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Coppo R, D'Arrigo G, Tripepi G, Russo ML, Roberts ISD, Bellur S, Cattran D, Cook TH, Feehally J, Tesar V, Maixnerova D, Peruzzi L, Amore A, Lundberg S, Di Palma AM, Gesualdo L, Emma F, Rollino C, Praga M, Biancone L, Pani A, Feriozzi S, Polci R, Barratt J, Del Vecchio L, Locatelli F, Pierucci A, Caliskan Y, Perkowska-Ptasinska A, Durlik M, Moggia E, Ballarin JC, Wetzels JFM, Goumenos D, Papasotiriou M, Galesic K, Toric L, Papagianni A, Stangou M, Benozzi L, Cusinato S, Berg U, Topaloglu R, Maggio M, Ots-Rosenberg M, D’Amico M, Geddes C, Balafa O, Quaglia M, Cravero R, Lino Cirami C, Fellstrom B, Floege J, Egido J, Mallamaci F, Zoccali C, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, Coppo R, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, Feehally J, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels JFM, Peters H, Berg U, Carvalho F, da Costa Ferreira AC, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Papastirou M, Galesic K, Toric L, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Rauen T, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders MEJ, Boria Grinyo JM, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Roszkowska-Blaim M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma AM, Ferrario F, Gutiérrez E, Asunis AM, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, GalesicLjubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene HJ, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E. Is there long-term value of pathology scoring in immunoglobulin A nephropathy? A validation study of the Oxford Classification for IgA Nephropathy (VALIGA) update. Nephrol Dial Transplant 2018; 35:1002-1009. [DOI: 10.1093/ndt/gfy302] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
It is unknown whether renal pathology lesions in immunoglobulin A nephropathy (IgAN) correlate with renal outcomes over decades of follow-up.
Methods
In 1130 patients of the original Validation Study of the Oxford Classification for IgA Nephropathy (VALIGA) cohort, we studied the relationship between the MEST score (mesangial hypercellularity, M; endocapillary hypercellularity, E; segmental glomerulosclerosis, S; tubular atrophy/interstitial fibrosis, T), crescents (C) and other histological lesions with both a combined renal endpoint [50% estimated glomerular filtration rate (eGFR) loss or kidney failure] and the rate of eGFR decline over a follow-up period extending to 35 years [median 7 years (interquartile range 4.1–10.8)].
Results
In this extended analysis, M1, S1 and T1–T2 lesions as well as the whole MEST score were independently related with the combined endpoint (P < 0.01), and there was no effect modification by age for these associations, suggesting that they may be valid in children and in adults as well. Only T lesions were associated with the rate of eGFR loss in the whole cohort, whereas C showed this association only in patients not treated with immunosuppression. In separate prognostic analyses, the whole set of pathology lesions provided a gain in discrimination power over the clinical variables alone, which was similar at 5 years (+2.0%) and for the whole follow-up (+1.8%). A similar benefit was observed for risk reclassification analyses (+2.7% and +2.4%).
Conclusion
Long-term follow-up analyses of the VALIGA cohort showed that the independent relationship between kidney biopsy findings and the risk of progression towards kidney failure in IgAN remains unchanged across all age groups and decades after the renal biopsy.
