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Siham A, Hafedh F, Jean-Jacques B, Pierre-Antoine M. Characteristics and prognosis of acute renal failure on dialysis in ANCA vasculitis. Nephrol Ther 2024; 20:5-16. [PMID: 38282439 DOI: 10.1684/ndt.2024.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Renal involvement in ANCA (Anti Neutrophil Cytoplasmic Antigen) vasculitis is common and is associated with increased mortality with a significant risk of progression to end-stage renal disease. The aim of this study is to investigate the epidemiological, clinicopathological, therapeutic and evolutionary characteristics of patients with ANCA vasculitis with acute renal injury, and to evaluate the impact of haemodialysis in the acute phase on mortality and renal recovery. Secondary objectives are to investigate other risk factors that impact on overall and renal survival. 31 patients were included ; the mean follow-up time was 30 months. The mean age was 68.52 years, and the sex ratio 0.72. All patients had acute renal failure, with histology revealing a mixed form in 45% of cases and a sclerotic form in 12.9% of cases. Pulmonary involvement was found in 58% of cases. 71% of patients had ANCA with anti-myeloperoxydase specificity, and 25.8% anti-proteinase 3 specificity. 32.2% of patients required haemodialysis, of which 60% were weaned. As initial treatment, 58.1% of patients received cyclophosphamide and 35.5% rituximab. The relapse rate was 6.5%. Infectious and cardiovascular complications affected more than half of the patients. The mortality rate was 19.35%. Comparing the two groups of patients dialysed in the acute phase and not dialysed, it appears that the overall and renal mortality was comparable. The progression to end-stage renal failure was higher in the dialysis patients. In a multivariate study, the presence of chronic kidney disease in the history and pulmonary involvement were associated with higher mortality.
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Affiliation(s)
- Azria Siham
- Hôpital Tenon, service de néphrologie, Paris, France
| | - Fessi Hafedh
- Hôpital Tenon, service de néphrologie, Paris, France
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Ștefan G, Jullien P, Masson I, Alamartine E, Mariat C, Maillard N. Circulating alternative pathway complement cleavage factor Bb is associated with vascular lesions and outcomes in IgA nephropathy. Nephrol Dial Transplant 2023; 38:ii11-ii18. [PMID: 37816675 DOI: 10.1093/ndt/gfad163] [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: 04/13/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Complement alternative pathway (AP) activation is linked to immunoglobulin A nephropathy (IgAN) prognosis severity, but Bb fragment's role is unclear. We examined the relationship between serum Bb fragment concentration at IgAN diagnosis and disease activity and outcomes. METHODS This retrospective study included 125 biopsy-proven IgAN patients [age 39.9 years, 75% male, estimated glomerular filtration rate (eGFR) 82 ml/min, proteinuria 0.5 g/day] enrolled from 1984 to 2010 and followed for a minimum of 18 months. Monitoring continued until the last follow-up, end-stage kidney disease (ESKD) or death. Serum Bb fragment was measured using an enzyme-linked immunosorbent assay at diagnosis. Oxford classification and global optical score (GOS) were utilized for pathology assessment. RESULTS Patients were followed for a median of 16 years; 42% developed chronic kidney disease stage ≥3, 19% reached ESKD and 9% died. Serum Bb fragment concentration negatively correlated with eGFR values at the last follow-up and positively with vascular and tubular histopathological indices. In univariate Cox regression analyses, higher Bb fragment concentration was associated with ESKD alongside older age, increased body mass index, arterial hypertension, lower eGFR, higher proteinuria, E1, S1, T1-2, GOS and corticotherapy. Patients with Bb levels ≥14.3 μg/ml had shorter mean kidney survival time (19.5 versus 22.7 years, P = .07); after adjusting for progression risk factors, the association persisted [hazard ratio 4.76 (95% confidence interval 1.56-14.43)]. CONCLUSIONS Serum Bb fragment concentration at diagnosis may predict long-term IgAN outcomes, potentially due to AP activation at the endothelial surface. Further research is needed to confirm these results and evaluate Bb fragment's role in IgAN management.
