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Song H, Liao Y, Hu H, Wan Q. Nonlinear association between proteinuria levels and the risk of cardiovascular disease events and all-cause mortality among chronic kidney disease patients. Ren Fail 2024; 46:2310727. [PMID: 38345084 PMCID: PMC10863521 DOI: 10.1080/0886022x.2024.2310727] [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: 08/14/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The association between proteinuria levels and cardiovascular disease (CVD) development and all-cause mortality in chronic kidney disease (CKD) patients remains controversial. METHODS In this investigation, we conducted a retrospective analysis involving 1138 patients who were registered in the CKD-Research of Outcomes in Treatment and Epidemiology (ROUTE) study. The primary outcome of this study was the composite of cardiovascular events or all-cause death. Cox proportional hazards regression, smooth curve fitting, piecewise linear regression, and subgroup analyses were used. RESULTS The mean age of the included individuals was 67.3 ± 13.6 years old. Adjusted hazard ratios (HRs) for UPCR in middle and high groups, compared to the low group, were 1.93 (95% CI: 1.28-2.91) and 4.12 (95% CI: 2.87-5.92), respectively, after multivariable adjustment. Further adjustments maintained significant associations; HRs for middle and high groups were 1.71 (95% CI: 1.12-2.61) and 3.07 (95% CI: 2.08-4.54). A nonlinear UPCR-primary outcome relationship was observed, with an inflection point at 3.93 g/gCr. CONCLUSION Among non-dialyzed patients with stage G2-G5 CKD, a nonlinear association between UPCR and the primary outcome was observed. A higher UPCR (when UPCR < 3.93 g/gCr) was an independent predictor of the primary outcome. Importantly, our study predates SGLT2 inhibitor use, showcasing outcomes achievable without these medications. Future research considerations will involve factors like SGLT-2 inhibitor utilization.
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Affiliation(s)
- Haiying Song
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, PRChina
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen, PR China
| | - Yuheng Liao
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, PRChina
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen, PR China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, PRChina
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen, PR China
| | - Qijun Wan
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, PRChina
- Department of Nephrology, Shenzhen University Health Science Center, Shenzhen, PR China
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Cheng Y, Liu Y, Lin L, Li D, Peng L, Zheng K, Tao J, Li M. The effects of Tripterygium wilfordii Hook F on renal outcomes in type 2 diabetic kidney disease patients with severe proteinuria: a single-center cohort study. Ren Fail 2024; 46:2295425. [PMID: 38178377 PMCID: PMC10773657 DOI: 10.1080/0886022x.2023.2295425] [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: 03/28/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
AIM Tripterygium wilfordii Hook F (TwHF) has been shown to substantially reduce proteinuria in patients with diabetic kidney disease (DKD); however, the effect of TwHF on renal outcomes in DKD remains unknown. Accordingly, we aimed to establish the effects of TwHF on renal outcomes in patients with DKD. METHODS Overall, 124 patients with DKD, induced by type 2 diabetes mellitus, with 24-h proteinuria > 2 g, and an estimated glomerular filtration rate > 30 mL/min/1.73 m2 were retrospectively investigated. The renal outcomes were defined as doubling serum creatinine levels or end-stage kidney disease. Kaplan-Meier curves and Cox regression analyses were performed to analyze prognostic factors for renal outcomes. RESULTS By the end of the follow-up, renal outcomes were observed in 23 and 11 patients in the non-TwHF and TwHF groups, respectively (p = 0.006). TwHF significantly reduced the risk of renal outcomes (adjusted hazard ratio [HR] 0.271, 95% confidence interval [CI] 0.111-0.660, p = 0.004) in patients with chronic kidney disease (CKD) G3 (adjusted HR 0.274, 95%CI 0.081-0.932, p = 0.039). Based on the Kaplan-Meier analysis, 1- and 3-year proportions of patients without renal outcomes were significantly lower in the non-TwHF group than those in the TwHF group (92.8% vs. 95.5% and 47.2% vs. 76.8%, respectively; p = 0.0018). CONCLUSION In DKD patients with severe proteinuria, TwHF could prevent DKD progression, especially in patients with CKD G3. A randomized clinical trial is needed to elucidate the benefits of TwHF on renal outcomes in patients with DKD.
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Affiliation(s)
- Yaqi Cheng
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuhao Liu
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Liling Lin
- Department of Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Danni Li
- Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liying Peng
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ke Zheng
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianling Tao
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Mingxi Li
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Oruc A, Sumnu A, Turkmen A, Basturk T, Cebeci E, Turgutalp K, Cetinkaya H, Uzerk Kibar M, Seyahi N, Tatar E, Ergul M, Derici Ü, Aylı MD, Pınar M, Bakar B, Kazancıoglu R, Yıldız A, Dirim AB, Yılmaz Z, Turkmen K, Tunca O, Koc M, Kutlay S, Micozkadıoglu H, Azak A, Boztepe B, Ustundag S, Şafak Ozturk S, Unsal A, Karadag S, Sahin G, Yenigun EC, Eren N, Gullulu M, Gursu M, Ozturk S. Immunosuppressive treatment results in patients with primary IgA nephropathy in Turkiye; the data from TSN-GOLD working group. Ren Fail 2024; 46:2341787. [PMID: 38637275 PMCID: PMC11028022 DOI: 10.1080/0886022x.2024.2341787] [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: 11/27/2023] [Accepted: 04/06/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Immunoglobulin A (IgA) nephropathy (IgAN) treatment consists of maximal supportive care and, for high-risk individuals, immunosuppressive treatment (IST). There are conflicting results regarding IST. Therefore, we aimed to investigate IST results among IgAN patients in Turkiye. METHOD The data of 1656 IgAN patients in the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases Study Group were analyzed. A total of 408 primary IgAN patients treated with IST (65.4% male, mean age 38.4 ± 12.5 years, follow-up 30 (3-218) months) were included and divided into two groups according to treatment protocols (isolated corticosteroid [CS] 70.6% and combined IST 29.4%). Treatment responses, associated factors were analyzed. RESULTS Remission (66.7% partial, 33.7% complete) was achieved in 74.7% of patients. Baseline systolic blood pressure, mean arterial pressure, and proteinuria levels were lower in responsives. Remission was achieved at significantly higher rates in the CS group (78% vs. 66.7%, p = 0.016). Partial remission was the prominent remission type. The remission rate was significantly higher among patients with segmental sclerosis compared to those without (60.4% vs. 49%, p = 0.047). In the multivariate analysis, MEST-C S1 (HR 1.43, 95% CI 1.08-1.89, p = 0.013), MEST-C T1 (HR 0.68, 95% CI 0.51-0.91, p = 0.008) and combined IST (HR 0.66, 95% CI 0.49-0.91, p = 0.009) were found to be significant regarding remission. CONCLUSION CS can significantly improve remission in high-risk Turkish IgAN patients, despite the reliance on non-quantitative endpoints for favorable renal outcomes. Key predictors of remission include baseline proteinuria and specific histological markers. It is crucial to carefully weigh the risks and benefits of immunosuppressive therapy for these patients.
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Affiliation(s)
- Aysegul Oruc
- Department of Nephrology, Bursa Uludag University Faculty of Medicine, Bursa, Turkiye
| | - Abdullah Sumnu
- Department of Nephrology, Medipol University Faculty of Medicine, Istanbul, Turkiye
| | - Aydın Turkmen
- Department of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkiye
| | - Taner Basturk
- Department of Nephrology, University of Health Sciences, Etfal Hamidiye Training and Research Hospital, Istanbul, Turkiye
| | - Egemen Cebeci
- Department of Nephrology, Istanbul Provincial Directorate of Health Istanbul Haseki Training and Research Hospital, Istanbul, Turkiye
| | - Kenan Turgutalp
- Department of Nephrology, Mersin University Faculty of Medicine, Training and Educational Hospital, Mersin, Turkiye
| | - Hakkı Cetinkaya
- Department of Nephrology, University of Health Sciences, Sultan 2. Abdülhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Müge Uzerk Kibar
- Department of Nephrology, Health Ministry of Turkiye Republic Ankara Bilkent City Hospital, Ankara, Turkiye
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Erhan Tatar
- Department of Nephrology, Izmir Provincial Directorate of Health Bozyaka Education and Research Hospital, Izmir, Turkiye
| | - Metin Ergul
- Department of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkiye
| | - Ülver Derici
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkiye
| | - Mehmet Deniz Aylı
- Department of Nephrology, Mınıstry Of Health Dıskapı Yıldırım Beyazıt Traınıng And Research Hospıtal, Ankara, Turkiye
| | - Musa Pınar
- Department of Nephrology, Faculty of Medicine, Sakarya University, Sakarya, Turkiye
| | - Betül Bakar
- Department of Nephrology, Ankara Provincial Health Directorate Ankara Training and Research Hospital, Ankara, Turkiye
| | - Rümeyza Kazancıoglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif Univeristy, Istanbul, Turkiye
| | - Abdülmecit Yıldız
- Department of Nephrology, Bursa Uludag University Faculty of Medicine, Bursa, Turkiye
| | - Ahmet Burak Dirim
- Department of Nephrology, Istanbul Provincial Health Directorate ˙Istanbul Bakirköy Dr. Sadi Konuk Education And Research Hospital, Istanbul, Turkiye
| | - Zülfükar Yılmaz
- Department of Nephrology, Dicle University Faculty of Medicine, Diyarbakır, Turkiye
| | - Kültigin Turkmen
- Department of Nephrology, Faculty of Medicine Hospital, Necmettin Erbakan University Meram, Konya, Turkiye
| | - Onur Tunca
- Department of Nephrology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkiye
| | - Mehmet Koc
- Department of Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkiye
| | - Sim Kutlay
- Department of Nephrology, Faculty of Medicine, Ankara University, Ankara, Turkiye
| | - Hasan Micozkadıoglu
- Department of Nephrology, Baskent University Faculty of Medicine, Dr. Turgut Noyan Adana Application and Research Hospital, Adana, Turkiye
| | - Alper Azak
- Department of Nephrology, Balikesir Provincial Health Directorate Atatürk City Hospital, Balıkesir, Turkiye
| | - Burcu Boztepe
- Department of Nephrology, Istanbul Provincial Health Directorate Haydarpasa Numune Traınıng And Research Hospıtal, Istanbul, Turkiye
| | - Sedat Ustundag
- Department of Nephrology, Faculty of Medicine, Trakya University, Edirne, Turkiye
| | - Seda Şafak Ozturk
- Department of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkiye
| | - Abdulkadir Unsal
- Department of Nephrology, University of Health Sciences, Etfal Hamidiye Training and Research Hospital, Istanbul, Turkiye
| | - Serhat Karadag
- Department of Nephrology, Istanbul Provincial Directorate of Health Istanbul Haseki Training and Research Hospital, Istanbul, Turkiye
| | - Gülizar Sahin
- Department of Nephrology, University of Health Sciences, Sultan 2. Abdülhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Ezgi Coşgun Yenigun
- Department of Nephrology, Ankara Provincial Health Directorate Ankara Training and Research Hospital, Ankara, Turkiye
| | - Necmi Eren
- Department of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkiye
| | - Mustafa Gullulu
- Department of Nephrology, Bursa Uludag University Faculty of Medicine, Bursa, Turkiye
| | - Meltem Gursu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif Univeristy, Istanbul, Turkiye
| | - Savaş Ozturk
- Department of Nephrology, Istanbul University Faculty of Medicine, Istanbul, Turkiye
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Sakaci T, Ahbap E, Basturk T, Ortaboz M, Ozagari AA, Mazı EE, Eken KG, Hasbal NB, Unsal A. Determinants of non-diabetic kidney diseases in type 2 diabetic patients: Twenty years of single center experience. Clin Nephrol 2024; 101:207-221. [PMID: 38431824 DOI: 10.5414/cn111093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Diabetic nephropathy is one of the most common complications associated with diabetes. However, non-diabetic kidney disease has been reported in patients with type 2 diabetes at varying incidence rates. The objective of our study is to investigate the occurrence, clinicopathological characteristics, and inflammatory markers linked to diabetic and non-diabetic nephropathy (NDN) in patients with type 2 diabetes mellitus (DM). Additionally, we aimed to explore the possibility of identifying non-diabetic pathology using different biopsy indications. MATERIALS AND METHODS A total of 159 patients with type 2 DM who underwent renal biopsy at a tertiary care nephrology clinic between January 2000 and January 2022 were enrolled in the study. We collected comprehensive data, including patient demographics, co-morbidities, diabetes duration, renal biopsy indications and results, serological markers, renal function, diabetic retinopathy (DRP), full blood count, blood biochemistry, urinalysis, and inflammatory markers. Patients were categorized based on their biopsy indications, and their biopsy results were classified into three groups: isolated NDN, isolated diabetic nephropathy (DN), and mixed nephropathy with concurrent NDN. We evaluated the relationship between biopsy indications and accompanying pathologies and statistically assessed the likelihood of each biopsy indication detecting non-diabetic renal pathology. Additionally, differences in other data, including demographic and laboratory results and medical histories, among the three groups were investigated. RESULTS The most frequent indication of renal biopsy was atypical presentations of nephrotic syndrome or nephrotic range proteinuria (ANS/ANP) in 25.1% of patients. Other indications included unexplained renal failure (URF) in 22.6%, atypical presentations of non-nephrotic range proteinuria (ANNP) in 18.2%, acute kidney injury or rapidly progressive kidney dysfunction (AKI/RPKD) in 16.9%, microscopic hematuria in 15.7%, URF with ANNP in 11.3%, and severe nephrotic range proteinuria (SNP) in 9.4%. Renal biopsy revealed isolated NDN in 64.8%, DN in 25.1%, and mixed nephropathy in 10.1% of patients. Primary glomerular diseases were the main non-diabetic renal pathology, predominantly focal segmental glomerulosclerosis (FSGS) (36.4%) followed by MN (10.6%) and IgA nephropathy (7.5%). In comparison with the isolated DN and mixed nephropathy groups, patients in the isolated NDN group had significantly shorter diabetes duration, fewer DRP, as well as lower serum creatinine and neutrophil-to-lymphocyte ratio (NLR). Multivariate logistic regression analysis revealed that presence of hematuria (OR 4.40; 95% CI 1.34 - 14.46, p = 0.014), acute nephrotic range proteinuria (OR 11.93; 95% CI 1.56 - 90.77, p = 0.017), and AKI/APKD (OR 41.08; 95% CI 3.40 - 495.39, p = 0.003) were strong predictors of NDN. Lower NLR (OR 0.77; 95% CI 0.60 - 0.98, p = 0.035), shorter duration of diabetes (OR 0.90; 95% CI 0.84 - 0.97, p = 0.010), and absence of DRP (OR 0.35; 95% CI 0.12 - 0.98, p = 0.046) were also found to be independent indicators of NDN. Receiver operating characteristic curve (ROC) analysis revealed a cut-off value of ≤ 3.01 for NLR (sensitivity of 63.1%, specificity of 63.5%) with regards to predicting non-diabetic renal pathology (p = 0.006). CONCLUSION Renal biopsy findings in patients with type 2 DM highlight that the prevalence of NDN may be higher than assumed, as presented mainly in the form of primary glomerular disease. The presence of AKI/RPKD, hematuria, and ANS/ANP serves as a reliable indicator of non-diabetic renal pathology. In more ambiguous situations, factors such as a shorter duration of diabetes, absence of DRP, and a lower NLR value may assist clinicians in biopsy decision.