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Affiliation(s)
- Rosanna Coppo
- Fondazione Ricerca Molinette, Turin, Piemonte, Italy
| | | | | | | | | | - Shubha Bellur
- Cellular Pathology, Oxford University Hospital, Oxford, UK
| | | | | | - John Feehally
- Department of Nephrology, Leicester General Hospital, Leicester, UK
| | - Vladimir Tesar
- Nephrology, General University Hospital, Prague, Czech Republic
| | - Dita Maixnerova
- Nephrology, General University Hospital, Prague, Czech Republic
| | - Licia Peruzzi
- Nephrology, Regina Margherita Hospital, Turin, Italy
| | | | - Sigrid Lundberg
- Department of Nephrology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Francesco Emma
- Department of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy
| | | | - Manuel Praga
- Department of Nephrology, H12Octubre, Madrid, Spain
| | | | | | | | - Rosaria Polci
- Department of Nephrology, Belcolle Hospital, Viterbo, Italy
| | - Jonathan Barratt
- Department of Nephrology, Leicester General Hospital, Leicester, UK
| | | | | | | | | | | | - Magdalena Durlik
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Jack F M Wetzels
- Department of Nephrology and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dimitris Goumenos
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | - Marios Papasotiriou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | | | - Luka Toric
- Department of Nephrology, Dubrava University, Zagreb, Croatia
| | - Aikaterini Papagianni
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Stangou
- Department of Nephrology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Ulla Berg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Huddinge, Sweden
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine Ankara, Turkey
| | - Milena Maggio
- Department of Nephrology, Hospital Maggiore di Lodi, Lodi, Italy
| | | | | | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Olga Balafa
- Department of Nephrology, Medical School University of Ioannina, Ioannina, Greece
| | - Marco Quaglia
- Department of Nephrology, Maggiore della Carità Hospital, Piem, Onte Orientale University, Novara, Italy
| | | | | | | | - Jürgen Floege
- Division of Nephrology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jesus Egido
- Department of Nephrology, Fundacion Jimenez Diaz, CIBERDEM, Madrid, Spain
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Barbour SJ, Espino-Hernandez G, Reich HN, Coppo R, Roberts IS, Feehally J, Herzenberg AM, Cattran DC, Bavbek N, Cook T, Troyanov S, Alpers C, Amore A, Barratt J, Berthoux F, Bonsib S, Bruijn J, D’Agati V, D’Amico G, Emancipator S, Emmal F, Ferrario F, Fervenza F, Florquin S, Fogo A, Geddes C, Groene H, Haas M, Hill P, Hogg R, Hsu S, Hunley T, Hladunewich M, Jennette C, Joh K, Julian B, Kawamura T, Lai F, Leung C, Li L, Li P, Liu Z, Massat A, Mackinnon B, Mezzano S, Schena F, Tomino Y, Walker P, Wang H, Weening J, Yoshikawa N, Zhang H, Coppo R, Troyanov S, Cattran D, Cook H, Feehally J, Roberts I, Tesar V, Maixnerova D, Lundberg S, Gesualdo L, Emma F, Fuiano L, Beltrame G, Rollino C, RC, Amore A, Camilla R, Peruzzi L, Praga M, Feriozzi S, Polci R, Segoloni G, Colla L, Pani A, Angioi A, Piras L, JF, Cancarini G, Ravera S, Durlik M, Moggia E, Ballarin J, Di Giulio S, Pugliese F, Serriello I, Caliskan Y, Sever M, Kilicaslan I, Locatelli F, Del Vecchio L, Wetzels J, Peters H, Berg U, Carvalho F, da Costa Ferreira A, Maggio M, Wiecek A, Ots-Rosenberg M, Magistroni R, Topaloglu R, Bilginer Y, D’Amico M, Stangou M, Giacchino F, Goumenos D, Kalliakmani P, Gerolymos M, Galesic K, Geddes C, Siamopoulos K, Balafa O, Galliani M, Stratta P, Quaglia M, Bergia R, Cravero R, Salvadori M, Cirami L, Fellstrom B, Kloster Smerud H, Ferrario F, Stellato T, Egido J, Martin C, Floege J, Eitner F, Lupo A, Bernich P, Menè P, Morosetti M, van Kooten C, Rabelink T, Reinders M, Boria Grinyo J, Cusinato S, Benozzi L, Savoldi S, Licata C, Mizerska-Wasiak M, Martina G, Messuerotti A, Dal Canton A, Esposito C, Migotto C, Triolo G, Mariano F, Pozzi C, Boero R, Bellur S, Mazzucco G, Giannakakis C, Honsova E, Sundelin B, Di Palma A, Ferrario F, Gutiérrez E, Asunis A, Barratt J, Tardanico R, Perkowska-Ptasinska A, Arce Terroba J, Fortunato M, Pantzaki A, Ozluk Y, Steenbergen E, Soderberg M, Riispere Z, Furci L, Orhan D, Kipgen D, Casartelli D, Galesic Ljubanovic D, Gakiopoulou H, Bertoni E, Cannata Ortiz P, Karkoszka H, Groene H, Stoppacciaro A, Bajema I, Bruijn J, Fulladosa Oliveras X, Maldyk J, Ioachim E. The MEST score provides earlier risk prediction in lgA nephropathy. Kidney Int 2016; 89:167-75. [DOI: 10.1038/ki.2015.322] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 01/12/2023]
