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Tan LW, Wan JL, Zhu CH, Xu H, Xia ZK, Chen LZ, Wu XC, Wang F, Liu XR, Zhao CG, Li XZ, Mao JH, Wang XW, Huang WY, Li YH, Zhang JJ, Feng SP, Yang J, Liu JJ, Gao CL, Rong LP, Shuai LJ, Xu K, Zhang HJ, Li Q, Zhang AH, Wang M. Risk factors for renal outcomes in children with antineutrophil cytoplasmic antibody-associated vasculitis: a nationwide retrospective study in China. World J Pediatr 2024; 20:506-516. [PMID: 37853276 PMCID: PMC11136751 DOI: 10.1007/s12519-023-00753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Pediatric antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a life-threatening systemic vasculitis featured by liability to renal involvement. However, there are few studies on the risk factors and predictive models for renal outcomes of AAV in children. METHODS Data from 179 AAV children in multiple centers between January 2012 and March 2020 were collected retrospectively. The risk factors and predictive model of end-stage renal disease (ESRD) in AAV were explored. RESULTS Renal involvement was the most typical manifestation (95.5%), and the crescent was the predominant pathological lesion (84.9%). The estimated glomerular filtration rate (eGFR) was evaluated in 114 patients, of whom 59.6% developed ESRD, and the median time to ESRD was 3.20 months. The eGFR [P = 0.006, odds ratio (OR) = 0.955, 95% confidence interval (CI) = 0.924-0.987] and the percentages of global glomerulosclerosis (pGGS; P = 0.018, OR = 1.060, 95% CI = 1.010-1.112) were independent risk factors for ESRD of renal biopsy. Based on the pGGS and eGFR at renal biopsy, we developed three risk grades of ESRD and one predictive model. The Kaplan‒Meier curve indicated that renal outcomes were significantly different in different risk grades (P < 0.001). Compared with serum creatinine at baseline, the predictive model had higher accuracy (0.86 versus 0.58, P < 0.001) and a lower coefficient of variation (0.07 versus 0.92) in external validation. CONCLUSIONS Renal involvement is the most common manifestation of pediatric AAV in China, of which more than half deteriorates into ESRD. The predictive model based on eGFR at renal biopsy and the pGGS may be stable and accurate in speculating the risk of ESRD in AAV children. Supplementary file 2 (MP4 18937 KB).
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Affiliation(s)
- Li-Wen Tan
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jun-Li Wan
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun-Hua Zhu
- Department of Nephrology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, National Paediatric Medical Center of China, Shanghai, China
| | - Zheng-Kun Xia
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Li-Zhi Chen
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Chuan Wu
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiao-Rong Liu
- Department of Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
- National Center for Children's Health, Beijing, China
| | - Cheng-Guang Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Zhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Jian-Hua Mao
- Department of Nephrology, Children Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Wen Wang
- Department of Nephrology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Wen-Yan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Hong Li
- Pediatric Nephrology Department, Guiyang Maternal & Child Health Care Hospital, Guiyang, China
| | - Jian-Jiang Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shi-Pin Feng
- Department of Nephrology, Chengdu Women and Children Central Hospital, Chengdu, 610041, China
| | - Jun Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiao-Jiao Liu
- Department of Nephrology, Children's Hospital of Fudan University, National Paediatric Medical Center of China, Shanghai, China
| | - Chun-Lin Gao
- Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Li-Ping Rong
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lan-Jun Shuai
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ke Xu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - He-Jia Zhang
- Department of Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
- National Center for Children's Health, Beijing, China
| | - Qiu Li
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ai-Hua Zhang
- Department of Nephrology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
| | - Mo Wang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Rd.136, Chongqing, 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Younger DS. Headaches and Vasculitis. Neurol Clin 2024; 42:389-432. [PMID: 38575258 DOI: 10.1016/j.ncl.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Vasculitis refers to heterogeneous clinicopathologic disorders that share the histopathology of inflammation of blood vessels. Unrecognized and therefore untreated, vasculitis of the nervous system leads to pervasive injury and disability making this a disorder of paramount importance to all clinicians. Headache may be an important clue to vasculitic involvement of central nervous system (CNS) vessels. CNS vasculitis may be primary, in which only intracranial vessels are involved in the inflammatory process, or secondary to another known disorder with overlapping systemic involvement. Primary neurologic vasculitides can be diagnosed with assurance after intensive evaluation that incudes tissue confirmation whenever possible.
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Affiliation(s)
- David S Younger
- Department of Medicine, Section of Neuroscience, City University of New York School of Medicine, New York, NY, USA; Department of Neurology, White Plains Hospital, White Plains, NY, USA.
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Sommer B, González-Ávila G, Flores-Soto E, Montaño LM, Solís-Chagoyán H, Romero-Martínez BS. Phytoestrogen-Based Hormonal Replacement Therapy Could Benefit Women Suffering Late-Onset Asthma. Int J Mol Sci 2023; 24:15335. [PMID: 37895016 PMCID: PMC10607548 DOI: 10.3390/ijms242015335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
It has been observed that plasmatic concentrations of estrogens, progesterone, or both correlate with symptoms in asthmatic women. Fluctuations in female sex steroid concentrations during menstrual periods are closely related to asthma symptoms, while menopause induces severe physiological changes that might require hormonal replacement therapy (HRT), that could influence asthma symptoms in these women. Late-onset asthma (LOA) has been categorized as a specific asthmatic phenotype that includes menopausal women and novel research regarding therapeutic alternatives that might provide relief to asthmatic women suffering LOA warrants more thorough and comprehensive analysis. Therefore, the present review proposes phytoestrogens as a promising HRT that might provide these females with relief for both their menopause and asthma symptoms. Besides their well-recognized anti-inflammatory and antioxidant capacities, phytoestrogens activate estrogen receptors and promote mild hormone-like responses that benefit postmenopausal women, particularly asthmatics, constituting therefore a very attractive potential therapy largely due to their low toxicity and scarce side effects.
