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Abedi M, Nili F, Dehkhoda F, Abdollahi A, Salarvand S. Evaluation of C4d expression and staining patterns by immunohistochemistry in renal biopsy samples with focal segmental glomerulosclerosis and minimal change disease. Ann Diagn Pathol 2024; 70:152281. [PMID: 38417352 DOI: 10.1016/j.anndiagpath.2024.152281] [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: 01/23/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION C4d is an activation product of lectin pathway of complement. Glomerular deposition of C4d is associated with poor prognosis in different types of immune-related glomerulonephritis. The present study was conducted to investigate expression level of C4d and its staining pattern in renal biopsy of patients with focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) by immunohistochemistry method. MATERIALS AND METHODS In this retrospective cross-sectional study, renal biopsy specimens from 46 samples of MCD, 47 samples of FSGS, and 15 samples without glomerular disease as the controls, were subjected to immunohistochemistry staining with C4d. Demographic characteristics and information obtained from light and electron microscopy (EM) of patients were also extracted from their files. RESULTS C4d positive staining was observed in 97.9 % of FSGS and 43.5 % of MCD samples, which showed a statistically significant difference (P < 0.001). The sensitivity and specificity of C4d expression for diagnosing FSGS were 97.9 % and 56.5 %, respectively. There was no significant correlation between C4d expression and any of the light and electron microscopy findings, including presence of foam cells, mesangial matrix expansion, interstitial fibrosis and tubular atrophy, and basement membrane changes in MCD patients. Also, no significant correlation was observed between C4d expression and clinical symptoms of proteinuria or prolonged high level of creatinine in patients with MCD. DISCUSSION AND CONCLUSION The expression of C4d marker had a good sensitivity and negative predictive value in the diagnosis of FSGS.
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Affiliation(s)
- Maryam Abedi
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nili
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Dehkhoda
- Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Salarvand
- Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Kurasawa S, Kato S, Ozeki T, Akiyama S, Ishimoto T, Mizuno M, Tsuboi N, Kato N, Kosugi T, Maruyama S. Rationale and design of the Japanese Biomarkers in Nephrotic Syndrome (J-MARINE) study. Clin Exp Nephrol 2024; 28:431-439. [PMID: 38267800 DOI: 10.1007/s10157-023-02449-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Disease subtyping and monitoring are essential for the management of nephrotic syndrome (NS). Although various biomarkers for NS have been reported, their clinical efficacy has not been comprehensively validated in adult Japanese patients. METHODS The Japanese Biomarkers in Nephrotic Syndrome (J-MARINE) study is a nationwide, multicenter, and prospective cohort study in Japan, enrolling adult (≥18 years) patients with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN), C3 glomerulopathy (C3G), and lupus nephritis (LN). Baseline clinical information and plasma and urine samples will be collected at the time of immunosuppressive therapy initiation or biopsy. Follow-up data and plasma and urine samples will be collected longitudinally based on the designated protocols. Candidate biomarkers will be measured: CD80, cytotoxic T-lymphocyte antigen 4, and soluble urokinase plasminogen activator receptor for MCD and FSGS; anti-phospholipase A2 receptor and thrombospondin type-1 domain-containing protein 7A antibodies for MN; fragment Ba, C3a, factor I, and properdin for MPGN/C3G; and CD11b, CD16b, and CD163 for LN. Outcomes include complete and partial remission, relapse of proteinuria, a 30% reduction in estimated glomerular filtration rate (eGFR), eGFR decline, and initiation of renal replacement therapy. The diagnostic accuracy and predictive ability for clinical outcomes will be assessed for each biomarker. RESULTS From April 2019 to April 2023, 365 patients were enrolled: 145, 21, 138, 10, and 51 cases of MCD, FSGS, MN, MPGN/C3G, and LN, respectively. CONCLUSION This study will provide valuable insights into biomarkers for NS and serve as a biorepository for future studies.
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MESH Headings
- Humans
- Biomarkers/blood
- Biomarkers/urine
- Nephrotic Syndrome/urine
- Nephrotic Syndrome/blood
- Nephrotic Syndrome/diagnosis
- Prospective Studies
- Japan
- Glomerulosclerosis, Focal Segmental/urine
- Glomerulosclerosis, Focal Segmental/blood
- Glomerulosclerosis, Focal Segmental/diagnosis
- Receptors, Urokinase Plasminogen Activator/blood
- Glomerulonephritis, Membranous/urine
- Glomerulonephritis, Membranous/blood
- Glomerulonephritis, Membranous/diagnosis
- Adult
- Nephrosis, Lipoid/urine
- Nephrosis, Lipoid/blood
- Nephrosis, Lipoid/diagnosis
- Research Design
- Receptors, Phospholipase A2/immunology
- Thrombospondins/blood
- Glomerulonephritis, Membranoproliferative/blood
- Glomerulonephritis, Membranoproliferative/urine
- Glomerulonephritis, Membranoproliferative/diagnosis
- Male
- Female
- Lupus Nephritis/blood
- Lupus Nephritis/urine
- Lupus Nephritis/diagnosis
- East Asian People
- B7-1 Antigen
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Affiliation(s)
- Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takaya Ozeki
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shin'ichi Akiyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Masashi Mizuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Noritoshi Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoki Kosugi
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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Needleman A, Sheaff M, Pepper RJ, Evans RDR. Immunoglobulin G4-related disease presenting with nephrotic syndrome due to minimal change disease: a case report. J Med Case Rep 2024; 18:192. [PMID: 38641649 PMCID: PMC11031906 DOI: 10.1186/s13256-024-04494-3] [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: 11/07/2023] [Accepted: 03/06/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease is an inflammatory disease affecting multiple organs including the kidney. Immunoglobulin G4-related kidney disease most commonly manifests as a tubulointerstitial nephritis and is associated with glomerular disease in a proportion of cases. Membranous nephropathy is the most frequent glomerular lesion. Herein, we report the first documented case of immunoglobulin G4-related disease presenting with nephrotic syndrome owing to minimal change disease. CASE PRESENTATION A 67-year-old South Asian male presented to our service with systemic upset and leg swelling. He had heavy proteinuria (urine protein:creatinine ratio 1042 mg/mmol) and was hypoalbuminemic (17 g/L) and hypercholersterolemic (9.3 mmol/L), consistent with the nephrotic syndrome. His serum creatinine was 140 μmol/L, and he was hypocomplementemic (C3 0.59 g/L, C4 < 0.02 g/L) with raised immunoglobulin G4 subclass levels (5.29 g/L). Kidney biopsy demonstrated minimal change disease alongside a plasma-cell-rich tubulointerstitial nephritis with strong positive staining for immunoglobulin G4. A diagnosis of minimal change disease in the setting of immunoglobulin G4-related disease was made. He was commenced on oral prednisolone at 60 mg daily but suffered infectious complications, including necrotizing fasciitis within 3 weeks of starting treatment, ultimately resulting in his death 52 days after initial presentation. CONCLUSION This case highlights the potential for immunoglobulin G4-related disease to be associated with a spectrum of glomerular pathologies including minimal change disease. It adds to the differential diagnosis of secondary causes of minimal change disease, and moreover, aids as an important reminder of the potential complications of high-dose steroids used in its treatment.
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Affiliation(s)
- Amy Needleman
- UCL Centre for Kidney and Bladder Health, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Michael Sheaff
- Department of Histopathology, Bart's Health NHS Trust, London, UK
| | - Ruth J Pepper
- UCL Centre for Kidney and Bladder Health, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Rhys D R Evans
- UCL Centre for Kidney and Bladder Health, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
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Teragaki M, Tanaka M, Yamamoto H, Watanabe T, Takeoka J, Fukumi A, Maeda K, Takami Y, Saita H, Iwanari S, Ikeda M, Takeoka H. Relapse of minimal change disease following the third mRNA COVID-19 vaccination: a case report and literature review. CEN Case Rep 2024; 13:53-58. [PMID: 37244881 PMCID: PMC10224756 DOI: 10.1007/s13730-023-00798-3] [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: 12/15/2022] [Accepted: 05/12/2023] [Indexed: 05/29/2023] Open
Abstract
Mass vaccination is the most important strategy to terminate the coronavirus disease 2019 (COVID-19) pandemic. Reports suggest the potential risk of the development of new-onset or relapse of minimal change disease (MCD) following COVID-19 vaccination; however, details on vaccine-associated MCD remain unclear. A 43-year-old man with MCD, who had been in remission for 29 years, developed nephrotic syndrome 4 days after receiving the third dose of the Pfizer-BioNTech vaccine. His kidney biopsy revealed relapsing MCD. Intravenous methylprednisolone pulse therapy followed by oral prednisolone therapy was administered, and his proteinuria resolved within 3 weeks. This report highlights the importance of careful monitoring of proteinuria after COVID-19 vaccination in patients with MCD, even if the disease is stable and no adverse events occurred during previous vaccinations. Our case report and literature review of COVID-19 vaccine-associated MCD indicated that MCD relapse tends to occur later after vaccination and slightly more often following the second and subsequent vaccine doses than new-onset MCD.
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Affiliation(s)
- Mariko Teragaki
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Mari Tanaka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroko Yamamoto
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Tomoka Watanabe
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Jun Takeoka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Awaisshafig Fukumi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Kotaro Maeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yohtaro Takami
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hirona Saita
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Sachio Iwanari
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Masaki Ikeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroya Takeoka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
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Chebotareva N, Vinogradov A, Birukova Y, Alentov I, Sergeeva N, Chemodanova D, Kononikhin AS, Moiseev SV. A pilot study of anti-nephrin antibodies in podocytopaties among adults. Nephrology (Carlton) 2024; 29:86-92. [PMID: 37864506 DOI: 10.1111/nep.14249] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/17/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
AIM Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are podocytopathies characterized by damage to the glomerular filtration barrier, leading to proteinuria and nephrotic syndrome. The production of anti-podocyte antibodies has been proposed as potential circulating factors contributing to the development of these conditions. The aim of the study is to evaluate the levels of anti-nephrin antibodies in patients with podocytopathies and healthy subjects. METHODS In this study, a total of 77 patients with active glomerulopathy and 11 healthy subjects were included. Forty one patients were diagnosed with FSGS, 11 with MCD, and 25 with MN. To measure the levels of anti-nephrin antibodies, enzyme-linked immunosorbent assay was used. RESULTS The levels of antibodies to nephrin were significantly higher in patients with MCD 61.2 [28.9-66.3] ng/mL and FSGS 32.5 [17.2-58.4] ng/mL compared to MN 20.3 [14.4-38.4] and healthy individuals 15.3 [12-18.9] ng/mL, p < .05. In patients with primary FSGS, the levels of antibodies to nephrin were significantly higher 45.2 [20-64.3] ng/mL compared to patients with secondary FSGS 26.7 [11.2-44.1] ng/mL, p < .05. There were no significant differences in the remission rate between the anti-nephrin antibodies positive and negative groups (log-rank test: p = .158). CONCLUSION The level of anti-nephrin antibodies was found to be significantly higher in patients with MCD and pFSGS compared to those with sFSGS, MN, and healthy subjects. Anti-nephrin antibodies in MCD and primary FSGS may be associated with the severity of podocytopathies, however they did not have an impact on the response to therapy.