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Torreggiani M, Stancanelli MR, Njandjo L, Fois A, Piccoli GB. Hypertension and Proteinuria in a Pregnancy: A Quiz. Am J Kidney Dis 2024; 83:A17-A18. [PMID: 38643986 DOI: 10.1053/j.ajkd.2023.10.019] [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: 08/01/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 04/23/2024]
Affiliation(s)
| | - Maria Rita Stancanelli
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France; Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. "G. Martino," University of Messina, Messina, Italy
| | - Linda Njandjo
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Antioco Fois
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
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Zhuo N, Wang G, Wu G. Neutrophil-to-lymphocyte ratio is an independent risk factor for proteinuria non-remission in idiopathic membranous nephropathy. Int Urol Nephrol 2024; 56:1775-1776. [PMID: 37919620 DOI: 10.1007/s11255-023-03871-z] [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: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Ning Zhuo
- Department of Nephrology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, China
| | - Gang Wang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Gang Wu
- Department of Nephrology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, China.
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Wagner BR, Rao PS. Sodium-glucose cotransporter 2 inhibitors: are they ready for prime time in the management of lupus nephritis? Curr Opin Rheumatol 2024; 36:163-168. [PMID: 38517337 DOI: 10.1097/bor.0000000000001002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW Lupus nephritis is a common complication of systemic lupus erythematosus and is associated with significant morbidity and mortality. The utility of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of lupus nephritis is currently uncertain. Here, we summarize the rationale for their use among patient with lupus nephritis. RECENT FINDINGS SGLT2 inhibitors were initially developed as antihyperglycemic agents. They have since been shown to have additional, profound effects to slow the progression of chronic kidney disease and lessen the long-term risks of cardiovascular disease in large clinic trials of patients with chronic kidney disease, with and without diabetes, as well as in patients with and without proteinuria. Patients with recent exposure to immunosuppression were excluded from these trials due to concern for risk of infection. In the few, small trials of patients with lupus nephritis, SGLT2 inhibitors were found to be well tolerated. They have been shown to reduce proteinuria and to have modest beneficial effects on blood pressure and BMI among patients with lupus nephritis. They have not been shown to influence disease activity. SUMMARY SGLT2 inhibitors may have a role in mitigating the chronic renal and cardiovascular effects of lupus nephritis. They should be introduced after kidney function has been stabilized with appropriate immunosuppression, in conjunction with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. They currently have no role in active disease.
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Affiliation(s)
- Benjamin R Wagner
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Wang Y, Yu J, Jiang Y, Li J, Yimamuyushan A, Xia X, Fan L, Huang F, Chen W, Liu Q. Corticosteroid in IgA nephropathy with moderate proteinuria: A retrospective cohort study. Nephrology (Carlton) 2024; 29:268-277. [PMID: 38186010 DOI: 10.1111/nep.14269] [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: 09/05/2023] [Revised: 12/04/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Corticosteroids remain contentious as a therapeutic option for IgA nephropathy. We conducted a retrospective cohort study to explore whether corticosteroid therapy is efficient and safe for IgAN patients with moderate proteinuria. METHODS A total of 336 patients with renal biopsy-confirmed IgAN, estimated glomerular filtration (eGFR) over 15 mL/min/1.73 m2 and urine protein levels of 0.75-3.5 g/d were enrolled. According to the treatment protocol, we classified the enrolled patients into two groups: one receiving corticosteroids and the other receiving supportive care. Complete remission, partial remission, and no remission were applied to describe the efficacy assessments. The endpoint was defined as a 40% reduction in eGFR, the onset of ESRD, or renal disease-related death. RESULTS Clinical and pathological progression risk factors were higher in corticosteroid-treated individuals. Logistic regression analysis revealed that the corticosteroid group was considerably related to a higher remission rate after adjustment for confounding factors. The occurrence of serious adverse events between the two groups was not found to be statistically significantly different. Then, we matched 95 couples of patients with similar baseline levels in both groups by propensity score matching. The results showed that corticosteroid-treated patients showed higher overall and complete remission rates than untreated patients. However, due to the relatively short follow-up period, no significant differences in the incidence of endpoint and survival analyses have been observed thus far. CONCLUSION Corticosteroid therapy may benefit IgAN patients with moderate proteinuria via proteinuria reduction and renal function preservation.
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Affiliation(s)
- Yu Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
- Department of Nephrology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jianwen Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yu Jiang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Jianbo Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Aikeda Yimamuyushan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xi Xia
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Li Fan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Qinghua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
- Department of Nephrology, Jieyang People's Hospital, Jieyang, China
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Yusei O, Nagasu H, Nakagawa N, Terawaki S, Moriwaki T, Itano S, Kishi S, Sasaki T, Kashihara N, Otomo T. A case series of Fabry diseases with CKD in Japan. Clin Exp Nephrol 2024; 28:404-408. [PMID: 38193991 PMCID: PMC11033225 DOI: 10.1007/s10157-023-02439-6] [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: 09/19/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND It is well known that kidney injury is vital organ damage in Fabry disease (FD). Renin-angiotensin system (RAS) inhibitors are known to reduce proteinuria in patients with chronic kidney disease (CKD) by dilating the glomerular export arteries and reducing intraglomerular pressure. This improvement in intraglomerular pressure, although lowering the glomerular filtration rate, is thought to prevent renal damage and be renoprotective in the long term. RAS inhibitors may be effective in FD patients with proteinuria to prevent the progression of kidney disease, however, the degree to which they are used in clinical practice is unknown. METHODS The J-CKD-DB-Ex is a comprehensive multicenter database that automatically extracts medical data on CKD patients. J-CKD-DB-Ex contains data on 187,398 patients in five medical centers. FD patients were identified by ICD-10. Clinical data and prescriptions of FD patients between January 1 of 2014, and December 31 of 2020 were used for the analysis. RESULTS We identified 39 patients with FD from the J-CKD-DB-Ex including those with suspected FD. We confirmed 22 patients as FD. Half of the patients received RAS inhibitors. RAS inhibitors tended to be used in CKD patients with more severe renal impairment. CONCLUSIONS This case series revealed the actual clinical practice of FD patients with CKD. In particular, we found cases in which patients had proteinuria, but were not treated with RAS inhibitors. The database was shown to be useful in assessing the clinical patterns of patients with rare diseases.
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Affiliation(s)
- Oi Yusei
- Department of Health Informatics, Faculty of Health and Welfare Services Administration, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Hajime Nagasu
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Respiratory and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Seigo Terawaki
- Department of Molecular and Genetic Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takahito Moriwaki
- Department of Molecular and Genetic Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Seiji Itano
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Seiji Kishi
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Tamaki Sasaki
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takanobu Otomo
- Department of Molecular and Genetic Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
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Chen X, Zhang Y, Yan L, Xie Y, Li S, Zhuang Y, Wang L. Urine albumin-to-creatinine ratio diurnal variation rate predicts outcomes in idiopathic membranous nephropathy. Clin Exp Nephrol 2024; 28:409-420. [PMID: 38240880 PMCID: PMC11033241 DOI: 10.1007/s10157-023-02444-9] [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: 09/01/2023] [Accepted: 12/01/2023] [Indexed: 04/23/2024]
Abstract
BACKGROUND Idiopathic membranous nephropathy (IMN) is a leading cause of end-stage renal disease (ESRD). The purpose of this study was to evaluate whether urinary albumin-to-creatinine ratio (UACR) diurnal variation rate calculated by spot urinary protein test predicts 1-year nephrotic outcomes as a biomarker of proteinuria severity in patients with IMN. METHODS Patients' baseline demographics, blood and urinary biomarkers, and clinical and pathological characteristics were collected retrospectively. Urine samples were collected at 7:00 (before breakfast) and 19:00 (after dinner) to calculate the UACR diurnal variation rate. A prediction model for no remission (NR) was developed statistically based on differences between prognosis groups. Receiver operating characteristic curve (ROC) analysis was performed to evaluate prediction abilities and determine optimal cut-off points of the model and UACR diurnal variation rate alone. RESULTS The formula for calculating the probability of NR was exp(L)/(1 + exp(L)), where the linear predictor L = - 22.038 + 0.134 × Age (years) + 0.457 × 24-h urinary protein + 0.511 × blood urea nitrogen (BUN) + 0.014 × serum uric acid (SUA) + 2.411 if glomerular sclerosis + 0.816 × fasting blood glucose (FBG)-0.039 × UACR diurnal variation rate (%). Optimal cut-off points for NR prediction by the final model and UACR diurnal variation rate alone were 0.331 and 58.5%, respectively. Sensitivity and specificity were 0.889 and 0.859 for the final model, and 0.926 and 0.676 for UACR diurnal variation rate alone. CONCLUSION UACR diurnal variation using spot urinary protein is a simpler way to predict nephrotic outcomes and is a highly sensitive screening tool for identifying patients who should undergo further comprehensive risk assessment.
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Affiliation(s)
- Xiaoqing Chen
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China
- Department of Nephrology, The 900th Hospital of Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China
| | - Yong Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China
- Department of Nephrology, The 900th Hospital of Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China
| | - Liqun Yan
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China
| | - Yangbin Xie
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China
| | - Shujing Li
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China
| | - Yongze Zhuang
- Department of Nephrology, The 900th Hospital of Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China
| | - Liping Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China.
- Department of Nephrology, The 900th Hospital of Joint Logistics Support Force, 156 West Second Ring Road, Fuzhou, 350025, People's Republic of China.
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11
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Tong R, Luo Z, Zhong X, Fan L, Lai H, Shen M, Huang Y. Atypical anti-glomerular basement membrane disease with membranous hyperplasia: diagnostic challenges and treatment variability. BMC Nephrol 2024; 25:132. [PMID: 38622525 PMCID: PMC11017607 DOI: 10.1186/s12882-024-03571-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
This case report presents a detailed analysis of a 31-year-old male patient who presented with a complex array of clinical symptoms, including proteinuria, hematuria, edema, and kidney insufficiency. Despite undergoing multiple tests, the results for anti-glomerular basement membrane antibodies yielded negative findings. Subsequently, kidney biopsy pathology revealed a distinct diagnosis of atypical anti-glomerular basement membrane (anti-GBM) disease with membrane hyperplasia. Treatment was initiated with a comprehensive approach involving high doses of corticosteroids therapy and cyclophosphamide (CTX). However, contrary to expectations, the patient's kidney function exhibited rapid deterioration following this therapeutic regimen. The culmination of these complications necessitated a pivotal transition to maintenance hemodialysis. This case underscores the intricate challenges associated with diagnosing and managing rare and atypical presentations of kidney disorders. The negative anti-GBM antibody results and subsequent identification of atypical anti-GBM nephropathy highlight the need for tailored diagnostic strategies to discern subtle nuances within complex clinical scenarios. Additionally, the unexpected response to the treatment regimen emphasizes the potential variability in individual patient responses, underlining the necessity for vigilant monitoring and adaptable treatment strategies. This case report contributes to the evolving understanding of atypical kidney pathologies and the complexities involved in their management.
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Affiliation(s)
- Ruoyu Tong
- Nephrology Department, Chinese PLA Southern Theater Command General Hospital, 510010, Guangzhou, China
| | - Zhengmao Luo
- Nephrology Department, Chinese PLA Southern Theater Command General Hospital, 510010, Guangzhou, China
| | - Xianyang Zhong
- Nephrology Department, Chinese PLA Southern Theater Command General Hospital, 510010, Guangzhou, China
| | - Liming Fan
- Nephrology Department, Chinese PLA Southern Theater Command General Hospital, 510010, Guangzhou, China
| | - Huangwen Lai
- Pathology Department, Chinese PLA Southern Theater Command General Hospital, 510010, Guangzhou, China
| | - Meng Shen
- Nephrology Department, Chinese PLA Southern Theater Command General Hospital, 510010, Guangzhou, China
| | - Yuanhang Huang
- Nephrology Department, Chinese PLA Southern Theater Command General Hospital, 510010, Guangzhou, China.
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12
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Fukata F, Eriguchi M, Tamaki H, Uemura T, Tasaki H, Furuyama R, Nishimoto M, Kosugi T, Tanabe K, Morimoto K, Okamoto K, Matsui M, Samejima KI, Tsuruya K. Differential impact of glomerular and tubule-interstitial histological changes on kidney outcome between non-proteinuric and proteinuric diabetic nephropathy. Clin Exp Nephrol 2024; 28:282-292. [PMID: 38019364 DOI: 10.1007/s10157-023-02433-y] [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: 09/02/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Studies on kidney function and histological findings in diabetic nephropathy (DN) with low urinary protein (UP) are few. We examined the differential impact of histological changes on kidney outcomes between non-proteinuric and proteinuric DN. METHODS Patients diagnosed with DN by renal biopsy during 1981-2014 were divided into non-proteinuric (UP ≤ 0.5 g/day) and proteinuric (UP > 0.5 g/day) DN. The Cox proportional hazard model was used to examine the association of glomerular lesions (GLs) and interstitial fibrosis and tubular atrophy (IFTA) with end-stage kidney disease (ESKD) development after adjusting for relevant confounders. RESULTS The non-proteinuric and proteinuric DN groups included 197 and 199 patients, respectively. During the 10.7-year median follow-up period, 16 and 83 patients developed ESKD in the non-proteinuric and proteinuric DN groups, respectively. In the multivariable Cox hazard model, hazard ratios (HRs) [95% confidence intervals (CIs)] of GL and IFTA for ESKD in proteinuric DN were 2.94 [1.67-5.36] and 3.82 [2.06-7.53], respectively. Meanwhile, HRs [95% CIs] of GL and IFTA in non-proteinuric DN were < 0.01 [0-2.48] and 4.98 [1.33-18.0], respectively. IFTA was consistently associated with higher incidences of ESKD regardless of proteinuria levels (P for interaction = 0.49). The prognostic impact of GLs on ESKD was significantly decreased as proteinuria levels decreased (P for interaction < 0.01). CONCLUSIONS IFTA is consistently a useful predictor of kidney prognosis in both non-proteinuric and proteinuric DN, while GLs are a significant predictor of kidney prognosis only in proteinuric DN.
