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Shaker N, Ben Musa R, Shaker N, Nasir H, Kamran TE, Poombal F, Abid A, Abu Shakra R, Mansoor I. Lipoprotein Glomerulopathy With Complete Resolution With Fenofibrate: Report of First Case From Pakistan. Int J Surg Pathol 2024:10668969241228298. [PMID: 38327135 DOI: 10.1177/10668969241228298] [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: 02/09/2024]
Abstract
Background: Lipoprotein glomerulopathy is an infrequent glomerular disorder that culminates in nephrotic syndrome and often progresses to kidney failure. Whereas most patients have been reported in Japan and China, limited reports have been documented outside these regions. This patient represents the first report of lipoprotein glomerulopathy in Pakistan. Case Presentation: A 25-year-old male patient, hypertensive for 2 years, presented with progressive body edema, frothy urine, and fatigue. Examination revealed elevated blood pressure, bilateral pedal edema, and positive shifting dullness. Laboratory results showed significant proteinuria and elevated cholesterol and triglyceride levels. Renal biopsy revealed enlarged glomeruli with a dilated capillary lumen filled with pale-staining mesh-like material "lipoprotein thrombi." Mild tubular atrophy and interstitial inflammation were observed. No interstitial fibrosis was evident. Electron microscopy detailed the lipoprotein thrombi with lipid granules and vacuoles of various sizes. A diagnosis of lipoprotein glomerulopathy was rendered. Treatment with fenofibrate, rosuvastatin, and captopril led to notable improvements in symptoms, blood pressure, and lipid levels during a 6-month follow-up. Subsequent biopsy showed complete resolution of the lipoprotein thrombi and a significant reduction in subendothelial granular densities. However, the flocculent subendothelial material persisted to some extent despite the complete resolution of lipoprotein thrombi. Conclusion: This report underscores the rarity of lipoprotein glomerulopathy in Pakistan and contributes valuable insights into its histopathologic features and global epidemiology. This unique instance aims to raise awareness among healthcare professionals, aiding in improved recognition of this rare entity. The favorable response to fenofibrate treatment underscores its effectiveness in managing lipoprotein glomerulopathy.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center/James Cancer Hospital, Columbus, USA
| | - Ruwaida Ben Musa
- Biomedical Sciences, University of Missouri-Columbia, Columbia, USA
| | - Nuha Shaker
- Department of Pathology, University of Pittsburgh Medical Center Health System, Pittsburgh, USA
| | - Humaira Nasir
- Shifa International Hospitals Ltd, Islamabad, Pakistan
| | | | - Fnu Poombal
- Department of Pathology, Nishtar Medical College and Hospital, Multan, Pakistan
| | - Abdul Abid
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, USA
| | - Rafat Abu Shakra
- Department of Pathology, International Medical Center Hospital, Jeddah, Saudi Arabia
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Tanimizu H, Hara R, Sekine A, Inoue N, Hasegawa E, Tanaka K, Kono K, Kinowaki K, Ohashi K, Okubo M, Yamaguchi Y, Kang D, Honda K, Saito T, Sawa N, Ubara Y, Hoshino J. Apolipoprotein E-associated Lipoprotein Glomerulo-tubulopathy. Intern Med 2023; 62:2209-2214. [PMID: 37532513 PMCID: PMC10465279 DOI: 10.2169/internalmedicine.0834-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/17/2022] [Indexed: 08/04/2023] Open
Abstract
A 32-year-old man was admitted for the evaluation of proteinuria (5.69 g/day). A light microscopic examination showed markedly dilated glomerular capillary loops with vacuolated areas in many glomeruli, and vacuolated areas were seen on peritubular capillaries in the tubulointerstitium. When electron microscopy specimens prepared by pre-fixation with glutaraldehyde and post-fixation with osmium tetroxide were used for oil red staining, the deposition was confirmed on the affected areas. A genetic analysis of apoE showed that the lipoprotein glomerulopathy was due to apoE-Sendai (Arg145Pro, p.R163P) heterozygosity, which was found in not only the patient but also his mother and twin brother.