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Affiliation(s)
- Natalia Chebotareva
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Yevgeniya Birukova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Igor Alentov
- Department of Prediction of Conservative Treatment Efficiency, Hertsen Moscow Oncology Research Institute, Moscow, Russia
| | - Natalia Sergeeva
- Department of Prediction of Conservative Treatment Efficiency, Hertsen Moscow Oncology Research Institute, Moscow, Russia
| | - Daria Chemodanova
- Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Alexey S Kononikhin
- Center for Molecular and Cellular Biology, Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Sergey V Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
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Wang S, Huang B, Wang P, Liu Y, Liu Y, Chen H, Zhang J. Mild mesangial proliferative IgA nephropathy with and without minimal change disease. Clin Exp Med 2023; 23:5367-5376. [PMID: 37796359 DOI: 10.1007/s10238-023-01184-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023]
Abstract
Mild mesangial proliferative IgA nephropathy with minimal change disease (MCD-IgAN) and mild mesangial proliferative IgA nephropathy without minimal change disease (Non-MCD-IgAN) have similar characteristics on light microscopy. Nevertheless, their discrepancies in clinicopathological features and prognosis remain unknown. A total of 589 patients with biopsy-proven mild mesangial proliferative IgA nephropathy (M-IgAN) combined with light microscopy and immunofluorescence were enrolled. Firstly, the diagnoses of the patients by electron microscopy were recorded and used as the gold standard. We calculated the sensitivity and specificity using nephrotic syndrome (NS) as the diagnostic criteria to identify MCD-IgAN. Then, excluding patients with a 24-h urinary total protein less than 0.5 g/day, incomplete clinical data, or less than the six-month follow-up, we included 184 cases of non-MCD-IgAN and 98 cases of MCD-IgAN. The patients' clinicopathological and outcome data were collected and compared. Among the 589 patients, according to electron microscopy, 381 were diagnosed with non-MCD-IgAN, 167 with MCD-IgAN, and 41 with M-IgAN complicated by other glomerular diseases. Using NS as the diagnostic criteria to distinguish non-MCD-IgAN and MCD-IgAN, the sensitivity and specificity were 83.8% and 99.5%, respectively. The patients in the MCD-IgAN group tended to be younger, hypotensive, with lower urinary erythrocytes, and more likely to achieve complete remission, and fewer patients progressed to the endpoint than those in the non-MCD-IgAN group (all P < 0 .05). NS appears to be an objective indicator for differentiating MCD-IgAN from non-MCD-IgAN. Non-MCD-IgAN varies greatly from MCD-IgAN in clinicopathology and treatment response, with a poorer prognosis.
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Affiliation(s)
- Shulei Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan, People's Republic of China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bo Huang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan, People's Republic of China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Peiheng Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan, People's Republic of China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yingchun Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan, People's Republic of China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yiming Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan, People's Republic of China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Huiming Chen
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan, People's Republic of China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Junjun Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan, People's Republic of China.
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Pirzadeh A, Emami S, Zuckerman JE, Nobakht N. Exacerbation of Minimal Change Disease Following mRNA COVID-19 Vaccination. Am J Case Rep 2023; 24:e941621. [PMID: 37941318 PMCID: PMC10643885 DOI: 10.12659/ajcr.941621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Minimal change disease is a common cause of nephrotic syndrome in adults. There are few reported cases of vaccine-related podocytopathy with nephrotic-range proteinuria in the setting of a minimal change disease history. There have been rare reports of acute renal damage following vaccination to prevent COVID-19 and some cases of exacerbation of ongoing nephropathy. This report is a 33-year-old man with a 22-year history of nephrotic syndrome due to minimal change disease which exacerbated following a third dose of an mRNA SARS-CoV-2 vaccine for COVID-19. CASE REPORT We report a case of nephrotic syndrome after the third dose of the BNT162b2 mRNA COVID-19 vaccine. The patient presented with mild edema in the bilateral lower extremities and sacrum. Laboratory investigations confirmed nephrotic-range proteinuria and hypoalbuminemia. A kidney sonogram demonstrated mild renal parenchymal disease and a small non-obstructing right renal calculus. Renal biopsy revealed diffuse podocyte foot process effacement, punctuate IgG podocyte cytoplasmic staining, and minimal global glomerulosclerosis, consistent with a diagnosis of a diffuse podocytopathy with a minimal change disease phenotype. The patient was started on oral prednisone treatment, which led to remission of his symptoms and normalization of lab test results with normal BUN and Cr and resolution of proteinuria. Treatment was tapered off over the course of 28 weeks. CONCLUSIONS We presents a case of longstanding minimal change disease that showed exacerbation following a third dose of an mRNA vaccine for SARS-CoV-2. Although this may be a rare association, this case supports that patients with chronic glomerulonephritis need to be monitored.
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Affiliation(s)
- Afshin Pirzadeh
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sina Emami
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Jonathan E. Zuckerman
- Department of Pathology, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Niloofar Nobakht
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Yoshida R, Hara Y, Fujii Y, Matuda H. A case of minimal change nephrotic syndrome complicated by Kimura disease treated with rituximab. CEN Case Rep 2023; 12:368-373. [PMID: 36809634 PMCID: PMC10620371 DOI: 10.1007/s13730-023-00778-7] [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: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
Kimura disease (eosinophilic granuloma of the soft tissue) is a benign granulomatous disease complicated by nephrotic syndrome. Herein, we report a case of recurrent minimal change nephrotic syndrome (MCNS) complicated by Kimura disease that was successfully treated with rituximab. A 57-year-old man presented to our hospital with relapsed nephrotic syndrome with worsening swelling of the right anterior ear and elevated serum IgE. MCNS was diagnosed on renal biopsy. Treatment with 50 mg of prednisolone rapidly placed the patient in remission. Therefore, RTX 375 mg/m2 was added to the treatment regimen, and steroid therapy was tapered. Early steroid tapering was successful, and the patient is currently in remission. In this case, the nephrotic syndrome flare-up was accompanied by worsening Kimura disease. Rituximab reduced the worsening of symptoms related to Kimura disease, including head and neck lymphadenopathy and elevated IgE levels. Kimura disease and MCNS may share a common IgE-mediated type I allergic condition. Rituximab effectively treats these conditions. In addition, rituximab suppresses Kimura disease activity in patients with MCNS, enables early tapering of steroids, and reduces the total dose of steroids.
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Affiliation(s)
- Ryuto Yoshida
- Department of Nephrology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-Ku, Yokohama, Kanagawa, 220-8521, Japan.
| | - Yoshikazu Hara
- Department of Nephrology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-Ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Yoshiaki Fujii
- Department of Nephrology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-Ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Hiroto Matuda
- Department of Nephrology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-Ku, Yokohama, Kanagawa, 220-8521, Japan
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Tokoyoda T, Inagaki T, Aoki Y, Okamoto T, Nakajima T, Yano D. Minimal change nephrotic syndrome diagnosed with acute femoral thromboembolism and successfully salvaged limb: a case report. CEN Case Rep 2023; 12:357-361. [PMID: 36773197 PMCID: PMC10620369 DOI: 10.1007/s13730-023-00774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023] Open
Abstract
A 64-year-old man visited the outpatient department of our hospital for the first time due to bilateral lower limb edema, which he noticed 1 week before the visit. Pain suddenly developed in the left lower limb while the patient was in the waiting room. Nephrotic syndrome was suspected based on blood and urine test results. Acute arterial thromboembolism in the left lower limb associated with hypercoagulation due to nephrotic syndrome was suspected, and a diagnosis was made using computed tomography angiography. Arterial thrombectomy was urgently performed, and the limb was salvaged without sequelae. Based on renal biopsy, minimal change nephrotic syndrome was diagnosed, and the patient underwent remission induction with steroid therapy. Heparin was drip infused and apixaban was orally administered to prevent recurrent thrombosis. Nephrotic syndrome in the acute phase is often complicated by thrombosis. Particularly, arterial thromboembolism requires prompt treatment, and prophylactic anticoagulation therapy needs to be considered.
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Affiliation(s)
- Tomoaki Tokoyoda
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan.
| | - Takahiro Inagaki
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Yuki Aoki
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Takeshi Okamoto
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Takashi Nakajima
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Daisuke Yano
- Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
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10
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Wada T, Shimizu S, Koizumi M, Sofue T, Nishiwaki H, Sasaki S, Nakaya I, Oe Y, Ishimoto T, Furuichi K, Okada H, Kurita N. Japanese clinical practice patterns of primary nephrotic syndrome 2021: a web-based questionnaire survey of certified nephrologists. Clin Exp Nephrol 2023; 27:767-775. [PMID: 37310570 DOI: 10.1007/s10157-023-02366-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND With the publication of the "Evidence-Based Clinical Practice Guideline for Nephrotic Syndrome 2020," we examined nephrologists' adherence to the recommendations of four of its clinical questions (CQs). METHODS This was a cross-sectional web-based survey conducted between November and December 2021. The target population comprised nephrologists certified by the Japanese Society of Nephrology who were recruited using convenience sampling. The participants answered six items regarding the four CQs about adult patients with nephrotic syndrome and their characteristics. RESULTS In total, 434 respondents worked in at least 306 facilities, of whom 386 (88.9%) provided outpatient care for primary nephrotic syndrome. Of these patients, 179 (41.2%) answered that they would not measure anti- phospholipase A2 receptor antibody levels in cases of suspected primary membranous nephropathy (MN) in which kidney biopsy was not possible (CQ1). Regarding immunosuppressants as maintenance therapy after relapse of minimal change nephrotic syndrome (CQ2), cyclosporine was the most common choice (290 [72.5%] and 300 [75.0%] of 400 respondents after the first and second relapses, respectively). The most common treatment for steroid-resistant cases of primary focal segmental glomerulosclerosis (CQ3) was cyclosporine (323 of 387, 83.5%). For the initial treatment of primary MN with nephrotic-range proteinuria (CQ4), corticosteroid monotherapy was the most common choice (240 of 403, 59.6%), followed by corticosteroid and cyclosporine (114, 28.3%). CONCLUSION Gaps in recommendations and practices regarding serodiagnosis and treatment of MN (i.e., CQ1 and 4) are observed, suggesting the need to address the barriers to their insurance reimbursement and the lack of evidence behind them.
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Affiliation(s)
- Takehiko Wada
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Kanagawa, Japan.
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan.
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Patient Driven Academic League (PeDAL), Tokyo, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masahiro Koizumi
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Kanagawa, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - Hiroki Nishiwaki
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
- Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
| | - Sho Sasaki
- Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Izaya Nakaya
- Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Yuji Oe
- Division of Nephrology, Rheumatology, and Endocrinology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Rheumatology, Aichi Medical University, Aichi, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University, Ishikawa, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Moroyama Town, Saitama, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
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11
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Gauckler P, Regele H, Eller K, Säemann MD, Lhotta K, Zitt E, Neumann I, Rudnicki M, Odler B, Kronbichler A, Windpessl M. [Diagnosis and treatment of Minimal Change Disease in adults-2023]. Wien Klin Wochenschr 2023; 135:628-637. [PMID: 37728648 PMCID: PMC10511370 DOI: 10.1007/s00508-023-02258-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/21/2023]
Abstract
Minimal change disease is a glomerulopathy that clinically manifests as acute onset nephrotic syndrome. A diagnosis is made by renal biopsy, implying the absence of glomerular lesions on light microscopy but detection of extensive podocyte foot process effacement on electron miscroscopy. Considering the typically excellent response to immunosuppressive measures (especially to glucocorticoids), an autoimmune pathogenesis is assumed. Although general prognosis is overall beneficial, steroid-dependent, steroid-resistant and frequently-relapsing disease courses may complicate the management of these patients and necessitate the use of alternative immunosuppressive treatment strategies. Here, the Austrian Society of Nephrology (ÖGN) provides a consensus on how to best diagnose and manage adult patients with minimal change disease.