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Radice A, Trezzi B, Maggiore U, Pregnolato F, Stellato T, Napodano P, Rolla D, Pesce G, D'Amico M, Santoro D, Londrino F, Ravera F, Ortisi G, Sinico RA. Clinical usefulness of autoantibodies to M-type phospholipase A2 receptor (PLA2R) for monitoring disease activity in idiopathic membranous nephropathy (IMN). Autoimmun Rev 2015; 15:146-54. [PMID: 26527329 DOI: 10.1016/j.autrev.2015.10.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
Abstract
Autoantibodies to M-type phospholipase A2 receptor (PLA2R) are specific markers of idiopathic membranous nephropathy (IMN). They can differentiate IMN from other glomerular diseases and primary from secondary forms of MN. Preliminary data suggest that anti-PLA2R antibody titer correlates with disease activity but more solid evidence is needed. To evaluate the performance of anti-PLA2R antibody for monitoring nephropathy activity, 149 anti-PLA2R antibody measurements were performed during the follow-up of 42 biopsy proven IMN consecutive patients. Patients were enrolled either at time of diagnosis (33 cases, inception cohort) or after diagnosis (9 patients, non-inception cohort). Anti-PLA2R detection was performed using the highly sensitive transfected cell-based indirect immunofluorescence (IIFT). Over the follow-up there was a linear time-trend of decreasing proteinuria (P<0.001), increasing serum albumin (P<0.001) and decreasing PLA2R antibody levels (P=0.002). There was a statistically significant association between changes in PLA2R antibody levels and the clinical course of PLA2R-positive IMN. The positive PLA2R serum antibody status was linearly associated with increasing proteinuria and decreasing serum albumin over time, compared with negative antibody status. Moreover, the strong correlation between the clinical conditions and PLA2R antibody levels allowed the prediction of prevalence distribution of patients with active disease, partial and complete remission. Over the course of the follow-up, the probability of halving proteinuria increased 6.5 times after disappearance of PLA2R antibodies. Our data suggest that the serial evaluation of anti-PLA2R antibodies could help in optimal timing and duration of the immunosuppressive therapy, reducing over(under)-treatment and associated side-effects.
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Affiliation(s)
- Antonella Radice
- Microbiology and Virology Department, S. Carlo Borromeo Hospital, Milano, Italy.
| | - Barbara Trezzi
- Clinical Immunology & Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy; Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy.
| | - Umberto Maggiore
- Nephrology & Transplant, Maggiore Hospital Parma University, Italy.
| | | | | | | | | | | | | | | | | | | | - Giuseppe Ortisi
- Microbiology and Virology Department, S. Carlo Borromeo Hospital, Milano, Italy.
| | - Renato Alberto Sinico
- Clinical Immunology & Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy; Renal Unit, S. Carlo Borromeo Hospital, Milano, Italy.
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Proletov I, Sipovskii V, Smirnov A, Hayashi N, Akiyama S, Okuyama H, Matsui Y, Fujimoto K, Atsumi H, Adachi H, Yamaya H, Maruyama S, Imai E, Matsuo S, Yokoyama H, Prasad N, Jaiswal A, Agarwal V, Yadav B, Rai M, Shin DH, Han IM, Moon SJ, Yoo TH, Faria B, Henriques C, Matos AC, Daha MR, Pestana M, Seelen M, Lundberg S, Carlsson MC, Leffler H, Pahlsson P, Segelmark M, Camilla R, Donadio ME, Loiacono E, Peruzzi L, Amore A, Chiale F, Vergano L, Gallo R, Boido A, Conrieri M, Bianciotto M, Bosetti FM, Mengozzi G, Puccinelli MP, Guidi C, Lastauka I, Coppo R, Nishiwaki H, Hasegawa T, Nagayama Y, Komukai D, Kaneshima N, Sasai F, Yoshimura A, Wang CL, Wei XY, Lv L, Jia NY, Vagane AM, Knoop T, Vikse BE, Reisaeter AV, Bjorneklett R, Mezzina N, Brunini F, Trezzi B, Gallieni M, D'Amico M, Stellato T, Santoro D, Ghiggeri GM, Radice A, Sinico RA, Kronbichler A, Kerschbaum J, Mayer G, Rudnicki M, Elena GS, Paula Jara CE, Jorge Enrique RR, Manuel P, Paek J, Hwang E, Park S, Caliskan Y, Aksoy A, Oztop N, Ozluk Y, Artan AS, Yazici H, Kilicaslan I, Sever MS, Yildiz A, Ihara K, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Stangou