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Affiliation(s)
- Fumihiro Fukata
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Hiroyuki Tamaki
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Takayuki Uemura
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Hikari Tasaki
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Riri Furuyama
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Masatoshi Nishimoto
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Takaaki Kosugi
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Kaori Tanabe
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Katsuhiko Morimoto
- 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
| | - Masaru Matsui
- Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan
| | - Ken-Ichi Samejima
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
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13
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Barbour SJ, Coppo R, Er L, Pillebout E, Russo ML, Alpers CE, Fogo AB, Ferrario F, Jennette JC, Roberts IS, Cook HT, Ding J, Su B, Zhong X, Fervenza FC, Zand L, Peruzzi L, Lucchetti L, Katafuchi R, Shima Y, Yoshikawa N, Ichikawa D, Suzuki Y, Murer L, Wyatt RJ, Park C, Nelson RD, Narus JH, Wenderfer S, Geetha D, Daugas E, Monteiro RC, Nakatani S, Mastrangelo A, Nuutinen M, Koskela M, Weber LT, Hackl A, Pohl M, Pecoraro C, Tsuboi N, Yokoo T, Takafumi I, Fujimoto S, Conti G, Santoro D, Materassi M, Zhang H, Shi S, Liu ZH, Tesar V, Maixnerova D, Avila-Casado C, Bajema I, Barreca A, Becker JU, Comstock JM, Cornea V, Eldin K, Hernandez LH, Hou J, Joh K, Lin M, Messias N, Muda AO, Pagni F, Diomedi-Camassei F, Tokola H, D'Armiento M, Seidl M, Rosenberg A, Sannier A, Soares MF, Wang S, Zeng C, Haas M. Histologic and Clinical Factors Associated with Kidney Outcomes in IgA Vasculitis Nephritis. Clin J Am Soc Nephrol 2024; 19:438-451. [PMID: 38261310 PMCID: PMC11020428 DOI: 10.2215/cjn.0000000000000398] [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: 09/12/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Nephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts. METHODS Biopsies from 262 children and 99 adults with IgA vasculitis nephritis ( N =361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients ( N =309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. RESULTS M, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N =91) and another with stable eGFR (class 2, N =218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2. CONCLUSIONS Kidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification.
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Affiliation(s)
- Sean J. Barbour
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Renal, Vancouver, British Columbia, Canada
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Lee Er
- BC Renal, Vancouver, British Columbia, Canada
| | | | - Maria Luisa Russo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Charles E. Alpers
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington
| | - Agnes B. Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Franco Ferrario
- Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy
| | - J. Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ian S.D. Roberts
- Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom
| | | | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Baige Su
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | | | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, AOU Città della Salute della Scienza di Torino, Turin, Italy
| | - Laura Lucchetti
- Division of Nephrology, Bambino Gesù Children's Hospital–IRCCS, Rome, Italy
| | - Ritsuko Katafuchi
- Kidney Unit, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Norishige Yoshikawa
- Clinical Research Center, Takatsuki General Hospital, Wakayam Medical University, Takatsuki City, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Luisa Murer
- Pediatric Nephrology Dialysis and Transplant Unit, Department of Women's and Child's Health, Azienda Ospedaliera-University of Padova, Padua, Italy
| | - Robert J. Wyatt
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Catherine Park
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Raoul D. Nelson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - JoAnn H. Narus
- Pediatrics Clinical Trials Office, University of Utah, Salt Lake City, Utah
| | - Scott Wenderfer
- Division of Pediatric Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- Texas Children's Hospital, Houston, Texas
| | - Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Daugas
- Nephrology, Bichat Hospital, AP-HP, Paris, France
- INSERM U1149 and Université Paris Cité, Paris, France
| | - Renato C. Monteiro
- Centre for Research on Inflammation, Bichat Hospital, Inserm and Université Paris Cité, Paris, France
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCC Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Matti Nuutinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Mikael Koskela
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lutz T. Weber
- Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Agnes Hackl
- Pediatric Nephrology, Faculty of Medicine and University Hospital Cologne, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Martin Pohl
- Medical Center, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carmine Pecoraro
- Comitato Tecnico Scientifico per la Ricerca e Innovaziione, A.O. Santobono-Pausilipon, Naples, Italy
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Department of Nephrology and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Ito Takafumi
- Kidney Center, Department of Internal Medicine, Nephrology, Teikyo University School of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Shouichi Fujimoto
- Division of Dialysis, Department of Nephrology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU Policlinic G Martino, University of Messina, Messina, Italy
| | - Domenico Santoro
- Nephrology and Dialysis Unit AOU, G. Martino, University of Messina, Messina, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Sufang Shi
- Kidney Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Dita Maixnerova
- Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | | | - Ingeborg Bajema
- Department of Pathology and Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Antonella Barreca
- Pathology Unit, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy
| | - Jan U. Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Virgilius Cornea
- Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky
| | - Karen Eldin
- Department of Pathology, Mass General Brigham, Salem Hospital, Salem, Massachusetts
| | | | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kensuke Joh
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mercury Lin
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nidia Messias
- Department of Pathology, Washington University in Saint Louis, St. Louis, Missouri
| | | | - Fabio Pagni
- Department of Medicine and Surgery, IRCCS San Gerardo, University Milan Bicocca, Monza, Italy
| | | | - Heikki Tokola
- Pathology, University Oulu and Oulu University Hospital, Oulu, Finland
| | - Maria D'Armiento
- Pathology Section, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maximilian Seidl
- Medical Center-University of Freiburg and Faculty of Medicine, Institute for Surgical Pathology, University of Freiburg, Freiburg, Germany
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aurélie Sannier
- Department of Pathology, AP-HP, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Maria Fernanda Soares
- Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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14
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Barratt J, Liew A, Yeo SC, Fernström A, Barbour SJ, Sperati CJ, Villanueva R, Wu MJ, Wang D, Borodovsky A, Badri P, Yureneva E, Bhan I, Cattran D. Phase 2 Trial of Cemdisiran in Adult Patients with IgA Nephropathy: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2024; 19:452-462. [PMID: 38214599 PMCID: PMC11020434 DOI: 10.2215/cjn.0000000000000384] [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: 07/27/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND IgA nephropathy is the most common primary GN. Clinical features of IgA nephropathy include proteinuria, which is the strongest known surrogate of progression to kidney failure. Complement pathway activation is a critical driver of inflammation and tissue injury in IgA nephropathy. Cemdisiran is an investigational RNA interference therapeutic that suppresses hepatic production of complement component 5 (C5), thereby potentially reducing proteinuria in IgA nephropathy. We evaluated the efficacy and safety of cemdisiran in adult patients with IgA nephropathy at high risk of kidney disease progression. METHODS In this phase 2, 36-week, double-blind study, adult patients with IgA nephropathy and urine protein ≥1 g/24 hours were randomized (2:1) to subcutaneous cemdisiran 600 mg or placebo every 4 weeks in combination with the standard of care. The primary end point was percentage change from baseline at week 32 in urine protein-to-creatinine ratio (UPCR) measured by 24-hour urine collection. Additional end points included change from baseline in UPCR measured by spot urine, serum C5 level, and safety assessments. RESULTS Thirty-one patients were randomized (cemdisiran, N =22; placebo, N =9). Cemdisiran-treated patients had a placebo-adjusted geometric mean change in 24-hour UPCR of -37.4% (cemdisiran-adjusted geometric mean ratio to baseline [SEM], 0.69 [0.10]) at week 32. Spot UPCR was consistent with 24-hour UPCR placebo-adjusted change of -45.8% (cemdisiran-adjusted geometric mean ratio to baseline [SEM], 0.73 [0.11]). Mean (SD) change in serum C5 level from baseline at week 32 was -98.7% (1.2) with cemdisiran and 25.2% (57.7) with placebo. Over 36 weeks, most adverse events were mild or moderate and transient; the most common adverse event after cemdisiran treatment was injection-site reaction (41%). CONCLUSIONS These findings indicate that treatment with cemdisiran resulted in a reduction of proteinuria at week 32 and was well tolerated.
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Affiliation(s)
- Jonathan Barratt
- Department of Cardiovascular Medicine, University of Leicester, Leicester, United Kingdom
| | - Adrian Liew
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - See Cheng Yeo
- Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anders Fernström
- Department of Nephrology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sean J. Barbour
- University of British Columbia, Division of Nephrology, Vancouver, British Columbia, Canada
| | - C. John Sperati
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ming-Ju Wu
- Department of Internal Medicine, Taichung Veterans General Hospital and Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Dazhe Wang
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | | | | | | | - Ishir Bhan
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
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Liu T, Wang W, Liu Z, Pei G, Wang C, Jiang Y, Pang C. A previously healthy 3-year-old female with hypertension, proteinuria, and hypercalciuria. Pediatr Nephrol 2024; 39:1301-1313. [PMID: 38165475 PMCID: PMC10899356 DOI: 10.1007/s00467-023-06230-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
A 3-year-old female patient with no significant medical history presented to her pediatrician with foamy urine. Initial testing revealed moderate proteinuria on qualitative testing, although she was incidentally noted to have severe hypertension (240/200 mmHg). Physical examination of the carotid and femoral areas revealed significant systolic vascular murmurs. Labs showed elevated serum creatinine, hypokalemia, metabolic alkalosis, elevated renin and aldosterone and hypercalciuria. Echocardiography identified ventricular hypertrophy. Computed tomography (CT) of the abdomen and magnetic resonance angiography of the head showed multiple tortuous or interrupted arteries and multiple calcifications in the renal sinus area. B-mode ultrasonography suggested thickening of the carotid and femoral artery walls, with numerous spotted calcifications. Genetic testing revealed that ABCC6 had a complex heterozygous mutation (exon 24: c.3340C > T and intron 30: c.4404-1G > A). Our panel of experts reviewed the evaluation of this patient with hypertension, proteinuria, hypercalciuria, and vascular abnormalities as well as the diagnosis and appropriate management of a rare disease.
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Affiliation(s)
- Tao Liu
- Department of Nephrology, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, 238 Longyan Road, Beichen District, Tianjin, 300134, China
| | - Wenhong Wang
- Department of Nephrology, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, 238 Longyan Road, Beichen District, Tianjin, 300134, China.
| | - Zhufeng Liu
- Department of Nephrology, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, 238 Longyan Road, Beichen District, Tianjin, 300134, China
| | - Guanghua Pei
- Ultrasonography Lab, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Chunxiang Wang
- Department of Imaging, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Ying Jiang
- Department of Nephrology, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, 238 Longyan Road, Beichen District, Tianjin, 300134, China
| | - Chuyue Pang
- Department of Nephrology, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, 238 Longyan Road, Beichen District, Tianjin, 300134, China
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16
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Swaminathan SM, Bhojaraja MV, Attur RP, Nagri SK, Rao IR, Rangaswamy D, Shenoy SV, Nagaraju SP. Study of prevalence, clinical profile, and predictors of rapid progression in diabetic kidney disease. Ir J Med Sci 2024; 193:1047-1054. [PMID: 37851330 DOI: 10.1007/s11845-023-03544-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: 08/30/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND A significant proportion of diabetic kidney disease (DKD) experience a rapid decline in eGFR, leading to end-stage kidney disease (ESKD) within months. This single-centered retrospective cohort study aimed to assess the prevalence, clinical profile, and predictors for rapid progression in type 2 diabetes mellitus (T2DM) patients with DKD. METHOD Three hundred fifty-nine T2DM patients with DKD between January 2018 and 2022 were included and those with superimposed non-diabetic kidney disease, chronic kidney disease 5, and < 6 months follow-up were excluded. They were classified as rapid and non-rapid progressors based on the annual eGFR decline of > 5 ml/min/1.73 m2/year. The primary outcome analyzed was the progression to ESKD. The secondary outcomes were the onset of microvascular and macrovascular complications and predictors for rapid progression as well as ESKD. RESULTS In a median follow-up of 3.5 years, 61.3% were rapid progressors (mean eGFR decline of 15.4 ml/1.73m2/year) and 38.7% were non-rapid progressors (mean eGFR decline 1.8 ml/1.73m2/year. Among rapid progressors, 61.4% reached ESKD. Severe proteinuria, the presence of retinopathy, and acute kidney injury (AKI) episodes were strong predictors of rapid progression. Cardiovascular disease and diabetic retinopathy (microvascular complications) were significantly higher among rapid progressors and had a mortality rate of 7.2%. CONCLUSION The majority of type 2 DKD patients were rapid progressors and two-thirds of them developed ESKD. The prevalence of hypertension, cardiovascular disease, diabetic retinopathy, AKI episodes, and mortality was higher in rapid progressors. Severe proteinuria and diabetic retinopathy were found to be strong predictors for rapid eGFR decline and its progression to ESKD.
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Affiliation(s)
- Shilna Muttickal Swaminathan
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Ravindra Prabhu Attur
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Shivashankara Kaniyoor Nagri
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
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17
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García-Prieto AM, Verdalles Ú, de José AP, Arroyo D, Aragoncillo I, Barbieri D, Camacho RE, Goicoechea M. Renin-angiotensin-aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial. Hipertens Riesgo Vasc 2024; 41:95-103. [PMID: 38508877 DOI: 10.1016/j.hipert.2023.11.005] [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: 09/20/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3-4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. RESULTS 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was -4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. CONCLUSIONS In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023).
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Affiliation(s)
- A M García-Prieto
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ú Verdalles
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A P de José
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D Arroyo
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Aragoncillo
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D Barbieri
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R E Camacho
- Servicio de Nefrología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - M Goicoechea
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Cozzi GD, Battarbee AN, Sanjanwala AR, Casey BM, Subramaniam A. Amount of Proteinuria and Duration of Expectant Management in Severe Preeclampsia. Am J Perinatol 2024; 41:790-797. [PMID: 35644128 DOI: 10.1055/s-0042-1748524] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the association between the amount of proteinuria at the time of diagnosis of preeclampsia with severe features (severe preeclampsia [SPE]) and duration of expectant management (EM) and other perinatal outcomes. STUDY DESIGN This is a retrospective cohort study of patients with SPE delivering live, non-anomalous singletons at 230/7 to 342/7 weeks' estimated gestational age (EGA) at a single tertiary center 2016 to 2018. Patients with proteinuria assessment (24-hour total urine protein or urine protein-to-creatinine ratio extrapolation) within 3 days of SPE diagnosis were included. Patients delivered for an indication other than SPE were excluded. Patients were categorized by amount of proteinuria (mg): none (≤300), mild (301-1,000), moderate (1,001-3,000), and massive (≥3,001). The primary outcome was the proportion of potential EM time achieved (%EM), i.e., days of EM divided by days from SPE diagnosis to 34 weeks. Secondary outcomes included delivery EGA, days of EM, and perinatal outcomes. Bivariable and multivariable analyses compared outcomes across groups. RESULTS Of 295 patients included, 21% had no proteinuria, 33% mild, 19% moderate, and 27% massive. Groups differed by EGA at diagnosis, age, parity, chronic hypertension, and renal disease. %EM was not significantly different between groups (adjusted β coefficient 4.1 [95% CI -5.3, 13.5] for mild proteinuria vs. none, -4.1 [95% CI -14.9, 6.6] for moderate proteinuria vs. none, and -5.6 [95% CI -16.0, 4.7] for massive proteinuria vs. none). Increasing proteinuria was associated with earlier delivery EGA but only days of EM in the mild versus no proteinuria groups. There was no significant association between proteinuria and maternal composite morbidity, but patients with mild and massive proteinuria had higher odds of neonatal composite morbidities compared with no proteinuria. CONCLUSION Among patients with SPE, proteinuria level was not consistently associated with duration of EM. However, patients with the greatest amounts of proteinuria may have worse neonatal and selected maternal outcomes. KEY POINTS · Amount of proteinuria was not associated with the duration of expectant management.. · Greater proteinuria was associated with earlier delivery in severe preeclampsia.. · Massive proteinuria in preeclampsia was associated with select adverse maternal and neonatal outcomes..