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Affiliation(s)
- Philipp Gauckler
- Department Innere Medizin IV (Nephrologie und Hypertensiologie), Medizinische Universität Innsbruck, Innsbruck, Österreich.
| | - Heinz Regele
- Klinisches Institut für Pathologie, Medizinische Universität Wien, Wien, Österreich
| | - Kathrin Eller
- Klinische Abteilung für Nephrologie, Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Medizinische Universität Graz, Graz, Österreich
| | - Marcus D Säemann
- 6. Medizinische Abteilung für Nephrologie & Dialyse, Klinik Ottakring, Wien, Österreich
- Medizinische Fakultät, Sigmund-FreudUniversität, Wien, Österreich
| | - Karl Lhotta
- Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Emanuel Zitt
- Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Irmgard Neumann
- Vasculitis.at, Wien, Österreich
- Immunologiezentrum Zürich (IZZ), Zürich, Schweiz
| | - Michael Rudnicki
- Department Innere Medizin IV (Nephrologie und Hypertensiologie), Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Balazs Odler
- Klinische Abteilung für Nephrologie, Abteilung für Innere Medizin III (Nephrologie, Dialyse und Hypertensiologie), Medizinische Universität Graz, Graz, Österreich
| | - Andreas Kronbichler
- Department Innere Medizin 4 (Nephrologie und Hypertensiologie), Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Martin Windpessl
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Österreich
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12
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Paul EN, Satish S, Kelur KK, Shetty MS. Glomerular parietal epithelial expression of CD44 in minimal change nephrotic syndrome and primary focal segmental glomerulosclerosis: A clinico-pathological study. INDIAN J PATHOL MICR 2023; 66:526-532. [PMID: 37530333 DOI: 10.4103/ijpm.ijpm_593_21] [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: 08/03/2023] Open
Abstract
Introduction Minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) are the two common causes of nephrotic syndrome (NS) in both children and adults with overlapping clinical features, but with distinct prognostic and therapeutic implications. The distinction between these relies entirely on histopathology, which can sometimes be difficult. CD44 is expressed by activated parietal epithelial cells, plays a role in matrix deposition and thus in the pathogenesis of FSGS. Aims To assess the expression of CD44 in MCNS and FSGS and to evaluate its association with the known clinical and histopathological prognostic factors. Materials and Methods Thirty cases each of MCNS and FSGS were studied. The clinical, laboratory, histopathological, and CD 44 immunohistochemical data were recorded. The findings were analyzed and correlated. A P value of < 0.05 was considered statistically significant. Results Statistical association was noted between CD44 positivity and serum creatinine (p = 0.031), estimated glomerular filtration rate (p = 0.040), segmental sclerosis (p < 0.001), tubular atrophy (p = 0.027), interstitial fibrosis (p = 0.027), and histological diagnosis (p < 0.001). The sensitivity, specificity, positive predictive, and negative predictive values were 90%, 76.67%, 79.41% and 88.46%, respectively. Conclusions CD44 immunostain can effectively distinguish MCNS from FSGS. The congruent results of CD44 positivity with known prognostic factors support the possibility of using the CD44 marker as a predictive tool in selecting high-risk patients and offering appropriate therapeutic measures.
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Affiliation(s)
- E Nithin Paul
- Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Suchitha Satish
- Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Kiran Krishnamurthy Kelur
- Department of Nephrology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Manjunath Sanjeev Shetty
- Department of Nephrology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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13
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Ozeki T, Gillespie BW, Larkina M, Maruyama S, Alakwaa F, Kretzler M, Mariani LH. Clinical Course of Adult FSGS and Minimal Change Disease in North American and Japanese Cohorts. Kidney360 2023; 4:924-934. [PMID: 37131280 PMCID: PMC10371276 DOI: 10.34067/kid.0000000000000133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
Key Points Data from different geographical regions highlighted the differences in clinical manifestations and treatment response of adult FSGS/minimal change disease. There were shared factors that were associated with treatment response across the cohorts: FSGS, higher BP, and lower eGFR. Recognizing geographical difference allows us better understanding of disease biology, risk prediction, and design of future clinical trials. Background Regional differences in presentation and clinical course of nephrotic syndrome (NS) have not been studied well because few studies directly compared the data from different intercontinental regions. Methods We included adult nephrotic patients with FSGS and minimal change disease (MCD) who received immunosuppressive therapy (IST) in a North American (Nephrotic Syndrome Study Network [NEPTUNE], N =89) or Japanese (Nagoya Kidney Disease Registry [N-KDR], N =288) cohort. Baseline characteristics and rates of complete remission (CR) were compared. Factors associated with time to CR were evaluated by Cox regression models. Results NEPTUNE participants had more FSGS (53.9 versus 17.0%) and family history of kidney disease (35.2 versus 3.2%). N-KDR participants were older (median 56 versus 43 years) and demonstrated greater levels of urine protein creatinine ratio (7.73 versus 6.65) and hypoalbuminemia (1.6 versus 2.2 mg/dl). N-KDR participants showed higher proportion of CR (overall: 89.2 versus 62.9%; FSGS: 67.3 versus 43.7%; MCD: 93.7 versus 85.4%). A multivariable model showed that FSGS (versus MCD: hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.20 to 0.41), systolic BP (per 10 mm Hg: HR, 0.93; 95% CI, 0.86 to 0.99), and eGFR (per 10 ml/min per 1.73 m2: HR, 1.16; 95% CI, 1.09 to 1.24) were associated with time to CR. There were significant interactions in patient age (P = 0.004) and eGFR (P = 0.001) between the cohorts. Conclusions The North American cohort had more FSGS and more frequent family history. Japanese patients showed more severe NS with better response to IST. FSGS, hypertension, and lower eGFR were shared predictors of poor treatment response. Identifying shared and unique features across geographically diverse populations may help uncover biologically relevant subgroups, improve prediction of disease course, and better design future multinational clinical trials.
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Affiliation(s)
- Takaya Ozeki
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Brenda W. Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Maria Larkina
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fadhl Alakwaa
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Matthias Kretzler
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Laura H. Mariani
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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14
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Yamamoto R, Isaka Y. Albumin Clearance as a Novel Predictor of Relapse in Adults with Minimal Change Nephrotic Syndrome. Kidney360 2023; 4:e720-e721. [PMID: 37384885 PMCID: PMC10371273 DOI: 10.34067/kid.0000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Ryohei Yamamoto
- Health and Counseling Center, Osaka University, Toyonaka, Japan
- Laboratory of Behavioral Health Promotion, Department of Health Promotion, Graduate School of Medicine, Osaka University, Toyonaka, Japan
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan
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15
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Kuno H, Kanzaki G, Sasaki T, Haruhara K, Okabe M, Yokote S, Koike K, Tsuboi N, Yokoo T. High Albumin Clearance Predicts the Minimal Change Nephrotic Syndrome Relapse. Kidney360 2023; 4:e787-e795. [PMID: 37166949 PMCID: PMC10371375 DOI: 10.34067/kid.0000000000000143] [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] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
Key Points Albumin kinetics not only reflected the pathophysiology of minimal change nephrotic syndrome but was also a predictor of relapse. The high estimated 24-hour albumin clearance predicts the minimal change nephrotic syndrome relapse. The 24-hour albumin clearance can easily be calculated from only serum albumin and urinary protein excretion, which are routine laboratory measurements. Background Although albuminuria leakage that occurs in minimal change nephrotic syndrome (MCNS) may be related to the disease state, albumin kinetics in MCNS has never been evaluated. In this study, we investigated albumin kinetics in adult Japanese patients with MCNS by the estimated 24-hour albumin clearance (eCALB) and examined the association between eCALB and relapse. Methods We retrospectively identified 103 adult patients with a histological diagnosis of MCNS from four hospitals in Japan (2010–2020). The primary outcome is the first relapse in 2 years after complete remission after corticosteroid therapy. The eCALB [µ l/min] was defined as (2.71828(0.0445+0.9488×log(urinary protein) [g/24 hours])/(serum albumin [g/dl]×1440 [min/24 hours]) for women and (2.71828(-0.1522+0.9742×log(urinary protein) [g/24 hours])/(serum albumin [g/dl]×1440 [min/24 hours]) for men. Results Relapse was observed in 44 patients (103 kidney biopsy samples; 42.7%). The mean patient age was 41.0 years. Patients had an eGFR of 71.0 ml/min per 1.73 m2, urinary protein excretion of 6.8 g/d, serum albumin of 1.4 g/dl, and eCALB of 2.27 μ l/min. eCALB was strongly associated with hypoalbuminemia, severe proteinuria, lipid abnormalities, and coagulopathy. In the multivariable analysis, a high eCALB was significantly associated with relapse after adjusting for age, eGFR, time to complete remission, and urinary protein excretion (adjusted hazard ratio, 5.027; 95% confidence interval, 1.88 to 13.47; P = 0.001). Conclusions This study revealed that eCALB, which could substitute albumin kinetics, reflected the severity of MCNS, and a high eCALB was associated with recurrence.
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Affiliation(s)
- Hideaki Kuno
- Division of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan
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16
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Downie ML, Gupta S, Chan MMY, Sadeghi-Alavijeh O, Cao J, Parekh RS, Diz CB, Bierzynska A, Levine AP, Pepper RJ, Stanescu H, Saleem MA, Kleta R, Bockenhauer D, Koziell AB, Gale DP. Shared genetic risk across different presentations of gene test-negative idiopathic nephrotic syndrome. Pediatr Nephrol 2023; 38:1793-1800. [PMID: 36357634 PMCID: PMC10154254 DOI: 10.1007/s00467-022-05789-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Idiop athic nephrotic syndrome (INS) is classified in children according to response to initial corticosteroid therapy into steroid-sensitive (SSNS) and steroid-resistant nephrotic syndrome (SRNS), and in adults according to histology into minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). However, there is well-recognised phenotypic overlap between these entities. Genome-wide association studies (GWAS) have shown a strong association between SSNS and variation at HLA, suggesting an underlying immunological basis. We sought to determine whether a risk score generated from genetic variants associated with SSNS could be used to gain insight into the pathophysiology of INS presenting in other ways. METHODS We developed an SSNS genetic risk score (SSNS-GRS) from the five variants independently associated with childhood SSNS in a previous European GWAS. We quantified SSNS-GRS in independent cohorts of European individuals with childhood SSNS, non-monogenic SRNS, MCD, and FSGS, and contrasted them with SSNS-GRS quantified in individuals with monogenic SRNS, membranous nephropathy (a different immune-mediated disease-causing nephrotic syndrome), and healthy controls. RESULTS The SSNS-GRS was significantly elevated in cohorts with SSNS, non-monogenic SRNS, MCD, and FSGS compared to healthy participants and those with membranous nephropathy. The SSNS-GRS in all cohorts with non-monogenic INS were also significantly elevated compared to those with monogenic SRNS. CONCLUSIONS The shared genetic risk factors among patients with different presentations of INS strongly suggests a shared autoimmune pathogenesis when monogenic causes are excluded. Use of the SSNS-GRS, in addition to testing for monogenic causes, may help to classify patients presenting with INS. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mallory L Downie
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sanjana Gupta
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Melanie M Y Chan
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Omid Sadeghi-Alavijeh
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Jingjing Cao
- Department of Medicine, Women's College Hospital, Toronto, Canada
| | - Rulan S Parekh
- Department of Medicine, Women's College Hospital, Toronto, Canada
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Canada
| | - Carmen Bugarin Diz
- Department of Paediatric Nephrology, Evelina London and Faculty of Life Sciences, King's College London, London, UK
| | - Agnieszka Bierzynska
- Bristol Renal, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam P Levine
- Research Department of Pathology, University College London, London, UK
| | - Ruth J Pepper
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Horia Stanescu
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Moin A Saleem
- Bristol Renal, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert Kleta
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ania B Koziell
- Department of Paediatric Nephrology, Evelina London and Faculty of Life Sciences, King's College London, London, UK
| | - Daniel P Gale
- Department of Renal Medicine, University College London, 1st Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
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Hadhri A, Mrabet S, Ben Aicha N, Fradi A, Azzabi A, Sahtout W, Boukadida R, Guedri Y, Zellama D, Abdessaied N, Ben Saad H, Achour A. Nephrotic syndrome with Minimal Change Disease and Atopy in NorthAfrican adults. Tunis Med 2023; 101:253-258. [PMID: 37682269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION In adults, minimal change disease (MCD) accounts for 15 to 25% of nephrotic syndrome (NS). Numerous reports have suggested a link between NS and atopy. However, data on treatment and prognosis of NS associated with allergy are limited. AIM To examine the presenting characteristics, treatments and outcomes of adults with allergic MCD in a North African center. METHODS This was an observational study using retrospectively collected data. Patients were recruited from the Nephrology department of Sahloul Hospital (Sousse, Tunisia) from January 2006 to December 2020. Adults with a biopsy proved MCD, which was associated with atopy, were included. RESULTS Fifteen patients (eight males, age mean±SD: 34±13 years) were included. High eosinophil and immunoglobulin E (IgE) levels were noted in three and twelve patients respectively. The IgE mean level at the initial presentation was 1431 IU/ml. Allergic skin tests were positive in nine patients. All patients were treated with corticosteroids, five had anti-histamine therapy and five had hyposensitization therapy, which was successful in two patients. Thirteen patients had relapsed during follow-up. Mean eosinophil level was significantly higher in patients with frequent relapses compared to those with infrequent relapses (5415/mm³ vs. 239.12/mm³, respectively, p=0.022). Two patients had progressed to chronic renal failure. CONCLUSION It is important to search for atopic disorders in patients with MCD to better control this disease and use specific treatments. However, the efficacy of anti-allergic therapies has to be proven.