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Affiliation(s)
- Hikaru Tanimizu
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Risa Hara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Akinari Sekine
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Noriko Inoue
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Kiho Tanaka
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital Toranomon, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital Toranomon, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Minoru Okubo
- Section of Lipid Research and Department of Endocrinology and Metabolism, Toranomon Hospital, Japan
| | | | - Dedong Kang
- Department of Anatomy, Showa University School of Medicine, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Japan
| | | | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
| | - Junichi Hoshino
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Toranomon, Japan
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3
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Ting JA, McRae SA, Schwartz D, Barbour SJ, Riazy M. Lipoprotein Glomerulopathy, First Case Report from Canada. Int J Nephrol Renovasc Dis 2022; 15:207-214. [PMID: 35761986 PMCID: PMC9233511 DOI: 10.2147/ijnrd.s364890] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Lipoprotein glomerulopathy (LPG) is caused by a mutation in the apolipoprotein E gene (APOE) gene and is characterized by lipoprotein thrombi in glomerular capillaries. Here, we describe a case of LPG, the first to be reported from Canada and the first case of LPG in North America to be associated with the APOE Tokyo/Maebashi mutation (p.Leu162_Lys164del, traditional nomenclature 142_144del). A 49-year-old man of Chinese descent with a previous diagnosis of dyslipidemia and a new diagnosis of hypertension was found to have proteinuria on routine urinalysis. Renal biopsy showed markedly dilated glomerular capillaries filled with pale staining mesh-like material that stained positive for Oil-Red-O, consistent with lipoprotein thrombi. APOE gene sequencing confirmed the diagnosis of LPG. The patient was treated with fenofibrate and perindopril. His lipid profile normalized and proteinuria dropped to minimal levels. Repeat renal biopsy 2 years after the first showed resolution of lipoprotein thrombi but with rare residual granular densities by electron microscopy consistent with lipoprotein in the subendothelial space, supporting the hypothesis that this subendothelial material contains precursors to lipoprotein thrombi.
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Affiliation(s)
- Julie Anne Ting
- Division of Nephrology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Susanna A McRae
- Division of Nephrology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.,Department of Pathology, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
| | - Daniel Schwartz
- Division of Nephrology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Sean J Barbour
- Division of Nephrology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Maziar Riazy
- Division of Nephrology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.,Department of Pathology, University of British Columbia, Vancouver, BC, V6Z 1Y6, Canada
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4
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Li Y, Chen J, Zou Y, Wang W, Li G. Lipoprotein glomerulopathy resulting from compound heterogeneous mutations of APOE gene: A case report. Medicine (Baltimore) 2022; 101:e28718. [PMID: 35119017 PMCID: PMC8812603 DOI: 10.1097/md.0000000000028718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/11/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Lipoprotein glomerulopathy (LPG) is a rare glomerular disease characterized by the deposition of lipoprotein thrombi in glomerular capillaries. The disease is characterized by proteinuria, progressive renal failure, and characteristic lipoprotein thrombosis in glomerular capillaries. Rare mutations in the apolipoprotein E (APOE) gene mainly contribute to disease pathogenesis. PATIENT CONCERNS A 28-year-old man presented with severe proteinuria and hyperlipidemia. The patient was treated with a full dose of prednisone for 2 months and then combined with leflunomide 20 mg daily for 20 days; however, his edema continued to worsen. DIAGNOSIS The patient was diagnosed LPG by laboratory examination and renal biopsy. INTERVENTIONS The patient was treated with atorvastatin (20 mg) combined with irbesartan (75 mg) once a day. OUTCOMES The patient's lipidaemia and proteinuria were significantly reduced. Genetic testing showed that the patient carried compound heterozygous mutations in APOE. The APOE gene was inherited from her mother and father. Parents with a heterogeneous mutation had normal kidney function without proteinuria. LESSONS Usually, a single mutation in APOE can lead to the pathogenesis of LPG. This case shows that LPG could result from compound heterogeneous mutations of the APOE gene inherited from his mother and father. Intensive lipid-lowering combined with RASIs is effective in patients with LPG. Early renal biopsy and genetic mutation detection can avoid the unnecessary use of glucocorticoids and immunosuppressants.