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Affiliation(s)
- Gabriel Ștefan
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- University of Medicine and Pharmacy "Carol Davila", Nephrology Department, Bucharest, Romania
| | - Perrine Jullien
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Ingrid Masson
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Eric Alamartine
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Christophe Mariat
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Nicolas Maillard
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
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Caillard P, Vigneau C, Halimi JM, Hazzan M, Thervet E, Heitz M, Juillard L, Audard V, Rabant M, Hertig A, Subra JF, Vuiblet V, Guerrot D, Tamain M, Essig M, Lobbedez T, Quemeneur T, Legendre M, Ganea A, Peraldi MN, Vrtovsnik F, Daroux M, Makdassi R, Choukroun G, Titeca-Beauport D. Prognostic value of complement serum C3 level and glomerular C3 deposits in anti-glomerular basement membrane disease. Front Immunol 2023; 14:1190394. [PMID: 37475859 PMCID: PMC10354545 DOI: 10.3389/fimmu.2023.1190394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Background and objectives Activation of the complement system is involved in the pathogenesis of anti-glomerular basement membrane (anti-GBM) disease. Glomerular deposits of complement 3 (C3) are often detected on kidney biopsies. The primary objective of this study was to analyze the prognostic value of the serum C3 level and the presence of C3 glomerular deposits in patients with anti-GBM disease. Methods We conducted a retrospective cohort study of 150 single-positive patients with anti-GBM disease diagnosed between 1997 and 2017. Patients were categorized according to the serum C3 level (forming a low C3 (C3<1.23 g/L) and a high C3 (C3≥1.23 g/L) groups) and positivity for C3 glomerular staining (forming the C3+ and C3- groups). The main outcomes were kidney survival and patient survival. Results Of the 150 patients included, 89 (65%) were men. The median [interquartile range (IQR)] age was 45 [26-64]. At diagnosis, kidney involvement was characterized by a median [IQR] peak serum creatinine (SCr) level of 578 [298-977] µmol/L, and 106 (71%) patients required dialysis. Patients in the low C3 group (72 patients) had more severe kidney disease at presentation, as characterized by higher prevalences of oligoanuria, peak SCr ≥500 µmol/L (69%, vs. 53% in the high C3 group; p=0.03), nephrotic syndrome (42%, vs. 24%, respectively; p=0.02) and fibrous forms on the kidney biopsy (21%, vs. 8%, respectively; p=0.04). Similarly, we observed a negative association between the presence of C3 glomerular deposits (in 52 (41%) patients) and the prevalence of cellular forms (83%, vs. 58% in the C3- group; p=0.003) and acute tubulo-interstitial lesions (60%, vs. 36% in the C3- group; p=0.007). When considering patients not on dialysis at diagnosis, the kidney survival rate at 12 months was poorer in the C3+ group (50% [25-76], vs. 91% [78-100] in the C3- group; p=0.01), with a hazard ratio [95% confidence interval] of 5.71 [1.13-28.85] (p=0.04, after adjusting for SCr). Conclusion In patients with anti-GBM disease, a low serum C3 level and the presence of C3 glomerular deposits were associated with more severe disease and histological kidney involvement at diagnosis. In patients not on dialysis at diagnosis, the presence of C3 deposits was associated with worse kidney survival.
