Madrid , IRSIN, RICORS40, Madrid , Spain
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut dInvestigació Biomèdica Sant Pau (IIB-SANT PAU) , Universitat Autònoma de Barcelona, Barcelona , Spain
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Quiroga B, Torra R. Dietary Aspects and Drug-Related Side Effects in Autosomal Dominant Polycystic Kidney Disease Progression. Nutrients 2022; 14:4651. [PMID: 36364911 PMCID: PMC9658114 DOI: 10.3390/nu14214651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 08/30/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most commonly inherited kidney disease. In the absence of targeted therapies, it invariably progresses to advanced chronic kidney disease. To date, the only approved treatment is tolvaptan, a vasopressin V2 receptor antagonist that has been demonstrated to reduce cyst growth and attenuate the decline in kidney function. However, it has various side effects, the most frequent of which is aquaresis, leading to a significant discontinuation rate. The strategies proposed to combat aquaresis include the use of thiazides or metformin and a reduction in the dietary osmotic load. Beyond the prescription of tolvaptan, which is limited to those with a rapid and progressive decline in kidney function, dietary interventions have been suggested to protect against disease progression. Moderate sodium restriction, moderate protein intake (up to 0.8 g/kg/day), avoidance of being overweight, and increased water consumption are recommended in ADPKD guidelines, though all with low-grade evidence. The aim of the present review is to critically summarize the evidence on the effect of dietary modification on ADPKD and to offer some strategies to mitigate the adverse aquaretic effects of tolvaptan.
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Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain
| | - Roser Torra
- Inherited Kidney Disorders, Department of Nephrology, Fundació Puigvert, Institut d’Investigació Biomèdica Sant Pau (IIB-SANT PAU), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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17
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Ortiz A, Wanner C, Gansevoort R, Wanner C, Gansevoort RT, Cozzolino M, Fliser D, Gambaro G, Ong A, Rosenkranz AR, Rychlık I, Sarafidis P, Torra R, Tuglular S. Chronic kidney disease as cardiovascular risk factor in routine clinical practice: a position statement by the Council of the European Renal Association. Clin Kidney J 2022; 16:403-407. [PMID: 36865018 PMCID: PMC9972834 DOI: 10.1093/ckj/sfac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Indexed: 11/14/2022] Open
Abstract
The European Society of Cardiology 2021 guideline on cardiovascular (CV) disease (CVD) prevention in clinical practice has major implications for both CV risk screening and kidney health of interest to primary care physicians, cardiologists, nephrol-ogists, and other professionals involved in CVD prevention. The proposed CVD prevention strategies require as first step the categorization of individuals into those with established atherosclerotic CVD, diabetes, familiar hypercholesterolaemia, or chronic kidney disease (CKD), i.e. conditions that are already associated with a moderate to very-high CVD risk. This places CKD, defined as decreased kidney function or increased albuminuria as a starting step for CVD risk assessment. Thus, for adequate CVD risk assessment, patients with diabetes, familiar hypercholesterolaemia, or CKD should be identified by an initial laboratory assessment that requires not only serum to assess glucose, cholesterol, and creatinine to estimate the glomerular filtration rate, but also urine to assess albuminuria. The addition of albuminuria as an entry-level step in CVD risk assessment should change clinical practice as it differs from the current healthcare situation in which albuminuria is only assessed in persons already considered to be at high risk of CVD. A diagnosis of moderate of severe CKD requires a specific set of interventions to prevent CVD. Further research should address the optimal method for CV risk assessment that includes CKD assessment in the general population, i.e. whether this should remain opportunistic screening or whether systematic screening.
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Affiliation(s)
- Alberto Ortiz
- IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain,Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
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18
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Ortiz A, Ars E, Bernis C, Fraga G, Furlano M, Martínez V, Martins J, Pérez-Gómez MV, Rodríguez-Pérez JC, Sans L, Torra R. Respuesta a Comentarios sobre el Documento de Consenso de Poliquistosis Renal Autosómica Dominante de la SENefro. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.07.002] [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: 11/29/2022] Open
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19
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Ars E, Bernis C, Fraga G, Furlano M, Martínez V, Martins J, Ortiz A, Pérez-Gómez MV, Rodríguez-Pérez JC, Sans L, Torra R. Consensus document on autosomal dominant polycystic kindey disease from the Spanish Working Group on Inherited Kindey Diseases. Review 2020. Nefrologia 2022; 42:367-389. [PMID: 36404270 DOI: 10.1016/j.nefroe.2022.11.011] [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: 06/17/2020] [Accepted: 05/02/2021] [Indexed: 06/16/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent cause of genetic renal disease and accounts for 6-10% of patients on kidney replacement therapy (KRT). Very few prospective, randomized trials or clinical studies address the diagnosis and management of this relatively frequent disorder. No clinical guidelines are available to date. This is a revised consensus statement from the previous 2014 version, presenting the recommendations of the Spanish Working Group on Inherited Kidney Diseases, which were agreed to following a literature search and discussions. Levels of evidence mostly are C and D according to the Centre for Evidence-Based Medicine (University of Oxford). The recommendations relate to, among other topics, the use of imaging and genetic diagnosis, management of hypertension, pain, cyst infections and bleeding, extra-renal involvement including polycystic liver disease and cranial aneurysms, management of chronic kidney disease (CKD) and KRT and management of children with ADPKD. Recommendations on specific ADPKD therapies are provided as well as the recommendation to assess rapid progression.
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Affiliation(s)
- Elisabet Ars
- Laboratorio de Biología Molecular, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Carmen Bernis
- Servicio de Nefrología, Hospital de la Princesa, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Gloria Fraga
- Sección de Nefrología Pediátrica, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mónica Furlano
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), REDinREN, Barcelona, Spain
| | - Víctor Martínez
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Judith Martins
- Servicio de Nefrología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, Spain
| | - Alberto Ortiz
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, IRSIN, REDinREN, Madrid, Spain
| | - Maria Vanessa Pérez-Gómez
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, IRSIN, REDinREN, Madrid, Spain
| | - José Carlos Rodríguez-Pérez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Laia Sans
- Servicio de Nefrología, REDinREN, Instituto de Investigación Carlos III, Hospital del Mar, Barcelona, Spain
| | - Roser Torra
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), REDinREN, Barcelona, Spain.
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20
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Winterbottom J, Simms RJ, Caroli A, Gall ECL, Demoulin N, Furlano M, Meijer E, Devuyst O, Gansevoort RT, Le-Meur Y, Perico N, Torra R, Ong ACM. Flank pain has a significant adverse impact on quality of life in ADPKD: the CYSTic-QoL study. Clin Kidney J 2022; 15:2063-2071. [PMID: 36825031 PMCID: PMC9942441 DOI: 10.1093/ckj/sfac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder and a major cause of kidney failure worldwide. However, its impact on quality-of-life has not been systematically explored. Methods The CYSTic-QoL study was an observational study designed to study quality-of-life in adult European ADPKD patients with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2. A total of 465 patients were recruited from six expert European centres with baseline data recorded, including health-related quality-of-life (HRQoL), incorporating a Kidney Disease QoL short form questionnaire (KDQoL-SF, version 1.3), magnetic resonance imaging (MRI) for total kidney volume (TKV) measurements and DNA for genotyping. The cohort was stratified by baseline eGFR, TKV or genotype and correlated with HRQoL scores. Bivariate and multivariate analyses were applied to examine the relationship between HRQoL and variables of interest. KDQoL-SF scores were calculated using an online tool provided by the RAND organization. For 36-item short form values, mean centre scores were normalized to their native populations. Results The mean age of participants was 43 years and 55% were female, with a mean eGFR of 77 mL/min/1.73 m2 and height-adjusted TKV (ht-TKV) of 849 mL/min; 66% had PKD1 pathogenic variants. ADPKD patients uniformly reported decreased general health and less energy, with the majority also experiencing poorer physical, mental or emotional health and limitations in social functioning. A total of 32.5% of participants experienced flank pain, which was significantly and negatively correlated with the majority of KDQoL-SF subscales by multivariate analysis. Higher ht-TKV and lower eGFR were negatively associated with decreased energy and poorer physical health, respectively, although not with flank pain. Conclusion ADPKD patients suffer from significantly decreased QoL in multiple domains, exacerbated particularly by chronic pain.
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Affiliation(s)
- Jean Winterbottom
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Roslyn J Simms
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anna Caroli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | | | - Nathalie Demoulin
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Monica Furlano
- Inherited Kidney Disorders, Nephrology Department, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Meijer
- Department of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Olivier Devuyst
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yannick Le-Meur
- Brest University, Inserm, UMR 1227, LBAI, CHU Brest, Brest, France
| | - Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Roser Torra
- Inherited Kidney Disorders, Nephrology Department, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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21
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Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease leading to kidney failure. To date, there is no cure for the disease although there is one approved disease-modifying therapy: tolvaptan. In this context, a common question that ADPKD patients ask in clinical practice is whether there is anything they can do to slow their disease by modifying their diet or lifestyle. Recent evidence from experimental PKD models has shown the potential benefits of caloric restriction, high water intake and especially ketogenic diets in preserving kidney function. Whether these benefits are translatable to humans remains unknown. In this issue of CKJ, Strubl et al. report results of a self-enrolled survey of autosomal dominant polycystic kidney disease (ADPKD) patients who have self-administered a ketogenic diet [1]. These results provide interesting insights into the tolerability, potential benefits and harms of such an intervention that could inform a future clinical trial.
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Affiliation(s)
- Albert C M Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Roser Torra
- Inherited Kidney Disorders, Department of Nephrology, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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22
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Rodríguez Espinosa D, Jesus Broseta Monzo J, Cuadrado E, Fernando Quintana Porras L, Poch E, Piñeiro G, Agraz I, Sánchez-Baya M, Furlano M, Ruiz C, Torra R, Blasco M. MO009: Creatine-Kinase Elevation in Autosomal Dominant Polycystic Kidney Disease Patients on Tolvaptan Treatment. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac061.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage kidney disease. Currently, tolvaptan is the only treatment that has proven to delay disease progression. The most notable side-effect of this therapy is drug-induced liver injury; however, recently, there have been two reports of creatine kinase (CK) elevation in ADPKD patients on tolvaptan treatment. We set out to monitor and determine the actual incidence of CK elevation and evaluate its potential association with other clinical factors.