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Affiliation(s)
- Gabriella D Cozzi
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashley N Battarbee
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aalok R Sanjanwala
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M Casey
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Mori M, Tanaka A, Maeda K, Saito S, Furuhashi K, Maruyama S. Proliferative glomerulonephritis with monoclonal immunoglobulin deposits and atypical pathological findings treated with corticosteroid and rituximab. CEN Case Rep 2024; 13:128-134. [PMID: 37548878 PMCID: PMC10982278 DOI: 10.1007/s13730-023-00813-7] [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: 05/02/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
A 16-year-old girl with fever that appeared after taking the second COVID-19 vaccine presented to the clinic with a serum creatinine of 0.89 mg/dL and C-reactive protein of 6.9 mg/dL. She had proteinuria and microscopic hematuria, with slowly worsening kidney function. Her kidney biopsy showed fibrocellular crescents in seven of nine glomeruli that were observed under light microscopy. Another glomerulus showed endocapillary hypercellularity and mesangial cell proliferation. Electron-dense deposits were significant in the mesangial area, with monoclonal IgG1-κ and C3 deposition by immunofluorescence. The patient was diagnosed with proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) and atypical pathological finding of diffuse crescent formation. The treatment regimen for PGNMID has not yet been established, and the appropriate duration of treatment is unknown. In our case, considering that rituximab acts by binding to CD20 on the surface of B cells through its crystallizable fragment, it was administered in addition to prednisolone, which successfully decreased the proteinuria over time.
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Affiliation(s)
- Machi Mori
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kayaho Maeda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shoji Saito
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kazuhiro Furuhashi
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan.
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Taniguchi M, Endo T, Asou M, Tsukamoto T. Nephrotic "full-house" glomerulonephritis successfully treated with antibiotics alone in secondary syphilis: a case report. CEN Case Rep 2024; 13:86-92. [PMID: 37351772 PMCID: PMC10982175 DOI: 10.1007/s13730-023-00803-9] [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: 01/07/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
A Japanese female in her twenties developed general edema with heavy proteinuria, and was referred to our hospital. She exhibited the common clinical manifestation of idiopathic nephrotic syndrome with massive proteinuria (20.37 g/day), hypoalbuminemia (1.8 g/dL), and hypercholesterolemia (300 mg/dL). Routine admission tests were positive results for both the rapid plasma reagin latex agglutination test for syphilis (RPR) and the Treponema pallidum particle agglutination assay (TPHA). As such, we made her a diagnosis of nephrotic syndrome due to secondary syphilis. Renal biopsy revealed "full-house" nephropathy. Following the commencement of penicillin treatment, she developed skin rash, indicating the Jarisch-Herxheimer reaction (JHR). Her nephrotic syndrome responded rapidly and she achieved complete remission with antibiotic therapy alone after 4 weeks. In light of the increasing incidence of syphilis in Japan, clinicians should consider syphilis as a reversible cause of nephrotic syndrome.
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Affiliation(s)
- Misaki Taniguchi
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Tomomi Endo
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Mea Asou
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
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Menn-Josephy H, Hodge LS, Birardi V, Leher H. Efficacy of Voclosporin in Proliferative Lupus Nephritis with High Levels of Proteinuria. Clin J Am Soc Nephrol 2024; 19:309-318. [PMID: 38110196 PMCID: PMC10937024 DOI: 10.2215/cjn.0000000000000297] [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: 04/19/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND In a phase 3 study of adults with active lupus nephritis, addition of voclosporin to mycophenolate mofetil (MMF) and low-dose glucocorticoids led to significant improvements in the proportion of participants achieving complete and partial renal response as well as sustained reduction in proteinuria. This analysis examined the efficacy and safety of voclosporin in a subgroup of the phase 3 study with proliferative lupus nephritis and high levels of proteinuria. METHODS Participants were randomized to oral voclosporin (23.7 mg twice daily) or placebo for 12 months; all participants received MMF and low-dose glucocorticoids. This analysis includes participants with class III or IV (±class V) lupus nephritis and baseline urine protein-creatinine ratio (UPCR) ≥3 g/g. Efficacy end points included complete renal response (UPCR ≤0.5 g/g with stable eGFR, low-dose glucocorticoids, and no rescue medication), partial renal response (≥50% reduction from baseline UPCR), and UPCR over time. Safety outcomes were also assessed. RESULTS A total of 148 participants were in the voclosporin ( n =76) and control ( n =72) arms. At 12 months, 34% and 11% of participants in the voclosporin and control arms, respectively, achieved a complete renal response (odds ratio, 4.43; 95% confidence interval [CI], 1.78 to >9.99; P = 0.001). A partial renal response was achieved by 65% of the voclosporin arm and 51% of the control arm at 12 months (odds ratio, 1.60; 95% CI, 0.8 to 3.20; P = 0.18). More voclosporin- than control-treated participants achieved UPCR ≤0.5 g/g (51% versus 26%), and voclosporin-treated participants met this end point significantly earlier (hazard ratio, 2.07; 95% CI, 1.19 to 3.60; P = 0.01). The incidence of adverse events was similar between the arms; mean eGFR values remained stable and within normal range in both arms. CONCLUSIONS Addition of voclosporin to MMF and low-dose glucocorticoids resulted in a significantly higher proportion of participants with proliferative lupus nephritis achieving complete and partial renal responses as well as earlier reductions in proteinuria, with no evidence of worsening kidney function.
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Affiliation(s)
| | - Lucy S. Hodge
- Aurinia Pharmaceuticals Inc., Edmonton, Alberta, Canada
| | | | - Henry Leher
- Aurinia Pharmaceuticals Inc., Edmonton, Alberta, Canada
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Cambier A, Roy JP, Dossier C, Patey N, Rabant M, Boyer O, Delbet JD, Lapeyraque AL, Hogan J. IgA nephropathy in children with minimal proteinuria: to biopsy or not to biopsy? Pediatr Nephrol 2024; 39:781-787. [PMID: 37698655 DOI: 10.1007/s00467-023-06121-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Tubulointerstitial lesions and glomerular inflammation severity have been shown to correlate with proteinuria in children with IgA nephropathy (cIgAN). However, there is a lack of data regarding severity of histopathologic findings in cIgAN in patients with minimal to absent proteinuria since kidney biopsy indications are not well defined in these cases. METHODS Twenty-eight cIgAN patients with kidney biopsy from 4 different centers in Paris (France) and Montreal (Canada) with a urine protein/creatinine ratio (UPCr) ≤ 0.03 g/mmol and a normal estimated glomerular filtration rate (eGFR > 90 ml/min/1.73 m2) on the day of kidney biopsy prior to treatment were included. RESULTS Median age was 11.82 (9.32-13.45) years, and median follow-up was 4 years (2.87-6.53). At time of biopsy, median eGFR was 116 (102.3-139.7) ml/min/1.73 m2, and median UPCr was 0.02 (0.011-0.03) g/mmol. Microscopic or macroscopic hematuria was present in 35.7% and 64.3% of cases, respectively. Kidney biopsy microscopy analysis showed mesangial (M1), endocapillary (E1), or extracapillary (C1) hypercellularity in 53.5%, 32.1%, and 7.1% of patients, respectively. Chronic histological lesions were also present: glomerulosclerosis (S1) in 42.8% and tubular atrophy/interstitial fibrosis in 7.1%. Podocytopathic features were detected in 21.4%. An ACE inhibitor or immunosuppressive therapy (IS) was prescribed in 42.8% and 21.4% of these patients respectively. One-third (35.7%) received no treatment. At last follow-up, median eGFR was 111.9 (90.47-136.1) ml/min/1.73 m2, and median UPCr was 0.028 (0.01-0.03) g/mmol. CONCLUSION cIgAN with minimal proteinuria at time of biopsy might be linked with acute and chronic glomerular lesions.
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Affiliation(s)
- Alexandra Cambier
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada.
- Sainte-Justine Hospital Pediatric Research Centre: Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, QC, Canada.
| | - Jean-Philippe Roy
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Claire Dossier
- Division of Nephrology, Hôpital Robert Debré, Paris, France
| | - Natacha Patey
- Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Marion Rabant
- Division of Pathology, Hôpital Necker, Paris, France
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Centre, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
| | | | - Anne-Laure Lapeyraque
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Julien Hogan
- Division of Nephrology, Hôpital Robert Debré, Paris, France
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Fryc J, Naumnik B. The Case | A patient with skin rash, monoclonal gammopathy, and proteinuria. Kidney Int 2024; 105:643-644. [PMID: 38388153 DOI: 10.1016/j.kint.2023.10.010] [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: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Justyna Fryc
- 1st Department of Nephrology and Transplantation With Dialysis Unit, Medical University of Bialystok, Bialystok, Poland.
| | - Beata Naumnik
- 1st Department of Nephrology and Transplantation With Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
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Akdemir I, Mekik Akar E, Yılmaz S, Çakar N, Fitöz S, Özçakar ZB. Nutcracker syndrome in pediatrics: initial findings and long-term follow-up results. Pediatr Nephrol 2024; 39:799-806. [PMID: 37733097 DOI: 10.1007/s00467-023-06150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Nutcracker syndrome (NCS) describes a set of symptoms and signs resulting from compression of the left renal vein (LRV). There is a lack of knowledge about its natural course, diagnosis, and management, especially in children. Herein, we present our single-center experience with a large number of patients who have long-term follow-up results. METHODS All patients with NCS diagnosed between January 2011 and March 2021 were included and their data were obtained retrospectively. RESULTS A total of 123 NCS patients (85 females) were included. The median age at the time of diagnosis was 12 (IQR 10-14) years, and BMI percentiles were below 5% in 38% of the cases. At the time of diagnosis, two-thirds of the patients were asymptomatic. The most common laboratory finding was nephritic proteinuria (98%), followed by microscopic hematuria (16%). Signs of LRV compression were significantly more evident in upright position Doppler ultrasonography (DUS) examination. All patients have been followed conservatively; hematuria and/or proteinuria resolved in 43 of the 108 patients (40%) within 35.8 ± 25.8 months of follow-up. Control DUS was performed in 52 patients after a mean period of 39.1 ± 21.3 months. The median peak velocity and diameter ratios of the LRV in the upright position were found to be decreased significantly when compared to the initial assessment (p < 0.05). Normal DUS findings were noted in 13 patients at the final evaluation. CONCLUSIONS In unexplained proteinuria and/or hematuria, NCS should be considered, especially in asthenic adolescents. Our results support conservative management in children as the first-line treatment approach.
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Affiliation(s)
- Iryna Akdemir
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Ece Mekik Akar
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Songül Yılmaz
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Nilgün Çakar
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Suat Fitöz
- Division of Pediatric Radiology, Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
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Gan W, Chen J, Zhu F, Fang X, Zeng X, Xiao W, Chen W. Prognostic value of neutrophil-to-lymphocyte ratio on proteinuria remission in patients with idiopathic membranous nephropathy. Int Urol Nephrol 2024; 56:1185-1193. [PMID: 37733125 DOI: 10.1007/s11255-023-03803-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: 04/08/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND As a novel marker of inflammation, the neutrophil-to-lymphocyte ratio (NLR) has been studied in various diseases. However, NLR in idiopathic membranous nephropathy (IMN) has been rarely studied. We sought to assess the role of NLR in predicting proteinuria remission in IMN. METHODS This retrospective study involved 561 patients with IMN from January 2018 to December 2022 in Department of Nephrology of Wuhan Central Hospital. All baseline data were collected before the immunosuppressive regiment was administered. The Cox proportional hazards model and Kaplan-Meier curve were applied to assess the prognostic value of NLR for proteinuria remission. RESULTS The area under the receiver operating characteristic curve revealed that the optimal cut-off NLR value for predicting proteinuria non-remission was 2.63, with a sensitivity and specificity of 58.2% and 72.7%, respectively. Kaplan-Meier curves showed a lower rate of proteinuria remission in patients with high NLR compared with low NLR (Log-rank = 5.04, p = 0.025). Multivariate Cox regression analysis showed that high NLR was an independent risk factor for proteinuria non-remission after adjustment (HR = 1.579, 95% CI 1.052-2.683, p = 0.023). Subgroup analysis indicated that high NLR was a risk factor for proteinuria non-remission especially in IMN patients with 24 h proteinuria ≥ 1 g (HR = 1.818, 95% CI 1.031-2.573, p = 0.012) and chronic kidney disease (CKD) stage 3-4 (HR = 1.935, 95% CI 1.084-2.495, p = 0.015). CONCLUSION The current study shows that NLR is an independent risk factor for proteinuria non-remission in IMN. More attention should be paid to IMN patients with high NLR, especially for those patients with 24 h proteinuria ≥ 1 g and CKD stage 3-4.
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Affiliation(s)
- Wenyuan Gan
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Jian Chen
- Information Center, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Fan Zhu
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xun Fang
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xingruo Zeng
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Wei Xiao
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
| | - Wenli Chen
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
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Schoonmaker JA, Ryan MS, Bhasin-Chhabra B. Nonalbumin Proteinuria in a Patient with Slowly Worsening Kidney Function. Kidney360 2024; 5:481-482. [PMID: 38546983 PMCID: PMC11000716 DOI: 10.34067/kid.0000000000000338] [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] [Indexed: 04/02/2024]
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Huang VW, Behairy M, Abelson B, Crane A, Liu W, Wang L, Dell KM, Rhee A. Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients. Pediatr Nephrol 2024; 39:829-835. [PMID: 37658873 DOI: 10.1007/s00467-023-06128-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Posterior urethral valves (PUV) is the most common cause of obstructive uropathy in boys; approximately 15% develop kidney failure by early adulthood. However, rates of kidney function decline are poorly defined in PUV children and adults, as is the impact of potentially modifiable chronic kidney disease (CKD) progression risk factors. METHODS We conducted a retrospective review of all PUV patients followed at our institution from 1995 to 2018. Inclusion criteria were estimated glomerular filtration rate (eGFR) > 20 ml/min/1.73 m2 after 1 year of age, no dialysis or kidney transplant history, and ≥ 2 yearly serum creatinine values after age 1 year. eGFRs were calculated using creatinine-based estimating formulas for children (CKID U25) or adults (CKD-EPI). The primary outcome was annualized change in eGFR, assessed with linear mixed effects models. We also examined the association of acute kidney injury (AKI), proteinuria, hypertension (HTN), and recurrent febrile urinary tract infections (UTIs) with eGFR decline. RESULTS Fifty-two PUV patients met the inclusion criteria. Median (interquartile range) eGFR decline was 2.6 (2.1, 3.1) ml/min/1.73 m2/year. Children (n = 35) and adults (n = 17) demonstrated progressive decline. Proteinuria and recurrent UTIs were significantly associated with faster progression; AKI and HTN were also associated but did not reach significance. CONCLUSION PUV patients show progressive loss of kidney function well into adulthood. Proteinuria and recurrent UTIs are associated with faster progression, suggesting potential modifiable risk factors. This is the first study to report annualized eGFR decline rates in PUV patients, which could help inform the design of clinical trials of CKD therapies.