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Affiliation(s)
- Pauline Caillard
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
- Mécanismes Physiopathologiques et Conséquences des Calcifications Cardiovasculaires (MP3CV) laboratory, Centre de Recherche en Santé (CURS), Amiens, France
| | - Cécile Vigneau
- Rennes University Hospital, Inserm, Ecole des hautes études en santé publique (EHESP), Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Jean-Michel Halimi
- Department of Nephrology, Tours University Hospital and EA4245, University of Tours, Tours, France
| | - Marc Hazzan
- Nephrology Department, Lille University Hospital, University of Lille, UMR 995, Lille, France
| | - Eric Thervet
- Department of Nephrology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris and INSERM UMRS970, Boulogne-Billancourt, France
| | - Morgane Heitz
- Department of Nephrology and Dialysis, Annecy Genevois Hospital, Pringy, France
| | - Laurent Juillard
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Carmen INSERM 1060 and Univ Lyon, Lyon, France
| | - Vincent Audard
- Department of Nephrology and Renal Transplantation, Reference Center-Idiopathic Nephrotic Syndrome, Henri-Mondor Hospital/Albert-Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP) Créteil, INSERMU955, Paris Est Créteil University, Créteil, France
| | - Marion Rabant
- Pathology Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre-Université de Paris, Paris, France
| | - Alexandre Hertig
- Department of Nephrology, Dialysis and Transplantation, Foch Hospital, Paris-Saclay University, Suresnes, France
| | - Jean-François Subra
- Department of Nephrology, Dialysis and Transplantation, University Hospital, Angers and Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), INSERM, Nantes University, Angers University, Angers, France
| | - Vincent Vuiblet
- Department of Nephrology and Renal Transplantation, Reims University Hospital, Reims, France
| | - Dominique Guerrot
- Department of Nephrology, Rouen University Hospital, Rouen and INSERM, U1096 Rouen, France
| | - Mathilde Tamain
- Department of Nephrology and Dialysis, Vichy Hospital, Vichy, France
| | - Marie Essig
- Department of Nephrology, Dialysis, and Renal Transplantation, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Boulogne-Billancourt, France
| | - Thierry Lobbedez
- Department of Nephrology, Caen University Hospital, Caen, France and the French Registry of Peritoneal Dialysis, Langue Française, Pontoise, France
| | - Thomas Quemeneur
- Department of Nephrology and Internal Medicine, Valenciennes General Hospital, Valenciennes, France
| | - Mathieu Legendre
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital, Dijon, France
| | | | - Marie-Noëlle Peraldi
- Department of Nephrology, Dialysis and Renal Transplantation, Necker University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Paris, France
| | - François Vrtovsnik
- Nephrology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France. Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Maïté Daroux
- Department of Nephrology, Duchenne Hospital, Boulogne-Sur-Mer, France
| | - Raïfah Makdassi
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
| | - Gabriel Choukroun
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
- Mécanismes Physiopathologiques et Conséquences des Calcifications Cardiovasculaires (MP3CV) laboratory, Centre de Recherche en Santé (CURS), Amiens, France
| | - Dimitri Titeca-Beauport
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
- Mécanismes Physiopathologiques et Conséquences des Calcifications Cardiovasculaires (MP3CV) laboratory, Centre de Recherche en Santé (CURS), Amiens, France
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Rodelo J, Aguirre L, Ortegón K, Ustáriz J, Calderon L, Taborda A, Arias LF, González LA. Predicting kidney outcomes among Latin American patients with lupus nephritis: The prognostic value of interstitial fibrosis and tubular atrophy and tubulointerstitial inflammation. Lupus 2023; 32:411-423. [PMID: 36647707 DOI: 10.1177/09612033231151597] [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: 01/18/2023]
Abstract