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Affiliation(s)
- Asma Hadhri
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Sanda Mrabet
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Narjes Ben Aicha
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Asma Fradi
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Awatef Azzabi
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Wissal Sahtout
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Raja Boukadida
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Yosra Guedri
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Dorsaf Zellama
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
| | - Nihed Abdessaied
- Department of Pathology - Farhat Hached University Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratory of Physiology and Functional Explorations - Farhat Hached Hospital, Sousse, Tunisia
| | - Abdellatif Achour
- Department of Nephrology, Dialysis, and Transplantation - Sahloul University Hospital, Sousse, Tunisia
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Zhang WJ, Gao N. Anti-Leucine-rich glioma-inactivated Protein 1 antibody-associated encephalitis complicated by minimal change nephrotic syndrome: a case report. Eur Rev Med Pharmacol Sci 2022; 26:7556-7560. [PMID: 36314326 DOI: 10.26355/eurrev_202210_30029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of the study was to summarize the clinical features, diagnosis and treatment of leucine-rich glioma inactivation protein 1 (LGI-1) antibody-associated encephalitis coexistence of minimal change nephrotic syndrome (MCNS), moreover, to strengthen the awareness of the disease. Increasing number of studies describe coexistence of autoimmune encephalitis and other systemic autoimmune diseases. CASE REPORT Here we report a case of a patient with anti- LGI1 antibody-associated encephalitis, who presented with cognitive dysfunction, faciobrachial dystonic seizures (FBDS), sleep disturbance, and hyponatremia. Treatment with immunoglobulins, corticosteroids, levetiracetam and oxcarbazepine was proven effective for this patient. The patient had a history of MCNS diagnosed by renal biopsy and responded to treatment with low dose of oral corticosteroids. CONCLUSIONS This case expanded the spectrum of autoimmune comorbidities in patients with anti-LGI1 encephalitis.
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Affiliation(s)
- W-J Zhang
- Department of Neurology, The First Hospital of Yulin City and The Second Affiliated Hospital of Yanan University, Yulin, Shaanxi Province, China.
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19
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Neupane S, Pudasaini P, Sharma A, Sharma S, Adhikari A, Roka K. Minimal Change Disease in an Adult: A Case Report. JNMA J Nepal Med Assoc 2022; 60:399-401. [PMID: 35633209 PMCID: PMC9252239 DOI: 10.31729/jnma.7433] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022] Open
Abstract
Minimal change disease is an important cause of nephrotic syndrome in children, however, few cases are seen among adults. There is very little literature regarding the occurrence of minimal change disease in adults. We reported a case of a 63-year-old male who presented with the complaint of swelling around the eyes mostly during the morning for 18 days and frothing of urine for 7 days. On examination, the patient was ill-looking and had edema around the eyes and over the ankles. After preliminary investigations, renal biopsy was performed and electron microscopy revealed diffuse effacement of foot processes of visceral epithelial cells suggesting minimal change disease (podocytopathy). The patient has been treated with tablet prednisolone 60 mg per oral once daily, tablet ramipril 2.5 mg per oral once daily, and tablet torsemide 20 mg per oral twice daily. Hence, minimal change disease should also be considered as a differential diagnosis in adults presenting with the features of nephrotic syndrome.
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Affiliation(s)
- Shashank Neupane
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
- Correspondence: Mr Shashank Neupane, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal. , Phone: +977-9841356389
| | - Prasamsa Pudasaini
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Anupam Sharma
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Shriya Sharma
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Aakriti Adhikari
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | - Kumar Roka
- Department of Internal Medicine, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
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20
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Mizushina Y, Shiihara J, Nomura M, Ohta H, Ohyanagi F, Morishita Y, Tsubochi H, Tanaka A, Yamaguchi Y. Immunoglobulin G4-related Pleuritis Complicated with Minimal Change Disease. Intern Med 2022; 61:723-728. [PMID: 34483205 PMCID: PMC8943386 DOI: 10.2169/internalmedicine.7010-20] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old woman with bilateral pleural effusion and respiratory failure was admitted to our hospital. Nephrotic syndrome due to minimal change disease had been diagnosed four months before admission. Because blood tests and a pleural fluid analysis did not reveal the etiology of her condition, we performed a video-assisted thoracoscopic pleural biopsy. No specific thoracoscopic findings were noted. The pathological findings revealed an increase in immunoglobulin G4 (IgG4)-positive cells; IgG4-related pleuritis was diagnosed. Her pleuritis improved with oral corticosteroid therapy. A further investigation was performed on previous kidney samples; however, the etiology of the nephrotic syndrome was not IgG4-related disease but minimal change disease.
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Affiliation(s)
- Yoshiko Mizushina
- Division of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Japan
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Jun Shiihara
- Division of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Motoko Nomura
- Division of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Hiromitsu Ohta
- Division of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Fumiyoshi Ohyanagi
- Division of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, Saitama Medical Center, Jichi Medical University, Japan
| | - Hiroyoshi Tsubochi
- Division of Thoracic Surgery, Saitama Medical Center, Jichi Medical University, Japan
- Department of Thoracic Surgery, Jichi Medical University, Japan
| | - Akira Tanaka
- Department of Pathology, Saitama Medical Center, Jichi Medical University, Japan
| | - Yasuhiro Yamaguchi
- Division of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Japan
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21
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Parikh RV, Tan TC, Fan D, Law D, Salyer AS, Yankulin L, Wojcicki JM, Zheng S, Ordonez JD, Chertow GM, Khoshniat-Rad F, Yang J, Go AS. Population-based identification and temporal trend of children with primary nephrotic syndrome: The Kaiser Permanente nephrotic syndrome study. PLoS One 2021; 16:e0257674. [PMID: 34648518 PMCID: PMC8516311 DOI: 10.1371/journal.pone.0257674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Limited population-based data exist about children with primary nephrotic syndrome (NS). METHODS We identified a cohort of children with primary NS receiving care in Kaiser Permanente Northern California, an integrated healthcare delivery system caring for >750,000 children. We identified all children <18 years between 1996 and 2012 who had nephrotic range proteinuria (urine ACR>3500 mg/g, urine PCR>3.5 mg/mg, 24-hour urine protein>3500 mg or urine dipstick>300 mg/dL) in laboratory databases or a diagnosis of NS in electronic health records. Nephrologists reviewed health records for clinical presentation and laboratory and biopsy results to confirm primary NS. RESULTS Among 365 cases of confirmed NS, 179 had confirmed primary NS attributed to presumed minimal change disease (MCD) (72%), focal segmental glomerulosclerosis (FSGS) (23%) or membranous nephropathy (MN) (5%). The overall incidence of primary NS was 1.47 (95% Confidence Interval:1.27-1.70) per 100,000 person-years. Biopsy data were available in 40% of cases. Median age for patients with primary NS was 6.9 (interquartile range:3.7 to 12.9) years, 43% were female and 26% were white, 13% black, 17% Asian/Pacific Islander, and 32% Hispanic. CONCLUSION This population-based identification of children with primary NS leveraging electronic health records can provide a unique approach and platform for describing the natural history of NS and identifying determinants of outcomes in children with primary NS.
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MESH Headings
- Adolescent
- Biopsy
- Child
- Child, Preschool
- Cohort Studies
- Female
- Glomerulonephritis, Membranous/diagnosis
- Glomerulonephritis, Membranous/epidemiology
- Glomerulonephritis, Membranous/pathology
- Glomerulosclerosis, Focal Segmental/diagnosis
- Glomerulosclerosis, Focal Segmental/epidemiology
- Glomerulosclerosis, Focal Segmental/pathology
- Humans
- Male
- Nephrosis, Lipoid/diagnosis
- Nephrosis, Lipoid/epidemiology
- Nephrosis, Lipoid/pathology
- Nephrotic Syndrome/diagnosis
- Nephrotic Syndrome/epidemiology
- Nephrotic Syndrome/pathology
- Proteinuria/diagnosis
- Proteinuria/epidemiology
- Proteinuria/pathology
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Affiliation(s)
- Rishi V. Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Thida C. Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - David Law
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA, United States of America
| | - Anne S. Salyer
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA, United States of America
| | - Leonid Yankulin
- Department of Nephrology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States of America
| | - Janet M. Wojcicki
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States of America
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Sijie Zheng
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA, United States of America
| | - Juan D. Ordonez
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA, United States of America
| | - Glenn M. Chertow
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Departments of Medicine (Nephrology) and Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Farzien Khoshniat-Rad
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Departments of Medicine (Nephrology) and Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
- * E-mail:
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22
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Suzuki T, Nagaoka K, Takahashi Y, Osawa R, Hosokawa N. Coronavirus Disease-19 in a patient with minimal change nephrotic syndrome undergoing rituximab monotherapy. Saudi J Kidney Dis Transpl 2021; 32:1505-1506. [PMID: 35532730 DOI: 10.4103/1319-2442.344780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Tomo Suzuki
- Department of Nephrology, Kameda Medical Center, Kamogawa, Japan
| | - Kanako Nagaoka
- Department of Nephrology, Kameda Medical Center, Kamogawa, Japan
| | | | - Ryosuke Osawa
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan
| | - Naoto Hosokawa
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan
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23
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Tanabe K, Samejima KI, Fukata F, Kosugi T, Tsushima H, Morimoto K, Okamoto K, Matsui M, Eriguchi M, Maruyama N, Akai Y, Tsuruya K. Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease. Clin Exp Nephrol 2021; 26:29-35. [PMID: 34365595 PMCID: PMC8738364 DOI: 10.1007/s10157-021-02119-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A dose of 0.5-1 mg/kg/day of prednisolone (PSL) is administered for the initial treatment of minimal change disease (MCD). However, little is known about the optimal PSL dose for the initial treatment of MCD. METHODS We conducted a retrospective multicenter cohort study of treatment-naive adult patients with MCD diagnosed by renal biopsy from 1981 to 2015 in whom PSL monotherapy was performed as the initial treatment. The exposure of interest was an initial median PSL dose of < 0.63 mg/kg/day (Group L) compared to ≥ 0.63 mg/kg/day (Group H). Cumulative remission and relapse after remission were compared between these groups using Cox regression adjusted for baseline characteristics. RESULTS Ninety-one patients met the inclusion criteria. During a median follow-up of 2.98 years, 87 (95.6%) patients achieved complete remission, and 47.1% relapsed after remission. There was no significant difference in the remission rate between the groups at 4 weeks of follow-up (66.7 vs. 82.6%). The median time to remission in Group L was comparable to that in Group H (17.0 vs. 14.0 days). A multivariable Cox hazard model revealed that the initial PSL dose was not a significant predictor of remission. The cumulative steroid doses at 6 months, 1 year, and 2 years after treatment initiation were significantly lower in Group L than in Group H. CONCLUSION The initial PSL dose was not associated with time to remission, remission rate, time to relapse, or relapse rate. Therefore, a low initial steroid dose may be sufficient to achieve remission.