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Affiliation(s)
- Victoria W Huang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mohga Behairy
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | | | - Alice Crane
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Lu Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine M Dell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
- Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
| | - Audrey Rhee
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
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Kim H, Hyun YY, Joo YS, Yun HR, Kim Y, Jung JY, Jeong JC, Kim J, Park JT, Yoo TH, Kang SW, Oh KH, Han SH. Proteinuria, measured or estimated albuminuria for risk prediction in patients with chronic kidney disease? Nephrol Dial Transplant 2024; 39:473-482. [PMID: 37723608 PMCID: PMC11024809 DOI: 10.1093/ndt/gfad195] [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: 06/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Although albuminuria is the gold standard for defining chronic kidney disease (CKD), total proteinuria has also been widely used in real-world clinical practice. Moreover, the superiority of the prognostic performance of albuminuria over proteinuria in patients with CKD remains inconclusive. Therefore, we aimed to compare the predictive performances of albuminuria and proteinuria in these patients. METHODS From the Korean Cohort Study for Outcome in Patients with CKD we included 2099 patients diagnosed with CKD grades 1-5 who did not require kidney replacement therapy. We measured the spot urine albumin:creatinine ratio (mACR) and protein:creatinine ratio (PCR) and estimated the ACR (eACR) using the PCR. Kidney failure risk equation (KFRE) scores were calculated using the mACR, PCR and eACR. The primary outcome was the 5-year risk of kidney failure with replacement therapy (KFRT). RESULTS The eACR significantly underestimated mACR in patients with low albuminuria levels. The time-dependent area under the receiver operating characteristics curve showed excellent predictive performance for all KFRE scores from the mACR, PCR and eACR. However, eACR was inferior to mACR based on the continuous net reclassification index (cNRI) and integrated discrimination improvement index (IDI) in all CKD cause groups, except for the group with an unclassified aetiology. Moreover, the cNRI and IDI statistics indicated that both eACR and PCR were inferior to mACR in patients with low albuminuria (<30 mg/g). Conversely, the predictive performance of PCR was superior in severe albuminuria and nephrotic-range proteinuria, in which the IDI and cNRI of the PCR were greater than those of the mACR. CONCLUSIONS The mACR, eACR and PCR showed excellent performance in predicting KFRT in patients with CKD. However, eACR was inferior to mACR in patients with low albuminuria, indicating that measuring rather than estimating albuminuria is preferred for these patients.
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Affiliation(s)
- Hyoungnae Kim
- Division of Nephrology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Young Su Joo
- Department of Internal Medicine, Yonsei University, Institute of Kidney Disease Research, College of Medicine, Seoul, Korea
| | - Hae-Ryong Yun
- Department of Internal Medicine, Yonsei University, Institute of Kidney Disease Research, College of Medicine, Seoul, Korea
| | - Yaeni Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jong Cheol Jeong
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University, Institute of Kidney Disease Research, College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University, Institute of Kidney Disease Research, College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University, Institute of Kidney Disease Research, College of Medicine, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University, Institute of Kidney Disease Research, College of Medicine, Seoul, Korea
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Chen Z, Yin B, Jiao J, Ye T. Case report: enzyme replacement therapy for Fabry disease presenting with proteinuria and ventricular septal thickening. BMC Nephrol 2024; 25:61. [PMID: 38383316 PMCID: PMC10882756 DOI: 10.1186/s12882-024-03499-w] [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: 12/06/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
Fabry disease (FD) is an uncommon, X-linked, lysosomal storage disease that causes defects in the glycosphingolipid metabolic pathway due to deficient or absent lysosomal α-galactosidase (α-Gal A) activity. This leads to the accumulation of globotriaosylceramide (GL-3) within lysosomes in a wide range of cells, including endothelial, cardiac, renal, and corneal cells, and consequently, the progressive appearance of clinical symptoms in target organs. Enzyme replacement therapy (ERT), which involves the exogenous supplementation of α-Gal A enzyme and has been successfully administered for treating FD.Here, we report a case of a 37-year-old male with complaints of recurrent proteinuria and ventricular septal thickening. A renal biopsy revealed vacuolization and foamy changes in podocytes, and the presence of myelin-like bodies and zebra bodies. The white blood cell α-Gal A activity was very low, while the Lyso-GL-3 level was high. Additionally, genetic analysis revealed a gene variant c.902G > A p. Arg301Gln. The patient was diagnosed with FD, and subsequently received intravenous ERT with a dose of Agalsidase α (0.2 mg/kg, 17.5 mg every 2 weeks). Currently, the values of proteinuria and ventricular septum thickness remain stable during the 6-month follow-up. Initiating ERT at an early age can effectively decrease the deposition of GL-3, attenuate the progressive clinical manifestations of FD, and provide greater long-term benefits.
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Affiliation(s)
- Zewei Chen
- Department of Nephrology, The First Navy Hospital of Southern Theater Command, Zhanjiang, Guangdong, China
| | - Bo Yin
- Department of Internal Medicine, The First Navy Hospital of Southern Theater Command, Zhanjiang, Guangdong, China
| | - Juan Jiao
- Department of Internal Medicine, The First Navy Hospital of Southern Theater Command, Zhanjiang, Guangdong, China
| | - Tianyang Ye
- Department of Internal Medicine, The First Navy Hospital of Southern Theater Command, Zhanjiang, Guangdong, China.
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Watanabe Y, Hirai K, Hirata M, Kitano T, Ito K, Ookawara S, Oshiro H, Morishita Y. Steroid-resistant minimal change nephrotic syndrome associated with thymoma treated effectively with rituximab following thymectomy and cyclosporine: a case report. BMC Nephrol 2024; 25:53. [PMID: 38336671 PMCID: PMC10858521 DOI: 10.1186/s12882-024-03485-2] [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: 12/02/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Minimal change nephrotic syndrome (MCNS) can be complicated by thymoma; however, no standard therapy for thymoma-associated MCNS has yet been established. We herein describe a case of steroid-resistant MCNS associated with thymoma, treated effectively with rituximab. CASE PRESENTATION A 71-year-old Japanese man was referred to our department with severe proteinuria (20 g/gCr). Renal biopsy showed minimal change disease and computed tomography revealed an anterior mediastinal mass. Based on these findings, he was diagnosed with thymoma-associated MCNS. He was treated with oral prednisolone (50 mg/day) and cyclosporine, and underwent thymectomy and plasma exchange. However, no improvement in proteinuria was observed. He therefore received intravenous rituximab 500 mg, resulting in a marked decrease in proteinuria from 5328 to 336 mg/day after 1 week. CONCLUSIONS This case suggests that rituximab might be an effective therapy in patients with steroid-resistant MCNS associated with thymoma.
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Affiliation(s)
- Yusaku Watanabe
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan.
| | - Momoko Hirata
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Taisuke Kitano
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Hisashi Oshiro
- Department of Diagnostic Pathology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
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Alstott J. Proteinuria on dipstick urinalysis in a woman with alkaline urine. Clin Nephrol 2024; 101:99-100. [PMID: 37997943 DOI: 10.5414/cn111086] [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] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 11/25/2023] Open
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Xu C, Xu T, Liu N, Liu L, Sun L, Li X, Li Z, Yao L. Colquhounia root tablet in the treatment of idiopathic membranous nephropathy with subnephrotic proteinuria. Int Urol Nephrol 2024; 56:699-706. [PMID: 37480482 DOI: 10.1007/s11255-023-03682-2] [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: 01/01/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Idiopathic membranous nephropathy (IMN) is the most frequent global cause of nephrotic syndrome in non-diabetic people. In clinical practice, An effective and mild treatment for IMN patients with subnephrotic proteinuria has been adopted. Colquhounia root tablet (CRT) is a traditional Chinese medicine that is widely used in China to treat glomerulopathies. In this study, the effectiveness and safety of CRT in the treatment of IMN with subnephrotic proteinuria have been determined by reviewing the clinical records of 44 patients with IMN. METHODS Retrospective analysis of IMN patients with subnephrotic proteinuria treated with CRT in combination with ACEI/ARB or ACEI/ARB alone. The remission rate (complete or partial remission) was the main outcome observed, and proteinuria, estimated glomerular filtration rate (eGFR), serum albumin levels, and adverse effects were the secondary outcomes. RESULTS This clinical trial included 44 patients, and the overall remission rates at months 6, 9, and 12 after treatment were 68.2% versus 27.3% (p = 0.016), 72.7% versus 36.4% (p = 0.015), and 77.3% versus 36.4% (p = 0.006) in the treatment and control groups, respectively. The application of CRT treatment was an independent predictor of proteinuria remission (p = 0.024). In addition, in patients who were positive for phospholipase A2 receptor (PLA2R) antibodies, the overall remission rate was higher in the treatment group than in the control group after 9 months of treatment (75% versus 23.08%, p = 0.017). CONCLUSION This retrospective study illustrates that, based on supportive therapy, CRT could be effective in the treatment of IMN with subnephrotic proteinuria with a good safety profile at the same time.
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Affiliation(s)
- Chunyan Xu
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China
| | - Tianhua Xu
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China
| | - Nan Liu
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China
| | - Linlin Liu
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China
| | - Li Sun
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China
| | - Xiaoli Li
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China
| | - Zilong Li
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China
| | - Li Yao
- The First Hospital of China Medical University, 155 Nanjing Street, Heping District, Shenyang, 110002, China.
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Shima Y, Mukaiyama H, Tanaka Y, Shimabukuro W, Nozu K, Kaito H, Tanaka R, Sako M, Iijima K, Tokuhara D, Yoshikawa N, Nakanishi K. Factors related to recurrence of proteinuria in childhood IgA nephropathy. Pediatr Nephrol 2024; 39:463-471. [PMID: 37594578 DOI: 10.1007/s00467-023-06116-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/09/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Proteinuria remission is the most significant predictive factor for kidney outcome in childhood IgA nephropathy (c-IgAN). Even if proteinuria remission can be obtained, some patients have recurrence of proteinuria in the long-term. METHODS This is a retrospective analysis of 312 cases of proteinuria remission among 538 consecutive children with biopsy-proven IgAN from 1976 to 2013. To elucidate the incidence and factors related to recurrence of proteinuria in c-IgAN, we compare clinical and pathological findings between patients with and without recurrence of proteinuria. RESULTS Among 312 patients with remission of proteinuria, 91 (29.2%) had recurrence of proteinuria within the observation period (median 8 years). Using a multivariate Cox regression analysis, significant factors associated with recurrence of proteinuria were onset age (HR 1.13 [95%CI: 1.05-1.22], P = 0.002) and presence of hematuria after proteinuria remission (HR 2.11 [95%CI: 1.30-3.45], P = 0.003). The Kaplan-Meier analysis showed significant differences in CKD G3a-G5-free survival between the patients with no-recurrence of proteinuria, recurrence of proteinuria and non-proteinuria remission (P < 0.0001, log-rank test). Kidney survival was 100% in no-recurrence of proteinuria, 92.2% in recurrence of proteinuria, and 65.6% in non-proteinuria remission at 15 years. Cox analyses adjusted by proteinuria remission showed that recurrence of proteinuria (HR 03.10e9 [95%CI: NA], P = 0.003) was a significant factor associated with progression to CKD G3a-G5 in all patients with c-IgAN. CONCLUSIONS Approximately 30% of patients with proteinuria remission had recurrence of proteinuria regardless of treatment. Both remission and recurrence of proteinuria are significant prognostic factors for kidney outcome. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan.
| | - Hironobu Mukaiyama
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan
| | - Yu Tanaka
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan
| | - Wataru Shimabukuro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara-Cho, Okinawa, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kaito
- Pediatric Nephrology, Hyogo Children's Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- Pediatric Nephrology, Hyogo Children's Hospital, Kobe, Japan
| | - Mayumi Sako
- Division for Clinical Trials, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, Kimiidera, Wakayama, 811-1, Japan
| | - Norishige Yoshikawa
- Clinical Research Center, Takatsuki General Hospital, Takatsuki City, Osaka, Japan
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara-Cho, Okinawa, Japan
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Ogata A, Deki S, Uchimura T, Inaba A, Otani M, Ito S. Multinucleated podocytes as a clue to diagnosis of juvenile nephropathic cystinosis. Pediatr Nephrol 2024; 39:609-612. [PMID: 37572116 DOI: 10.1007/s00467-023-06103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND : Cystinosis is a rare autosomal recessive lysosomal disorder that mainly affects the kidney and eye. Early treatment with cysteamine significantly improves the prognosis. However, early diagnosis of cystinosis, especially the juvenile nephropathic form, remains challenging because typical symptoms only become apparent in adulthood. We herein describe a 13-year-old girl who presented with proteinuria only but was diagnosed with juvenile nephropathic cystinosis based on multinucleated podocytes in her kidney biopsy specimen. We also studied the nephropathology of another case to determine the features of the multinucleated podocytes. CASE DIAGNOSIS: A previously healthy 13-year-old girl presented to our hospital because proteinuria had been detected in her school urine screening. She had been noted to have proteinuria on her school urine screening when she was 11 years of age but there was no consultation with her physician at that time. She was asymptomatic and had no other abnormalities on examination other than a relatively high urinary β-2 microglobulin level. Her kidney biopsy showed 15 multinucleated podocytes in 34 glomeruli, and the mean number of nuclei per multinucleated podocyte was 4.4. Ophthalmological examination showed cystine crystals in her cornea. Her white blood cell cystine level was high, and she was diagnosed with juvenile nephropathic cystinosis. She started oral cysteamine treatment and showed almost no progression of the disease after 2 years. In another patient with juvenile nephropathic cystinosis, there were 25 multinucleated podocytes in 63 glomeruli, and the mean number of nuclei per multinucleated podocyte was 2.9. CONCLUSION: Early diagnosis is crucial to improve the prognosis of patients with cystinosis. This report emphasizes the importance of recognizing the unique pathological feature of multinucleated podocytes as an essential clue to the diagnosis of cystinosis.