OBJECTIVE To assess the effect of tubulointerstitial inflammation (TII) and interstitial fibrosis and tubular atrophy (IFTA) on kidney survival in lupus nephritis (LN). METHODS Two hundred eighty five patients with biopsy-proven LN were retrospectively studied. Kidney survival was defined as the time from initial biopsy to end-stage kidney disease (ESKD), dialysis, or transplant. Kidney survival analysis was performed by the Kaplan-Meier method and the statistical difference between survival curves compared by the log-rank test. Cumulative incidence functions with competing risk of death for kidney survival were also graphed. Multivariable Cox proportional hazards regression and competing-risk analyses were performed to identify independent predictors of ESKD. RESULTS Fifty-seven patients (20%) progressed to ESKD during a median time of 4.2 (2.0-55.2) months after biopsy. TII was present in 206 (72.3%) biopsies, while IFTA in 99 (34.7%) biopsies. Patients with moderate-to-severe IFTA had worse kidney survival than those with none or mild IFTA in both the Kaplan-Meier (p = 0.018) and the competing-risk analyses (p = 0.017). Patients with class IV ± V LN had worse kidney survival than those with non-class IV LN by the Kaplan-Meier method (p = 0.050), but not in the competing-risk analysis (p = 0.154). Worse kidney survival was also found among those with fibrous crescents than those without, in both the Kaplan-Meier (p = 0.010) and the competing-risk (p = 0.011) analyses. By multivariable Cox regression analysis, older age (HR 1.04, 95% CI 1.01-1.07) and class IV ± V LN (HR 5.06, 95% CI 1.82-14.09) were associated with higher risk of ESKD after adjusting for sex, ethnicity, TII, and IFTA. By competing-risk analyses, class IV ± V LN (SHR 3.32, 95% CI 1.25-8.83) and no response to immunosuppressive therapy (SHR 4.55, 95% CI 1.54-13.41) were associated with a higher risk of ESKD, while eGFR >90 mL/min/1.73 m2 (SHR 0.98 for each ml/min/1.73 m2, 95% 0.97-0.99) with a lower risk. CONCLUSIONS Patients with moderate-to-severe IFTA had worse kidney survival than those with none or mild IFTA. Worse kidney survival was also found among those with class IV LN and fibrous crescents versus those without IV LN and fibrous crescents, respectively.
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Affiliation(s)
- Joaquín Rodelo
- Division of Nephrolology, Department of Internal Medicine, School of Medicine, Hospital Universitario de San Vicente Fundación, 161932Universidad de Antioquia, Medellín, Colombia
| | - Lina Aguirre
- Division of Nephrolology, Department of Internal Medicine, School of Medicine, Hospital Universitario de San Vicente Fundación, 161932Universidad de Antioquia, Medellín, Colombia
| | - Katherine Ortegón
- Division of Nephrolology, Department of Internal Medicine, School of Medicine, Hospital Universitario de San Vicente Fundación, 161932Universidad de Antioquia, Medellín, Colombia
| | - José Ustáriz
- Division of Nephrolology, Department of Internal Medicine, School of Medicine, Hospital Universitario de San Vicente Fundación, 161932Universidad de Antioquia, Medellín, Colombia
| | - Ligia Calderon
- Division of Nephrolology, Department of Internal Medicine, School of Medicine, Hospital Universitario de San Vicente Fundación, 161932Universidad de Antioquia, Medellín, Colombia
| | - Alejandra Taborda
- Department of Pathology, School of Medicine, 161932Universidad de Antioquia, Medellín, Colombia
| | - Luis Fernando Arias
- Department of Pathology, School of Medicine, 161932Universidad de Antioquia, Medellín, Colombia
| | - Luis Alonso González
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Hospital Universitario de San Vicente Fundación, 161932Universidad de Antioquia, Medellín, Colombia
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Stefan G, Stancu S, Zugravu A, Popa O, Zubidat D, Petre N, Mircescu G. Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous nephropathy. Ren Fail 2022; 44:258-268. [PMID: 35172682 PMCID: PMC8863379 DOI: 10.1080/0886022x.2022.2033265] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background The value of anti-phospholipase A2 receptor antibody (anti-PLA2R ab) monitoring at 3 months after diagnosis in membranous nephropathy (MN) remains uncertain. Methods We retrospectively examined the outcome on 1 August 2020 of 59 adult patients (age 54 (44, 68) years, 69% male, SCr 1.0 (0.9, 1.3) mg/dL) diagnosed with MN (kidney biopsy, positive serum anti-PLA2R ab). The outcomes were: kidney survival; partial and/or complete remission. Results Most of the studied patients (97%) received immunosuppression, cyclophosphamide regimens were the most frequent (87%), followed by cyclosporine (10%). The median time to remission was 12.0 months and the cumulative remission rates were 34% at 6, 54% at 12, and 73% at 24 months. Forty (69%) patients had negative anti-PLA2R ab at 3 months, they had similar age, serum creatinine, albumin, proteinuria, and treatment with the group with positive ab at 3 months. In