M, Bantis C, Skoularopoulou M, Toulkeridis G, Labropoulou I, Kasimatis S, Kouri NM, Papagianni A, Efstratiadis G, Mircescu G, Stancu S, Zugravu A, Petrescu L, Andreiana I, Taran L, Suzuki T, Iyoda M, Yamaguchi Y, Watanabe M, Wada Y, Matsumoto K, Shindo-Hirai Y, Kuno Y, Yamamoto Y, Saito T, Iseri K, Shibata T, Gniewek K, Krajewska M, Jakuszko K, Koscielska-Kasprzak K, Klinger M, Nunes AT, Ferreira I, Neto R, Mariz E, Pereira E, Frazao J, Praca A, Sampaio S, Pestana M, Kim HJ, Lee JE, Proletov I, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Oliveira CBL, Oliveira ASA, Carvalho CJB, Sette LHBC, Fernandes GV, Cavalcante MA, Valente LM, Ismail G, Andronesi A, Jurubita R, Bobeica R, Finocchietti D, Cantaluppi V, Medica D, Daidola G, Colla L, Besso L, Burdese M, Segoloni GP, Biancone L, Camussi G, Goto S, Nakai K, Ito J, Fujii H, Tasaki K, Suzuki T, Fukami K, Hara S, Nishi S, Hayami N, Ubara Y, Hoshino J, Takaichi K, Suwabe T, Sumida K, Mise K, Wang CL, Tian YQ, Wang H, Saganova E, Proletov I, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Stancu S, Mandache E, Zugravu A, Petrescu L, Avram A, Mircescu G, Angelini C, Reggiani F, Podesta MA, Cucchiari D, Malesci A, Badalamenti S, Laganovi M, Ars E, ivko M, eljkovic Vrki T, Cori M, Karanovi S, Torra R, Jelakovi B, Jia NY, Wang CL, Zhang YH, Nan L, Nagasawa Y, Yamamoto R, Shinzawa M, Hamahata S, Kida A, Yahiro M, Kuragano T, Shoji T, Hayashi T, Nagatoya K, Yamauchi A, Isaka Y, Nakanishi T, Ivkovic V, Premuzic V, Laganovic M, Dika Z, Kos J, Zeljkovic Vrkic T, Fistrek Prlic M, Zivko M, Jelakovic B, Gigliotti P, Leone F, Lofaro D, Papalia T, Mollica F, Mollica A, Vizza D, Perri A, Bonofilgio R, Meneses G, Viana H, Santos MC, Ferreira C, Calado J, Carvalho F, Remedio F, Nolasco F, Caliskan Y, Oztop N, Aksoy A, Ozluk Y, Artan AS, Turkmen A, Kilicaslan I, Yildiz A, Sever MS, Nagaraju SP, Kosuru S, Parthasarathy R, Bairy M, Prabhu RA, Guddattu V, Koulmane Laxminarayana SL, Oruc A, Gullulu M, Acikgoz E, Aktas N, Yildiz A, Gul B, Premuzic V, Laganovic M, Ivkovic V, Coric M, Zeljkovic Vrkic T, Fodor L, Dika Z, Kos J, Fistrek Prlic M, Zivko M, Jelakovic B, Bale CB, Dighe TA, Kate P, Karnik S, Sajgure A, Sharma A, Korpe J, Jeloka T, Ambekar N, Sadre A, Buch A, Mulay A, Merida E, Huerta A, Gutierrez E, Hernandez E, Sevillano A, Caro J, Cavero T, Morales E, Moreno JA, Praga M. PRIMARY AND SECONDARY GLOMERULONEPHRITIDES 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fabrizi F, Mangano S, Stellato T, Martin P, Messa P. Lamivudine treatment for hepatitis B in dialysis population : case reports and literature review. Acta Gastroenterol Belg 2013; 76:423-428. [PMID: 24592546] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It is well known that chronic hepatitis B plays a detrimental role on survival in patients on long-term dialysis and after kidney transplantation. The advent of nucleos(t)ide analogues offers the opportunity to change the natural history of hepatitis B in patients with chronic kidney disease. We report our experience on lamivudine use in two patients with HBV-related liver disease on long-term dialysis. At the beginning, both the patients were HBsAg positive and HBeAg positive with high viral load; after long-term lamivudine therapy, clearance of HBV viremia from serum was observed in both. Raised aminotransferase levels fell into the normal range and one patient experienced clearance of HBsAg by anti-HBV therapy. Tolerance to lamivudine was satisfactory and lamivudine resistance was not detected. Information on antiviral therapy with lamivudine in HBsAg positive patients on regular dialysis is extremely limited; we identified by an extensive review of the literature five studies with a total of 38 unique patients, most of them being renal transplant candidates. Lamivudine proved to be effective as the clearance of HBV viraemia from serum ranged between 56% and 100% ; the clearance of HBeAg from serum was less evident (between 37.5% and 100%). No significant side-effects due to lamivudine were observed and emergence of lamivudine-resistant strains was observed in two (5%) patients. Only a minority of patients experienced HBsAg loss (13%). We conclude that anti-HBV treatment with a nucleoside analogue such as lamivudine gives satisfactory results in some patients on long-term dialysis. Clinical trials are in progress to assess efficacy and safety of last-generation nucleos(t)ide analogues for anti-HBV therapy in dialysis population.