METHOD
This is an observational prospective multicenter study performed in rapidly progressive ADPKD patients on tolvaptan treatment from Barcelona, Spain. Laboratory tests, demographics, treatment dose and reported symptoms were collected from October 2018 to March 2021.
RESULTS
Ninety-five patients initiated tolvaptan treatment during follow-up. The medication had to be discontinued in 31 (32.6%) patients, primarily due to aquaretic effects (12.6%), elevated liver enzymes (8.4%) and symptomatic or persistently elevated CK levels (3.2%). Moreover, a total of 27 (28.4%) patients elevated CK levels, with most of them being either transient (12.6%), mild and asymptomatic (4.2%), or resolved after dose reduction (3.2%) or temporary discontinuation (2.1%).
CONCLUSION
We present the largest cohort that has monitored CK levels in a real-life setting, finding them elevated in 28.4% of patients. More research and monitoring will help us understand the clinical implications and the pathophysiological mechanism of CK elevation in this population.
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Affiliation(s)
| | | | | | | | | | | | - Irene Agraz
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
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23
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Aapkes SE, Bernts LHP, van den Berg AP, van den Berg M, Blokzijl H, Cantineau AEP, van Gastel MDA, de Haas RJ, Kappert P, Müller RU, Nevens F, Torra R, Visser A, Drenth JPH, Gansevoort RT. Protocol for a randomized controlled multicenter trial assessing the efficacy of leuprorelin for severe polycystic liver disease: the AGAINST-PLD study. BMC Gastroenterol 2022; 22:82. [PMID: 35216547 PMCID: PMC8876117 DOI: 10.1186/s12876-022-02142-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background In patients with severe polycystic liver disease (PLD), there is a need for new treatments. Estrogens and possibly other female sex hormones stimulate growth in PLD. In some patients, liver volume decreases after menopause. Female sex hormones could therefore be a target for therapy. The AGAINST-PLD study will examine the efficacy of the GnRH agonist leuprorelin, which blocks the production of estrogen and other sex hormones, to reduce liver growth in PLD.
Methods The AGAINST-PLD study is an investigator-driven, multicenter, randomized controlled trial. Institutional review board (IRB) approval was received at the University Medical Center of Groningen and will be collected in other sites before opening these sites. Thirty-six female, pre-menopausal patients, with a very large liver volume for age (upper 10% of the PLD population) and ongoing liver growth despite current treatment options will be randomized to direct start of leuprorelin or to 18 months standard of care and delayed start of leuprorelin. Leuprorelin is given as 3.75 mg subcutaneously (s.c.) monthly for the first 3 months followed by 3-monthly depots of 11.25 mg s.c. The trial duration is 36 months. MRI scans to measure liver volume will be performed at screening, 6 months, 18 months, 24 months and 36 months. In addition, blood will be drawn, DEXA-scans will be performed and questionnaires will be collected. This design enables comparison between patients on study treatment and standard of care (first 18 months) and within patients before and during treatment (whole trial). Main outcome is annualized liver growth rate compared between standard of care and study treatment. Secondary outcomes are PLD disease severity, change in liver growth within individuals and (serious) adverse events. The study is designed as a prospective open-label study with blinded endpoint assessment (PROBE). Discussion In this trial, we combined the expertise of hepatologist, nephrologists and gynecologists to study the effect of leuprorelin on liver growth in PLD. In this way, we hope to stop liver growth, reduce symptoms and reduce the need for liver transplantation in severe PLD. Trial registration Eudra CT number 2020-005949-16, registered at 15 Dec 2020. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2020-005949-16.
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Affiliation(s)
- S E Aapkes
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L H P Bernts
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A P van den Berg
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M van den Berg
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Blokzijl
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A E P Cantineau
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M D A van Gastel
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R J de Haas
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P Kappert
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R U Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - F Nevens
- Department of Gastroenterology and Hepatology, Universiteitsziekenhuis Leuven, Leuven, Belgium
| | - R Torra
- Department of Nephrology, Fundacio Puigvert, Barcelona, Spain
| | - A Visser
- Department of Applied Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Hughes DA, Aguiar P, Lidove O, Nicholls K, Nowak A, Thomas M, Torra R, Vujkovac B, West ML, Feriozzi S. Do clinical guidelines facilitate or impede drivers of treatment in Fabry disease? Orphanet J Rare Dis 2022; 17:42. [PMID: 35135579 PMCID: PMC8822651 DOI: 10.1186/s13023-022-02181-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Variable disease progression confounds accurate prognosis in Fabry disease. Evidence supports the long-term benefit of early intervention with disease-specific therapy, but current guidelines recommend treatment initiation based on signs that may present too late to avoid irreversible organ damage. Findings from the ‘PRoposing Early Disease Indicators for Clinical Tracking in Fabry Disease’ (PREDICT-FD) initiative included expert consensus on 27 early indicators of disease progression in Fabry disease and on drivers of and barriers to treatment initiation in Fabry disease. Here, we compared the PREDICT-FD indicators with guidance from the European Fabry Working Group and various national guidelines to identify differences in signs supporting treatment initiation and how guidelines themselves might affect initiation. Finally, anonymized patient histories were reviewed by PREDICT-FD experts to determine whether PREDICT-FD indicators supported earlier treatment than existing guidance. Results Current guidelines generally aligned with PREDICT-FD on indicators of renal involvement, but most lacked specificity regarding cardiac indicators. The prognostic significance of neurological indicators such as white matter lesions (excluded by PREDICT-FD) was questioned in some guidelines and excluded from most. Some PREDICT-FD patient-reported signs (e.g., febrile crises) did not feature elsewhere. Key drivers of treatment initiation in PREDICT-FD were: (A) male sex, young age, and clinical findings (e.g., severe pain, organ involvement), (B) improving clinical outcomes and preventing disease progression, and (C) a family history of Fabry disease (especially if outcomes were severe). All guidelines aligned with (A) and several advocated therapy for asymptomatic male patients. There was scant evidence of (B) in current guidance: for example, no countries mandated ancillary symptomatic therapy, and no guidance advocated familial screening with (C) when diagnosis was confirmed. Barriers were misdiagnosis and a lack of biomarkers to inform timing of treatment. Review of patient histories generally found equal or greater support for treatment initiation with PREDICT-FD indicators than with other guidelines and revealed that the same case and guideline criteria often yielded different treatment recommendations. Conclusions Wider adoption of PREDICT-FD indicators at a national level could promote earlier treatment in Fabry disease. Clearer, more concise guidance is needed to harmonize treatment initiation in Fabry disease internationally. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02181-4.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Institute of Immunity and Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, NW3 2PF, UK. .,Department of Haematology, University College London, London, UK.
| | - Patrício Aguiar
- Inborn Errors of Metabolism Reference Center, North Lisbon Hospital Center, Lisbon, Portugal.,Medicine Department, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Olivier Lidove
- Department of Internal Medicine-Rheumatology, Croix Saint Simon Hospital, Paris, France
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, University of Melbourne - Parkville Campus, Parkville, VIC, Australia
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Department of Internal Medicine, Psychiatry University Hospital Zurich, Zurich, Switzerland
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Roser Torra
- Inherited Renal Diseases Unit, Fundacio Puigvert, University Autónoma de Barcelona, Barcelona, Spain
| | - Bojan Vujkovac
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Michael L West
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
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25
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Naranjo J, Furlano M, Torres F, Hernandez J, Pybus M, Ejarque L, Cordoba C, Guirado L, Ars E, Torra R. Comparative analysis of tools to predict rapid progression in autosomal dominant polycystic kidney disease. Clin Kidney J 2021; 15:912-921. [PMID: 35498884 PMCID: PMC9050526 DOI: 10.1093/ckj/sfab293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease and shows a wide phenotype. Only patients with rapid progression (RP) are included in clinical trials or are approved to receive disease-modifying drugs. This study aims at comparing different available predictive tools in ADPKD with the Mayo classification (MC) identification of rapid progressors based on high total kidney volume (TKV) according to age. Methods A total of 164 ADPKD patients were recruited retrospectively from a single centre. The performance of diverse tools to identify RP defined as being in MC categories 1C–1E was assessed. Results A total of 118 patients were MC 1C–1E. The algorithm developed by the European Renal Association–European Dialysis and Transplant Association Working Group on Inherited Kidney Disorders/European Renal Best Practice had a low sensitivity in identifying MC 1C–1E. The sensitivity and specificity of TKV to predict RP depend on the cut-off used. A kidney length of >16.5 cm before age 45 years has high specificity but low sensitivity. Assessing the MC by ultrasonography had high levels of agreement with magnetic resonance imaging (MRI) data, especially for 1A, 1D and 1E. The estimated glomerular filtration rate (eGFR) decline was very sensitive but had low specificity. In contrast, the Predicting Renal Outcome in Polycystic Kidney Disease (PROPKD) score was very specific but had poor sensitivity. Having hypertension before 35 years of age is a good clinical predictor of MC 1C–1E. Family history can be of help in suggesting RP, but by itself it lacks sufficient sensitivity and specificity. Conclusions The MC by ultrasonography could be an option in hospitals with limited access to MRI as it performs well generally, and especially at the extremes of the MC, i.e. classes 1A, 1D and 1E. The eGFR decline is sensitive but not very specific when compared with the MC, whereas the PROPKD score is very specific but has low sensitivity. Integrating the different tools currently available to determine RP should facilitate the identification of rapid progressors among patients with ADPKD.
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Affiliation(s)
- Javier Naranjo
- Nephrology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Medicine Department, Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
| | - Mónica Furlano
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Medicine Department, Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
| | - Ferran Torres
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | | | - Marc Pybus
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
| | - Laia Ejarque
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
| | - Christian Cordoba
- Nephrology Department, Fundació Puigvert, REDinREN, IIB Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lluis Guirado
- Nephrology Department, Fundació Puigvert, REDinREN, IIB Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Medicine Department, Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
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Bichet DG, Torra R, Wallace E, Hughes D, Giugliani R, Skuban N, Krusinska E, Feldt-Rasmussen U, Schiffmann R, Nicholls K. Corrigendum to "Long-term follow-up of renal function in patients treated with migalastat for Fabry disease" [Bichet et al., MGM Reports; 28 (2021) 100786]. Mol Genet Metab Rep 2021; 29:100807. [PMID: 34934630 DOI: 10.1016/j.ymgmr.2021.100807] [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: 11/17/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.ymgmr.2021.100786.].