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Liao J, Bai J, An X, Liu Y, Wang Y, Liu G, Huang W, Xia Y. Lipoprotein Glomerulopathy-Like Lesions in Atherosclerotic Mice Defected With HDL Receptor SR-B1. Front Cardiovasc Med 2021; 8:734824. [PMID: 34692787 PMCID: PMC8531488 DOI: 10.3389/fcvm.2021.734824] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 12/25/2022] Open
Abstract
High-density lipoprotein (HDL) homeostasis is important in maintaining both cardiovascular and renal health. Scavenger receptor class B type 1 (SR-B1), the major HDL receptor in mammals, plays a crucial role in reverse cholesterol transport and HDL metabolism. Evidence from mouse study has well demonstrated that HDL disorders caused by Srb1 inactivation accelerate atherosclerosis and even induce lethal cardiovascular diseases. However, the renal consequences of Srb1 dysfunction are still unknown. Here we explored this issue in both Srb1 knockout (Srb1-/-) mice and atherosclerotic low-density lipoprotein receptor knockout (Ldlr-/-) mice with Srb1 deletion. Our data showed that no apparent renal damage was observed in 5-month-old Srb1-/- mice fed on standard rodent chow diet as well as Srb1-/- mice fed on a high-fat diet (HFD) for 12 weeks. However, 5-month-old Srb1/Ldlr-/- mice fed on rodent chow had increased urinary albumin excretion and developed spontaneous intraglomerular Oil-red O (ORO)-positive lipoprotein deposition that is similar to lesions observed in human lipoprotein glomerulopathy (LPG). HFD feeding accelerated LPG-like lesions in Srb1/Ldlr-/- mice, inducing severe proteinuria and significantly promoting intraglomerular ORO-positive lipoprotein deposition. Interestingly, probucol reversed HFD-induced HDL disorders and almost fully abrogated LPG-like lesions in Srb1/Ldlr-/- mice. In conclusion, the present study demonstrates that SR-B1 dysfunction leads to LPG-like lesions in atherosclerotic mice, which could be rescued by probucol. SR-B1 loss-of-function mutant carriers therefore might be susceptible to developing metabolic nephropathy in addition to cardiovascular diseases, and probucol might be a potential therapeutics.
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Affiliation(s)
- Jiawei Liao
- Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University Health Science Center, Beijing, China
| | - Jie Bai
- Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiangbo An
- Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yang Liu
- Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuhui Wang
- Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University Health Science Center, Beijing, China
| | - George Liu
- Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University Health Science Center, Beijing, China
| | - Wei Huang
- Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University Health Science Center, Beijing, China
| | - Yunlong Xia
- Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Kollbrunner L, Hirt-Minkowski P, Sanz J, Bresin E, Neuhaus TJ, Hopfer H, Jehle AW. Case Report: Lipoprotein Glomerulopathy Complicated by Atypical Hemolytic Uremic Syndrome. Front Med (Lausanne) 2021; 8:679048. [PMID: 34150810 PMCID: PMC8206272 DOI: 10.3389/fmed.2021.679048] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/14/2022] Open
Abstract
Lipoprotein glomerulopathy (LPG) is a rare inherited disease caused by mutations in the APOE gene, encoding apolipoprotein E (apoE). Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy (TMA) characterized by overactivation of the alternative complement pathway. Here we report the case of a 21-year-old man with LPG who developed aHUS. A functional complement assay demonstrated an overactivation of the complement system. Complementary genetic analysis revealed a homozygous aHUS risk allele for complement factor-H related 1 (CFHR1), CFHR1*B. To the best of our knowledge, this is the first report of an aHUS in a patient with LPG.