the Cox proportional hazard model, three months anti-PLA2R ab negativization (HR 0.4 (95%CI 0.1, 0.9)) was an independent predictor for remission, while baseline hypoalbuminemia (HR 3.0 (95%CI 1.5, 5.7)) was associated with absence of remission. Six (10%) patients died, mostly due to cardiovascular disease and infections. A total of five (9%) patients started dialysis. Mean kidney survival time was 50.3 months and there was no survival difference in relation to baseline anti-PLA2R ab titer (p .09) or 3 months negativization (p .8). Conclusions Three months anti-PLA2R ab negativization seems to be a late predictor of remission, and lower serum albumin at diagnosis is an early marker for remission absence. Abbreviations: anti-P LA2R ab, anti-phospholipase A2 receptor antibody; eGFR, estimated glomerular filtration rate; ESKD, end stage kidney disease; MN, membranous nephropathy; NELL-1, neural epidermal growth factor-like 1 protein; RAAS: renin–angiotensin–aldosterone system; RBC: red blood cells; RRT, renal replacement therapy; T HSD7A, thrombospondin type-1 domain containing 7A
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Affiliation(s)
- Gabriel Stefan
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Simona Stancu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Adrian Zugravu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Otilia Popa
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Dalia Zubidat
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Nicoleta Petre
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gabriel Mircescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
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Muchtar E, Drake MT, Leung N, Dispenzieri A, Lacy MQ, Buadi FK, Dingli D, Hayman SR, Kapoor P, Hwa YL, Fonder A, Hobbs M, Gonsalves W, Kourelis TV, Warsame R, Russell S, Go RS, Binder M, Kyle RA, Rajkumar SV, Kumar SK, Gertz MA. Hypovitaminosis D Is Prevalent in Patients With Renal AL Amyloidosis and Associated With Renal Outcome. Front Endocrinol (Lausanne) 2022; 13:891712. [PMID: 35800433 PMCID: PMC9253369 DOI: 10.3389/fendo.2022.891712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Vitamin D deficiency is common, but no data have been reported on vitamin D levels in light chain (AL) amyloidosis. PATIENTS AND METHODS In this exploratory study, stored serum samples from 173 patients with newly diagnosed AL amyloidosis were analyzed for vitamin studies which included 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D] and vitamin D binding protein (DBP). Measurements were made by liquid chromatography-tandem mass spectrometry. Kidney survival and overall survival (OS) were assessed in association to vitamin D status. RESULTS Cardiac and kidney involvement occurred in 69% and 63% of patients, respectively. 25(OH)D deficiency (<20 ng/mL) was seen in 56.6% of the patients and was notably found among patients with heavy proteinuria (96%), hypoalbuminemia (84.3%) and morbidly obese patients (68.3%). Heavy proteinuria (>5 gr/24-h) and vitamin D supplementation were independent predictors of 25(OH)D level on nominal multivariate regression analysis. 1,25(0H)2D deficiency was noted in 37.6% of patients and was independently associated with low eGFR and hypoalbuminemia. Progression to ESRD occurred in 23.7% of evaluable patients. Patients who progressed to ESRD had lower serum 25(OH)D and 1,25(OH)2D levels compared to those who did not progress to ESRD. On a multivariate analysis, severe 25(OH)D deficiency was an independent predictor of progression to ESRD as was renal stage, while 1,25(OH)2D deficiency was not. CONCLUSIONS Hypovitaminosis D is common in AL amyloidosis, particularly among patients with heavy proteinuria. Severe 25(OH)D deficiency at time of diagnosis predicts progression to ESRD.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Eli Muchtar,
| | - Matthew T. Drake
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- Department of Endocrinology and Kogod Center of Aging, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | | | - Martha Q. Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Francis K. Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Wilson Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Stephen Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Robert A. Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Morie A. Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