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Affiliation(s)
- Daniel G Bichet
- Department of Medicine, Hôpital du Sacré-Coeur, University of Montréal, Montreal, Quebec, Canada
| | - Roser Torra
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, REDINREN, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eric Wallace
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Roberto Giugliani
- Medical Genetics Service, Department of Genetics, Institute of Biosciences, Institute of Basic Health Sciences, Faculty of Medicine, Faculty of Pharmacy (UFRGS) and National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Nina Skuban
- Amicus Therapeutics, Inc., Cranbury, NJ, USA
| | | | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Kathy Nicholls
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Müller RU, Messchendorp AL, Birn H, Capasso G, Cornec-Le Gall E, Devuyst O, van Eerde A, Guirchoun P, Harris T, Hoorn EJ, Knoers NVAM, Korst U, Mekahli D, Le Meur Y, Nijenhuis T, Ong ACM, Sayer JA, Schaefer F, Servais A, Tesar V, Torra R, Walsh SB, Gansevoort RT. An update on the use of tolvaptan for ADPKD: Consensus statement on behalf of the ERA Working Group on Inherited Kidney Disorders (WGIKD), the European Rare Kidney Disease Reference Network (ERKNet) and Polycystic Kidney Disease International (PKD-International). Nephrol Dial Transplant 2021; 37:825-839. [PMID: 35134221 PMCID: PMC9035348 DOI: 10.1093/ndt/gfab312] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
Approval of the vasopressin V2 receptor antagonist tolvaptan—based on the landmark TEMPO 3:4 trial—marked a transformation in the management of autosomal dominant polycystic kidney disease (ADPKD). This development has advanced patient care in ADPKD from general measures to prevent progression of chronic kidney disease to targeting disease-specific mechanisms. However, considering the long-term nature of this treatment, as well as potential side effects, evidence-based approaches to initiate treatment only in patients with rapidly progressing disease are crucial. In 2016, the position statement issued by the European Renal Association (ERA) was the first society-based recommendation on the use of tolvaptan and has served as a widely used decision-making tool for nephrologists. Since then, considerable practical experience regarding the use of tolvaptan in ADPKD has accumulated. More importantly, additional data from REPRISE, a second randomized clinical trial (RCT) examining the use of tolvaptan in later-stage disease, have added important evidence to the field, as have post hoc studies of these RCTs. To incorporate this new knowledge, we provide an updated algorithm to guide patient selection for treatment with tolvaptan and add practical advice for its use.
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Affiliation(s)
| | - A Lianne Messchendorp
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Departments of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, Vanvitelli University, Naples, Italy
- Biogem Institute for Molecular Biology and Genetics, Ariano Irpino, Italy
| | | | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, UCL Medical School, Brussels, Belgium
| | - Albertien van Eerde
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nine V A M Knoers
- Department Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Uwe Korst
- PKD Familiäre Zystennieren e.V., Bensheim, Germany
| | - Djalila Mekahli
- PKD Research Group, Laboratory of Pediatrics, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology and Organ Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Yannick Le Meur
- Department of Nephrology, Hemodialysis and Renal Transplantation, CHU and University of Brest, Brest, France
| | - Tom Nijenhuis
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboudumc Center of Expertise for Rare Kidney Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Albert C M Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Aude Servais
- Nephrology and Transplantation Department, Necker University Hospital, APHP, Paris, France
| | - Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | - Roser Torra
- Inherited Kidney Diseases Nephrology Department, Fundació Puigvert Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- REDINREN, Barcelona, Spain
| | - Stephen B Walsh
- Department of Renal Medicine, University College London, London, UK
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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28
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Goicoechea M, Gomez-Preciado F, Benito S, Torras J, Torra R, Huerta A, Restrepo A, Ugalde J, Astudillo DE, Agraz I, Lopez-Mendoza M, de Arriba G, Corchete E, Quiroga B, Gutierrez MJ, Martin-Conde ML, Lopes V, Ramos C, Mendez I, Cao M, Dominguez F, Ortiz A. Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy. Nefrologia 2021; 41:652-660. [PMID: 36165155 DOI: 10.1016/j.nefroe.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 06/16/2023] Open
Abstract
UNLABELLED Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología Hospital General Universitario Gregorio Marañon, Spain; Red de Investigación Renal (REDinRen), Fondos FEDER, Spain.
| | | | | | - Joan Torras
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Hospital Universitario de Bellvitge, Spain
| | - Roser Torra
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Fundacion Puigvert, Spain
| | - Ana Huerta
- Servicio de Nefrología Hospital Universitario Puerta del Hierro Majadahonda, Spain
| | | | - Jessica Ugalde
- Servicio de Nefrología Hospital Clinic de Barcelona, Spain
| | | | - Irene Agraz
- Servicio de Nefrología Hospital Vall d'Hebron, Spain
| | | | - Gabriel de Arriba
- Servicio de Nefrología Hospital General Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain
| | | | - Borja Quiroga
- Servicio de Nefrología Hospital Universitario de la Princesa, Spain
| | | | | | - Vanessa Lopes
- Servicio de Nefrología del Hospital Universitario Ramon y Cajal, Spain
| | - Carmela Ramos
- Servicio de Nefrología del Hospital Clínico Universitario de Valencia, Spain
| | - Irene Mendez
- Servicio de Cardiología del Hospital General Universitario Gregorio Marañon, Spain
| | - Mercedes Cao
- Servicio de Nefrología Complexo Hospitalario Universitario A Coruña, Spain
| | | | - Alberto Ortiz
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología de la Fundación Jimenez Diaz, Spain
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29
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Torra R, Pérez-Gómez MV, Furlano M. Autosomal dominant polycystic kidney disease: possibly the least silent cause of chronic kidney disease. Clin Kidney J 2021; 14:2281-2284. [PMID: 34754424 PMCID: PMC8573017 DOI: 10.1093/ckj/sfab132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 11/12/2022] Open
Abstract
Pain is the highest prioritized patient-reported outcome in people with autosomal dominant polycystic kidney disease (ADPKD) but it remains infrequently and inconsistently measured across countries, studies and trials. The study by El-Damanawi et al. integrated a network of ADPKD expert clinicians, pain specialists, researchers and patient representatives from the national UK PKD charity, with the aim of addressing the lack of validated ADPKD-specific pain assessment tools (APATs). The APAT designed by the authors included several pain measurement tools and was tested in ADPKD patients, although further validation through assessment in larger cohorts is needed. Establishing a standardized instrument for pain measurement will ensure that pain is measured and reported in a consistent way to inform decision-making and identify effective interventions aimed at managing pain and minimizing the impact pain has on patients with ADPKD. In this context, the APAT established by the authors is to be warmly welcomed.
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Affiliation(s)
- Roser Torra
- Inherited Kidney Diseases Nephrology Department, Fundació Puigvert IIB-Sant Pau Medicine Department, Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
| | | | - Mónica Furlano
- Inherited Kidney Diseases Nephrology Department, Fundació Puigvert IIB-Sant Pau Medicine Department, Universitat Autónoma de Barcelona, REDinREN, Barcelona, Spain
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30
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Domingo-Gallego A, Pybus M, Madariaga L, Piñero-Fernández JA, González-Pastor S, López-González M, Simarro-Rueda E, Quintanilla-Mata ML, Matoses-Ruipérez ML, Ejarque-Vila L, Gall ECL, Guirado L, Torra R, Ariceta G, Ars E. Clinical and genetic characterization of a cohort of proteinuric patients with biallelic CUBN variants. Nephrol Dial Transplant 2021; 37:1906-1915. [PMID: 34610128 DOI: 10.1093/ndt/gfab285] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Proteinuria is a well-known risk factor for progressive kidney impairment. Recently, C-terminal cubilin (CUBN) variants have been associated with isolated proteinuria without progression of kidney disease. METHODS Genetic testing of 347 families with proteinuria of suspected monogenic cause was performed by next-generation sequencing of a custom-designed kidney disease gene panel. Families with CUBN biallelic proteinuria-causing variants were studied at the clinical, genetic, laboratory, and pathologic levels. RESULTS Twelve families (15 patients) bearing homozygous or compound heterozygous proteinuria-causing variants in the C-terminal CUBN gene were identified, representing 3.5% of the total cohort. We identified 14 different sequence variants, five of which were novel. The median age at diagnosis of proteinuria was 4 years (range 9 months to 44 years), and in most cases proteinuria was detected incidentally. Thirteen patients had moderate-severe proteinuria at diagnosis without nephrotic syndrome. These patients showed lack of response to angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) treatment, normal kidney biopsy, and preservation of normal kidney function over time. The two remaining patients presented a more severe phenotype, likely caused by associated comorbidities. CONCLUSIONS Identification of C-terminal pathogenic CUBN variants is diagnostic of an entity characterized by glomerular proteinuria, normal kidney histology, and lack of response to ACEi/ARB treatment. This study adds evidence and increases awareness about albuminuria caused by C-terminal variants in the CUBN gene, which is a benign condition usually diagnosed in childhood with preserved renal function until adulthood.