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Affiliation(s)
- Lara Kollbrunner
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | | | - Javier Sanz
- Division of Human Genetics, University Hospital of Bern, Bern, Switzerland
| | - Elena Bresin
- Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bergamo, Italy
| | - Thomas J Neuhaus
- Department of Pediatrics, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Helmut Hopfer
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | - Andreas W Jehle
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.,Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
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Abstract
Background: Lipoprotein glomerulopathy is a rare kidney disease characterized by lipoprotein thrombi in the glomerulus. Here, we report a case of lipoprotein glomerulopathy in a Chinese pediatric patient. Furthermore, we summarized the clinical features and genetic characteristics of lipoprotein glomerulopathy in China. Case Presentation: An 11-year-old Chinese girl presented with nephrotic syndrome with anemia (98 g/L). After excluding secondary causes, primary nephrotic syndrome was considered. Treatment with prednisone (60 mg/day) did not improve her condition. Renal biopsy showed marked dilation of the capillary lumen with lipoprotein thrombi and positive oil red O staining. Genetic testing revealed the genetic variant c.127C > T (p.R43C), known as the Kyoto mutation of the APOE gene. These findings are consistent with the diagnosis of lipoprotein glomerulopathy. Prednisone was gradually tapered and captopril was initiated. A 2-year follow-up revealed elevated urine protein and serum creatinine levels. We also reviewed 17 pediatric and 156 adult cases of lipoprotein glomerulopathy reported in China from the year of creation to 2021. The most common clinical features were edema, hematuria, hypertriglyceridemia, and increased serum apoE levels. Extra-renal manifestations included anemia, splenomegaly, and cardiac lipoprotein deposition. Conclusion: APOE Kyoto is the most common mutation in patients with lipoprotein glomerulopathy. In China, homozygosity for E3 (E3/3) is the most common isoform.
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Affiliation(s)
- Yue Song
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Changqiang Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Yang M, Weng Q, Pan X, Hussain HMJ, Yu S, Xu J, Yu X, Liu Y, Jin Y, Zhang C, Li X, Ren H, Chen N, Xie J. Clinical and genetic analysis of lipoprotein glomerulopathy patients caused by APOE mutations. Mol Genet Genomic Med 2020; 8:e1281. [PMID: 32441489 PMCID: PMC7434605 DOI: 10.1002/mgg3.1281] [Citation(s) in RCA: 8] [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: 10/05/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 11/07/2022] Open
Abstract
Background Lipoprotein glomerulopathy (LPG) is a rare kidney disease caused by APOE mutations. The aim of this study was to correlate the genetic and clinical features of LPG. Methods Totally eight LPG patients were recruited in this study and Sanger sequencing of APOE was performed for all available family members. Clinical and histological features were analyzed. A literature review of LPG was also conducted. Results Genetic analysis revealed five patients with APOE‐Kyoto, two with APOE‐Osaka/Kurashiki, and one with APOE‐Chicago mutations. LPG patients with urine protein reduced more than 50% had a slower decrease in renal function than those with less urine protein reduction (estimated glomerular filtration rate reduction rate −5.0 ± 0.8 vs. 1.5 ± 0.7 ml/min per 1.73 m2⋅month−1, p = .03). We then enrolled 95 LPG patients from previous studies and this study. LPG patients had higher blood pressure (mean arterial pressure: 109.4 ± 19.4 vs. 94.4 ± 11.1 mmHg, p < .001) than the control group. Interestingly, patients with APOE mutations in the LDL receptor binding region had higher serum apolipoprotein E (apoE) levels [ln(apoE): 2.7 ± 0.4 vs. 2.0 ± 0.5 mg/dl, p < .001] in comparison to other domains. Conclusion Here, we report for the first time APOE‐Osaka/Kurashiki and APOE‐Chicago mutations in the Chinese population. LPG was associated with higher blood pressure and serum apoE levels were higher in patients with mutations in LDL receptor binding region. In addition, the findings further indicated that treatment of proteinuria might slow down renal function progression in these patients.