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Affiliation(s)
- F Fabrizi
- Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano.
| | - S Mangano
- Nephrology Unit. Como University Hospital
| | - T Stellato
- Nephrology Unit, Monza University Hospital
| | - P Martin
- Division of Hepatology, School of Medicine, University of Miami, USA
| | - P Messa
- Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano
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Stellato T, Cappelleri A, Farina M, Pisano L, Scanziani R, Meroni M, Banfi G, Imbasciati E, Stella A. Severe reversible acute renal failure in idiopathic nephrotic syndrome. J Nephrol 2010; 23:717-724. [PMID: 20301082] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Only few cases of acute renal failure (ARF) requiring dialysis have been reported in patients with idiopathic nephrotic syndrome (NS). This study aims to better define the clinical outcome and treatment of this condition. METHODS A pilot enquiry regarding the occurrence of ARF requiring dialysis in patients with NS and biopsy proven minimal changes (MC) or focal segmental glomerulosclerosis (FSGS) was conducted among 5 nephrology centers. RESULTS From 1996-2006, 6 patients with idiopathic NS (4 MC, 2 FSGS) developed ARF requiring dialysis early after onset of NS. At presentation all but 1 patient had elevated blood pressure. Patients were treated with dialysis from 7-40 days. All achieved complete or partial remission after 4-8 weeks of steroids. Recovery of renal function paralleled with the reduction of proteinuria. At renal biopsy proximal tubules showed a large amount of protein droplets, flattening of epithelial cells, and focal detachment of cells from the basal membrane. After a follow-up of 24-60 months, 5 patients had a relapse. Of these 4 were responsive to steroids, while one progressed to dialysis after an episode of hemolytic uremic syndrome related to cyclosporine treatment. ARF did not recur. CONCLUSION ARF requiring dialysis is a rare and unexpected complication of idiopathic NS occurring in most cases early after presentation. These patients are sensitive to steroids that should be administered as promptly as possible in view of the potential noxious effect of protein overload on proximal tubular cells.
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Affiliation(s)
- Tiziana Stellato
- Nephrology Unit, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi 23, Monza, Italy
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Brell JM, Hardacre J, Schulak J, Onders R, Stellato T, Sanabria J, Schulchter M, Strickland L, Sprosty R, Pink J. Characterization of human skeletal muscle in weight-losing pancreatic cancer patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9571] [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: 11/20/2022] Open
Abstract
9571 Background: Decreased body mass (cachexia) is a common cause of functional decline in pancreas carcinoma (PC) and other malignancies. The etiology is unknown. Characterization of human PC skeletal muscle, in regard to proteolysis and gene expression, compared to control muscle may reveal information about pathophysiology. Methods: Biopsies of rectus abdominus muscle were performed in weight-losing PC patients all stages (A) during cancer-related surgery and in cancer-free controls undergoing ventral hernia repair (B). Caspase-3, pAkt, and urinary 3-methylhistidine (u3-MH) were assessed by Western blot and high-performance liquid chromatography. Fat-free mass (FFM), body mass index (BMI), and time to progression were recorded. Muscle from five patients (median weight loss 21%) and five controls were analyzed for gene expression patterns using Affymetrix Human Genome U133 A 2.0 array chip. Two hundred differentially over- and under-expressed genes were examined in group A for potential association with cachexia. RT-PCR confirmation of six candidate genes was performed. Results: Thirty-eight patients were enrolled. Median weight loss in group A (N=27) was 14.5% (5% - 34%). No differences were noted between groups in caspase-3 and pAkt expression. Baseline u3-MH (p=0.86) and FFM (p= 0.28) did not differ; baseline BMI was lower in group A (p=0.04). BMI follow-up measurements (N=17) were significantly decreased (p=0.0005). In 65% patients, progressive disease was noted within median time of 3 months. RT-PCR established up-regulation of CHRNA1 and LMO7, but not GDF8. mRNA down-regulation for TRIM63, IGF-BP6, and MYH-1 was confirmed. Conclusions: Muscle proteolysis in human PC skeletal muscle was not demonstrated, perhaps due to unmeasurable proteolysis or use of non-informative endpoints. BMI decreased in group A with PD; further studies need tight control of BMI variables. New hypotheses about cachexia include neuromuscular junction dysfunction, as CHRNA1 has specific role in ion channel gating; this is disrupted in the paraneoplastic Eaton-Lambert syndrome. This is first study analyzing human muscle in weight-losing PC and proves symptom management multidisciplinary research is feasible in academic setting. Supported by American Cancer Society pilot grant. No significant financial relationships to disclose.