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Affiliation(s)
- Andrea Domingo-Gallego
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Barcelona, Catalonia, Spain.,Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Barcelona, Catalonia, Spain
| | - Marc Pybus
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Barcelona, Catalonia, Spain.,Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Barcelona, Catalonia, Spain
| | - Leire Madariaga
- Pediatric Nephrology Department, Cruces University Hospital, Instituto de Investigación Sanitaria Biocruces-Bizkaia, CIBERER, CIBERDEM, Universidad del País Vasco UPV/EHU, Barakaldo, Spain
| | | | - Sara González-Pastor
- Pediatric Nephrology Department, Hospital Universitario Germans Trias i Pujol, Barcelona, Catalonia, Spain
| | - Mercedes López-González
- Pediatric Nephrology Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Esther Simarro-Rueda
- Clinical Analysis Department, Hospital General Universitario de Albacete, Castilla-La Mancha, Spain
| | | | | | - Laia Ejarque-Vila
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Barcelona, Catalonia, Spain
| | - Emilie Cornec-Le Gall
- Service de Néphrologie, Hémodialyse et Transplantation Rénale, Centre Hospitalier Universitaire, Brest, France; UMR1078 Génétique, Génomique Fonctionnelle et Biotechnologies, INSERM, Université de Brest, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Lluís Guirado
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Barcelona, Catalonia, Spain
| | - Roser Torra
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Barcelona, Catalonia, Spain
| | - Gema Ariceta
- Pediatric Nephrology Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Barcelona, Catalonia, Spain.,Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Barcelona, Catalonia, Spain
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31
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Bichet DG, Torra R, Wallace E, Hughes D, Giugliani R, Skuban N, Krusinska E, Feldt-Rasmussen U, Schiffmann R, Nicholls K. Long-term follow-up of renal function in patients treated with migalastat for Fabry disease. Mol Genet Metab Rep 2021; 28:100786. [PMID: 34401344 PMCID: PMC8353473 DOI: 10.1016/j.ymgmr.2021.100786] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 12/14/2022] Open
Abstract
The effect of migalastat on long-term renal outcomes in enzyme replacement therapy (ERT)-naive and ERT-experienced patients with Fabry disease is not well defined. An integrated posthoc analysis of the phase 3 clinical trials and open-label extension studies was conducted to evaluate long-term changes in renal function in patients with Fabry disease and amenable GLA variants who were treated with migalastat for ≥2 years during these studies. The analysis included ERT-naive (n = 36 [23 females]; mean age 45 years; mean baseline estimated glomerular filtration rate (eGFR), 91.4 mL/min/mL/1.73 m2) and ERT-experienced (n = 42 [24 females]; mean age, 50 years; mean baseline eGFR, 89.2 mL/min/1.73m2) patients with amenable variants who received migalastat 123 mg every other day for ≥2 years. The annualized rate of change from baseline to last observation in estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI) was calculated by both simple linear regression and a random coefficient model. In ERT-naive patients, mean annualized rates of change from baseline in eGFRCKD-EPI were - 1.6 mL/min/1.73 m2 overall and - 1.8 mL/min/1.73 m2 and - 1.4 mL/min/1.73 m2 in male and female patients, respectively, as estimated by simple linear regression. In ERT-experienced patients, mean annualized rates of change from baseline in eGFRCKD-EPI were - 1.6 mL/min/1.73 m2 overall and - 2.6 mL/min/1.73 m2 and - 0.8 mL/min/1.73 m2 in male and female patients, respectively. Mean annualized rate of change in eGFRCKD-EPI in ERT-naive patients with the classic phenotype (defined by white blood cell alpha galactosidase A [α-Gal A] activity of <3% of normal and multiorgan system involvement) was -1.7 mL/min/1.73 m2. When calculated using the random coefficient model, which adjusted for sex, age, and baseline renal function, the annualized eGFRCKD-EPI change was minimal (mean: -0.1 and 0.1 mL/min/1.73 m2 in ERT-naive and ERT-experienced patients, respectively). In conclusion, patients with Fabry disease and amenable GLA variants receiving long-term migalastat treatment (≤8.6 years) maintained renal function irrespective of treatment status, sex, or phenotype.
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Affiliation(s)
- Daniel G Bichet
- Department of Medicine, Hôpital du Sacré-Coeur, University of Montréal, Montreal, Quebec, Canada
| | - Roser Torra
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, REDINREN, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eric Wallace
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Roberto Giugliani
- Medical Genetics Service, Department of Genetics, Institute of Biosciences, Institute of Basic Health Sciences, Faculty of Medicine, Faculty of Pharmacy (UFRGS) and, National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Nina Skuban
- Amicus Therapeutics, Inc., Cranbury, NJ, USA
| | | | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Kathy Nicholls
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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32
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Furlano M, Martínez V, Pybus M, Arce Y, Crespí J, Venegas MDP, Bullich G, Domingo A, Ayasreh N, Benito S, Lorente L, Ruíz P, Gonzalez VL, Arlandis R, Cabello E, Torres F, Guirado L, Ars E, Torra R. Clinical and Genetic Features of Autosomal Dominant Alport Syndrome: A Cohort Study. Am J Kidney Dis 2021; 78:560-570.e1. [PMID: 33838161 DOI: 10.1053/j.ajkd.2021.02.326] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 05/16/2020] [Accepted: 02/14/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE & OBJECTIVE Alport syndrome is a common genetic kidney disease accounting for approximately 2% of patients receiving kidney replacement therapy (KRT). It is caused by pathogenic variants in the gene COL4A3, COL4A4, or COL4A5. The aim of this study was to evaluate the clinical and genetic spectrum of patients with autosomal dominant Alport syndrome (ADAS). STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 82 families (252 patients) with ADAS were studied. Clinical, genetic, laboratory, and pathology data were collected. OBSERVATIONS A pathogenic DNA variant in COL4A3 was identified in 107 patients (35 families), whereas 133 harbored a pathogenic variant in COL4A4 (43 families). Digenic/complex inheritance was observed in 12 patients. Overall, the median kidney survival was 67 (95% CI, 58-73) years, without significant differences across sex (P=0.8), causative genes (P=0.6), or type of variant (P=0.9). Microhematuria was the most common kidney manifestation (92.1%), and extrarenal features were rare. Findings on kidney biopsies ranged from normal to focal segmental glomerulosclerosis. The slope of estimated glomerular filtration rate change was-1.46 (-1.66 to-1.26) mL/min/1.73m2 per year for the overall group, with no significant differences between ADAS genes (P=0.2). LIMITATIONS The relatively small size of this series from a single country, potentially limiting generalizability. CONCLUSIONS Patients with ADAS have a wide spectrum of clinical presentations, ranging from asymptomatic to kidney failure, a pattern not clearly related to the causative gene or type of variant. The diversity of ADAS phenotypes contributes to its underdiagnosis in clinical practice.
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Affiliation(s)
- Mónica Furlano
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Medicine Department-Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Victor Martínez
- Nephrology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Marc Pybus
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Yolanda Arce
- Department of Pathology, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Jaume Crespí
- Departments of Ophthalmology, Hospital de Sant Pau i la Santa Creu, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - María Del Prado Venegas
- Otolaryngology-Head and Neck Surgery, Hospital de Sant Pau i la Santa Creu, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Gemma Bullich
- Centre Nacional d'Anàlisi Genómica, Centre for Genomic Regulation, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Andrea Domingo
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Nadia Ayasreh
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Medicine Department-Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Silvia Benito
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Medicine Department-Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Laura Lorente
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Patricia Ruíz
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Vanesa López Gonzalez
- Genetics Laboratory, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Rosa Arlandis
- Nephrology Department, Hospital General de la Palma, Islas Canarias, Spain
| | - Elisa Cabello
- Nephrology Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Ferran Torres
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lluis Guirado
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Medicine Department-Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain.
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Medicine Department-Universitat Autónoma de Barcelona, Red de Investigación Renal, Instituto de Investigación Carlos III, Barcelona, Spain.
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Chertow GM, Appel GB, Andreoli S, Bangalore S, Block GA, Chapman AB, Chin MP, Gibson KL, Goldsberry A, Iijima K, Inker LA, Knebelmann B, Mariani LH, Meyer CJ, Nozu K, O'Grady M, Silva AL, Stenvinkel P, Torra R, Warady BA, Pergola PE. Study Design and Baseline Characteristics of the CARDINAL Trial: A Phase 3 Study of Bardoxolone Methyl in Patients with Alport Syndrome. Am J Nephrol 2021; 52:180-189. [PMID: 33789284 DOI: 10.1159/000513777] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 10/27/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Alport syndrome is a rare genetic disorder that affects as many as 60,000 persons in the USA and a total of 103,000 persons (<5 per 10,000) in the European Union [1, 2]. It is the second most common inherited cause of kidney failure and is characterized by progressive loss of kidney function that often leads to end-stage kidney disease. Currently, there are no approved disease-specific agents for therapeutic use. We designed a phase 3 study (CARDINAL; NCT03019185) to evaluate the safety, tolerability, and efficacy of bardoxolone methyl in patients with Alport syndrome. METHODS The CARDINAL phase 3 study is an international, multicenter, double-blind, placebo-controlled, randomized registrational trial. Eligible patients were of ages 12-70 years with confirmed genetic or histologic diagnosis of Alport syndrome, eGFR 30-90 mL/min/1.73 m2, and urinary albumin to creatinine ratio (UACR) ≤3,500 mg/g. Patients with B-type natriuretic peptide values >200 pg/mL at baseline or with significant cardiovascular histories were excluded. Patients were randomized 1:1 to bardoxolone methyl or placebo, with stratification by baseline UACR. RESULTS A total of 371 patients were screened, and 157 patients were randomly assigned to receive bardoxolone methyl (n = 77) or placebo (n = 80). The average age at screening was 39.2 years, and 23 (15%) were <18 years of age. Of the randomized population, 146 (93%) had confirmed genetic diagnosis of Alport syndrome, and 62% of patients had X-linked mode of inheritance. Mean baseline eGFR was 62.7 mL/min/1.73 m2, and the geometric mean UACR was 141.0 mg/g. The average annual rate of eGFR decline prior to enrollment in the study was -4.9 mL/min/1.73 m2 despite 78% of the patient population receiving ACE inhibitor (ACEi) or ARB therapy. DISCUSSION/CONCLUSION CARDINAL is one of the largest interventional, randomized controlled trials in Alport syndrome conducted to date. Despite the use of ACEi or ARB, patients were experiencing significant loss of kidney function prior to study entry.