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Affiliation(s)
- Kaori Tanabe
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
- Department of Community-Based Medicine, Nara Medical University, Nara, Japan
| | - Ken-Ichi Samejima
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Fumihiro Fukata
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
- Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan
| | - Takaaki Kosugi
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
- Department of Nephrology, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Hideo Tsushima
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
- Department of Nephrology, Saiseikai Suita Hospital, Suita, Japan
| | - Katsuhiko Morimoto
- Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan
- Department of Nephrology, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Keisuke Okamoto
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
- Department of Nephrology, Saiseikai Suita Hospital, Suita, Japan
| | - Masaru Matsui
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
- Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Naoki Maruyama
- Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan
| | - Yasuhiro Akai
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
- Department of Community-Based Medicine, Nara Medical University, Nara, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
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Kervella D, Jacquemont L, Chapelet-Debout A, Deltombe C, Ville S. Minimal change disease relapse following SARS-CoV-2 mRNA vaccine. Kidney Int 2021; 100:457-458. [PMID: 33964312 PMCID: PMC8098029 DOI: 10.1016/j.kint.2021.04.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Delphine Kervella
- CHU de Nantes, Nantes Université, Néphrologie et Immunologie clinique, Nantes, France; CHU de Nantes, Université de Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, Nantes, France.
| | - Lola Jacquemont
- CHU de Nantes, Nantes Université, Néphrologie et Immunologie clinique, Nantes, France
| | - Agnès Chapelet-Debout
- CHU de Nantes, Nantes Université, Néphrologie et Immunologie clinique, Nantes, France
| | - Clément Deltombe
- CHU de Nantes, Nantes Université, Néphrologie et Immunologie clinique, Nantes, France
| | - Simon Ville
- CHU de Nantes, Nantes Université, Néphrologie et Immunologie clinique, Nantes, France; CHU de Nantes, Université de Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, Nantes, France
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25
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Shimamura Y, Abe K, Maeda T, Ogawa Y, Takizawa H, Ishigami J, Matsushita K. Association between diuretic administration before diagnosis and incidence of acute kidney injury in patients with minimal change disease: A single-center observational study. Medicine (Baltimore) 2021; 100:e25845. [PMID: 33950999 PMCID: PMC8104140 DOI: 10.1097/md.0000000000025845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/18/2021] [Indexed: 01/04/2023] Open
Abstract
We examined the association between diuretic administration before the diagnosis of minimal change disease and the incidence of acute kidney injury. Moreover, we examined whether the use of diuretics affected the time to complete remission in adults with such disease.The present study was a single-center, retrospective, observational cohort study. We included 107 patients with biopsy-proven minimal change disease who were treated at a tertiary referral center in Japan between January 1, 2000 and March 31, 2019. All biopsy specimens were examined by a board-certified renal pathologist. The patients were considered to have minimal change disease when the kidney biopsy specimen had no glomerular lesions or only mild focal mesangial prominence (not exceeding 3 or 4 cells per segment) by light microscopy and/or foot process effacement by electron microscopy. Logistic regression and Kaplan-Meier curve analyses were performed, comparing the data of patients who received diuretics or not.The median age was 47 (28-66) years, 52% of patients were women, and the median proteinuria dosage was 8.3 (5.3-11.2) g/d. When minimal change disease was diagnosed, 27% of patients were taking diuretics. Within 30 days after the diagnosis, acute kidney injury occurred in 27% of patients. On multivariable logistic regression analysis, the use of diuretics was significantly associated with a higher risk of acute kidney injury. The use of diuretics was also associated with a longer time to complete remission.Diuretic administration can be associated with an elevated acute kidney injury risk and longer remission time in adult patients with newly diagnosed minimal change disease.
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Affiliation(s)
| | - Koki Abe
- Department of Nephrology, Teine Keijinkai Medical Center
| | - Takuto Maeda
- Department of Nephrology, Teine Keijinkai Medical Center
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Hokkaido, Japan
| | | | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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26
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Affiliation(s)
- Andrew S Bomback
- The Center for Glomerular Diseases, Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, New York
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27
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Pereira LHDM, da Silva CA, Monteiro MLGDR, Araújo LS, Rocha LP, Reis MBDR, Ramalho FS, Corrêa RRM, Silva MV, Reis MA, Machado JR. Podocin and uPAR are good biomarkers in cases of Focal and segmental glomerulosclerosis in pediatric renal biopsies. PLoS One 2019; 14:e0217569. [PMID: 31188898 PMCID: PMC6561567 DOI: 10.1371/journal.pone.0217569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/14/2019] [Indexed: 01/10/2023] Open
Abstract
There are controversies whether Minimal Change Disease (MCD) and Focal and Segmental Glomerulosclerosis (FSGS) are distinct glomerular lesions or different manifestations within the same spectrum of diseases. The uPAR (urokinase-type plasminogen activator receptor) and some slit diaphragm proteins may be altered in FSGS glomeruli and may function as biomarkers of the disease in renal biopsies. Thus, this study aims to evaluate the diagnostic potential of uPAR and glomerular proteins for differentiation between MCD and FSGS in renal pediatric biopsy. Renal biopsies from 50 children between 2 and 18 years old were selected, with diagnosis of MCD (n = 29) and FSGS (n = 21). Control group consisted of pediatric autopsies (n = 15) from patients younger than 18 years old, with no evidences of renal dysfunction. In situ expressions of WT1, nephrin, podocin and uPAR were evaluated by immunoperoxidase technique. Renal biopsy of patients with MCD and FSGS expressed fewer WT1 (p≤0.0001, F = 19.35) and nephrin (p<0.0001; H = 21.54) than patients in the control group. FSGS patients expressed fewer podocin than control (p<0.0359, H = 6.655). FSGS cases expressed more uPAR than each of control and MCD (p = 0.0019; H = 12.57) and there was a positive and significant correlation between nephrin and podocin (p = 0.0026, rS = 0.6502) in these cases. Podocin had sensitivity of 73.3% and specificity of 86.7% (p = 0.0068) and uPAR had sensitivity of 78.9% and specificity of 73.3% (p = 0.0040) for diagnosis of FSGS patients. The main limitation of the study is the limited number of cases due to the difficulty in performing biopsy in pediatric patients. Podocin and uPAR are good markers for FSGS and differentiate these cases from MCD, reinforcing the theory of distinct glomerular diseases. These findings suggest that podocin and uPAR can be used as biomarkers in the routine analysis of renal biopsies in cases of podocytopathies when the lesion (sclerosis) is not sampled.
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MESH Headings
- Adolescent
- Autopsy
- Biomarkers/metabolism
- Biopsy
- Case-Control Studies
- Child
- Child, Preschool
- Diagnosis, Differential
- Female
- Gene Expression
- Glomerulosclerosis, Focal Segmental/diagnosis
- Glomerulosclerosis, Focal Segmental/genetics
- Glomerulosclerosis, Focal Segmental/metabolism
- Glomerulosclerosis, Focal Segmental/pathology
- Humans
- Intracellular Signaling Peptides and Proteins/genetics
- Intracellular Signaling Peptides and Proteins/metabolism
- Kidney Glomerulus/metabolism
- Kidney Glomerulus/pathology
- Male
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Nephrosis, Lipoid/diagnosis
- Nephrosis, Lipoid/genetics
- Nephrosis, Lipoid/metabolism
- Nephrosis, Lipoid/pathology
- Predictive Value of Tests
- Receptors, Urokinase Plasminogen Activator/genetics
- Receptors, Urokinase Plasminogen Activator/metabolism
- WT1 Proteins/genetics
- WT1 Proteins/metabolism
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Affiliation(s)
- Lívia Helena de Morais Pereira
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Crislaine Aparecida da Silva
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | - Liliane Silvano Araújo
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Laura Penna Rocha
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Marcelo Bernardes da Rocha Reis
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Fernando Silva Ramalho
- Department of Pathology and Forensic Medicine, Ribeirão Preto Faculty of Medicine of São Paulo University, Ribeirão Preto, São Paulo, Brazil
| | - Rosana Rosa Miranda Corrêa
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Marcos Vinicius Silva
- Institute of Biological and Natural Sciences, Discipline of Parasitology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Marlene Antonia Reis
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Juliana Reis Machado
- Institute of Biological and Natural Sciences, Discipline of General Pathology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
- * E-mail:
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28
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Abstract
BACKGROUND Kugelberg-Welander (K-W) syndrome is a type of spinal muscular atrophy that causes weakness of the hip-girdle muscles. If severe enough, this weakness can confine patients to a wheelchair in adult life. Proteinuria, a manifestation of kidney dysfunction, is associated with disorders of many organ systems. The evaluation of kidney function in the context of K-W syndrome is challenging. CASE REPORT A 45-year-old man with K-W syndrome first diagnosed at 5 years of age developed peripheral edema and was found to have proteinuria under 1 g/24 h. His past history was significant for hypertension for 7 years. He was managed conservatively initially, but over the next year the serum creatinine concentration increased from 18 to 32 µmol/L (0.2 to 0.36 mg/dL). A percutaneous kidney biopsy was performed in the fetal position due to an inability of the patient to lay prone or supine. Minimal change disease (MCD) was diagnosed. Treatment consisted of dietary salt restriction, ramipril, amiloride, and hydrochlorothiazide, while avoiding corticosteroids. The serum creatinine concentration initially returned to the 18-20 µmol/L (0.2-0.22 mg/dL) range with increased fluid intake, but then slowly declined to 6 µmol/L (0.07 mg/dL) over the next 14 years. Muscle strength remained poor. CONCLUSIONS K-W syndrome, when associated with proteinuria, presents novel diagnostic and therapeutic challenges to the latter. The serum creatinine concentration may be unhelpful in assessing kidney function in K-W syndrome. A conservative management approach to MCD is reasonable to minimize comorbidity.
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Affiliation(s)
- Michael West
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
| | - Michelle M. Nash
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
| | - Lindita Rapi
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
| | - Adriana Krizova
- Department of Anatomical Pathology, St. Michael’s Hospital, Toronto, Canada
| | - G.V. Ramesh Prasad
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, St. Michael’s Hospital, Toronto, Canada
- Corresponding Author: G.V. Ramesh Prasad, e-mail:
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29
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Ngoh CLY, Goh GHS, Wong WK. Paraneoplastic relapsing minimal change disease associated with type A thymoma in an elderly patient: A case report and literature review. Med J Malaysia 2019; 74:97-98. [PMID: 30846674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Thymoma is a rare mediastinal tumour that can be accompanied by different paraneoplastic syndromes. Here we report a case of Type A thymoma associated with relapsing minimal change disease (MCD). This case highlights: (1) The need to balance rapid prednisolone weaning against risk for relapse in an elderly patient at risk for steroid-induced complications. (2) The addition of calcineurin inhibitor in relapsed thymoma-related MCD, to achieve steroid sparing effects. Resection of the offending tumour and prompt immunosuppressive therapy are critical in getting best renal and overall outcomes in this rare entity.
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Affiliation(s)
- C L Y Ngoh
- National University Health System, Department of Medicine, Singapore.
| | - G H S Goh
- National University Health System, Department of Pathology, Singapore
| | - W K Wong
- National University Health System, Department of Medicine, Singapore
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Minamikawa S, Nozu K, Maeta S, Yamamura T, Nakanishi K, Fujimura J, Horinouchi T, Nagano C, Sakakibara N, Nagase H, Shima H, Noda K, Ninchoji T, Kaito H, Iijima K. The utility of urinary CD80 as a diagnostic marker in patients with renal diseases. Sci Rep 2018; 8:17322. [PMID: 30470792 PMCID: PMC6251900 DOI: 10.1038/s41598-018-35798-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/06/2018] [Indexed: 01/23/2023] Open
Abstract
CD80, which regulates T cell activation, may provide a differential diagnostic marker between minimal change disease (MCD) and other renal diseases, including focal segmental glomerular sclerosis (FSGS). However, recent reports show contrasting results. Therefore, we evaluated the utility of urinary CD80 as a diagnostic biomarker. We collected 65 urine samples from 55 patients with MCD (n = 31), FSGS (n = 4), inherited nephrotic syndrome (n = 4), Alport syndrome (n = 5) and other glomerular diseases (n = 11), and control samples (n = 30). We measured urinary CD80 levels by ELISA. Urinary CD80 (ng/gCr) (median, interquartile range) levels were significantly higher in patients with MCD in relapse (91.5, 31.1-356.0), FSGS (376.2, 62.7-1916.0), and inherited nephrotic syndrome (220.1, 62.9-865.3), than in patients with MCD in remission (29.5, 21.7-52.8) (p < 0.05). Elevation of urinary CD80 was observed, even in patients with inherited nephrotic syndrome unrelated to T cell activation. Additionally, urinary CD80 was positively correlated with urinary protein levels. Our results suggest that urinary CD80 is unreliable as a differential diagnostic marker between MCD in relapse and FSGS or inherited kidney diseases. Increased urinary CD80 excretion was present in all patients with active kidney disease.