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Affiliation(s)
- Mingxin Yang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinjie Weng
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxia Pan
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hafiz Muhammad Jafar Hussain
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuwen Yu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Xu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xialian Yu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunzi Liu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanmeng Jin
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunli Zhang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Ren
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Saito T, Matsunaga A, Fukunaga M, Nagahama K, Hara S, Muso E. Apolipoprotein E-related glomerular disorders. Kidney Int 2019; 97:279-288. [PMID: 31874799 DOI: 10.1016/j.kint.2019.10.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 08/07/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022]
Abstract
Of the glomerular disorders that occur due to apolipoprotein E (apoE) mutations, apoE2 homozygote glomerulopathy and lipoprotein glomerulopathy (LPG) have been characterized. ApoE2 homozygote glomerulopathy has been found in individuals expressing homozygous apoE2/2. This was characterized histologically by glomerulosclerosis with marked infiltration of foam cells derived from macrophages, and occasionally with non-lamellated lipoprotein thrombi. Recently, several cases of apoE Toyonaka (Ser197Cys) combined with homozygous apoE2/2 have been reported, in which non-immune membranous nephropathy-like features were observed in glomeruli. Interestingly, in these cases, apoE accumulation was identified by tandem mass spectrometry. Therefore, it is speculated that these findings may arise from apoE molecules without lipids, which result from hinge damage by apoE Toyonaka and may cross the glomerular basement membrane as small molecules. LPG is primarily associated with heterozygous apoE mutations surrounding the low-density lipoprotein-receptor binding site, and it is histologically characterized by lamellated lipoprotein thrombi that lack foam cells. Recent studies have suggested that LPG can be induced by thermodynamic destabilization, hydrophobic surface exposure, and the aggregation of apoE resulting from the incompatibility of apoE mutated residues within helical regions. Additionally, apoE5 may play a supporting role in the development of LPG and in lipid-induced kidney diseases via hyperlipoproteinemia. Thus, it is interesting that many apoE mutations contribute to characteristic glomerular disorders through various mechanisms. In particular, macrophages may uptake lipoproteins into the cytoplasm and contribute to the development of apoE2 homozygote glomerulopathy as foam cells, and their dysfunction may contribute to the accumulation of lipoproteins in the glomerulus, causing lipoprotein thrombi in LPG.
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Affiliation(s)
- Takao Saito
- Sanko Clinic, Fukuoka, Japan; Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Akira Matsunaga
- Department of Laboratory Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Kiyotaka Nagahama
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Eri Muso
- Division of Nephrology and Dialysis, Kitano Hospital, Osaka, Japan; Department of Food and Nutrition, Faculty of Contemporary Home Economics, Kyoto Kacho University, Kyoto, Japan
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10
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Majeed NK, McLaughlin J, Gonzalez M. Lipoprotein Glomerulopathy in a Hispanic Female: A Case Report and Literature Review. Can J Kidney Health Dis 2019; 6:2054358119859576. [PMID: 31285830 PMCID: PMC6600489 DOI: 10.1177/2054358119859576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/16/2019] [Indexed: 11/30/2022] Open
Abstract
Rationale: Lipoprotein glomerulopathy (LPG) is a rare renal disorder that features
glomerular capillary lipoprotein thrombi, proteinuria, and progressive renal
failure. Although most reported cases describe involvement in Asian
patients, occurrence in Caucasian and other ethnicities has also been
reported. Presenting concern: A 28-year-old Hispanic female with a past medical history of hypertension,
high cholesterol, gastritis, and a strong family history of renal disease
presented with abdominal pain. On admission, her blood pressure was
elevated. A computed tomography scan was unremarkable. Her laboratory
studies showed proteinuria, high creatinine level, and an abnormal lipid
profile. Diagnosis: The kidney biopsy showed glomerular capillary lipoprotein thrombi that
stained positively for Oil-Red-O, confirming the lipid nature of the
material consistent with LPG. Intervention: After stabilizing her blood pressure, the patient was started on fenofibrate
to treat her high cholesterol and improve her renal function. Outcome: Her lipid profile and renal function were initially improved. However, after
one year of treatment, her renal function started to decline and the patient
was referred to a transplant center for further management. Novel finding: To the best of our knowledge, this the first reported incidence of LPG in a
Hispanic female.