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Affiliation(s)
- Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Gerald B Appel
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sharon Andreoli
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sripal Bangalore
- Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York, USA
| | - Geoffrey A Block
- Department of Clinical Research and Medical Affairs, US Renal Care, Inc., Plano, Texas, USA
| | - Arlene B Chapman
- Section of Nephrology, University of Chicago, Chicago, Illinois, USA
| | - Melanie P Chin
- Department of Product Development, Reata Pharmaceuticals, Plano, Texas, USA
| | - Keisha L Gibson
- University of North Carolina Kidney Center at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angie Goldsberry
- Department of Product Development, Reata Pharmaceuticals, Plano, Texas, USA
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Bertrand Knebelmann
- Department of Nephrology, Necker Hospital, AP-HP, Université de Paris, Paris, France
| | - Laura H Mariani
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - Colin J Meyer
- Department of Product Development, Reata Pharmaceuticals, Plano, Texas, USA
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Megan O'Grady
- Department of Product Development, Reata Pharmaceuticals, Plano, Texas, USA
| | - Arnold L Silva
- Boise Kidney and Hypertension Institute, Meridian, Idaho, USA
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Roser Torra
- Inherited Kidney Disorders, Nephrology Department, Fundacio Puigvert, Instituto de Investigacion Carlos III, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
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Gorriz JL, Arroyo D, D'Marco L, Torra R, Tomás P, Puchades MJ, Panizo N, Pantoja J, Montomoli M, Llisterri JL, Pallares-Carratalá V, Valdivielso JM. Cardiovascular risk factors and the impact on prognosis in patients with chronic kidney disease secondary to autosomal dominant polycystic kidney disease. BMC Nephrol 2021; 22:110. [PMID: 33765945 PMCID: PMC7995703 DOI: 10.1186/s12882-021-02313-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent hereditary renal disease. There is an increased rate of cardiovascular disease (CVD) in ADPKD. In this study, we evaluate the prevalence of cardiovascular risk factors, the achievement rates for treatment goals and cardiovascular events (CVE) in ADPKD and their relations with asymptomatic CVD in CKD from other etiologies (CKDoe) and controls. METHODS We evaluated 2445 CKD patients (2010-2012). The information collected was: clinical, anthropometric and analytical parameters, treatments and CVD evaluation (intima-media thickness (IMT), atheromatous plaque presence and ankle-brachial index (ABI)). Laboratory, vital status, CVE and hospitalizations were collected for 4 years. RESULTS ADPKD patients had a worse renal function and worst achievement of blood pressure, higher parathormone levels but lower proteinuria compared to CKDoe. ADPKD patients presented lower IMT values than other groups, however, an intermediate rate of pathologic ABI and atheromatous plaque was present. More than half of the patients received statins, achieving LDL-c levels < 100 only in 50 and 39.8% of them (ADPKD and CKDoe respectively). The number of CVE during the follow-up period was low. In adjusted Cox regression model, ADPDK had the lowest occurrence of CVE of all three groups (HR:0.422, 95%CI 0.221-0.808, p = 0.009). CONCLUSION ADPKD patients show intermediate control rates of CVD. A better control of CVD risk seems to be related with a lower load of CVD compared to other groups, which may lead in the long term to a better prognosis. Further investigation is necessary to determine cardiovascular prognosis in ADPKD.
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Affiliation(s)
- José Luis Gorriz
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain.
| | - David Arroyo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis D'Marco
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Medicine Department-Universitat Autónoma de Barcelona, REDinREN, nstituto de Investigación Carlos III, Barcelona, Spain
| | - Patricia Tomás
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - María Jesús Puchades
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - Nayara Panizo
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - Jonay Pantoja
- Department of Nephrology, University Dr Peset Hospital, Valencia, Spain
| | - Marco Montomoli
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | | | - Vicente Pallares-Carratalá
- Health Surveillance Unit, Castellon Mutual Insurance Union, Castellon, Spain. Department of Medicine, Jaume I University, Castellon, Spain.
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain, 2 Statistics Department, University of Lleida, Lleida, Spain
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Torra R, Furlano M, Ortiz A, Ars E. Genetic kidney diseases as an underrecognized cause of chronic kidney disease: the key role of international registry reports. Clin Kidney J 2021; 14:1879-1885. [PMID: 34345410 PMCID: PMC8323147 DOI: 10.1093/ckj/sfab056] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 03/05/2021] [Indexed: 01/01/2023] Open
Abstract
Inherited kidney diseases (IKDs) are among the leading causes of early-onset chronic kidney disease (CKD) and are responsible for at least 10-15% of cases of kidney replacement therapy (KRT) in adults. Paediatric nephrologists are very aware of the high prevalence of IKDs among their patients, but this is not the case for adult nephrologists. Recent publications have demonstrated that monogenic diseases account for a significant percentage of adult cases of CKD. A substantial number of these patients have received a non-specific/incorrect diagnosis or a diagnosis of CKD of unknown aetiology, which precludes correct treatment, follow-up and genetic counselling. There are a number of reasons why genetic kidney diseases are difficult to diagnose in adulthood: (i) adult nephrologists, in general, are not knowledgeable about IKDs; (ii) existence of atypical phenotypes; (iii) genetic testing is not universally available; (iv) family history is not always available or may be negative; (v) lack of knowledge of various genotype-phenotype relationships and (vi) conflicting interpretation of the pathogenicity of many sequence variants. Registries can contribute to visualize the burden of IKDs by regularly grouping all IKDs in their annual reports, as is done for glomerulonephritis or interstitial diseases, rather than reporting only cystic disease and hiding other IKDs under labels such as 'miscellaneous' or 'other'. Any effort to reduce the percentage of patients needing KRT with a diagnosis of 'nephropathy of unknown etiology' or an unspecific/incorrect diagnosis should be encouraged as a step towards precision nephrology. Genetic testing may be of value in this context but should not be used indiscriminately, but rather on the basis of a deep knowledge of IKDs.
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Affiliation(s)
- Roser Torra
- Department of Nephrology, Inherited Kidney Diseases, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Medicine Department-Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Mónica Furlano
- Department of Nephrology, Inherited Kidney Diseases, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Medicine Department-Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Alberto Ortiz
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
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Goicoechea M, Gomez-Preciado F, Benito S, Torras J, Torra R, Huerta A, Restrepo A, Ugalde J, Astudillo DE, Agraz I, Lopez-Mendoza M, de Arriba G, Corchete E, Quiroga B, Gutierrez MJ, Martin-Conde ML, Lopes V, Ramos C, Mendez I, Cao M, Dominguez F, Ortiz A. Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy. Nefrologia 2021; 41:S0211-6995(21)00031-X. [PMID: 33714629 DOI: 10.1016/j.nefro.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología Hospital General Universitario Gregorio Marañon, Spain; Red de Investigación Renal (REDinRen), Fondos FEDER, Spain.
| | | | | | - Joan Torras
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Hospital Universitario de Bellvitge, Spain
| | - Roser Torra
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Fundacion Puigvert, Spain
| | - Ana Huerta
- Servicio de Nefrología Hospital Universitario Puerta del Hierro Majadahonda, Spain
| | | | - Jessica Ugalde
- Servicio de Nefrología Hospital Clinic de Barcelona, Spain
| | | | - Irene Agraz
- Servicio de Nefrología Hospital Vall d'Hebron, Spain
| | | | - Gabriel de Arriba
- Servicio de Nefrología Hospital General Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain
| | | | - Borja Quiroga
- Servicio de Nefrología Hospital Universitario de la Princesa, Spain
| | | | | | - Vanessa Lopes
- Servicio de Nefrología del Hospital Universitario Ramon y Cajal, Spain
| | - Carmela Ramos
- Servicio de Nefrología del Hospital Clínico Universitario de Valencia, Spain
| | - Irene Mendez
- Servicio de Cardiología del Hospital General Universitario Gregorio Marañon, Spain
| | - Mercedes Cao
- Servicio de Nefrología Complexo Hospitalario Universitario A Coruña, Spain
| | | | - Alberto Ortiz
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología de la Fundación Jimenez Diaz, Spain
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Domingo-Gallego A, Pybus M, Bullich G, Furlano M, Ejarque-Vila L, Lorente-Grandoso L, Ruiz P, Fraga G, López González M, Piñero-Fernández JA, Rodríguez-Peña L, Llano-Rivas I, Sáez R, Bujons-Tur A, Ariceta G, Lluis G, Torra R, Ars E. Clinical utility of genetic testing in early-onset kidney disease: seven genes are the main players. Nephrol Dial Transplant 2021; 37:687-696. [PMID: 33532864 DOI: 10.1093/ndt/gfab019] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Inherited kidney diseases are one of the leading causes of chronic kidney disease (CKD) that manifests before the age of 30 years. Precise clinical diagnosis of early-onset CKD is complicated due to the high phenotypic overlap, but genetic testing is a powerful diagnostic tool. We aimed to develop a genetic testing strategy to maximize the diagnostic yield for patients presenting with early-onset CKD and to determine the prevalence of the main causative genes. METHODS We performed genetic testing of 460 patients with early-onset CKD of suspected monogenic cause using next-generation sequencing of a custom-designed kidney disease gene panel in addition to targeted screening for c.428dupC MUC1. RESULTS We achieved a global diagnostic yield of 65% (300/460), which varied depending on the clinical diagnostic group: 77% in cystic kidney diseases, 76% in tubulopathies, 67% in autosomal dominant tubulointerstitial kidney disease, 61% in glomerulopathies, and 38% in congenital anomalies of the kidney and urinary tract. Among the 300 genetically diagnosed patients, the clinical diagnosis was confirmed in 77%, a specific diagnosis within a clinical diagnostic group was identified in 15%, and 7% of cases were reclassified. Of the 64 causative genes identified in our cohort, seven (COL4A3, COL4A4, COL4A5, HNF1B, PKD1, PKD2, and PKHD1) accounted for 66% (198/300) of the genetically diagnosed patients. CONCLUSIONS Two-thirds of patients with early-onset CKD in this cohort had a genetic cause. Just seven genes were responsible for the majority of diagnoses. Establishing a genetic diagnosis is crucial to define the precise etiology of CKD, which allows accurate genetic counseling and improved patient management.