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Stefan G, Stancu S, Zugravu A, Capusa C. Inflammation-based modified Glasgow prognostic score and renal outcome in chronic kidney disease patients: is there a relationship? Intern Med J 2021; 52:968-974. [PMID: 33647179 DOI: 10.1111/imj.15251] [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: 08/30/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) progression is presumably related to inflammatory response. The modified Glasgow prognostic score (mGPS), based on combination between albumin and C-reactive protein, has been derived from oncology and validated in multiple diseases. AIMS We aimed to evaluate the relationship between the mGPS and CKD progression. METHODS The present retrospective unicentric cohort study included 547 CKD patients (age 60.2 years, 53% male, eGFR 42.0 mL/min, mean change -2 mL/min/year) admitted between January 1, 2007 and December 31, 2012. Patients records were reviewed from the CKD diagnosis to one of the four outcomes: end-stage kidney disease (ESKD), death, loss to follow-up, or until July 31, 2017. RESULTS The mGPS score was 0 for 420 (78%), 1 for 110 (19%), and 2 for 17 (3%) patients. More patients with rapid CKD progression were found in the group with the highest mGPS (p=0.05). mGPS was negatively correlated with baseline eGFR and positively with albuminuria. In the multivariate analysis, mGPS was associated with the eGFR slope. During the study period, 130 patients (24%) died and 109 (20%) reached ESKD. The mean kidney survival time was 8.1 (95%CI 7.9 to 8.4) years. Patients with zero mGPS had better kidney survival than those with the score of one and two (Kaplan-Meier, p=0.02). However, the kidney survival differences were not present after adjusting for CKD progression risk factors. CONCLUSION The inflammation-based mGPS score was associated with eGFR decline in CKD patients. Therefore, could prove useful in improving risk stratification of CKD patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Simona Stancu
- Dr. Carol Davila Teaching Hospital of Nephrology.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Adrian Zugravu
- Dr. Carol Davila Teaching Hospital of Nephrology.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cristina Capusa
- Dr. Carol Davila Teaching Hospital of Nephrology.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Caravaca-Fontán F, Trujillo H, Alonso M, Díaz-Encarnación M, Cabello V, Ariceta G, Quintana LF, Marco H, Barros X, Ramos N, Rodríguez-Mendiola N, Cruz S, Fernández-Juárez G, Rodríguez E, de la Cerda F, Pérez de José A, López I, Fernández L, Pérez Gómez V, Ávila A, Bravo L, Lumbreras J, Allende N, Sanchez de la Nieta MD, Olea T, Melgosa M, Huerta A, Miquel R, Mon C, Fraga G, de Lorenzo A, Draibe J, González F, Shabaka A, Illescas ML, Calvo C, Oviedo V, Da Silva I, Goicoechea de Jorge E, Caravaca F, Praga M. Validation of a Histologic Scoring Index for C3 Glomerulopathy. Am J Kidney Dis 2020; 77:684-695.e1. [PMID: 33359150 DOI: 10.1053/j.ajkd.2020.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022]
Abstract
RATIONALE & OBJECTIVE A previous study that evaluated associations of kidney biopsy findings with disease progression in patients with C3 glomerulopathy (C3G) proposed a prognostic histologic index (C3G-HI) that has not yet been validated. Our objective was to validate the performance of the C3G-HI in a new patient population. STUDY DESIGN Multicenter, retrospective cohort study. SETTING & PARTICIPANTS 111 patients fulfilling diagnostic criteria of C3G between January 1995 and December 2019, from 33 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). PREDICTORS Demographic, clinical parameters, C3G-HI total activity score, and the C3G-HI total chronicity score. OUTCOME Time to kidney failure. ANALYTICAL APPROACH Intraclass correlation coefficients and κ statistic were used to summarize inter-rater reproducibility for assessment of histopathology in kidney biopsies. The nonlinear relationships of risk of kidney failure with the total activity score and total chronicity score were modeled using Cox proportional hazards analysis that incorporated cubic splines. RESULTS The study group included 93 patients with C3 glomerulonephritis and 18 with dense-deposit disease. Participants had an overall meanage of 35±22 (SD) years. Forty-eight patients (43%) developed kidney failure after a mean follow-up of 65±27 months. The overall inter-rater reproducibility was very good for the total activity score (intraclass correlation coefficient [ICC]=0.63) and excellent for total chronicity score (ICC=0.89). Baseline estimated glomerular filtration rate (eGFR), 24-hour proteinuria, and treatment with immunosuppression were the main determinants of kidney failure in a model with only clinical variables. Only tubular atrophy and interstitial fibrosis were identified as predictors in a model with histological variables. When the total activity score and total chronicity score were added to the model, only the latter was identified as an independent predictor of kidney failure. LIMITATIONS Only a subset of the kidney biopsies was centrally reviewed. Residual confounding. CONCLUSIONS We validated the performance of C3G-HI as a predictor of kidney failure in patients with C3G. The total chronicity score was the principal histologic correlate of kidney failure.