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Affiliation(s)
- Ayako Ogata
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Saori Deki
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Toru Uchimura
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Aya Inaba
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Masako Otani
- Department of Pathology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
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Muraoka M, Nagata H, Yamamura K, Sakamoto I, Ishikita A, Nishizaki A, Eguchi Y, Fukuoka S, Uike K, Nagatomo Y, Hirata Y, Nishiyama K, Tsutsui H, Ohga S. Long-Term Renal Involvement in Association with Fontan Circulation. Pediatr Cardiol 2024; 45:340-350. [PMID: 37966520 DOI: 10.1007/s00246-023-03334-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
Multiorgan dysfunction is a concern of Fontan patients. To clarify the pathophysiology of Fontan nephropathy, we characterize renal disease in the long-term observational study. Medical records of 128 consecutive Fontan patients [median age: 22 (range 15-37) years old] treated between 2009 and 2018 were reviewed to investigate the incidence of nephropathy and its association with other clinical variables. Thirty-seven patients (29%) showed proteinuria (n = 34) or < 90 mL/min/1.73 m2 of estimated glomerular filtration rate (eGFR) (n = 7), including 4 overlapping cases. Ninety-six patients (75%) had liver dysfunction (Forns index > 4.21). Patients with proteinuria received the Fontan procedure at an older age [78 (26-194) vs. 56 (8-292) months old, p = 0.02] and had a higher cardiac index [3.11 (1.49-6.35) vs. 2.71 (1.40-4.95) L/min/m2, p = 0.02], central venous pressure [12 (7-19) vs. 9 (5-19) mmHg, p < 0.001], and proportion with > 4.21 of Forns index (88% vs. 70%, p = 0.04) than those without proteinuria. The mean renal perfusion pressure was lower in patients with a reduced eGFR than those without it [55 (44-65) vs. 65 (45-102) mmHg, p = 0.03], but no other variables differed significantly. A multivariable analysis revealed that proteinuria was associated with an increased cardiac index (unit odds ratio 2.02, 95% confidence interval 1.12-3.65, p = 0.02). Seven patients with severe proteinuria had a lower oxygen saturation than those with no or mild proteinuria (p = 0.01, 0.03). Proteinuria or a decreased eGFR differentially occurred in approximately 30% of Fontan patients. Suboptimal Fontan circulation may contribute to the development of proteinuria and reduced eGFR.
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Affiliation(s)
- Mamoru Muraoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayako Ishikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Nishizaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshimi Eguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shoji Fukuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kiyoshi Uike
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yusaku Nagatomo
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuichiro Hirata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kei Nishiyama
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Yano Y, Nagasu H, Kanegae H, Nangaku M, Hirakawa Y, Sugawara Y, Nakagawa N, Wada J, Sugiyama H, Nakano T, Wada T, Shimizu M, Suzuki H, Komatsu H, Nakashima N, Kitaoka K, Narita I, Okada H, Suzuki Y, Kashihara N. Kidney outcomes associated with haematuria and proteinuria trajectories among patients with IgA nephropathy in real-world clinical practice: The Japan Chronic Kidney Disease Database. Nephrology (Carlton) 2024; 29:65-75. [PMID: 37871587 DOI: 10.1111/nep.14250] [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: 07/04/2023] [Revised: 09/01/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
AIM Among patients with Immunoglobulin A (IgA) nephropathy, we aimed to identify trajectory patterns stratified by the magnitude of haematuria and proteinuria using repeated urine dipstick tests, and assess whether the trajectories were associated with kidney events. METHODS Using a nationwide multicentre chronic kidney disease (CKD) registry, we analysed data from 889 patients with IgA nephropathy (mean age 49.3 years). The primary outcome was a sustained reduction in eGFR of 50% or more from the index date and thereafter. During follow-up (median 49.0 months), we identified four trajectories (low-stable, moderate-decreasing, moderate-stable, and high-stable) in both urine dipstick haematuria and proteinuria measurements, respectively. RESULTS In haematuria trajectory analyses, compared to the low-stable group, the adjusted hazard ratios (HRs) (95% confidence interval [CI]) for kidney events were 2.59 (95% CI, 1.48-4.51) for the high-stable, 2.31 (95% CI, 1.19-4.50) for the moderate-stable, and 1.43 (95% CI, (0.72-2.82) for the moderate-decreasing groups, respectively. When each proteinuria trajectory group was subcategorized according to haematuria trajectories, the proteinuria group with high-stable and with modest-stable haematuria trajectories had approximately 2-times higher risk for eGFR reduction ≥50% compared to that with low-stable haematuria trajectory. CONCLUSION Assessments of both haematuria and proteinuria trajectories using urine dipstick could identify high-risk IgA nephropathy patients.
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Affiliation(s)
- Yuichiro Yano
- Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Hajime Nagasu
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroshi Kanegae
- Office of Research and Analysis, Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yosuke Hirakawa
- Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yuka Sugawara
- Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoki Nakagawa
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Miho Shimizu
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroyuki Komatsu
- Center for Medical Education and Career Development, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kaori Kitaoka
- Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hirokazu Okada
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
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Caravaca-Fontán F, Stevens K, Padrón M, Huerta A, Montomoli M, Villa J, González F, Vega C, López Mendoza M, Fernández L, Shabaka A, Rodríguez-Moreno A, Martín-Gómez A, Labrador PJ, Molina Andújar A, Prados Soler MC, Martín-Penagos L, Yerovi E, Medina Zahonero L, De La Flor JC, Mon C, Ibernon M, Rodríguez Gómez A, Miquel R, Sierra M, Mascarós V, Luzardo L, Papasotiriou M, Arroyo D, Verdalles Ú, Martínez-Miguel P, Ramírez-Guerrero G, Pampa-Saico S, Moral Berrio E, Canga JLP, Tarragón B, Fraile Gómez P, Regidor D, Relea J, Xipell M, Andrades Gómez C, Navarro M, Álvarez Á, Rivas B, Quintana LF, Gutiérrez E, Pérez-Valdivia MÁ, Odler B, Kronbichler A, Geddes C, Anders HJ, Floege J, Fernández-Juárez G, Praga M. Sodium-glucose cotransporter 2 inhibition in primary and secondary glomerulonephritis. Nephrol Dial Transplant 2024; 39:328-340. [PMID: 37550217 DOI: 10.1093/ndt/gfad175] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management glomerular/systemic autoimmune diseases with proteinuria in real-world clinical settings is unclear. METHODS This is a retrospective, observational, international cohort study. Adult patients with biopsy-proven glomerular diseases were included. The main outcome was the percentage reduction in 24-h proteinuria from SGLT2i initiation to 3, 6, 9 and 12 months. Secondary outcomes included percentage change in estimated glomerular filtration rate (eGFR), proteinuria reduction by type of disease and reduction of proteinuria ≥30% from SGLT2i initiation. RESULTS Four-hundred and ninety-three patients with a median age of 55 years and background therapy with renin-angiotensin system blockers were included. Proteinuria from baseline changed by -35%, -41%, -45% and -48% at 3, 6, 9 and 12 months after SGLT2i initiation, while eGFR changed by -6%, -3%, -8% and -10.5% at 3, 6, 9 and 12 months, respectively. Results were similar irrespective of the underlying disease. A correlation was found between body mass index (BMI) and percentage proteinuria reduction at last follow-up. By mixed-effects logistic regression model, serum albumin at SGLT2i initiation emerged as a predictor of ≥30% proteinuria reduction (odds ratio for albumin <3.5 g/dL, 0.53; 95% CI 0.30-0.91; P = .02). A slower eGFR decline was observed in patients achieving a ≥30% proteinuria reduction: -3.7 versus -5.3 mL/min/1.73 m2/year (P = .001). The overall tolerance to SGLT2i was good. CONCLUSIONS The use of SGLT2i was associated with a significant reduction of proteinuria. This percentage change is greater in patients with higher BMI. Higher serum albumin at SGLT2i onset is associated with higher probability of achieving a ≥30% proteinuria reduction.
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Affiliation(s)
| | - Kate Stevens
- Department of Nephrology and Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - Maite Padrón
- Department of Nephrology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Marco Montomoli
- Department of Nephrology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan Villa
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Fayna González
- Department of Nephrology, Hospital Doctor Negrín, Gran Canaria, Spain
| | - Cristina Vega
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel López Mendoza
- Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Loreto Fernández
- Department of Nephrology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | | | - Pedro J Labrador
- Department of Nephrology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | | | - Luis Martín-Penagos
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Estefanía Yerovi
- Department of Nephrology, Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Carmen Mon
- Department of Nephrology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Meritxell Ibernon
- Department of Nephrology, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | | | - Rosa Miquel
- Department of Nephrology, Hospital Universitario Canarias, Tenerife, Spain
| | - Milagros Sierra
- Department of Nephrology, Hospital San Pedro de Logroño, La Rioja, Logroño, Spain
| | - Victoria Mascarós
- Department of Nephrology, Hospital Francesc de Borja, Gandia, Valencia, Spain
| | - Leonella Luzardo
- Department of Nephrology, Hospital de Clínicas "Dr Manuel Quintela", Universidad de la República, Montevideo, Uruguay
| | | | - David Arroyo
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Úrsula Verdalles
- Department of Nephrology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Saúl Pampa-Saico
- Department of Nephrology, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Esperanza Moral Berrio
- Department of Nephrology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - José Luis Pérez Canga
- Department of Nephrology, Hospital Universitario San Agustín, Avilés, Asturias, Spain
| | - Blanca Tarragón
- Department of Nephrology, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Pilar Fraile Gómez
- Department of Nephrology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Dabaiba Regidor
- Department of Nephrology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Javier Relea
- Department of Nephrology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Marc Xipell
- Department of Nephrology, Hospital Clinic, Barcelona, Spain
| | | | - Maruja Navarro
- Department of Nephrology, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Álvaro Álvarez
- Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Begoña Rivas
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Eduardo Gutiérrez
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Balazs Odler
- Department of Medicine, University of Cambridge, Cambridge, UK
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Kronbichler
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Colin Geddes
- Department of Nephrology and Transplantation, Queen Elizabeth University Hospital, Glasgow, UK
| | - Hans-Joachim Anders
- Department of Internal Medicine IV, Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Jürgen Floege
- Division of Nephrology, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Manuel Praga
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Huang WH, Tu KH, Chen TD, Weng CH, Hsu CW. Presentation of glomerulocystic disease in a young onset diabetes: A case report. Medicine (Baltimore) 2024; 103:e36952. [PMID: 38277556 PMCID: PMC10817088 DOI: 10.1097/md.0000000000036952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024] Open
Abstract
RATIONALE This case report presents a challenging medical scenario involving a young adult male who exhibited an unusual combination of symptoms, including abrupt weight loss, declining renal function, proteinuria, and concurrent onset of diabetes mellitus. Remarkably, the patient had no previous medical history or family history of similar conditions, necessitating a comprehensive investigation. PATIENT CONCERNS On March 10, 2021, a 25-year-old male sought medical attention due to the aforementioned symptoms. Initial assessments revealed stage 5 chronic kidney disease, with elevated blood urea nitrogen (BUN) and serum creatinine (Cr) levels, as well as significant proteinuria. The only notable physical finding was obesity, and renal ultrasound showed normal-sized kidneys without cysts. DIAGNOSIS A treatment plan was initiated to stabilize creatinine levels, including medications such as Glimepiride, Glyxambi, Bisoprolol, Amlodipine, and Valsartan. However, despite diligent medication management, proteinuria persisted, prompting further evaluation. A renal biopsy was performed on April 12th, 2023, leading to the diagnosis of glomerulocystic kidney disease with early-stage changes indicative of diabetic nephropathy. INTERVENTIONS The patient continues to receive ongoing care and follow-up at our outpatient clinic to optimize therapeutic interventions and elucidate the underlying etiology of this complex clinical scenario. OUTCOMES Ongoing investigations and therapeutic interventions are crucial to understand the underlying cause and optimize patient care in this intricate clinical scenario. LESSONS This case underscores the complexity of diagnosing and managing a young adult presenting with concurrent renal dysfunction, proteinuria, and diabetes mellitus in the absence of prior underlying conditions. It highlights the importance of comprehensive evaluation and ongoing care in such challenging cases.
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Affiliation(s)
- Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Hemodialysis Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Hemodialysis Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tai-Di Chen
- Department of Pathology, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Hemodialysis Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
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Jung S, Lee S, Jeon H, Kim MH, Lee JS, Chang SH, Kim HJ, Jang H. Successful management of proteinuria in recurrent immunoglobulin A nephropathy after deceased donor kidney transplantation: A case report. Medicine (Baltimore) 2024; 103:e36990. [PMID: 38241588 PMCID: PMC10798750 DOI: 10.1097/md.0000000000036990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis, and recurrent IgAN is common after kidney transplantation (KT). Owing to the differences in various biopsy protocols and follow-ups in each study, the recurrence rate varies from 9.7% to 46%. Although the relapse rates are high, there is no definitive treatment for IgAN recurrence. METHODS We present a case of successful management of proteinuria in recurrent IgAN after deceased donor KT. A 60-year-old man diagnosed with IgAN 20 years prior, who progressed to end-stage renal disease, underwent deceased donor KT 5 years prior and was admitted to our hospital with progressively increasing proteinuria. RESULTS The pathological examination of the kidney biopsy specimen revealed recurrent IgAN. High-dose steroid treatment was initiated, and the patient was discharged while maintaining steroid treatment. However, outpatient follow-up showed that proteinuria did not decrease while steroids were maintained. Therefore, an angiotensin receptor blocker was administered after explaining its benefits to the patient. After the addition of angiotensin receptor blocker, proteinuria continued to decrease. CONCLUSION This case report highlights the importance of using renin-angiotensin system inhibitors with supportive care in cases of suspected of recurrent IgAN after KT. It also emphasizes the need to prescribe renin-angiotensin system inhibitors when steroid therapy is unsuccessful in cases of recurrent IgAN after KT.
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Affiliation(s)
- Sehyun Jung
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Seunghye Lee
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Hyejin Jeon
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Min Hye Kim
- Department of Pathology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Jong Sil Lee
- Department of Pathology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Se-Ho Chang
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Hyun-Jung Kim
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Hani Jang
- Division of Nephrology, Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
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Mehdipour Dalivand M, Hadjiabbasi A, Ramezanzadeh E, Habibzadeh SM, Goudarzi K, Shahriarirad R, Zayeni H. Nephrotic syndrome due to focal segmental glomerulosclerosis complicating scleroderma: a case report. J Med Case Rep 2024; 18:32. [PMID: 38225664 PMCID: PMC10790409 DOI: 10.1186/s13256-023-04273-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/17/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Systemic scleroderma (SSc) is an insidious autoimmune connective tissue disorder with multiorgan involvement. Renal involvement is one of the important causes of morbidity and mortality in scleroderma; however, nephrotic syndrome is reported rarely in association with SSc. We present a patient with SSc who developed focal segmental glomerulosclerosis (FSGS) as a complication of scleroderma. CASE PRESENTATION A 59 year old Caucasian female patient, with a known history of diffuse systemic sclerosis from 8 years, presented to our clinic with symptoms of anasarca and weight gain. Her physical examination was unremarkable except for periorbital and extremity edema. Her biochemistry assessment revealed decreased serum albumin levels and elevated serum creatinine levels. A renal biopsy was performed, which showed histopathological patterns of FSGS type of nephrotic syndrome. After administration of high doses of steroid and rituximab in the course of her treatment for 6 months, her symptoms and proteinuria were improved without the occurrence of scleroderma renal crises. CONCLUSION SSc is a complex multisystemic autoimmune disorder. SRC is the most prominent renal involvement in SSc, but other renal pathologies may also occur. Each patient should be precisely investigated since managing these renal conditions can differ significantly. Nephrotic syndrome is a rare complication of SSc, which could be managed with prompt diagnosis and steroid administration.