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Affiliation(s)
- Andrea Domingo-Gallego
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain.,Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Marc Pybus
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain.,Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Gemma Bullich
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain.,Centre Nacional d'Anàlisi Genòmica (CNAG)- Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona, Catalonia, Spain
| | - Mónica Furlano
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Laia Ejarque-Vila
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Laura Lorente-Grandoso
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Patricia Ruiz
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Gloria Fraga
- Pediatric Nephrology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Mercedes López González
- Pediatric Nephrology Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | | | - Lidia Rodríguez-Peña
- Clinical Genetics Department, Pediatrics Service, Hospital Clínico Universitario Virgen de la Arrixaca, Centre for Biomedical Research on Rare Diseases (CIBERER), Murcia, Spain
| | - Isabel Llano-Rivas
- Genetics Department, Hospital Universitario Cruces, Biocruces Health Research Institute, Centre for Biomedical Research on Rare Diseases (CIBERER), Barakaldo-Bizkaia, Spain
| | - Raquel Sáez
- Genetics Department, Hospital Donostia, San Sebastian, Spain
| | - Anna Bujons-Tur
- Urology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Surgery Department, Barcelona, Catalonia, Spain
| | - Gema Ariceta
- Pediatric Nephrology Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Guirado Lluis
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Roser Torra
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain.,Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Medicine Department, REDinREN, Instituto de Investigación Carlos III, Barcelona, Catalonia, Spain
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Ortiz A, Cozzolino M, Fliser D, Fouque D, Goumenos D, Massy ZA, Rosenkranz AR, Rychlık I, Soler MJ, Stevens K, Torra R, Tuglular S, Wanner C, Gansevoort RT, Duivenvoorden R, Franssen CFM, Hemmelder MH, Hilbrands LB, Jager KJ, Noordzij M, Vart P, Gansevoort RT. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrol Dial Transplant 2021; 36:87-94. [PMID: 33340043 PMCID: PMC7771976 DOI: 10.1093/ndt/gfaa314] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
Diabetes, hypertension and cardiovascular disease have been listed as risk factors for severe coronavirus disease 2019 (COVID-19) since the first report of the disease in January 2020. However, this report did not mention chronic kidney disease (CKD) nor did it provide information on the relevance of estimated glomerular filtration rate (eGFR) or albuminuria. As the disease spread across the globe, information on larger populations with greater granularity on risk factors emerged. The recently published OpenSAFELY project analysed factors associated with COVID-19 death in 17 million patients. The picture that arose differs significantly from initial reports. For example, hypertension is not an independent risk factor for COVID-19 death [adjusted hazard ratio (aHR) 0.89], but renal disease very much is. Dialysis (aHR 3.69), organ transplantation (aHR 3.53) and CKD (aHR 2.52 for patients with eGFR <30 mL/min/1.73 m2) represent three of the four comorbidities associated with the highest mortality risk from COVID-19. The risk associated with CKD Stages 4 and 5 is higher than the risk associated with diabetes mellitus (aHR range 1.31-1.95, depending upon glycaemic control) or chronic heart disease (aHR 1.17). In another recent publication, the Global Burden of Disease collaboration identified that worldwide, CKD is the most prevalent risk factor for severe COVID-19. Moreover, the distribution of risk factors for COVID-19 mortality appears to be different in patients with CKD when compared with the general population. The high prevalence of CKD in combination with the elevated risk of mortality from COVID-19 in CKD necessitates urgent action for this group of patients. This article defines essential action points (summarized in Box 1), among which is advocating the inclusion of CKD patients in clinical trials testing the efficacy of drugs and vaccines to prevent severe COVID-19.
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Hughes DA, Aguiar P, Deegan PB, Ezgu F, Frustaci A, Lidove O, Linhart A, Lubanda JC, Moon JC, Nicholls K, Niu DM, Nowak A, Ramaswami U, Reisin R, Rozenfeld P, Schiffmann R, Svarstad E, Thomas M, Torra R, Vujkovac B, Warnock DG, West ML, Johnson J, Rolfe MJ, Feriozzi S. Early indicators of disease progression in Fabry disease that may indicate the need for disease-specific treatment initiation: findings from the opinion-based PREDICT-FD modified Delphi consensus initiative. BMJ Open 2020; 10:e035182. [PMID: 33039984 PMCID: PMC7549469 DOI: 10.1136/bmjopen-2019-035182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The PRoposing Early Disease Indicators for Clinical Tracking in Fabry Disease (PREDICT-FD) initiative aimed to reach consensus among a panel of global experts on early indicators of disease progression that may justify FD-specific treatment initiation. DESIGN AND SETTING Anonymous feedback from panellists via online questionnaires was analysed using a modified Delphi consensus technique. Questionnaires and data were managed by an independent administrator directed by two non-voting cochairs. First, possible early indicators of renal, cardiac and central/peripheral nervous system (CNS/PNS) damage, and other disease and patient-reported indicators assessable in routine clinical practice were compiled by the cochairs and administrator from panellists' free-text responses. Second, the panel scored indicators for importance (5-point scale: 1=not important; 5=extremely important); indicators scoring ≥3 among >75% of panellists were then rated for agreement (5-point scale: 1=strongly disagree; 5=strongly agree). Indicators awarded an agreement score ≥4 by >67% of panellists achieved consensus. Finally, any panel-proposed refinements to consensus indicator definitions were adopted if >75% of panellists agreed. RESULTS A panel of 21 expert clinicians from 15 countries provided information from which 83 possible current indicators of damage (kidney, 15; cardiac, 15; CNS/PNS, 13; other, 16; patient reported, 24) were compiled. Of 45 indicators meeting the importance criteria, consensus was reached for 29 and consolidated as 27 indicators (kidney, 6; cardiac, 10; CNS/PNS, 2; other, 6; patient reported, 3) including: (kidney) elevated albumin:creatinine ratio, histological damage, microalbuminuria; (cardiac) markers of early systolic/diastolic dysfunction, elevated serum cardiac troponin; (CNS/PNS) neuropathic pain, gastrointestinal symptoms suggestive of gastrointestinal neuropathy; (other) pain in extremities/neuropathy, angiokeratoma; (patient-reported) febrile crises, progression of symptoms/signs. Panellists revised and approved proposed chronologies of when the consensus indicators manifest. The panel response rate was >95% at all stages. CONCLUSIONS PREDICT-FD captured global opinion regarding current clinical indicators that could prompt FD-specific treatment initiation earlier than is currently practised.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
- Department of Haematology, University College London, London, UK
| | - Patricio Aguiar
- Inborn Errors of Metabolism Reference Center, North Lisbon Hospital Center, Lisbon, Portugal
- Medicine Department, University of Lisbon, Lisbon, Portugal
| | - Patrick B Deegan
- Lysosomal Disorders Unit, Addenbrooke's Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Fatih Ezgu
- Department and Laboratory of Paediatric Metabolic Disorders, Gazi University, Ankara, Turkey
| | - Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Geriatric and Anesthesiologic Sciences, University of Rome La Sapienza, Rome, Italy
| | - Olivier Lidove
- Department of Internal Medicine-Rheumatology, Croix Saint Simon Hospital, Paris, France
| | - Aleš Linhart
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jean-Claude Lubanda
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - James C Moon
- Cardiac Imaging Department, Barts Heart Centre, London, UK
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Internal Medicine, Psychiatry University Hospital Zurich, Zurich, Switzerland
| | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
| | - Ricardo Reisin
- Department of Neurology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paula Rozenfeld
- Instituto de Estudios Inmunológicos y Fisiopatológicos, UNLP - CONICET, La Plata, Argentina
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas, USA
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roser Torra
- Inherited Renal Diseases Unit, Autonomous University of Barcelona, Barcelona, Spain
| | - Bojan Vujkovac
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - David G Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael L West
- Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jack Johnson
- Fabry Support & Information Group, Concordia, Missouri, USA
- Fabry International Network, Beveren, Belgium
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Abstract
In this issue, Matthews et al. provide a comprehensive review of published cohorts with heterozygous pathogenic variants in COL4A3 or COL4A4, documenting the wide spectrum of the disease. Due to the extreme phenotypes that patients with heterozygous pathogenic variants in COL4A3 or COL4A4 may show, the disease has been referred to in a variety of ways, including 'autosomal dominant Alport syndrome', 'thin basement membrane disease', 'thin basement membrane nephropathy', 'familial benign hematuria' and 'carriers of autosomal dominant Alport syndrome'. This confusion over terminology has prevented nephrologists from being sufficiently aware of the relevance of the entity. Nowadays, however, next-generation sequencing facilitates the diagnosis and it is becoming a relatively frequent finding in haematuric-proteinuric nephropathies of unknown origin, even in non-familial cases. There is a need to raise awareness among nephrologists about the disease in order to improve diagnosis and provide better management for these patients.
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Affiliation(s)
- Roser Torra
- Department of Nephrology, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Medicine Department-Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Monica Furlano
- Department of Nephrology, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Medicine Department-Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autónoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
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41
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Goicoechea M, Gomez-Preciado F, Benito S, Torras J, Torra R, Huerta A, Restrepo A, Ugalde J, Astudillo D, Agraz I, Lopez-Mendoza M, De Arriba G, Corchete E, Quiroga B, Martin-Conde ML, Gutierrez MJ, Lopes V, Ramos C, Mendez I, Cao M, Dominguez F, Ortiz A. P0067PREDICTORS OF LONG-TERM OUTCOME IN A SPANISH COHORT OF PATIENTS WITH FABRY DISEASE ON ENZYME REPLACEMENT THERAPY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0067] [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
Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in Fabry disease patients on ERT.
Method
Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120).
Results
In 69 patients (42 males, 27 females, mean age 44.6 ±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242 to 128 mg/g (p = 0.05).
At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR ≤60 ml/min/1.73 m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043), being these differences more relevant in females (log Rank 18.514, p<0.001) than males (logRank: 3.442, p=0.064). Lower baseline eGFR was associated with a 3- to 7-fold increase in the risk of clinical events in different Cox models.
Conclusion
GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes. For the first time, we show that initiation of ERT in women before renal function deteriorates has a similar or even larger impact as in Fabry males to prevent clinical events.