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Affiliation(s)
- Nasma K Majeed
- Department of Pathology, The University of Illinois at Chicago, USA
| | | | - Miguel Gonzalez
- Department of Pathology, Advocate Lutheran General Hospital, Park Ridge, IL, USA
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11
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Hirashima H, Komiya T, Toriu N, Hara S, Matsunaga A, Saito T, Muso E. A case of nephrotic syndrome showing contemporary presence of apolipoprotein E2 homozygote glomerulopathy and membranous nephropathy-like findings modified by apolipoprotein E Toyonaka. Clin Nephrol Case Stud 2018; 6:45-51. [PMID: 30542638 DOI: 10.5414/CNCS109509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022] Open
Abstract
A 79-year-old man was admitted to our hospital for proteinuria due to nephrotic syndrome. Renal biopsy revealed focal sclerosis and foam cell infiltration in the glomerulus. In addition, electron microscopic findings (EM) revealed peculiar electron-dense deposits (EDDs) in both sides of the glomerular basement membrane. Although subepithelial deposits had spike formation highly resembling those seen in membranous nephropathy (MN), immunoglobulins and complements were not identified by immunofluorescence study, and microbubbles appeared in high magnification of EM different from the immune disease. The analysis of apolipoprotein (Apo) E showed an elevated concentration of plasma ApoE. The phenotype, genotype, and DNA sequence studies revealed homozygous ApoE2/2 and a novel missense mutation called ApoE Toyonaka (Ser197Cys). This case may confirm the independent responsibility of ApoE2/2 and ApoE Toyonaka for ApoE2 homozygote glomerulopathy and MN-like EDD findings, respectively.
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Kobayashi R, Chambers JK, Yoshida K, Nakamura T, Yasuno K, Uchida K, Kamiie J, Shirota K. SPONTANEOUS LIPOPROTEIN GLOMERULOPATHY-LIKE NEPHROPATHY IN A SQUIRREL (SCIURUS VULGARIS). J Zoo Wildl Med 2016; 47:663-6. [PMID: 27468047 DOI: 10.1638/2015-0245.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lipoprotein glomerulopathy (LPG) is a rare human glomerular disease caused by abnormal lipid metabolism. Naturally occurring LPG has not been reported in animals. We describe the histopathological characterization of spontaneous LPG-like nephropathy in a captive squirrel ( Sciurus vulgaris ). Macroscopically, swollen glomeruli were distinctively identified as fine white granules in the renal cortex. Histologically, most glomeruli were markedly enlarged with distended capillaries containing faintly eosinophilic and amorphous materials. The amorphous material was negative using the periodic acid-Schiff reaction, periodic acid-methenamine silver stain, or Masson's trichrome stain. Sudan III staining revealed lipid in the materials, and immunohistochemistry demonstrated that the material additionally contained apolipoprotein E. Electron microscopy showed numerous lipid granules and vacuoles of various sizes in the capillary lumina associated with foot process effacement of podocytes. These pathological characteristics bear some resemblance to those of human LPG.