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Affiliation(s)
- Mahsa Mehdipour Dalivand
- Rheumatology Research Center, Department of Internal Medicine, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Asghar Hadjiabbasi
- Guilan Rheumatology Research Center, Department of Rheumatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Elham Ramezanzadeh
- Guilan Nephrology Research Center, Department of Nephrology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Kimia Goudarzi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Habib Zayeni
- Rheumatology Research Center, Department of Internal Medicine, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Mathur M, Barratt J, Chacko B, Chan TM, Kooienga L, Oh KH, Sahay M, Suzuki Y, Wong MG, Yarbrough J, Xia J, Pereira BJG. A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy. N Engl J Med 2024; 390:20-31. [PMID: 37916620 DOI: 10.1056/nejmoa2305635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND A proliferation-inducing ligand (APRIL) is implicated in the pathogenesis of IgA nephropathy. Sibeprenlimab is a humanized IgG2 monoclonal antibody that binds to and neutralizes APRIL. METHODS In this phase 2, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial, we randomly assigned adults with biopsy-confirmed IgA nephropathy who were at high risk for disease progression, despite having received standard-care treatment, in a 1:1:1:1 ratio to receive intravenous sibeprenlimab at a dose of 2, 4, or 8 mg per kilogram of body weight or placebo once monthly for 12 months. The primary end point was the change from baseline in the log-transformed 24-hour urinary protein-to-creatinine ratio at month 12. Secondary end points included the change from baseline in the estimated glomerular filtration rate (eGFR) at month 12. Safety was also assessed. RESULTS Among 155 patients who underwent randomization, 38 received sibeprenlimab at a dose of 2 mg per kilogram, 41 received sibeprenlimab at a dose of 4 mg per kilogram, 38 received sibeprenlimab at a dose of 8 mg per kilogram, and 38 received placebo. At 12 months, the geometric mean ratio reduction (±SE) from baseline in the 24-hour urinary protein-to-creatinine ratio was 47.2±8.2%, 58.8±6.1%, 62.0±5.7%, and 20.0±12.6% in the sibeprenlimab 2-mg, 4-mg, and 8-mg groups and the placebo group, respectively. At 12 months, the least-squares mean (±SE) change from baseline in eGFR was -2.7±1.8, 0.2±1.7, -1.5±1.8, and -7.4±1.8 ml per minute per 1.73 m2 in the sibeprenlimab 2-mg, 4-mg, and 8-mg groups and the placebo group, respectively. The incidence of adverse events that occurred after the start of administration of sibeprenlimab or placebo was 78.6% in the pooled sibeprenlimab groups and 71.1% in the placebo group. CONCLUSIONS In patients with IgA nephropathy, 12 months of treatment with sibeprenlimab resulted in a significantly greater decrease in proteinuria than placebo. (Funded by Visterra; ENVISION ClinicalTrials.gov number, NCT04287985; EudraCT number, 2019-002531-29.).
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MESH Headings
- Adult
- Humans
- Administration, Intravenous
- Creatinine/urine
- Double-Blind Method
- Glomerular Filtration Rate
- Glomerulonephritis, IGA/complications
- Glomerulonephritis, IGA/drug therapy
- Glomerulonephritis, IGA/genetics
- Proteinuria/drug therapy
- Proteinuria/etiology
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Tumor Necrosis Factor Ligand Superfamily Member 13/antagonists & inhibitors
- Tumor Necrosis Factor Ligand Superfamily Member 13/genetics
- Immunoglobulin G
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Affiliation(s)
- Mohit Mathur
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Jonathan Barratt
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Bobby Chacko
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Tak Mao Chan
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Laura Kooienga
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Kook-Hwan Oh
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Manisha Sahay
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Yusuke Suzuki
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Muh Geot Wong
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Jill Yarbrough
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Jing Xia
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
| | - Brian J G Pereira
- From Visterra, Waltham, MA (M.M., J.Y., B.J.G.P.); John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom (J.B.); Nephrology and Transplantation, John Hunter Hospital and University of Newcastle, Newcastle, NSW (B.C.), and the University of Sydney, Sydney (M.G.W.) - both in Australia; the University of Hong Kong, Queen Mary Hospital, Hong Kong (T.M.C.); Colorado Kidney Care, Denver (L.K.); Seoul National University College of Medicine, Seoul, South Korea (K.-H.O.); Osmania General Hospital, Hyderabad, India (M.S.); the Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo (Y.S.); and Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ (J.X.)
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Luo X, Wang J, Lin Z, Zhao J, Cao K, Liu J. Megaloblastic anemia and benign proteinuria: Clues to the diagnosis of Imerslund-Gräsbeck syndrome. Pediatr Blood Cancer 2024; 71:e30731. [PMID: 37855200 DOI: 10.1002/pbc.30731] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Xiaojuan Luo
- Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jieying Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhenhu Lin
- Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jiwei Zhao
- Department of Laboratory Medicine, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Ke Cao
- Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jinlin Liu
- Department of Clinical Laboratory, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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Ganesh K, Jayaram JK, Thomas RM, Abraham TT, Kumar JS, Simon SS, Abraham MA. Immunoglobulin A Deposits In Renal Allografts: A Prospective Longitudinal Single-Center Study. Transplant Proc 2024; 56:97-104. [PMID: 38216361 DOI: 10.1016/j.transproceed.2023.11.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/26/2023] [Indexed: 01/14/2024]
Abstract
AIMS AND BACKGROUND To describe the prevalence of IgA deposits (IgAD) in renal allografts in a cohort of renal transplant recipients and to analyze their management strategies and histopathology. To assess graft function and proteinuria after 1 year of follow-up. MATERIALS AND METHODS A prospective longitudinal follow-up study was carried out in VPS Lakeshore Hospital and Research Centre, Kochi, Kerala, over a period of 5 years (July 2015 to June 2020). Kidney transplant recipients with allograft biopsies that reported IgAD on immunofluorescence were included in the study. Light microscopy and immunofluorescence studies were performed. Mesangial hypercellularity (M); segmental glomerulosclerosis (S); endocapillary hypercellularity (E); tubular atrophy/interstitial fibrosis (T); crescents (C) (MEST-C) Scoring was done in patients with pathogenic IgAD. Treatment strategies included increased baseline steroid dosage, rituximab administration, and plasma exchange. Clinical details and management strategies were analyzed, and patients were followed up for 1 year after diagnosis. Changes in graft function (S. Creatinine) and proteinuria (Urine Protein/Creatinine ratio) were analyzed. Clinico-pathologic correlation with the MEST-C scores was also done. RESULTS Out of 1036 kidney transplants done in the study period, 760 graft biopsies were performed. Sixty-four cases had post-transplant deposition of IgA (8%). The mean age was 45 ± 11.25SD years. The study had 51 men and 13 women. Induction immunosuppression comprised rabbit antithymocyte globulin in 29 (45%) patients and basiliximab in 35 (54%). Maintenance immunosuppression in all comprised tacrolimus, mycophenolate mofetil, and steroids. There were 2 groups: group A (pathogenic IgAD) and group B (incidental IgAD). Group A had 46 cases (71.9%), out of which 8 had "active" IgA nephropathy (endocapillary proliferation, crescents, and IgA vasculitis), and 38 had "inactive" IgAD. In patients with active deposits, 3 had cellular crescents (18%, 30%, and 23%), all 8 had endocapillary proliferation, and 2 had vasculitis. Group B had 18 cases (28.1%), comprising T cell-mediated rejections (5), antibody-mediated rejection (8), BK virus nephropathy (1), and interstitial fibrosis and tubular atrophy (4). In group A, 22 (47.8%) presented with graft dysfunction, 8 (17.3%) with isolated proteinuria, and 14 (30.4%) patients presented with a combination. Two (4.3%) patients had neither. Fourteen (30.4%) patients presented within 1 month of renal transplant. In patients of group A, at the end of 1 year of treatment, the mean S. Creatinine reduced to 1.68 mg/dL from 1.84 mg/dL, and the mean protein/creatinine ratio reduced from 1.2 to 0.5 (±1.17). In patients with "active IgA" lesions, at the end of 1 year of treatment, the mean S. Creatinine increased slightly to 1.68 mg/dL (±0.47SD) from 1.48 mg/dL (±0.52SD), and the mean protein/creatinine ratio reduced from 2.32 (±1.56SD) to 1.05 (±1.70SD). In the 16 patients with IgAD and proteinuria, at the end of 1 year of treatment, the mean S. Creatinine decreased to 1.41 ± 0.32 SD mg/dL from 1.47±0.37SD mg/dL and the mean protein/creatinine ratio reduced from 1.12 ± 1.31 SD to 0.39±0.75 SD. In the remaining 22 patients with acute tubular injury, at the end of 1 year, the mean S. Creatinine decreased to 1.920.32 SD mg/dL from 2.10.8SD mg/dL, and the mean protein/creatinine ratio reduced from 1.1 ± 1.31 SD to 0.66 ± 1.45 SD. In the MEST-C scoring analysis, all scores were 0 in 20 (43.4%) biopsies, only M1 score in 11 (23.9%) biopsies, only E1 score in 10 biopsies (21.7%), S1 in 13 (28.2%) cases. CONCLUSION Immunoglobulin A deposits occur commonly after transplant; these may represent recurrence, de novo IgA, or donor-derived IgAD. Although commonly benign, some may cause significant graft dysfunction and graft loss. IgAD can present as varying combinations of graft dysfunction and proteinuria. Active IgA pathologies may occur early in the post-transplant course, may have significant graft dysfunction, and need proactive management. There is a correlation between segmental sclerosis and proteinuria. Evidence for the efficacy of Rituximab, plasma exchange, and prolonged courses of steroids is wanting; however, some benefits are possible. Long-term follow-up is essential.
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Affiliation(s)
- Kartik Ganesh
- Department of Nephrology and Renal Transplantation, VPS Lakeshore Hospital and Research Center, Nettoor, Maradu, Kochi, Kerala, India.
| | - J K Jayaram
- Department of Nephrology and Renal Transplantation, VPS Lakeshore Hospital and Research Center, Nettoor, Maradu, Kochi, Kerala, India
| | - Renu Mariam Thomas
- Department of Pathology, VPS Lakeshore Hospital and Research Center, Nettoor, Maradu, Kochi, Kerala, India
| | - Tena Thomas Abraham
- Department of Nephrology and Renal Transplantation, VPS Lakeshore Hospital and Research Center, Nettoor, Maradu, Kochi, Kerala, India
| | - Jithin S Kumar
- Department of Nephrology and Renal Transplantation, VPS Lakeshore Hospital and Research Center, Nettoor, Maradu, Kochi, Kerala, India
| | - Sunita S Simon
- Department of Nephrology and Renal Transplantation, VPS Lakeshore Hospital and Research Center, Nettoor, Maradu, Kochi, Kerala, India
| | - M Abi Abraham
- Department of Nephrology and Renal Transplantation, VPS Lakeshore Hospital and Research Center, Nettoor, Maradu, Kochi, Kerala, India
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Sun K, Shang D, Hao C, Lai L. Renal outcomes in IgA nephropathy following inactivated SARS-CoV-2 vaccination. Clin Exp Nephrol 2024; 28:23-30. [PMID: 37713044 DOI: 10.1007/s10157-023-02398-y] [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: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION There are increasing case reports on de novo or relapsing IgA nephropathy (IgAN) following SARS-CoV-2 vaccines, although the follow-up information on renal outcomes in IgAN patients post-SARS-CoV-2 vaccination is limited. In this study, we evaluated the renal outcomes of IgAN patients following inactivated vaccines. METHODS We investigated the change in eGFR, proteinuria and hematuria in 113 primary IgAN patients post-vaccination. Worsening proteinuria was defined as an increase in proteinuria by more than 0.5 times and proteinuria > 1 g/d. Univariate and multivariable logistic regression analysis were used to evaluate possible predictors of worsening proteinuria. We then compared the renal outcomes of vaccinated patients after 6 months with 101 unvaccinated patients who were followed during the same period. RESULTS A 2.54% (0.64, 8.61) decrease in renal function was observed in post-vaccination patients. Subgroup analysis revealed a significant decrease in eGFR in patients with 30 ≤ eGFR < 60 (mL/min/1.73 m2) post second SARS-CoV-2 dose (n = 18, p = 0.01). In addition, 10 individuals displayed worsening proteinuria post-vaccination, with the proteinuria subsequently ameliorating significantly after 6-month. Multivariate analysis showed that higher eGFR levels was an independent protective factor for worsening proteinuria. The renal outcome tended towards a decrease in eGFR in vaccinated patients after 6 months follow-up, although the difference was not significant (p = 0.06). CONCLUSION Kidney function in IgAN patients tended to worsen after SARS-CoV-2 vaccination, particularly those with initial poor kidney function. This pattern of disease flare appears to be clinically mild, and further research is needed to determine whether the impact on kidney function is long-term.
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Affiliation(s)
- Ke Sun
- Division of Nephrology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Da Shang
- Division of Nephrology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - LingYun Lai
- Division of Nephrology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China.
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Al Jurdi A, El Mouhayyar C, Efe O, Jeyabalan A, Riella LV. Nephrotic-range proteinuria: a potential risk factor for failure of tixagevimab-cilgavimab prophylaxis. J Nephrol 2024; 37:141-147. [PMID: 37658973 DOI: 10.1007/s40620-023-01750-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis with tixagevimab-cilgavimab has been shown to reduce the incidence of SARS-CoV-2 infection in immunocompromised individuals. Individuals with nephrotic-range proteinuria can lose immunoglobulins such as tixagevimab-cilgavimab in the urine and, therefore, may derive less benefit from tixagevimab-cilgavimab. There are no published studies evaluating the association of nephrotic-range proteinuria with failure of tixagevimab-cilgavimab prophylaxis. METHODS We conducted a retrospective observational cohort study of all individuals at our center who received tixagevimab-cilgavimab while they had nephrotic-range proteinuria. Each individual in the nephrotic group was matched 1:3 with controls who were matched for B cell depletion therapy in addition to the total dose and date of first tixagevimab-cilgavimab administration. The primary outcome was the development of breakthrough SARS-CoV-2 infection after receiving tixagevimab-cilgavimab. RESULTS Sixteen patients received tixagevimab-cilgavimab between January 1st, 2022, and June 30th, 2022, at a time when they had nephrotic-range proteinuria. Proteinuria levels and serum creatinine levels were higher while serum albumin levels were lower in the nephrotic group compared to the control group. At a median follow-up of 251 days, 38% of individuals in the nephrotic group had developed breakthrough SARS-CoV-2 infections, compared to only 13% in the control group at a median follow-up of 238 days. Nephrotic-range proteinuria was associated with a higher incidence of breakthrough infection (log-rank P = 0.04). CONCLUSIONS Nephrotic-range proteinuria may increase the risk of failure of tixagevimab-cilgavimab pre-exposure prophylaxis. Prospective studies to validate these findings and to evaluate the optimal dosing strategy of antibody-based prophylaxis in this group of patients are needed.