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Affiliation(s)
- Marian Goicoechea
- Hospital General Universitario Gregorio Marañon, Nephrology, Madrid, Spain
- Spanish Kidney Research Network (REDINREN), FEDER FUND, Madrid, Spain
| | | | | | - Joan Torras
- Spanish Kidney Research Network (REDINREN), FEDER FUND, Madrid, Spain
- Hospital Bellvitge, Nephrology
| | - Roser Torra
- Spanish Kidney Research Network (REDINREN), FEDER FUND, Madrid, Spain
- Fundacion Puigvert, Nephrology
| | - Ana Huerta
- Hospital Universitario Puerta de Hierro, Cardiology
| | - Alejandra Restrepo
- Hospital Universitario Puerta de Hierro, CIBERCV, Heart Failure and Inherited Cardiac Diseases Unit, Madrid
| | | | | | | | | | - Gabriel De Arriba
- Hospital Universitario de Guadalajara, Nephrology
- Universidad de Alcala de Henares, Medicine
| | | | | | | | | | | | - Carmela Ramos
- Hospital Universitario y Politecnico La Fe, Nephrology Unit, Valencia, Spain
| | - Irene Mendez
- Hospital Universitario Gregorio Marañon, Cardiology
| | - Mercedes Cao
- Complejo Hospitalario Universitario A Coruña, Nephrology
| | - Fernando Dominguez
- Hospital Universitario Puerta de Hierro, CIBERCV, Heart Failure and Inherited Cardiac Diseases Unit, Madrid
| | - Alberto Ortiz
- Spanish Kidney Research Network (REDINREN), FEDER FUND, Madrid, Spain
- Fundación JImenez Diaz, Nephrology
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Olinger E, Hofmann P, Kidd K, Dufour I, Belge H, Schaeffer C, Kipp A, Bonny O, Deltas C, Demoulin N, Fehr T, Fuster DG, Gale DP, Goffin E, Hodaňová K, Huynh-Do U, Kistler A, Morelle J, Papagregoriou G, Pirson Y, Sandford R, Sayer JA, Torra R, Venzin C, Venzin R, Vogt B, Živná M, Greka A, Dahan K, Rampoldi L, Kmoch S, Bleyer AJ, Devuyst O. Clinical and genetic spectra of autosomal dominant tubulointerstitial kidney disease due to mutations in UMOD and MUC1. Kidney Int 2020; 98:717-731. [PMID: 32450155 DOI: 10.1016/j.kint.2020.04.038] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/23/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
Autosomal dominant tubulointerstitial kidney disease (ADTKD) is an increasingly recognized cause of end-stage kidney disease, primarily due to mutations in UMOD and MUC1. The lack of clinical recognition and the small size of cohorts have slowed the understanding of disease ontology and development of diagnostic algorithms. We analyzed two registries from Europe and the United States to define genetic and clinical characteristics of ADTKD-UMOD and ADTKD-MUC1 and develop a practical score to guide genetic testing. Our study encompassed 726 patients from 585 families with a presumptive diagnosis of ADTKD along with clinical, biochemical, genetic and radiologic data. Collectively, 106 different UMOD mutations were detected in 216/562 (38.4%) of families with ADTKD (303 patients), and 4 different MUC1 mutations in 72/205 (35.1%) of the families that are UMOD-negative (83 patients). The median kidney survival was significantly shorter in patients with ADTKD-MUC1 compared to ADTKD-UMOD (46 vs. 54 years, respectively), whereas the median gout-free survival was dramatically reduced in patients with ADTKD-UMOD compared to ADTKD-MUC1 (30 vs. 67 years, respectively). In contrast to patients with ADTKD-UMOD, patients with ADTKD-MUC1 had normal urinary excretion of uromodulin and distribution of uromodulin in tubular cells. A diagnostic algorithm based on a simple score coupled with urinary uromodulin measurements separated patients with ADTKD-UMOD from those with ADTKD-MUC1 with a sensitivity of 94.1%, a specificity of 74.3% and a positive predictive value of 84.2% for a UMOD mutation. Thus, ADTKD-UMOD is more frequently diagnosed than ADTKD-MUC1, ADTKD subtypes present with distinct clinical features, and a simple score coupled with urine uromodulin measurements may help prioritizing genetic testing.
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Affiliation(s)
- Eric Olinger
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Nephrology and Hypertension, Inselspital Bern University Hospital, Bern, Switzerland; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Patrick Hofmann
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Internal Medicine, Hospital Uster, Uster, Switzerland
| | - Kendrah Kidd
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Inès Dufour
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hendrica Belge
- Center for Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Céline Schaeffer
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Anne Kipp
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Olivier Bonny
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - Constantinos Deltas
- Molecular Medicine Research Center, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - Nathalie Demoulin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Thomas Fehr
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital Bern University Hospital, Bern, Switzerland
| | - Daniel P Gale
- Department of Nephrology, University College of London, London, UK
| | - Eric Goffin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Kateřina Hodaňová
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, Inselspital Bern University Hospital, Bern, Switzerland
| | - Andreas Kistler
- Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Johann Morelle
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Gregory Papagregoriou
- Molecular Medicine Research Center, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - Yves Pirson
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Richard Sandford
- Department of Medical Genetics, Cambridge Biomedical Campus, Cambridge, UK
| | - John A Sayer
- Renal Services, Newcastle upon Tyne Hospitals National Health Service Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Roser Torra
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, Spanish Renal Research Network (REDinREN), Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christina Venzin
- Division of Nephrology, Department of Internal Medicine, Hospital Davos, Davos, Switzerland
| | - Reto Venzin
- Division of Nephrology, Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital Bern University Hospital, Bern, Switzerland
| | - Martina Živná
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Greka
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Broad Institute of MIT and Harvard, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Karin Dahan
- Center for Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Luca Rampoldi
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Stanislav Kmoch
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anthony J Bleyer
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Abstract
Alport syndrome (AS) is the most frequent inherited kidney disease after autosomal dominant polycystic kidney disease. It has three different patterns of inheritance-autosomal dominant, autosomal recessive and X-linked-which in part explains the wide spectrum of disease, ranging from isolated microhaematuria to end-stage renal disease early in life. The search for a treatment for AS is being pursued vigorously, not only because of the obvious unmet need but also because AS is a rare disease and any drug approved will have an orphan drug designation with its various benefits. Moreover, AS patients are quite young with very few comorbidities, which facilitates clinical trials. This review identifies the particularities of each pattern of inheritance but focuses mainly on new drugs or therapeutic targets for the disease. Most treatment-related investigations are directed not at the main abnormality in AS, namely collagen IV composition, but rather at the associated inflammation and fibrosis. Thus, AS may serve as a proof of concept for numerous drugs of potential value in many diseases that cause chronic kidney disease.
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Affiliation(s)
- Roser Torra
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, REDINREN, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mónica Furlano
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, REDINREN, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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44
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Ariceta G, Buj MJ, Furlano M, Martínez V, Matamala A, Morales M, Robles NR, Sans L, Villacampa F, Torra R. Recommendations for the management of renal involvement in the tuberous sclerosis complex. Nefrologia 2019; 40:142-151. [PMID: 31722796 DOI: 10.1016/j.nefro.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 12/01/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare, hereditary, multisystemic disease with a broad phenotypic spectrum. Its management requires the collaboration of multiple specialists. Just as in the paediatric age, the paediatric neurologist takes on special importance; in adulthood, renal involvement is the cause of the greatest morbidity and mortality. There are several recommendations on the general management of patients with TSC but none that focuses on renal involvement. These recommendations respond to the need to provide guidelines to facilitate a better knowledge and diagnostic-therapeutic management of the renal involvement of TSC through a rational use of complementary tests and the correct use of available treatments. Their elaboration has been based on consensus within the hereditary renal diseases working group of the SEN/REDINREN (Spanish Society of Nephrology/Kidney Research Network). It has also counted on the participation of non-nephrologist specialists in TSC in order to expand the vision of the disease.
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Affiliation(s)
- Gema Ariceta
- Servicio de Nefrología Pediátrica, Hospital Valle Hebrón, REDINREN, Barcelona, España
| | - María José Buj
- Servicio de Radiología, Hospital 12 de Octubre, Madrid, España
| | - Mónica Furlano
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autónoma de Barcelona, REDINREN, Barcelona, España
| | - Víctor Martínez
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, España
| | - Anna Matamala
- Departamento de Enfermería, Fundació Puigvert, Barcelona, España
| | | | | | - Laia Sans
- Servicio de Nefrología, Hospital del Mar, REDINREN, Barcelona, España
| | - Felipe Villacampa
- Servicio de Urología, Clínica Universidad de Navarra, Madrid, España
| | - Roser Torra
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autónoma de Barcelona, REDINREN, Barcelona, España.
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45
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Gimpel C, Bergmann C, Bockenhauer D, Breysem L, Cadnapaphornchai MA, Cetiner M, Dudley J, Emma F, Konrad M, Harris T, Harris PC, König J, Liebau MC, Marlais M, Mekahli D, Metcalfe AM, Oh J, Perrone RD, Sinha MD, Titieni A, Torra R, Weber S, Winyard PJD, Schaefer F. International consensus statement on the diagnosis and management of autosomal dominant polycystic kidney disease in children and young people. Nat Rev Nephrol 2019; 15:713-726. [PMID: 31118499 PMCID: PMC7136168 DOI: 10.1038/s41581-019-0155-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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] [Indexed: 02/08/2023]
Abstract
These recommendations were systematically developed on behalf of the Network for Early Onset Cystic Kidney Disease (NEOCYST) by an international group of experts in autosomal dominant polycystic kidney disease (ADPKD) from paediatric and adult nephrology, human genetics, paediatric radiology and ethics specialties together with patient representatives. They have been endorsed by the International Pediatric Nephrology Association (IPNA) and the European Society of Paediatric Nephrology (ESPN). For asymptomatic minors at risk of ADPKD, ongoing surveillance (repeated screening for treatable disease manifestations without diagnostic testing) or immediate diagnostic screening are equally valid clinical approaches. Ultrasonography is the current radiological method of choice for screening. Sonographic detection of one or more cysts in an at-risk child is highly suggestive of ADPKD, but a negative scan cannot rule out ADPKD in childhood. Genetic testing is recommended for infants with very-early-onset symptomatic disease and for children with a negative family history and progressive disease. Children with a positive family history and either confirmed or unknown disease status should be monitored for hypertension (preferably by ambulatory blood pressure monitoring) and albuminuria. Currently, vasopressin antagonists should not be offered routinely but off-label use can be considered in selected children. No consensus was reached on the use of statins, but mTOR inhibitors and somatostatin analogues are not recommended. Children with ADPKD should be strongly encouraged to achieve the low dietary salt intake that is recommended for all children.