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Affiliation(s)
- J. M. Brell
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - J. Hardacre
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - J. Schulak
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - R. Onders
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - T. Stellato
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - J. Sanabria
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - M. Schulchter
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - L. Strickland
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - R. Sprosty
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
| | - J. Pink
- Case Western Reserve University, Cleveland, OH; Ireland Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Clevleand, OH
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8
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Abstract
Obesity has become a foremost health problem. More than half of US adults are overweight or obese. This has been due to sedentary lifestyles, increased intake of refined carbohydrates, and fat-rich diets. Obese women are particularly susceptible to a variety of health risks including cancer, especially cancers of the breast, endometrium, and colon. Bariatric surgery appears to be a viable option for the treatment of severe obesity. As the role of surgery in the management of this condition becomes increasingly frequent, it is important for gynecological oncologists to recognize the potential for gynecological malignancies in this patient population.
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Affiliation(s)
- A E Green
- Division of Gynecologic Oncology, Department of Reproductive Biology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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9
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Haaga JR, Nakamoto D, Stellato T, Novak RD, Gavant ML, Silverman SG, Bellmore M. Intracavitary urokinase for enhancement of percutaneous abscess drainage: phase II trial. AJR Am J Roentgenol 2000; 174:1681-5. [PMID: 10845505 DOI: 10.2214/ajr.174.6.1741681] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of urokinase as an abscess-cavity irrigant during percutaneous abscess drainage. SUBJECTS AND METHODS In a prospective study, approved by the Food and Drug Administration and the review board at our institution, urokinase and saline were used as abscess-cavity irrigants. In the study group of 42 patients, half the patients were randomly placed into the urokinase group and the other half were placed into the control saline group. Doses used varied with the size of the abscess. Data collected from patient charts were evaluated with standard statistical methods. RESULTS The results indicate definite benefits of the urokinase treatment. The length of stay (p = 0.0025) and treatment costs (p = 0.0021) were significantly less for the urokinase group. Other clinical parameters, including the febrile course, elevated WBC, and days of drainage, trended in a favorable fashion. CONCLUSION Urokinase injected intracavitarily is an effective technique for shortening the treatment time and improves the clinical course for patients treated with percutaneous drainage techniques.
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Affiliation(s)
- J R Haaga
- Department of Radiology, University Hospital of Cleveland, Case Western Reserve University, OH 44106-5056, USA
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10
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Abstract
BACKGROUND Choledocholithiasis is a major source of morbidity among patients undergoing cholecystectomy for symptomatic gallstones. There is no consensus on the best approach to diagnosing bile duct stones. We compared the safety, accuracy, diagnostic yield, and cost of EUS- and ERCP-based approaches. METHODS Sixty-four consecutive pre- and post-cholecystectomy patients referred for endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis were prospectively evaluated in a blinded fashion. All were stratified into risk groups using predefined criteria. Endoscopic ultrasonography (EUS) and ERCP were sequentially performed by two endoscopists. RESULTS The success rates of EUS and ERCP were 98% and 94%, respectively. The accuracy of EUS for diagnosing choledocholithiasis was 94%. EUS provided an additional or alternative diagnosis to bile duct stones in 21% of patients. The complication rate of EUS was significantly lower than diagnostic ERCP. An EUS-based strategy costs less than diagnostic ERCP in patients with low, moderate, or intermediate risk. CONCLUSIONS EUS is comparably accurate, but safer and less costly than ERCP for evaluating patients with suspected choledocholithiasis. It is useful in patients with an increased risk of having common bile duct stones based on clinical criteria and those with contraindications for or prior unsuccessful ERCP. EUS may enable selective performance of ERCP and improve the cost-effectiveness of diagnosing choledocholithiasis.