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Affiliation(s)
- Shogo Minamikawa
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shingo Maeta
- Sysmex Corporation, Technology Development, Elemental Technology Development 2, Kobe, Japan
| | - Tomohiko Yamamura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keita Nakanishi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Fujimura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nana Sakakibara
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Shima
- Sysmex Corporation, Technology Development, Elemental Technology Development 2, Kobe, Japan
| | - Kenta Noda
- Sysmex Corporation, Technology Development, Elemental Technology Development 2, Kobe, Japan
| | - Takeshi Ninchoji
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kaito
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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Romaniouk Jakovler I, Mouzo Javier R, Perez Nieto C, Romero A, Simal F, Castañon B. A minimum changes disease compatible with C1q nephropathy in a paediatric patient. Evolution and treatment of a difficult pathology. Nefrologia 2018; 39:84-86. [PMID: 30075963 DOI: 10.1016/j.nefro.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 04/08/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Antonio Romero
- Servicio de Nefrología, Hospital del Bierzo, Ponferrada, León, España
| | - Fernando Simal
- Servicio de Nefrología, Hospital del Bierzo, Ponferrada, León, España
| | - Beatriz Castañon
- Servicio de Anatomía Patológica, Hospital del Bierzo, Ponferrada, León, España
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Ahmed HM, Ezzat DA, Doudar NA, Adel M. Urinary CD80 as a Replacement for Renal Biopsy for Diagnosis of Pediatric Minimal Change Disease. Iran J Kidney Dis 2018; 12:107-111. [PMID: 29507273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/09/2017] [Accepted: 12/24/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Early diagnosis of minimal change disease (MCD) is challenging in nephrotic children. CD80 is a protein expressed on the surface of podocytes associated with nephrotic syndrome and it is implicated in the induction of proteinuria. This study aimed to investigate the use of urinary CD80 for the diagnosis of MCD. MATERIALS AND METHODS Urinary CD80 levels were evaluated in 36 children with nephrotic syndrome and normal glomerular filtration rate. They were divided into three groups of MCD (n = 21), focal segmental glomerulosclerosis (n = 9), and other glomerulopathies (n = 6). The MCD group was subdivided into 2 of those with remission (n = 11) and those in the active stage (n = 10). Forty healthy children were included as controls. RESULTS The urinary CD80 level was significantly higher in the MCD group (3.5 ± 2.1 ng/mg creatinine) than in the focal segmental glomerulosclerosis group (1.2 ± 0.5 ng/mg creatinine, P < .001), the other glomerulopathies group (1.4 ± 0.7 ng/mg creatinine, P < .001), and the control group (0.7 ± 0.2 ng/mg creatinine, P < .001), while it showed no significant difference among the non-MCD groups. There was no significant difference between MCD in remission and MCD in relapse, either. A urinary CD80 cutoff value of 1.5 ng/gm creatinine showed a sensitivity of 100% and a specificity of 86% for diagnosis of MCD. CONCLUSIONS Urinary CD80 levels were significantly higher in the children with MCD than in the controls and patients with other causes of nephrotic syndrome.
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Affiliation(s)
- Heba Mostafa Ahmed
- Departement of Pediatrics, Faculty of Medicine, Beni-Suef University, Egypt.
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Liu D, Zhao N, Wang M, Pi X, Feng Y, Wang Y, Tong H, Zhu L, Wang C, Li E. Urine volatile organic compounds as biomarkers for minimal change type nephrotic syndrome. Biochem Biophys Res Commun 2017; 496:58-63. [PMID: 29291407 DOI: 10.1016/j.bbrc.2017.12.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/29/2017] [Indexed: 11/17/2022]
Abstract
Urinary volatile organic compounds (VOCs) profiling has recently received considerable attention because it can be obtained noninvasively and conveniently while it can be successfully used in a variety of diseases and can provide unique biomarkers. The aim of current study was to investigate potential biomarkers between minimal change type nephrotic syndrome (MCNS) and normal. Urinary samples were collected from 38 minimal change type nephrotic syndrome patients and 15 healthy controls. Solid phase microextraction (SPME) and chromatography- mass spectrometry (GC-MS) were used to analysis the urinary metabolites. To deal with the final data, the statistical methods principal component analysis (PCA) and orthogonal partial least-squares discriminant analysis (OPLSDA) were performed. Six specific VOC biomarkers were present at abnormal levels in the urine of MCNS patients. These VOCs included trans-2,2-dimethyl-4-decene; pyrrole; carbamic acid, monoammonium salt; 1-butyne, 3,3-dimethyl-; diisopropylamine; and 4-heptanone. These biomarkers may be useful as a new diagnostic method and for monitoring the prognosis for MCNS patients.
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Affiliation(s)
- Desheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Nana Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Mingao Wang
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Xin Pi
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yue Feng
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yue Wang
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Hongshuang Tong
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Lin Zhu
- Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Changsong Wang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Enyou Li
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Tamura H, Nakazato H, Kuraoka S, Yoneda K, Takahashi W, Endo F. Reduced INF2 expression in nephrotic syndrome is possibly related to clinical severity of steroid resistance in children. Nephrology (Carlton) 2017; 21:467-75. [PMID: 26383224 DOI: 10.1111/nep.12627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/21/2022]
Abstract
AIM Mutations of the inverted formin 2 gene (INF2), which encodes a member of the formin family, cause autosomal dominant focal segmental glomerulosclerosis (FSGS) and Charcot-Marie-Tooth (CMT) disease-associated FSGS. However, their role in idiopathic FSGS remains unclear. This study investigated INF2 localization in the normal adult kidney and its expression in children with idiopathic nephrotic syndrome. METHODS We generated a rabbit polyclonal antibody against the conjugated peptide from human INF2 and studied the glomerular expression of INF2 and synaptopodin using normal human adult kidney tissues and tissues from children with glomerular diseases such as minimal change disease (MCD), FSGS, IgA nephropathy (IgAN), non-IgA mesangial proliferative glomerulonephritis (non-IgAN), and Henoch-Schönlein purpura nephritis (HSPN). RESULTS The anti-INF2 antibody detected an approximately 140-kD fragment isolated from adult mature glomeruli by western blotting. Immunohistochemically, INF2 was detected in podocytes and renal arteries. Among 56 patients, INF2 in glomeruli was expressed at a similar level in patients with MCD, IgAN, non-IgAN, or HSPN and controls. In FSGS patients, INF2 expression in glomeruli was either decreased or absent. There was a relationship between decreased INF2 expression and the clinical severity of steroid resistant nephrotic syndrome (SRNS). CONCLUSION We propose that examination of INF2 expression may help to differentiate MCD from FSGS and evaluate the clinical severity of SRNS in children.
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Affiliation(s)
- Hiroshi Tamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hitoshi Nakazato
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shohei Kuraoka
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kaori Yoneda
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Wataru Takahashi
- Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Fumio Endo
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Hyun JI, Min JW, Lee HM, Kim YK, Choi EJ, Song HC. Minimal change nephrotic syndrome showing complete remission after resection of a neurofibroma in a type I neurofibromatosis patient. Korean J Intern Med 2017; 32:186-189. [PMID: 26951918 PMCID: PMC5214715 DOI: 10.3904/kjim.2015.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/09/2015] [Accepted: 04/15/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ji In Hyun
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Won Min
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Min Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eu Jin Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Cheol Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Ho Choel Song, M.D. Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea Tel: +82-32-340-7015 Fax: +82-32-340-2667 E-mail:
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Abstract
A hypercoagulable state exists in patients with nephrotic syndrome (NS), which more easily leads to venous thromboembolism (VTE). However, whether acute kidney injury (AKI), a common complication of NS, affects the hypercoagulable state and VTE has rarely been elucidated. In this study, we aimed to explore coagulation changes and analyze relevant influencing factors in NS-AKI patients.A total of 269 consecutive NS patients with minimal change disease (MCD) between 2011 and 2016 were included in this observational study. Ninety-one cases were in the AKI group and 178 cases in the non-AKI group. The 1:1 propensity score matching (PSM) method was applied to match the baseline information. The coagulation biomarkers were compared, and the thrombosis events were recorded. Linear correlation was performed to detect any relation between D-dimer and clinical data.The PSM method gave matched pairs of 88 MCD patients with AKI and non-AKI patients, resulting in no differences in baseline information. The D-dimer, fibrinogen, and thromboelastography parameters maximum amplitude (MA), G values of the MCD-AKI patients were significantly higher than the levels of the MCD patients without AKI (D-dimer: 1.8 [1.0, 3.3] vs 1.1 [0.6, 1.7] mg/L, P < 0.001; fibrinogen: 7.0±2.0 vs 6.5 ± 1.4 g/L, P = 0.036; MA: 74.6 ± 5.0 vs 70.5 ± 5.3 mm, P = 0.020; G: 15.7 ± 5.3 vs 12.5 ± 3.3, P = 0.034). For the MCD patients, the serum creatinine, white blood cell count, and interleukin-6 levels in the patients with D-dimers >1 mg/L were significantly higher than those of patients with D-dimers ≤1 mg/L. The correlation analysis showed that the D-dimer level was correlated with serum creatinine, white blood cell count, and interleukin-6 (r = 0.410, P = < 0.001; r = 0.248, P = < 0.001; r = 0.306, P = < 0.001, respectively). Five deep vein thrombosis events occurred in the AKI group and 1 pulmonary embolism event occurred in the non-AKI group after adjusting the propensity score value. AKI appeared to have an association with higher incidence of VTE, but the difference was not statistically significant (RR: 4.9, 95% CI: 0.6-42.7, P = 0.154).The MCD-NS patients complicated with AKI had a more severe hypercoagulable state, which might be associated with the active inflammation of AKI that mediated activation of the coagulation system.
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Abstract
BACKGROUND Myasthenia gravis superimposed with proteinuria is a very rare disorder with only 39 cases reported so far. Of these cases, the most commonly associated disorder is minimal change disease. Myasthenia gravis and minimal change disease are both related to the dysfunction of T lymphocytes and hence the 2 disorders may be connected. METHODS Here we report the first case on a patient diagnosed with myasthenia gravis concurrently with the minimal change disease, and it was presented in the absence of thymoma or thymic hyperplasia. RESULTS Treatment for myasthenia gravis also lowered proteinuria of minimal change disease. He ever experienced good control for myasthenia gravis and minimal change disease. However, pneumonia related septic shock occurred to him and finally he was dead. Minimal change disease is generally considered to occur subsequent to the onset of myasthenia gravis with causal association. After extensive literature review, we noted only 47.8% minimal change disease had occurred after the onset of myasthenia gravis. CONCLUSION Minimal change disease mostly occurs in children and if diagnosed in adults, clinicians should search for a potential cause such as myasthenia gravis and other associated thymic disorders.
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Affiliation(s)
- Jun-Li Tsai
- Department of Family Medicine, Cheng Ching General Hospital
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital
- School of Medicine, China Medical University
- Department of Life Science, Tunghai University, Taichung
- Department of Medicine, Nation Yang Ming University, Taipei, Taiwan
- Correspondence: Shang-Feng, Tsai, Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan (e-mail: )
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Abstract
Minimal change disease (MCD) is a well-known benign primary glomerulonephritis because of its distinct rare tendency to progress to end-stage renal disease. However, factors associated with relapse in adults are not well known. We aimed to identify predictors of relapse in adult-onset MCD patients.A retrospective cohort of 195 patients with adult-onset primary MCD with nephritic syndrome and disease onset between 1979 and 2013 was followed up for >12 months. The number of relapses was counted and predictors of relapse were analyzed.A total of 195 patients were included. Median age at diagnosis was 38 years (IQR, 23-53 years) and 113 (57.9%) were men. During 81 months (IQR, 44-153 months) of follow-up, 92% of patients achieved remission after initial treatment. However, only 60 (32.8%) did not experience a relapse and 11 patients failed to remit. Among the remaining 124 patients, 65 experienced a relapse once or twice and 59 experienced a relapse more than twice. Younger onset age, increased severity of nephrotic features such as lower serum albumin levels and higher cholesterol level were associated with relapse. Interestingly, the grade of mesangial proliferation was lower in patients who experienced a relapse. Initial combined treatment with corticosteroids (CS) and cyclophosphamide reduced the number of relapses. In addition, patients with shorter treatment duration tended to experience relapse more often. Multivariate analysis showed that younger onset age, combined mesangial proliferation, initial treatment regimen, and treatment duration were independent risk factors for relapse. Progression to end-stage renal disease was developed in only a patient.In conclusion, more than two-thirds of adult-onset nephrotic MCD patients experienced relapse, although their renal progression was rare. Younger onset age, CS without cyclophosphamide treatment, and shorter treatment duration were independent risk factors for relapse in adult-onset MCD patients.