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Affiliation(s)
- Charlotte Gimpel
- Division of Pediatric Nephrology, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Carsten Bergmann
- Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Detlef Bockenhauer
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Luc Breysem
- Department of Pediatric Radiology, University Hospital of Leuven, Leuven, Belgium
| | - Melissa A Cadnapaphornchai
- Rocky Mountain Pediatric Kidney Center, Rocky Mountain Hospital for Children at Presbyterian St Luke's Medical Center, Denver, CO, USA
| | - Metin Cetiner
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Jan Dudley
- Renal Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Francesco Emma
- Division of Nephrology and Dialysis, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Tess Harris
- PKD International, Geneva, Switzerland
- PKD Charity, London, UK
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Jens König
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Max C Liebau
- Department of Pediatrics and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matko Marlais
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Djalila Mekahli
- Department of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium
- PKD Research Group, Laboratory of Pediatrics, Department of Development and Regeneration, GPURE, KU Leuven, Leuven, Belgium
| | - Alison M Metcalfe
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Jun Oh
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald D Perrone
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Manish D Sinha
- Kings College London, Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Andrea Titieni
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Roser Torra
- Department of Nephrology, University of Barcelona, Barcelona, Spain
| | - Stefanie Weber
- Department of Pediatrics, University of Marburg, Marburg, Germany
| | - Paul J D Winyard
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
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Fernandez-Prado R, Carriazo-Julio SM, Torra R, Ortiz A, Perez-Gomez MV. MYH9-related disease: it does exist, may be more frequent than you think and requires specific therapy. Clin Kidney J 2019; 12:488-493. [PMID: 31384439 PMCID: PMC6671427 DOI: 10.1093/ckj/sfz103] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
In this issue of ckj, Tabibzadeh et al. report one of the largest series of patients with MYH9 mutations and kidney disease. The cardinal manifestation of MYH9-related disease is thrombocytopenia with giant platelets. The population frequency of pathogenic MYH9 mutations may be at least 1 in 20 000. The literature abounds in misdiagnosed cases treated for idiopathic thrombocytopenic purpura with immune suppressants and even splenectomy. Additional manifestations include neurosensorial deafness and proteinuric and hematuric progressive kidney disease (at some point, it was called Alport syndrome with macrothrombocytopenia), leucocyte inclusions, cataracts and liver enzyme abnormalities, resulting in different names for different manifestation combinations (MATINS, May-Hegglin anomaly, Fechtner, Epstein and Sebastian syndromes, and deafness AD 17). The penetrance and severity of kidney disease are very variable, which may obscure the autosomal dominant inheritance. A correct diagnosis will both preclude unnecessary and potentially dangerous therapeutic interventions and allow genetic counselling and adequate treatment. Morphological erythrocyte, granulocyte and platelet abnormalities may allow the future development of high-throughput screening techniques adapted to clinical peripheral blood flow cytometers.
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Affiliation(s)
- Raul Fernandez-Prado
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Sol Maria Carriazo-Julio
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Roser Torra
- REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
- Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - María Vanessa Perez-Gomez
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
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Savige J, Ariani F, Mari F, Bruttini M, Renieri A, Gross O, Deltas C, Flinter F, Ding J, Gale DP, Nagel M, Yau M, Shagam L, Torra R, Ars E, Hoefele J, Garosi G, Storey H. Expert consensus guidelines for the genetic diagnosis of Alport syndrome. Pediatr Nephrol 2019; 34:1175-1189. [PMID: 29987460 DOI: 10.1007/s00467-018-3985-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/22/2018] [Accepted: 05/10/2018] [Indexed: 12/16/2022]
Abstract
Recent expert guidelines recommend genetic testing for the diagnosis of Alport syndrome. Here, we describe current best practice and likely future developments. In individuals with suspected Alport syndrome, all three COL4A5, COL4A3 and COL4A4 genes should be examined for pathogenic variants, probably by high throughput-targeted next generation sequencing (NGS) technologies, with a customised panel for simultaneous testing of the three Alport genes. These techniques identify up to 95% of pathogenic COL4A variants. Where causative pathogenic variants cannot be demonstrated, the DNA should be examined for deletions or insertions by re-examining the NGS sequencing data or with multiplex ligation-dependent probe amplification (MLPA). These techniques identify a further 5% of variants, and the remaining few changes include deep intronic splicing variants or cases of somatic mosaicism. Where no pathogenic variants are found, the basis for the clinical diagnosis should be reviewed. Genes in which mutations produce similar clinical features to Alport syndrome (resulting in focal and segmental glomerulosclerosis, complement pathway disorders, MYH9-related disorders, etc.) should be examined. NGS approaches have identified novel combinations of pathogenic variants in Alport syndrome. Two variants, with one in COL4A3 and another in COL4A4, produce a more severe phenotype than an uncomplicated heterozygous change. NGS may also identify further coincidental pathogenic variants in genes for podocyte-expressed proteins that also modify the phenotype. Our understanding of the genetics of Alport syndrome is evolving rapidly, and both genetic and non-genetic factors are likely to contribute to the observed phenotypic variability.
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Affiliation(s)
- Judy Savige
- Department of Medicine, Melbourne and Northern Health, The University of Melbourne, Parkville, VIC, 3050, Australia.
| | | | | | | | | | - Oliver Gross
- Clinic of Nephrology and Rheumatology, University of Gottingen, Gottingen, Germany
| | | | - Frances Flinter
- Department of Clinical Genetics, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Jie Ding
- Peking University First Hospital, Beijing, China
| | - Daniel P Gale
- Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Mato Nagel
- Centre for Nephrology and Metabolic Disorders, Weisswasser, Germany
| | - Michael Yau
- Genetics, Guy's Hospital, Viapath, London, UK
| | - Lev Shagam
- Institute of Pediatrics, Pirogov Russian Medical University, Moscow, Russia
| | - Roser Torra
- Inherited Kidney Disorders, Nephrology Department, Fundacio Puigvert, Instituto de Investigacion Carlos III, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundacio Puigvert, Instituto de Investigacion Carlos III, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Julia Hoefele
- Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - Guido Garosi
- Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Barba-Romero MÁ, Serena J, Puig JM, Valverde C. V, Climent V, Herrero JA, Huertas R, Torra R. Clinical profile of women diagnosed with Fabry disease non receiving enzyme replacement therapy. Med Clin (Barc) 2019; 153:47-55. [DOI: 10.1016/j.medcli.2018.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/17/2023]
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Martinez Fernandez I, Oltra AM, Devesa R, Martínez JG, De Juan-Ribera J, Gil-Garcia C, González-Robaina F, Pérez-Borges P, Del Castillo N, Torra R, Escamilla B, Díaz R, Saracho R, García-Merino ML, González L, García R, Vello A, Pazos B, MOUZO RICARDO, Del Pino MD. FP416PrEFINE: SPANISH PREVALENCE OF FABRY DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ana María Oltra
- General University Hospital Consortium of Valencia, Valencia, Spain
| | - Ramón Devesa
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | | | - Patricia Pérez-Borges
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Nieves Del Castillo
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Raquel Díaz
- Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | | | | | - Rebeca García
- Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
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Auvin S, Bissler JJ, Cottin V, Fujimoto A, Hofbauer GFL, Jansen AC, Jóźwiak S, Kerecuk L, Kingswood JC, Moavero R, Torra R, Villanueva V. A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex: a Delphi consensus report. Orphanet J Rare Dis 2019; 14:91. [PMID: 31039793 PMCID: PMC6492321 DOI: 10.1186/s13023-019-1072-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/04/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder associated with mutations in TSC1 and TSC2 genes, upregulation of mammalian target of rapamycin signaling, and subsequent tumor formation in various organs. Due to the many manifestations of TSC and their potential complications, management requires the expertise of multiple medical disciplines. A multidisciplinary care approach is recommended by consensus guidelines. Use of multidisciplinary teams (MDTs) has been shown to be beneficial in treating other complex diseases, such as cancer. In a lifelong disease such as TSC, an MDT may facilitate the transition from pediatric to adult care. However, little guidance exists in the literature regarding how to organize an MDT in TSC. Methods To discuss the best approach to assembling an MDT, this project was initiated in October 2017 with a meeting of 12 physicians from various specialties and various countries. Following this first meeting, the experts generated statements on the most important aspects to implement in establishing an MDT for TSC by 3 rounds of selection using a Delphi process via electronic correspondence. Finally, TSC patient advocates reviewed the findings and provided additional insights from a patient perspective. Results A 3-step roadmap was recommended, starting with identifying a single individual to begin organizing care (Step 1), then establishing a small core team (Step 2), and finally, establishing a larger multi-disciplinary team (Step 3). Because of the multisystemic nature of TSC, the MDT should include specialists such as a neurologist, a neurosurgeon, a nephrologist, a urologist, a pulmonologist, an ophthalmologist, a cardiologist, a dermatologist, a geneticist, and a psychiatrist/psychologist. The MDT should recommend a care plan for each patient based on the individual’s needs and in consultation with him/her or his/her family. Some of the most important aspects of an MDT that were agreed upon included identifying a case manager to help coordinate care, providing access to health care professionals of varying specialties, and including a lead physician who takes medical responsibility for patients’ overall care. Conclusions The results of our consensus provide guidance to support the initiation of an MDT in TSC.
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Affiliation(s)
- Stéphane Auvin
- Service de Neurologie Pédiatrique et des Maladies Métaboliques, APHP, Robert-Debré Children's Hospital, 48 Boulevard Serurier, 75019, 19, Paris Cedex, France. .,INSERM U1141, Paris, France.
| | - John J Bissler
- St. Jude Children's Research Hospital and Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN, 38103, USA
| | - Vincent Cottin
- Claude Bernard University of Lyon 1, Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, UMR754, 69677, Lyon, Cedex, France
| | - Ayataka Fujimoto
- Seirei Hamamatsu General Hospital, 2 Chome-12-12 Sumiyoshi, Naka Ward, Hamamatsu, Japan
| | | | - Anna C Jansen
- UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Sergiusz Jóźwiak
- Department of Child Neurology, Warsaw Medical University, Banacha 1, 02-097, Warsaw, Poland.,Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Larissa Kerecuk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TG, UK
| | | | - Romina Moavero
- Tor Vergata University Hospital, Via Columbia, 2, 00133, Rome, Italy.,Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roser Torra
- Fundació Puigvert, Universitat Autónoma Barcelona, REDINREN, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Vicente Villanueva
- Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
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