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Kaur A, Sethi S. Histiocytic and Nonhistiocytic Glomerular Lesions: Foam Cells and Their Mimickers. Am J Kidney Dis 2015; 67:329-36. [PMID: 26606995 DOI: 10.1053/j.ajkd.2015.07.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 05/14/2015] [Accepted: 07/27/2015] [Indexed: 12/30/2022]
Abstract
Numerous histiocytes are sometimes noted in glomeruli, giving rise to a foamy-appearing glomerulus. Foamy-appearing glomeruli may also be noted in conditions that do not contain numerous histiocytes. These disease entities are rare, have different underlying causes and pathophysiology, and can cause a diagnostic dilemma. We have observed this histiocytic/foamy glomerular change on the kidney biopsy specimen in 5 different disease entities: crystal-storing histiocytosis, histiocytic glomerulopathy associated with macrophage-activating syndrome, thrombotic microangiopathy, lecithin-cholesterol acyltransferase deficiency, and lipoprotein glomerulopathy. We describe and compare the kidney biopsy findings of these histiocytic and foamy-appearing entities. It is important to recognize the kidney biopsy findings of these rare conditions to correctly evaluate and identify the cause and manage these patients.
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Affiliation(s)
- Amulyajit Kaur
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Cheung CY, Chan AOK, Chan GPT, Iu HYP, Shek CC, Chau KF. Long-term outcome of kidney transplantation in a patient with coexisting lipoprotein glomerulopathy and fibrillary glomerulonephritis. Clin Kidney J 2015; 7:396-8. [PMID: 25852917 PMCID: PMC4377804 DOI: 10.1093/ckj/sfu058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/22/2014] [Indexed: 11/14/2022] Open
Abstract
Both lipoprotein glomerulopathy (LPG) and fibrillary glomerulonephritis (FGN) are rare causes of end-stage renal disease (ESRD), and the literature concerning the outcome of kidney transplant in patients with LPG or FGN is scarce. We report a patient who suffered from ESRD with coexisting FGN and LPG and received deceased kidney transplant >10 years ago did not reveal any clinical features of disease recurrence during follow-up. Our case shows that the prognosis of patients with LPG component who received kidney transplant can be good. Kidney transplantation remains a viable therapeutic option for patients with ESRD secondary to FGN with LPG.
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Affiliation(s)
- Chi Yuen Cheung
- Department of Medicine , Queen Elizabeth Hospital , Hong Kong
| | - Angel O K Chan
- Department of Pathology and Clinical Biochemistry , Queen Mary Hospital , Hong Kong
| | - Gordon P T Chan
- Department of Pathology , Queen Elizabeth Hospital , Hong Kong
| | - Heidi Y P Iu
- Department of Pathology , Queen Elizabeth Hospital , Hong Kong
| | - Chi Chung Shek
- Department of Pathology , Queen Elizabeth Hospital , Hong Kong
| | - Ka Foon Chau
- Department of Medicine , Queen Elizabeth Hospital , Hong Kong
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Tavori H, Fan D, Giunzioni I, Zhu L, Linton MF, Fogo AB, Fazio S. Macrophage-derived apoESendai suppresses atherosclerosis while causing lipoprotein glomerulopathy in hyperlipidemic mice. J Lipid Res 2014; 55:2073-81. [PMID: 25183802 DOI: 10.1194/jlr.m049874] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Lipoprotein glomerulopathy (LPG) is a renal disease often accompanied by dyslipidemia and increased serum apoE levels. apoESendai (Arg145Pro), a rare mutant based on the apoE3 sequence carrying an apoE2 charge, causes LPG in humans and transgenic mice, but its effects on the artery wall are unknown. Macrophage expression of apoESendai may also directly influence renal and arterial homeostasis. We investigated the effects of macrophage-expressed apoESendai in apoE(-/-) mice with or without LDL receptor (LDLR). Murine bone marrow transduced to express apoE2, apoE3, or apoESendai was transplanted into lethally irradiated mice. Macrophage apoESendai expression reduced aortic lesion size and inflammation by 32 and 28%, respectively, compared with apoE2 in apoE(-/-) recipients. No differences in lesion size or inflammation were found between apoESendai and apoE3 in apoE(-/-) recipients. Macrophage apoESendai expression also reduced aortic lesion size by 18% and inflammation by 29% compared with apoE2 in apoE(-/-)/LDLR(-/-) recipients. Glomerular lesions compatible with LPG with increased mesangial matrix, extracellular lipid accumulation, and focal mesangiolysis were only observed in apoE(-/-)/LDLR(-/-) mice expressing apoESendai. Thus, macrophage expression of apoESendai protects against atherosclerosis while causing lipoprotein glomerulopathy. This is the first demonstration of an apoprotein variant having opposing effects on vascular and renal homeostasis.