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Affiliation(s)
- M I Canto
- Department of Medicine (Gastroenterology), University Hospitals of Cleveland-Case Western Reserve University, Ohio, USA
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11
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Youngner SJ, O'Toole E, Stellato T. Two times what? Quantity and quality of life in tube feeding decisions. J Gen Intern Med 1997; 12:134-5. [PMID: 9051566 PMCID: PMC1497074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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12
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Franceschi D, Brandt C, Margolin D, Szopa B, Ponsky J, Priebe P, Stellato T, Eckhauser ML. The management of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Am Surg 1993; 59:525-32. [PMID: 8338284] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The management of suspected and/or unsuspected common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is controversial. Decisions on whether to perform an open CBD exploration versus employing therapeutic options such as preoperative/post-operative endoscopic retrograde cholangiography (ERCP) or endoscopic duct exploration are polemic. To determine indications, timing, benefits, and potential morbidity of these approaches, we gathered data on 401 patients undergoing LC within the last 18 months. Indications for preoperative ERCP included jaundice (40%), dilated ducts (28%), elevated amylase (19%) or alkaline phosphatase (21%), suspicion of CBD stones by ultrasound (17%) and "other" (17%). Indications for postoperative ERCP were retained stones (33%) and CBD evaluation (67%). Indications for CBD exploration included abnormal cholangiogram (64%), palpable stones (18%), and other (18%). A significant correlation was observed between suspected stones by ultrasound and stones found by ERCP (P < 0.01). For patients in the "other" category, preoperative ERCP was universally negative (P = 0.04). Overall ERCP morbidity was 4/59 (6.8%), and the overall failure rate for clearing CBD stones was 2/28 (7.1%). The timing of the ERCP did not affect morbidity/mortality. Multivariate analysis revealed that age (P << 0.001), the presence of pre-existing medical risk factors (P << 0.001), and duration of LC (P = 0.0034), but not ERCP (P = 0.08), were the important factors determining LC morbidity. In summary, common bile duct stones can be successfully cleared endoscopically in the majority of patients undergoing LC. Patients with suspected CBD stones should undergo pre-operative ERCP, and strict criteria should be applied in the selection of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Franceschi
- Department of Surgery, Mount Sinai University Hospitals, Cleveland, Ohio
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13
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Abstract
OBJECTIVE Percutaneous drainage of abscesses is an effective treatment, but the success rate is lower for abscesses that have septa and are multilocular. Several clinical and in vitro studies suggest urokinase may be useful in such cases. Our study was designed to determine the safety of urokinase administered into an abscess cavity during the course of percutaneous drainage. SUBJECTS AND METHODS Our study included 26 consecutive patients with 31 abscesses treated with percutaneous drainage. Exclusion criteria included age less than 18 or more than 95 years, CNS disorders (e.g., tumor, vascular problems), coagulation impairments, hepatic failure, pregnancy, and abscesses in the spleen, pancreas, or interloop area. Three doses were used: group 1 (nine patients), 1000 IU of urokinase per centimeter of abscess diameter; group 2 (11 patients), 2500 IU of urokinase per centimeter of abscess diameter; and group 3 (nine patients), 5000 IU of urokinase per centimeter of abscess diameter. These doses were administered every 8 hr for 3 days along with percutaneous drainage. Charts were reviewed to determine success and to detect adverse clinical events. Studies included sequential CT scans; serial serum determinations of hematocrit, prothrombin time, partial thromboplastin time, platelet count, fibrinogen levels, and levels of fibrin degradation products; and serial laboratory analysis of purulent material for fibrinogen and fibrin degradation products. Percutaneous drainage was considered successful if no surgical intervention was required. RESULTS Our results showed no significant change in hematologic studies and no bleeding complications. Analysis of purulent material indicated that urokinase remained active in the abscess milieu. Drainage was successful in seven of 11 patients in group 1, all nine patients in group 2, and 10 of 11 patients in group 3. All eight abscesses with septa were successfully drained. CONCLUSION Intracavitary urokinase can be given safely during percutaneous drainage of an abscess, with no associated bleeding complications or changes in coagulation parameters.