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Affiliation(s)
- Fernando Caravaca-Fontán
- Instituto de Investigación Hospital 12 de octubre (i+12), Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Hernando Trujillo
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marina Alonso
- Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Virginia Cabello
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology, Hospital Clinic de Barcelona Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Helena Marco
- Department of Nephrology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitario Doctor Josep Trueta, Gerona, Spain
| | - Natalia Ramos
- Department of Nephrology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Sonia Cruz
- Department of Nephrology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Gema Fernández-Juárez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Francisco de la Cerda
- Department of Pediatric Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez de José
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Inmaculada López
- Department of Nephrology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Loreto Fernández
- Department of Nephrology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Vanessa Pérez Gómez
- Department of Nephrology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Ávila
- Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Luis Bravo
- Department of Nephrology, Hospital Universitario A Coruña, La Coruña, Spain
| | - Javier Lumbreras
- Pediatric Nephrology Unit, Hospital Universitario Son Espases, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Natalia Allende
- Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Teresa Olea
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Melgosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rosa Miquel
- Department of Nephrology, Hospital Universitario Canarias, Tenerife, Spain
| | - Carmen Mon
- Department of Nephrology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Gloria Fraga
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alberto de Lorenzo
- Department of Nephrology, Hospital Universitario de Getafe, Madrid, Spain
| | - Juliana Draibe
- Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fayna González
- Department of Nephrology, Hospital Doctor Negrín, Gran Canaria, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Maria Luisa Illescas
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Consuelo Calvo
- Department of Nephrology, Hospital General Universitario de Castellón, Castellón, Spain
| | - Victoria Oviedo
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Iara Da Silva
- Department of Nephrology, Fundación Puigvert, Barcelona, Spain
| | - Elena Goicoechea de Jorge
- Department of Immunlogy, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid and Centro de Investigación Biomédica en Red en Enfermedades Raras, Madrid, Spain
| | - Francisco Caravaca
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Manuel Praga
- Instituto de Investigación Hospital 12 de octubre (i+12), Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Uslu A, Cayhan VK, Simsek C, Aykas A, Karatas M, Tarcan IC, Okut G, Tatar E. Tubular vesicopyelostomy for the management of types 2 and 3 (long-segment) ureteric stenosis after kidney transplantation. Int J Artif Organs 2018; 42:3-8. [PMID: 30182796 DOI: 10.1177/0391398818796346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Late ureteral stenosis following kidney transplantation needs immediate correction in order to protect allograft function and requires a complicated surgical procedure. In this study, we present the long-term results of tubular bladder reconfiguration and cystopyelostomy (tubular vesicopyelostomy), an innovative and practical procedure for the management of long-segment ureteric stenosis (types 2 and 3) after transplantation. Between 2002 and 2017, 722 kidney transplant patients were monitored