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Affiliation(s)
- Ayman Al Jurdi
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Vasculitis and Glomerulonephritis Center, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Orhan Efe
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Vasculitis and Glomerulonephritis Center, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Anushya Jeyabalan
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Vasculitis and Glomerulonephritis Center, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Leonardo V Riella
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA.
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Zhao W, Jiang J, Chen W. Plasma neutrophil gelatinase-associated lipocalin predicts renal tubulointerstitial injury in patients with IgA nephropathy. Clin Nephrol 2024; 101:1-8. [PMID: 37942929 DOI: 10.5414/cn111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE To investigate the relationship of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) with clinical indicators and pathology in patients with IgA nephropathy (IgAN). MATERIALS AND METHODS Clinical and pathological data of 36 patients with primary IgAN diagnosed by kidney biopsy were selected. The Oxford and Lee classifications were used to rank the pathology of IgAN patients and the particle-enhanced immunoturbidimetric method was adopted to measure pNGAL and uNGAL. Subsequently, the correlations of pNGAL and uNGAL levels with clinical indices and pathology were analyzed to evaluate the diagnostic value. RESULTS Referring to the comparison group, pNGAL levels were elevated in the women, 24-hour proteinuria ≥ 1 g/day, Lee classification IV - V, and tubular atrophy/interstitial fibrosis (T) score of 1 subgroup of Oxford classification (p < 0.05). The pNGAL was positively correlated with 24-hour proteinuria, urine microalbumin, urine α1 microglobulin, and the score of T (p < 0.05), while uNGAL was negatively correlated with serum albumin (p < 0.05). The occurrence of T1 was evaluated by pNGAL, serum creatinine (Scr), 24-hour proteinuria, and estimated glomerular filtration rate (eGFR), and it was shown that the area under the curve of 24-hour proteinuria, pNGAL, Scr, and eGFR were 0.629, 0.817, 0.919, and 0.799, respectively; in addition, the sensitivity of both pNGAL and eGFR are 100%. CONCLUSION The pNGAL levels in patients with IgAN are positively correlated with the Lee and Oxford classifications of T scores. The level of pNGAL in IgAN patients is found to be a prominent indicator for identification of renal tubulointerstitial injury and perhaps this feature may make it a non-invasive predictor for progression of IgAN.
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Balestra E, Barbi E, Ceconi V, Di Maso V, Conversano E, Pennesi M. Pioglitazone, a PPAR-y agonist, as one of the new therapeutic candidates for C3 glomerulopathy. Pediatr Nephrol 2024; 39:309-314. [PMID: 37493956 PMCID: PMC10673980 DOI: 10.1007/s00467-023-06088-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND C3-glomerulopathy (C3G) is a rare pediatric kidney disease characterised by dysregulation of the alternative complement pathway, with glomerular deposition of C3. C3G may often present as a steroid-resistant nephrotic syndrome (SRNS), and there is no established effective therapy: the usual treatment involves corticosteroids and immunosuppressive drugs. Pioglitazone, a PPAR-γ agonist with a protective action on podocytes, was reported in a few cases as helpful in reducing proteinuria when combined with steroids. CASE-DIAGNOSIS/TREATMENT We report the case of a 13-year-old girl with silent past medical history who presented with SRNS. A kidney biopsy showed findings indicative of C3G. A low sodium diet and angiotensin-converting enzyme inhibitor were started; immunosuppressive treatment with mycophenolate mofetil (MMF) was administered due to the cortico-resistance. Because of poor response to the immunosuppressant, a trial with eculizumab was attempted without significant response and persistence of proteinuria in the nephrotic range. A further therapeutic trial was performed with tacrolimus with no disease remission. Due to a severe deterioration in her condition, the girl was hospitalized and treated with high-dose steroid bolus. A daily dose of oral prednisone and MMF were re-started without benefit with persistent levels of nephrotic range proteinuria. The administration of pioglitazone consistently lowered proteinuria levels for the first time since the onset of the disease, with a maintenance of the effect and normalization (< 0.15 g/24 h) at the 10-month follow-up. CONCLUSIONS In this patient affected by C3G, pioglitazone proved effective in reducing proteinuria levels.
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Affiliation(s)
- Elia Balestra
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
| | - Egidio Barbi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Viola Ceconi
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Vittorio Di Maso
- Department of Nephrology, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Ester Conversano
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Pennesi
- Paediatric Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
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Rosales IA, Kinoshita K, Maenaka A, How IDAL, Selig MK, Laguerre CM, Collins AB, Ayares D, Cooper DKC, Colvin RB. De novo membranous nephropathy in a pig-to-baboon kidney xenograft: A new xenograft glomerulopathy. Am J Transplant 2024; 24:30-36. [PMID: 37633449 DOI: 10.1016/j.ajt.2023.08.016] [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: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
De novo membranous nephropathy (dnMN) is an uncommon immune complex-mediated late complication of human kidney allografts that causes proteinuria. We report here the first case of dnMN in a pig-to-baboon kidney xenograft. The donor was a double knockout (GGTA1 and β4GalNT1) genetically engineered pig with a knockout of the growth hormone receptor and addition of 6 human transgenes (hCD46, hCD55, hTBM, hEPCR, hHO1, and hCD47). The recipient developed proteinuria at 42 days posttransplant, which progressively rose to the nephrotic-range at 106 days, associated with an increase in serum antidonor IgG. Kidney biopsies showed antibody-mediated rejection (AMR) with C4d and thrombotic microangiopathy that eventually led to graft failure at 120 days. In addition to AMR, the xenograft had diffuse, global granular deposition of C4d and IgG along the glomerular basement membrane on days 111 and 120. Electron microscopy showed extensive amorphous subepithelial electron-dense deposits with intervening spikes along the glomerular basement membrane. These findings, in analogy to human renal allografts, are interpreted as dnMN in the xenograft superimposed on AMR. The target was not identified but is hypothesized to be a pig xenoantigen expressed on podocytes. Whether dnMN will be a significant problem in other longer-term xenokidneys remains to be determined.
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Affiliation(s)
- Ivy A Rosales
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - Kohei Kinoshita
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Akihiro Maenaka
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ira Doressa Anne L How
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin K Selig
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christina M Laguerre
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - A Bernard Collins
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - David K C Cooper
- Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert B Colvin
- Department of Pathology, Immunopathology Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Rheault MN, Alpers CE, Barratt J, Bieler S, Canetta P, Chae DW, Coppock G, Diva U, Gesualdo L, Heerspink HJL, Inrig JK, Kirsztajn GM, Kohan D, Komers R, Kooienga LA, Lieberman K, Mercer A, Noronha IL, Perkovic V, Radhakrishnan J, Rote W, Rovin B, Tesar V, Trimarchi H, Tumlin J, Wong MG, Trachtman H. Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis. N Engl J Med 2023; 389:2436-2445. [PMID: 37921461 DOI: 10.1056/nejmoa2308550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND An unmet need exists for focal segmental glomerulosclerosis (FSGS) treatment. In an 8-week, phase 2 trial, sparsentan, a dual endothelin-angiotensin receptor antagonist, reduced proteinuria in patients with FSGS. The efficacy and safety of longer-term treatment with sparsentan for FSGS are unknown. METHODS In this phase 3 trial, we enrolled patients with FSGS (without known secondary causes) who were 8 to 75 years of age; patients were randomly assigned to receive sparsentan or irbesartan (active control) for 108 weeks. The surrogate efficacy end point assessed at the prespecified interim analysis at 36 weeks was the FSGS partial remission of proteinuria end point (defined as a urinary protein-to-creatinine ratio of ≤1.5 [with protein and creatinine both measured in grams] and a >40% reduction in the ratio from baseline). The primary efficacy end point was the estimated glomerular filtration rate (eGFR) slope at the time of the final analysis. The change in eGFR from baseline to 4 weeks after the end of treatment (week 112) was a secondary end point. Safety was also evaluated. RESULTS A total of 371 patients underwent randomization: 184 were assigned to receive sparsentan and 187 to receive irbesartan. At 36 weeks, the percentage of patients with partial remission of proteinuria was 42.0% in the sparsentan group and 26.0% in the irbesartan group (P = 0.009), a response that was sustained through 108 weeks. At the time of the final analysis at week 108, there were no significant between-group differences in the eGFR slope; the between-group difference in total slope (day 1 to week 108) was 0.3 ml per minute per 1.73 m2 of body-surface area per year (95% confidence interval [CI], -1.7 to 2.4), and the between-group difference in the slope from week 6 to week 108 (i.e., chronic slope) was 0.9 ml per minute per 1.73 m2 per year (95% CI, -1.3 to 3.0). The mean change in eGFR from baseline to week 112 was -10.4 ml per minute per 1.73 m2 with sparsentan and -12.1 ml per minute per 1.73 m2 with irbesartan (difference, 1.8 ml per minute per 1.73 m2; 95% CI, -1.4 to 4.9). Sparsentan and irbesartan had similar safety profiles, and the frequency of adverse events was similar in the two groups. CONCLUSIONS Among patients with FSGS, there were no significant between-group differences in eGFR slope at 108 weeks, despite a greater reduction in proteinuria with sparsentan than with irbesartan. (Funded by Travere Therapeutics; DUPLEX ClinicalTrials.gov number, NCT03493685.).
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Affiliation(s)
- Michelle N Rheault
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Charles E Alpers
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Jonathan Barratt
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Stewart Bieler
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Pietro Canetta
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Dong-Wan Chae
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Gaia Coppock
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Ulysses Diva
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Loreto Gesualdo
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Hiddo J L Heerspink
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Jula K Inrig
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Gianna M Kirsztajn
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Donald Kohan
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Radko Komers
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Laura A Kooienga
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Kenneth Lieberman
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Alex Mercer
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Irene L Noronha
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Vlado Perkovic
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Jai Radhakrishnan
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - William Rote
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Brad Rovin
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Vladimir Tesar
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Hernán Trimarchi
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - James Tumlin
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Muh Geot Wong
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
| | - Howard Trachtman
- From the Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis (M.N.R.); the Department of Laboratory Medicine and Pathology, University of Washington, Seattle (C.E.A.); the Department of Cardiovascular Sciences, University of Leicester General Hospital, Leicester, United Kingdom (J.B.); Travere Therapeutics, San Diego, CA (S.B., U.D., J.K.I., R.K., W.R.); the Division of Nephrology, Columbia University Irving Medical Center, New York (P.C., J.R.); the Division of Nephrology, Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea (D.-W.C.); Penn Renal Electrolyte and Hypertension Perelman, University of Pennsylvania, Philadelphia (G.C.); the Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy (L.G.); the Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, the Netherlands (H.J.L.H.); the George Institute for Global Health (H.J.L.H., V.P.) and the Faculty of Medicine and Health (V.P.), University of New South Wales, Sydney, and the Department of Renal Medicine, Concord Repatriation General Hospital, and Concord Clinical School, University of Sydney, Concord, NSW (M.G.W.) - all in Australia; the Department of Medicine (Nephrology), Federal University of São Paulo (G.M.K.), and the Division of Nephrology, University of São Paulo (I.L.N.) - both in São Paulo; the Department of Internal Medicine, Division of Nephrology, School of Medicine, University of Utah, Salt Lake City (D.K.); Colorado Kidney Care, Denver (L.A.K.); Hackensack University Medical Center, Hackensack, NJ (K.L.); JAMCO Pharma Consulting, Stockholm (A.M.); the Division of Nephrology, Ohio State University Wexner Medical Center, Columbus (B.R.); Všeobecná fakultní nemocnice v Praze, Prague, Czech Republic (V.T.); the Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires (H. Trimarchi); the Renal Division, Emory University, Atlanta, and the NephroNet Clinical Trials Consortium, Lawrenceville - both in Georgia (J.T.); and the Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor (H. Trachtman)
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López Del Moral C, Wu K, Naik M, Osmanodja B, Akifova A, Lachmann N, Stauch D, Hergovits S, Choi M, Bachmann F, Halleck F, Schrezenmeier E, Schmidt D, Budde K. Predictors of graft failure after first detection of de novo donor-specific HLA antibodies in kidney transplant recipients. Nephrol Dial Transplant 2023; 39:84-94. [PMID: 37410616 DOI: 10.1093/ndt/gfad149] [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: 03/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND De novo donor-specific antibodies (dnDSAs) may cause antibody-mediated rejection and graft dysfunction. Little is known about the clinical course after first detection of dnDSAs during screening in asymptomatic patients. We aimed to assess the value of estimated glomerular filtration rate (eGFR) and proteinuria to predict graft failure in patients with dnDSAs and their potential utility as surrogate endpoints. METHODS All 400 kidney transplant recipients with dnDSAs at our centre (1 March 2000-31 May 2021) were included in this retrospective study. The dates of graft loss, rejection, doubling of creatinine, ≥30% eGFR decline, proteinuria ≥500 mg/g and ≥1000 mg/g were registered from the first dnDSA appearance. RESULTS During 8.3 years of follow-up, graft failure occurred in 33.3% of patients. Baseline eGFR and proteinuria correlated with 5-year graft loss (area under the receiver operating characteristics curve 0.75 and 0.80, P < .001). Creatinine doubled after a median of 2.8 years [interquartile range (IQR) 1.5-5.0] from dnDSA and the time from doubling creatinine to graft failure was 1.0 year (IQR 0.4-2.9). Analysing eGFR reduction ≥30% as a surrogate endpoint (148/400), the time from dnDSA to this event was 2.0 years (IQR 0.6-4.2), with a positive predictive value (PPV) of 45.9% to predict graft loss, which occurred after 2.0 years (IQR 0.8-3.2). The median time from proteinuria ≥500 mg/g and ≥1000 mg/g to graft failure was identical, 1.8 years, with a PPV of 43.8% and 49.0%, respectively. Composite endpoints did not improve PPV. Multivariable analysis showed that rejection was the most important independent risk factor for all renal endpoints and graft loss. CONCLUSIONS Renal function, proteinuria and rejection are strongly associated with graft failure in patients with dnDSA and may serve as surrogate endpoints.
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Affiliation(s)
- Covadonga López Del Moral
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Nephrology, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
| | - Kaiyin Wu
- Department of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcel Naik
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bilgin Osmanodja
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Aylin Akifova
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nils Lachmann
- Institute for Transfusion Medicine, HLA-Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Diana Stauch
- Institute for Transfusion Medicine, HLA-Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Hergovits
- Institute for Transfusion Medicine, HLA-Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mira Choi
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Bachmann
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eva Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health Charité - Universitätsmedizin Berlin, BIH Academy, Berlin, Germany
| | - Danilo Schmidt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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