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Affiliation(s)
- Hajeong Lee
- From the Department of Internal Medicine (HL, DKK, KHO, KWJ, YSK, CA, JSH, CSL), Seoul National University Hospital; Kidney Research Institute (YKO, DKK, KWJ, YSK, CA, JSH, CSL), Seoul National University; Department of Internal Medicine (YKO, CSL), Seoul National University Boramae Medical Center, Seoul; and Department of Internal Medicine (KDY), Dongguk University Medical Center, Gyeongju, Republic of Korea
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Lee SW, YU MY, Baek SH, Ahn SY, Kim S, Na KY, Chae DW, Chin HJ. Glomerular Immune Deposits Are Predictive of Poor Long-Term Outcome in Patients with Adult Biopsy-Proven Minimal Change Disease: A Cohort Study in Korea. PLoS One 2016; 11:e0147387. [PMID: 26799663 PMCID: PMC4723049 DOI: 10.1371/journal.pone.0147387] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/04/2016] [Indexed: 01/10/2023] Open
Abstract
Background and Objectives There has been little published information on risk factors for poor long-term outcome in adult biopsy-proven minimal change disease (MCD). Methods Data from sixty-three adult, biopsy-proven primary MCD patients treated at a tertiary university hospital between 2003 and 2013 were analyzed. Baseline clinical and pathologic factors were assessed for the associations with composite outcome of creatinine doubling, end stage renal disease, or all-cause mortality. Results During a median (interquartile) 5.0 (2.8–5.0) years, the composite outcome occurred in 11.1% (7/63) of patients. The rate of glomerular immune deposits was 23.8% (15/63). Patients with glomerular immune deposits showed a significantly lower urine protein creatinine ratio than those without deposits (P = 0.033). The rate of non-responders was significantly higher in patients with glomerular immune deposits than in those without deposits (P = 0.033). In patients with deposits, 26.7% (4/15) developed the composite outcome, while only 6.3% (3/48) developed the composite outcome among those without deposits (P = 0.049). In multivariate Cox proportional hazards regression analysis, the presence of glomerular immune deposits was the only factor associated with development of the composite outcome (hazard ratio: 2.310, 95% confidence interval: 1.031–98.579, P = 0.047). Conclusion Glomerular immune deposits were associated with increased risk of a composite outcome in adult MCD patients. The higher rate of non-responders in patients with deposits might be related to the poor outcome. Future study is needed.
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Affiliation(s)
- Sung Woo Lee
- Department of Immunology, Seoul National University Postgraduate School, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Yeon YU
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seon Ha Baek
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Shin-Young Ahn
- Department of Immunology, Seoul National University Postgraduate School, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Young Na
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Chae
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Department of Immunology, Seoul National University Postgraduate School, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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Rabin AS, Hamnvik OPR, Robinson ES, Miller AL, Loscalzo J. CLINICAL PROBLEM-SOLVING. Springing a Leak. N Engl J Med 2015; 373:1362-7. [PMID: 26422727 DOI: 10.1056/nejmcps1401950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Johnston PA, Coulshed SJ, Davison AM. Renal biopsy findings in patients older than 65 years of age presenting with the nephrotic syndrome. A report from the MRC Glomerulonephritis Registry. Contrib Nephrol 2015; 105:127-32. [PMID: 8252857 DOI: 10.1159/000422482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- P A Johnston
- Department of Renal Medicine, St. James's University Hospital, Leeds, UK
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Trautmann A, Bodria M, Ozaltin F, Gheisari A, Melk A, Azocar M, Anarat A, Caliskan S, Emma F, Gellermann J, Oh J, Baskin E, Ksiazek J, Remuzzi G, Erdogan O, Akman S, Dusek J, Davitaia T, Özkaya O, Papachristou F, Firszt-Adamczyk A, Urasinski T, Testa S, Krmar RT, Hyla-Klekot L, Pasini A, Özcakar ZB, Sallay P, Cakar N, Galanti M, Terzic J, Aoun B, Caldas Afonso A, Szymanik-Grzelak H, Lipska BS, Schnaidt S, Schaefer F. Spectrum of steroid-resistant and congenital nephrotic syndrome in children: the PodoNet registry cohort. Clin J Am Soc Nephrol 2015; 10:592-600. [PMID: 25635037 PMCID: PMC4386250 DOI: 10.2215/cjn.06260614] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/22/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Steroid-resistant nephrotic syndrome is a rare kidney disease involving either immune-mediated or genetic alterations of podocyte structure and function. The rare nature, heterogeneity, and slow evolution of the disorder are major obstacles to systematic genotype-phenotype, intervention, and outcome studies, hampering the development of evidence-based diagnostic and therapeutic concepts. To overcome these limitations, the PodoNet Consortium has created an international registry for congenital nephrotic syndrome and childhood-onset steroid-resistant nephrotic syndrome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Since August of 2009, clinical, biochemical, genetic, and histopathologic information was collected both retrospectively and prospectively from 1655 patients with childhood-onset steroid-resistant nephrotic syndrome, congenital nephrotic syndrome, or persistent subnephrotic proteinuria of likely genetic origin at 67 centers in 21 countries through an online portal. RESULTS Steroid-resistant nephrotic syndrome manifested in the first 5 years of life in 64% of the patients. Congenital nephrotic syndrome accounted for 6% of all patients. Extrarenal abnormalities were reported in 17% of patients. The most common histopathologic diagnoses were FSGS (56%), minimal change nephropathy (21%), and mesangioproliferative GN (12%). Mutation screening was performed in 1174 patients, and a genetic disease cause was identified in 23.6% of the screened patients. Among 14 genes with reported mutations, abnormalities in NPHS2 (n=138), WT1 (n=48), and NPHS1 (n=41) were most commonly identified. The proportion of patients with a genetic disease cause decreased with increasing manifestation age: from 66% in congenital nephrotic syndrome to 15%-16% in schoolchildren and adolescents. Among various intensified immunosuppressive therapy protocols, calcineurin inhibitors and rituximab yielded consistently high response rates, with 40%-45% of patients achieving complete remission. Confirmation of a genetic diagnosis but not the histopathologic disease type was strongly predictive of intensified immunosuppressive therapy responsiveness. Post-transplant disease recurrence was noted in 25.8% of patients without compared with 4.5% (n=4) of patients with a genetic diagnosis. CONCLUSIONS The PodoNet cohort may serve as a source of reference for future clinical and genetic research in this rare but significant kidney disease.
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MESH Headings
- Adolescent
- Age Distribution
- Age of Onset
- Biopsy
- Child
- Child, Preschool
- DNA Mutational Analysis
- Europe/epidemiology
- Female
- Genetic Markers
- Genetic Predisposition to Disease
- Glomerulonephritis, Membranoproliferative/diagnosis
- Glomerulonephritis, Membranoproliferative/epidemiology
- Glomerulonephritis, Membranoproliferative/genetics
- Glomerulonephritis, Membranoproliferative/therapy
- Glomerulosclerosis, Focal Segmental/diagnosis
- Glomerulosclerosis, Focal Segmental/epidemiology
- Glomerulosclerosis, Focal Segmental/genetics
- Glomerulosclerosis, Focal Segmental/therapy
- Humans
- Immunosuppressive Agents/therapeutic use
- Infant
- Infant, Newborn
- Kidney Transplantation
- Latin America/epidemiology
- Male
- Middle East/epidemiology
- Mutation
- Nephrosis, Lipoid/diagnosis
- Nephrosis, Lipoid/epidemiology
- Nephrosis, Lipoid/genetics
- Nephrosis, Lipoid/therapy
- Nephrotic Syndrome/congenital
- Nephrotic Syndrome/diagnosis
- Nephrotic Syndrome/epidemiology
- Nephrotic Syndrome/genetics
- Nephrotic Syndrome/therapy
- Phenotype
- Prospective Studies
- Recurrence
- Registries
- Remission Induction
- Retrospective Studies
- Risk Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Agnes Trautmann
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Monica Bodria
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Fatih Ozaltin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alaleh Gheisari
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Anette Melk
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marta Azocar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Ali Anarat
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Salim Caliskan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Francesco Emma
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jutta Gellermann
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jun Oh
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Esra Baskin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Joanna Ksiazek
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Giuseppe Remuzzi
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Ozlem Erdogan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sema Akman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jiri Dusek
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Tinatin Davitaia
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Ozan Özkaya
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Fotios Papachristou
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Agnieszka Firszt-Adamczyk
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Tomasz Urasinski
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sara Testa
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Rafael T Krmar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Lidia Hyla-Klekot
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Andrea Pasini
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Z Birsin Özcakar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Peter Sallay
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Nilgun Cakar
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Monica Galanti
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Joelle Terzic
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Bilal Aoun
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alberto Caldas Afonso
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Hanna Szymanik-Grzelak
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Beata S Lipska
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sven Schnaidt
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Franz Schaefer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
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43
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Smeets B, Stucker F, Wetzels J, Brocheriou I, Ronco P, Gröne HJ, D'Agati V, Fogo AB, van Kuppevelt TH, Fischer HP, Boor P, Floege J, Ostendorf T, Moeller MJ. Detection of activated parietal epithelial cells on the glomerular tuft distinguishes early focal segmental glomerulosclerosis from minimal change disease. Am J Pathol 2014; 184:3239-48. [PMID: 25307344 DOI: 10.1016/j.ajpath.2014.08.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/11/2014] [Accepted: 08/22/2014] [Indexed: 12/26/2022]
Abstract
In rodents, parietal epithelial cells (PECs) migrating onto the glomerular tuft participate in the formation of focal segmental glomerulosclerosis (FSGS) lesions. We investigated whether immunohistologic detection of PEC markers in the initial biopsies of human patients with first manifestation of idiopathic nephrotic syndrome with no immune complexes can improve the sensitivity to detect sclerotic lesions compared with standard methods. Ninety-five renal biopsies were stained for claudin-1 (PEC marker), CD44 (activated PECs), and LKIV69 (PEC matrix); 38 had been diagnosed as early primary FSGS and 57 as minimal change disease. PEC markers were detected on the tuft in 87% of the biopsies of patients diagnosed as primary FSGS. PEC markers were detected in FSGS lesions from the earliest stages of disease. In minimal change disease, no PEC activation was observed by immunohistology. However, in 25% of biopsies originally diagnosed as minimal change disease the presence of small lesions indicative of a sclerosing process were detected, which were undetectable on standard periodic acid-Schiff staining, even though only a single histologic section for each PEC marker was evaluated. Staining for LKIV69 detected lesions with the highest sensitivity. Two novel PEC markers A-kinase anchor protein 12 and annexin A3 exhibited similar sensitivity. In summary, detection of PECs on the glomerular tuft by immunostaining improves the differentiation between minimal change disease and primary FSGS and may serve to guide clinical decision making.
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Affiliation(s)
- Bart Smeets
- Division of Nephrology and Clinical Immunology, Department of Internal Medicine II, RWTH Aachen University Hospital, Aachen, Germany
| | - Fabien Stucker
- Department of Pathology, INSERM U702, Hôpital Tenon, Paris, France; Nephrology Service, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Jack Wetzels
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Pierre Ronco
- Department of Pathology, INSERM U702, Hôpital Tenon, Paris, France
| | - Hermann-Josef Gröne
- Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany
| | - Vivette D'Agati
- Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, New York
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toin H van Kuppevelt
- Department of Biochemistry, NCMLS, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Hans-Peter Fischer
- Q1 platform of the TRR57, Institute for Pathology, Sigmund-Freud-Straße 25, Bonn, Germany
| | - Peter Boor
- Q1 platform of the TRR57, Institute for Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, Department of Internal Medicine II, RWTH Aachen University Hospital, Aachen, Germany
| | - Tammo Ostendorf
- Division of Nephrology and Clinical Immunology, Department of Internal Medicine II, RWTH Aachen University Hospital, Aachen, Germany
| | - Marcus J Moeller
- Division of Nephrology and Clinical Immunology, Department of Internal Medicine II, RWTH Aachen University Hospital, Aachen, Germany.