at the University of Medical Sciences, Bozyaka Organ Transplantation and Research Center. Twenty-eight of these patients underwent tubular vesicopyelostomy operation; 17 male and 11 female patients with a mean age of 45.6 ± 10.5 years. Time to surgical intervention for urinary tract obstruction was 122.5 ± 114.7 months. The mean serum creatinine values previous to and 3 days following the tubular vesicopyelostomy operation were 3.46 ± 1.5 mg/dL and 1.75 ± 0.7 mg/dL, respectively (p < 0.0001). Within a mean follow-up period of 55.1 ± 40.9 months, functional grafts were recorded in 22 patients with a mean serum creatinine value of 1.92 ± 0.8 mg/dL. Only one patient developed anastomotic stenosis after the tubular vesicopyelostomy procedure, giving an overall success rate for tubular vesicopyelostomy of 96.4%. Six patients returned to hemodialysis. In five, the underlying etiology was not related to recurrent obstruction or surgical complications. Sixteen patients underwent allograft biopsy after the operation, but features of tubulointerstitial nephritis were seen in only one. Tubular vesicopyelostomy operation is a safe and successful method for the surgical treatment of late and complicated ureteral obstructions with excellent long-term results. It may be a good, practical alternative to other more sophisticated surgical options.
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Affiliation(s)
- Adam Uslu
- 1 Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Veli Kursat Cayhan
- 1 Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Cenk Simsek
- 1 Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ahmet Aykas
- 1 Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Murat Karatas
- 1 Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ismail Can Tarcan
- 1 Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Gokalp Okut
- 1 Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Erhan Tatar
- 2 Department of Internal Nephrology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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Ştefan G, Ismail G, Stancu S, Zugravu A, Andronesi A, Mandache E, Mircescu G. Validation study of Oxford Classification of IgA Nephropathy: the significance of extracapillary hypercellularity and mesangial IgG immunostaining. Pathol Int 2016; 66:453-9. [PMID: 27439692 DOI: 10.1111/pin.12442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/20/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022]
Abstract
The Oxford classification (OC) of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as predictors of outcome. We aimed to validate the OC and to investigate the clinical significance of extracapillary hypercellularity and IgG immunostaining. We examined the renal outcome at December 31, 2014, of 121 adult patients with biopsy proven primary IgAN between 2003 and 2013. The primary endpoint was doubling of serum creatinine or renal replacement therapy initiation. The mean observation period was 59.7 months. Thirty-one percent of the patients presented with a grade of extracapillary hypercellularity. In comparison with the group with no crescents, they had higher grade of inflammation, lower eGFR and increased proteinuria. There were no differences between the IgA and IgA&IgG immunostaining groups regarding the disease progression risk factors. Mean kidney survival time for the entire cohort was 10.6 (9.1, 12.0) years. In the Cox regression model, the independent predictors of decreased renal survival were eGFR at time of biopsy, S1 and the presence of crescents. Our study showed that extracapillary proliferation and S1 had the greatest importance in establishing the renal prognosis of patients with IgAN.
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Affiliation(s)
- Gabriel Ştefan
- Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Romanian Renal Registry
| | - Gener Ismail
- Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Center of Internal Medicine-Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Simona Stancu
- Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Adrian Zugravu
- Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Andreea Andronesi
- Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Center of Internal Medicine-Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Eugen Mandache
- "Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gabriel Mircescu
- Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Dr Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.,Romanian Renal Registry
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