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Affiliation(s)
- J M Lahorra
- Department of Radiology, University Hospitals of Cleveland, OH 44106
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14
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Markowitz SD, Molkentin K, Gerbic C, Jackson J, Stellato T, Willson JK. Growth stimulation by coexpression of transforming growth factor-alpha and epidermal growth factor-receptor in normal and adenomatous human colon epithelium. J Clin Invest 1990; 86:356-62. [PMID: 2365825 PMCID: PMC296730 DOI: 10.1172/jci114709] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.3] [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] [Indexed: 12/31/2022] Open
Abstract
Autocrine stimulation of the epidermal growth factor receptor (EGF-R), by coexpression of transforming growth factor-alpha (TGF-alpha), causes malignant transformation of some fibroblast cell lines. TGF-alpha and EGF-R are both known to be expressed in colon carcinoma tissue and have been shown coexpressed in colon carcinoma cell lines. TGF-alpha autocrine activation of EGF-R has been suggested as a potential mechanism contributing to abnormal growth control in colon cancer. We now report coexpression of TGF-alpha and EGF-R transcripts in morphologically normal colonic epithelium from five individuals, in colonic adenomas from three individuals, and in a nontumorigenic colon adenoma cell line, VACO-330. Functional studies demonstrate VACO-330 growth is stimulated by exogenous TGF-alpha and is completely abolished by a blocking anti-EGF-R antibody. Autocrine stimulation of EGF-R by TGF-alpha is therefore required for growth of the adenoma cell line. Autocrine stimulation of EGF-R by TGF-alpha does not cause malignant transformation of the colonic epithelial cell. In normal and adenomatous human colon TGF-alpha, via either an autocrine or paracrine mechanism, is likely an important physiologic stimulant of epithelial proliferation.
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Affiliation(s)
- S D Markowitz
- Ireland Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106
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15
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Markowitz S, Haut M, Stellato T, Gerbic C, Molkentin K. Expression of the ErbA-beta class of thyroid hormone receptors is selectively lost in human colon carcinoma. J Clin Invest 1989; 84:1683-7. [PMID: 2553781 PMCID: PMC304038 DOI: 10.1172/jci114349] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [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] [Indexed: 01/01/2023] Open
Abstract
Members of the erbA gene family are involved both in control of differentiation and in neoplasia. V-erbA, a retroviral oncogene, blocks avian erythroid differentiation. V-erbA-related transcripts are physiologically expressed in multiple normal tissues. They encode a family of transcriptional regulatory factors, some of which are thyroid hormone receptors. In man, two genes, erbA-alpha and erbA-beta, are transcriptionally active. We examined expression of erbA-related transcripts in normal and neoplastic colon. In normal colon mucosa, as well as in a colon polyp and in a colon polyp cell line, three characteristic erbA-related transcripts were consistently found. One transcript of 6 kb was erbA-beta related. Two transcripts of 2.7 and 5.2 kb were erbA-alpha related. In eight patients' colon carcinomas expression of the 6-kb erbA-beta transcript was absent or markedly diminished when compared with the same patients' noninvolved mucosa. In contrast, expression of the two erbA-alpha transcripts was the same in both colon carcinoma and noninvolved mucosa. No evidence was found of erbA-beta gene deletion in any of the tumors lacking erbA-beta expression. These data suggest that selective loss of normally present erbA-beta gene expression accompanies malignant transformation of the colonic epithelial cell.
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Affiliation(s)
- S Markowitz
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
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16
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Peterson DK, Stellato T, Nochomovitz ML, DiMarco AF, Abelson T, Mortimer JT. Electrical activation of respiratory muscles by methods other than phrenic nerve cuff electrodes. Pacing Clin Electrophysiol 1989; 12:854-60. [PMID: 2471174 DOI: 10.1111/j.1540-8159.1989.tb01910.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D K Peterson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106
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17
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Stellato T, Rhodes RS, McDougal WS. Azotemia in upper gastrointestinal hemorrhage. A review. Am J Gastroenterol 1980; 73:486-9. [PMID: 6968509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The cause of the azotemia associated with gastrointestinal hemorrhage has been controversial but review of the literature reveals consistent findings. If extraneous, complicating factors are excluded, the azotemia produced with blood ingestion does not reproduce that seen with gastrointestinal hemorrhage. Azotemia with blood ingestion alone demonstrates a mild peak and usually lasts less than 24 hours, whereas that seen clinically is both higher and longer and a manifestation of blood ingestion plus the renal effects of hypovolemia. The hypovolemia contributes quantitatively more than the digestion of blood and is the sole determinant of azotemia after 24 hours. Consequently, azotemia which persists beyond this time indicates either continuation of bleeding, continuation of hypovolemia insult or intrinsic renal disease. Persistent azotemia following gastrointestinal hemorrhage is an indication for re-evaluation of fluid management.
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