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Affiliation(s)
- Hagai Tavori
- Knight Cardiovascular Institute, Center for Preventive Cardiology, Oregon Health and Science University, Portland, OR Section of Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Daping Fan
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC
| | - Ilaria Giunzioni
- Knight Cardiovascular Institute, Center for Preventive Cardiology, Oregon Health and Science University, Portland, OR
| | - Lin Zhu
- Section of Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - MacRae F Linton
- Section of Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Agnes B Fogo
- Pathology, Immunology, and Microbiology, Vanderbilt University Medical Center, Nashville, TN
| | - Sergio Fazio
- Knight Cardiovascular Institute, Center for Preventive Cardiology, Oregon Health and Science University, Portland, OR Section of Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN Pathology, Immunology, and Microbiology, Vanderbilt University Medical Center, Nashville, TN
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Magistroni R, Bertolotti M, Furci L, Fano RA, Leonelli M, Pisciotta L, Pellegrini E, Calabresi L, Bertolini S, Calandra S. Lipoprotein glomerulopathy associated with a mutation in apolipoprotein e. Clin Med Insights Case Rep 2013; 6:189-96. [PMID: 24348079 PMCID: PMC3859823 DOI: 10.4137/ccrep.s12209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 11/25/2022]
Abstract
Lipoprotein glomerulopathy is a pathological condition characterized by lipid accumulation in the glomerular capillaries that has been associated with the presence of rare mutants of apolipoprotein E (ApoE). We describe a 51-year-old Italian patient presenting Type III hyperlipidemia and proteinuria in whom renal biopsy showed capillary ectasia and intraluminal lipid deposits, suggesting the diagnosis of lipoprotein glomerulopathy. The patient, who had elevated plasma ApoE level, was found to be heterozygous for a mutation in ApoE (Arg150Cys), designated apoEMODENA. This mutation induces the formation of ApoE dimers that are detectable under non-reducing conditions. Treatment with hypolipidemic drugs did not result in a complete remission of the proteinuria and was accompanied by a slow but progressive worsening of renal function with the persistence of intracapillary lipid thrombi. The introduction of low-density lipoprotein aphaeresis combined with a more aggressive lipid lowering and antihypertensive therapy resulted in the remission of proteinuria and a substantial improvement of renal function. Switching from low-density lipoprotein aphaeresis to plasma filtration did not result in an equivalent control of renal damage. The patient died of intracranial hemorrhage during an acute episode of malignant hypertension.
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Affiliation(s)
- Riccardo Magistroni
- Department of Surgical, Medical, Dental and Morphological Sciences with Transplant Interest, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia
| | - Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia
| | - Luciana Furci
- Department of Surgical, Medical, Dental and Morphological Sciences with Transplant Interest, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia
| | - Rita Adriana Fano
- Department of Surgical, Medical, Dental and Morphological Sciences with Transplant Interest, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia
| | - Marco Leonelli
- Department of Surgical, Medical, Dental and Morphological Sciences with Transplant Interest, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia
| | | | - Elisa Pellegrini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia
| | - Laura Calabresi
- Department of Pharmacological and Biomolecular Sciences, University of Milano
| | | | - Sebastiano Calandra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia
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