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Zhou Y, Deng YM, Li C, Gong YB, Mao ZG, Wu J, Li SZ, Liu ZH, Tang Z. Comparison of characteristics of chronic kidney diseases between Tibet plateau and plain areas. Int J Clin Exp Pathol 2014; 7:6172-6178. [PMID: 25337266 PMCID: PMC4203237] [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] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/23/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The purpose of the current study was to investigate the pathological characteristics of chronic kidney diseases in the Tibet plateau and the plain. METHODS 77 cases from the Tibet plateau and 154 cases from the plain of renal biopsied patients with chronic kidney diseases were compared in a randomized, and parallel controlled manner. Pathological characteristics were defined according to the standards of WHO and associated classifications. RESULTS The ration of sex was shown that most of patients in the plateau region were female, whereas those in the plain were male. The characteristics of pathological types were shown that the patients in the plateau region were primarily minimal change disease, but IgA nephropathy was rare; meanwhile, the proportional lupus nephritis (LN) ratio of the secondary glomerulonephritis in the plateau region was significantly lower than those in the plain region. CONCLUSIONS The current data demonstrated that the most common kidney disease in the Tibet Plateau region is still the primary glomerulonephritis as the same as those in the plain region. However, the primary glomerular disease in the plateau region is minimal change disease, and the most common clinical manifestations are the nephrotic syndrome. The IgA nephropathy in the plain is the most frequent disease. In terms of the secondary renal diseases, Henoch-Schnolein purpura nephritis are dominated in the plateau region, whereas LN-based diseases are frequently found in the plain. There is a statistical significance existed between those two groups.
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Affiliation(s)
- Yan Zhou
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Nanjing University School of MedicineNanjing 210016, China
| | - Yong-Ming Deng
- Department of Urology, General Hospital of Tibetan Military CommandLhasa, Tibet 850007, China
| | - Chuan Li
- Department of Urology, General Hospital of Tibetan Military CommandLhasa, Tibet 850007, China
| | - Yun-Bing Gong
- Department of Urology, General Hospital of Tibetan Military CommandLhasa, Tibet 850007, China
| | - Zhi-Guo Mao
- Department of Nephrology, Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
| | - Jun Wu
- Department of Nephrology, Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
| | - Su-Zhi Li
- Department of Urology, General Hospital of Tibetan Military CommandLhasa, Tibet 850007, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Nanjing University School of MedicineNanjing 210016, China
| | - Zheng Tang
- National Clinical Research Center of Kidney Diseases, Jingling Hospital, Nanjing University School of MedicineNanjing 210016, China
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45
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Cara-Fuentes G, Wei C, Segarra A, Ishimoto T, Rivard C, Johnson RJ, Reise J, Garin EH. CD80 and suPAR in patients with minimal change disease and focal segmental glomerulosclerosis: diagnostic and pathogenic significance. Pediatr Nephrol 2014; 29:1363-71. [PMID: 24263531 PMCID: PMC4136522 DOI: 10.1007/s00467-013-2679-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/22/2013] [Accepted: 10/24/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimal change disease (MCD) is characterized by increased urinary excretion of CD80, whereas focal segmental glomerulosclerosis (FSGS) is associated with increased serum soluble urokinase-type plasminogen activator receptor (suPAR). The aim of the study was to assess whether the simultaneous measurement of urinary CD80 and serum suPAR helps differentiate MCD and FSGS. METHODS Urine and sera were collected from patients with MCD in relapse or in remission, from FSGS patients with nephrotic syndrome, and from healthy individuals. CD80 and suPAR were measured by ELISA. RESULTS Urinary CD80 was significantly increased in MCD patients in relapse compared with those in remission and with FSGS patients and control individuals. Serum suPAR levels were significantly higher in patients with FSGS when compared with MCD patients in relapse. Urinary suPAR showed a positive correlation with proteinuria in MCD in relapse and FSGS patients, whereas urinary CD80 correlated with proteinuria only in MCD patients in relapse. CONCLUSION Urinary CD80 is elevated in MCD patients in relapse compared with FSGS patients. In contrast, serum suPAR is significantly elevated in FSGS patients. The consistent pattern of these two biomarkers in MCD and FSGS suggests that these two conditions represent different entities rather than a continuum spectrum of one disease.
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Affiliation(s)
- Gabriel Cara-Fuentes
- Division of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, USA
| | - Changli Wei
- Department of Internal Medicine, Rush University Medical Center, Chicago, USA
| | - Alfons Segarra
- Division of Nephrology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Takuji Ishimoto
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, USA
| | - Christopher Rivard
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, USA
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, USA
| | - Jochen Reise
- Department of Internal Medicine, Rush University Medical Center, Chicago, USA
| | - Eduardo H. Garin
- Division of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, USA
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46
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Nongnuch A, Assanatham M, Sumethkul V, Chalermsanyakorn P, Kitiyakara C. Early posttransplant nephrotic range proteinuria as a presenting feature of minimal change disease and acute T cell-mediated rejection. Transplant Proc 2014; 46:290-4. [PMID: 23267783 DOI: 10.1016/j.transproceed.2012.07.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/19/2012] [Indexed: 02/08/2023]
Abstract
Early-onset nephrotic range proteinuria is an extremely rare presentation of an acute rejection episode. Herein, we have reported a patient who developed nephrotic range proteinuria 7 days after receiving a renal allograft from his sister despite minor changes in serum creatinine levels. A kidney biopsy spcimen revealed a T cell-mediated acute rejection process concomitant with minimal change disease (MCD). Proteinuria and renal dysfunction improved dramatically in response to corticosteroids. The possibility of acute cellular rejection and coexisting MCD should be considered in patients with early posttransplantation nephrosis and normal serum creatinine levels. The coexistence of these entities provides support for the role of T cells in the pathogenesis of MCD.
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Affiliation(s)
- A Nongnuch
- Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Thailand
| | - M Assanatham
- Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Thailand
| | - V Sumethkul
- Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Thailand
| | - P Chalermsanyakorn
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Thailand
| | - C Kitiyakara
- Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Thailand.
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47
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Al-Saegh RM, Assad LW. The spectrum of glomerular diseases as studied by immunofluorescence microscopy a single center study in Iraq. Arab J Nephrol Transplant 2013; 6:161-167. [PMID: 24053742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Immunofluorescence (IF) microscopy is an important tool for the diagnosis of glomerular diseases. In this study, we focused on using IF technique together with light microscopy (LM) and clinical features in the diagnosis of different types of glomerulonephritis (GN). We aimed to evaluate the spectrum of glomerular diseases in our center and compare it with other centers in Iraq as well as in other countries. METHODS We studied a total of 58 kidney biopsies taken between June 2010 and June 2012. All biopsies were examined by LM and 56 of them were examined by IF technique. Clinical information was recorded in a predesigned form before taking the biopsy. RESULTS Nephrotic syndrome was the predominant clinical presentation in this study (75.9%). Focal segmental glomerulosclerosis (FSGS) was the commonest GN in this study (29.3%) followed by minimal change disease (20.7%) and membranous glomerulonephritis (13.8%). Immune deposition was observed in 37.5% of cases and the predominant deposit was immunoglobulin G (IgG). In all cases but one, deposition was granular and was found in the glomerular basement membrane (GBM) and/ or in the mesangium. In one case, IF showed dominant positive staining (3+) for complement factor 1q (C1q) in the glomerular mesangium and slightly positive staining for complement factor 3 (C3) in the same mesangeal areas. Two cases (3.4%) fulfilled the clinical, serological and histopathological criteria of lupus nephritis (LN). CONCLUSION Nephrotic syndrome was the predominant clinical presentation and FSGS was the most commonly diagnosed GN in this study. Using IF technique and correlating it with LM, clinical, biochemical and serological markers was very useful for the correct diagnosis of glomerular diseases.
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MESH Headings
- Adolescent
- Adult
- Biomarkers/metabolism
- Biopsy
- Child
- Female
- Glomerulonephritis/complications
- Glomerulonephritis/diagnosis
- Glomerulonephritis/metabolism
- Glomerulonephritis/pathology
- Glomerulonephritis, Membranous/complications
- Glomerulonephritis, Membranous/diagnosis
- Glomerulonephritis, Membranous/metabolism
- Glomerulonephritis, Membranous/pathology
- Glomerulosclerosis, Focal Segmental/complications
- Glomerulosclerosis, Focal Segmental/diagnosis
- Glomerulosclerosis, Focal Segmental/metabolism
- Glomerulosclerosis, Focal Segmental/pathology
- Humans
- Iraq
- Kidney/metabolism
- Kidney/pathology
- Lupus Nephritis/complications
- Lupus Nephritis/diagnosis
- Lupus Nephritis/metabolism
- Lupus Nephritis/pathology
- Male
- Microscopy, Fluorescence
- Middle Aged
- Nephrosis, Lipoid/complications
- Nephrosis, Lipoid/diagnosis
- Nephrosis, Lipoid/metabolism
- Nephrosis, Lipoid/pathology
- Nephrotic Syndrome/etiology
- Retrospective Studies
- Young Adult
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Affiliation(s)
- Riyadh Muhi Al-Saegh
- Assistant Professor of Medicine and Nephrology, University of Kerbala, Kerbala, Iraq
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Ikezumi Y, Suzuki T, Karasawa T, Yamada T, Hasegawa H, Nishimura H, Uchiyama M. Low birthweight and premature birth are risk factors for podocytopenia and focal segmental glomerulosclerosis. Am J Nephrol 2013; 38:149-57. [PMID: 23920104 DOI: 10.1159/000353898] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/20/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Recent reports suggest that low birthweight (LBW) is a risk factor for kidney diseases, including focal segmental glomerulosclerosis (FSGS), although the underlying pathological mechanism remains unknown. Podocyte loss triggers glomerulosclerosis; however, whether FSGS in LBW children is associated with podocytopenia is unclear. METHODS We reviewed the birthweights and gestational age of all patients who underwent renal biopsies from 1995 to 2011 at our Institute. Sixteen patients had FSGS, of which 6 (37.5%) had LBW; this LBW rate was significantly higher than the overall LBW rate in Japan (9.7%). The incidence of LBW was also high in patients with minimal change nephrotic syndrome (MCNS; 12.5%). The glomerular cell numbers in biopsy sections were calculated using computer image analysis and compared with FSGS of normal birthweight (NBW-FSGS). Biopsy specimens from age-matched patients with MCNS were also compared. Wilms' tumor-1 (WT1) immunohistochemistry was performed to enumerate the podocytes. RESULTS All patients in the LBW-FSGS group were also preterm, with an average gestational age of 25.8 weeks. The number of podocytes per glomerulus in the LBW-FSGS patients was 34 and 24% lower as compared to that in the MCNS patients (p < 0.01) and the NBW-FSGS patients (p < 0.05), respectively. Similar results were observed for the WT1-positive glomerular cell number. CONCLUSION LBW and premature birth were associated with FSGS development. The possibility that LBW and premature birth may be predisposing factors for severe podocytopenia in children with FSGS warrants further investigation.
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Affiliation(s)
- Yohei Ikezumi
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan.
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49
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Tsuruya K. [Progressive renal diseases: recent advances in diagnosis and treatments. Topics: II. Pathophysiology and treatments; 1. Pathogenesis and management of minimal change nephrotic syndrome]. Nihon Naika Gakkai Zasshi 2013; 102:1105-1113. [PMID: 23847974 DOI: 10.2169/naika.102.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Japan
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50
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Tang HL, Mak YF, Chu KH, Lee W, Fung SKS, Chan TYK, Tong KL. Minimal change disease caused by exposure to mercury-containing skin lightening cream: a report of 4 cases. Clin Nephrol 2013; 79:326-329. [PMID: 23537684] [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: 06/02/2023] Open
Abstract
Mercury is a known cause of nephrotic syndrome and the underlying renal pathology in most of the reported cases was membranous nephropathy. We describe here 4 cases of minimal change disease following exposure to mercury-containing skin lightening cream for 2 - 6 months. The mercury content of the facial creams was very high (7,420 - 30,000 parts per million). All patients were female and presented with nephrotic syndrome and heavy proteinuria (8.35 - 20.69 g/d). The blood and urine mercury levels were 26 - 129 nmol/l and 316 - 2,521 nmol/d, respectively. Renal biopsy revealed minimal change disease (MCD) in all patients. The use of cosmetic cream was stopped and chelation therapy with D-penicillamine was given. Two patients were also given steroids. The time for blood mercury level to normalize was 1 - 7 months, whereas it took longer for urine mercury level to normalize (9 - 16 months). All patients had complete remission of proteinuria and the time to normalization of proteinuria was 1 - 9 months. Mercury-containing skin lightening cream is hazardous because skin absorption of mercury can cause minimal change disease. The public should be warned of the danger of using such products. In patients presenting with nephrotic syndrome, a detailed history should be taken, including the use of skin lightening cream. With regard to renal pathology, apart from membranous nephropathy, minimal change disease should be included as another pathological entity caused by mercury exposure or intoxication.
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Affiliation(s)
- Hon-Lok Tang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China.
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