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Affiliation(s)
- Bettina Sommer
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias ‘Ismael Cosio Villegas’, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City CP 14080, Mexico
| | - Georgina González-Ávila
- Laboratorio de Oncología Biomédica, Departamento de Enfermedades Crónico Degenerativas, Instituto Nacional de Enfermedades Respiratorias ‘Ismael Cosio Villegas’, Mexico City CP 14080, Mexico;
| | - Edgar Flores-Soto
- Departmento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico; (E.F.-S.); (L.M.M.); (B.S.R.-M.)
| | - Luis M. Montaño
- Departmento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico; (E.F.-S.); (L.M.M.); (B.S.R.-M.)
| | - Héctor Solís-Chagoyán
- Neurociencia Cognitiva Evolutiva, Centro de Investigación en Ciencias Cognitivas, Universidad Autónoma del Estado de Morelos, Cuernavaca CP 62209, Morelos, Mexico;
| | - Bianca S. Romero-Martínez
- Departmento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City CP 04510, Mexico; (E.F.-S.); (L.M.M.); (B.S.R.-M.)
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Fijolek J, Radzikowska E. Eosinophilic granulomatosis with polyangiitis - Advances in pathogenesis, diagnosis, and treatment. Front Med (Lausanne) 2023; 10:1145257. [PMID: 37215720 PMCID: PMC10193253 DOI: 10.3389/fmed.2023.1145257] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease characterized by eosinophil-rich granulomatous inflammation and necrotizing vasculitis, pre-dominantly affecting small-to-medium-sized vessels. It is categorized as a primary antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) but also shares features of hypereosinophilic syndrome (HES); therefore, both vessel inflammation and eosinophilic infiltration are suggested to cause organ damage. This dual nature of the disease causes variable clinical presentation. As a result, careful differentiation from mimicking conditions is needed, especially from HES, given the overlapping clinical, radiologic, and histologic features, and biomarker profile. EGPA also remains a diagnostic challenge, in part because of asthma, which may pre-dominate for years, and often requires chronic corticosteroids (CS), which can mask other disease features. The pathogenesis is still not fully understood, however, the interaction between eosinophils and lymphocytes B and T seems to play an important role. Furthermore, the role of ANCA is not clear, and only up to 40% of patients are ANCA-positive. Moreover, two ANCA-dependent clinically and genetically distinct subgroups have been identified. However, a gold standard test for establishing a diagnosis is not available. In practice, the disease is mainly diagnosed based on the clinical symptoms and results of non-invasive tests. The unmet needs include uniform diagnostic criteria and biomarkers to help distinguish EGPA from HESs. Despite its rarity, notable progress has been made in understanding the disease and in its management. A better understanding of the pathophysiology has provided new insights into the pathogenesis and therapeutic targets, which are reflected in novel biological agents. However, there remains an ongoing reliance on corticosteroid therapy. Therefore, there is a significant need for more effective and better-tolerated steroid-sparing treatment schemes.
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Bernardi S, Seugé L, Boyer O. ANCA-associated vasculitis in children. Nephrol Dial Transplant 2023; 38:66-69. [PMID: 36166356 DOI: 10.1093/ndt/gfac265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Silvia Bernardi
- School of Nephrology, Università degli Studi di Milano, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laure Seugé
- Néphrologie pédiatrique, centre de référence MARHEA, Hôpital Necker - Enfants Malades, APHP, Inserm U1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Olivia Boyer
- Néphrologie pédiatrique, centre de référence MARHEA, Hôpital Necker - Enfants Malades, APHP, Inserm U1163, Institut Imagine, Université Paris Cité, Paris, France
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6
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Pediatric ANCA vasculitis: clinical presentation, treatment, and outcomes in a French retrospective study. Pediatr Nephrol 2023:10.1007/s00467-022-05855-0. [PMID: 36622443 DOI: 10.1007/s00467-022-05855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 11/20/2022] [Accepted: 12/08/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pediatric ANCA vasculitis is a rare group of diseases with a scarcity of data in children. Annual incidence appeared to increase in the last several years, placing higher interest in the clinical and therapeutical outcomes of the disorder. Also, the growing use of rituximab questions the latest outcomes in these diseases. We therefore conducted a retrospective study to better understand the current characteristics, management, and the latest outcomes of the disorder. METHODS We conducted a 9-year retrospective study of 46 children in 14 different centers across France to describe their clinical and laboratory presentations, therapeutic regimens, and kidney outcome. RESULTS P-ANCA appeared to be a potential marker for higher relapse risk. Compared to adults, we found that ear-nose-throat presentations were frequent (45.7%) and more severe. Despite an evolution in the treatment management, kidney outcome remained poor with a substantial proportion of chronic kidney disease (54.8% at 1 year). Mortality stays low with 3 patients (6.5%) deceased at the end of our study. CONCLUSION Clinical presentation was as previously described and time to diagnosis remains long. P-ANCA is a statistically significant marker for increased relapse risk. We observed a modification in the treatment regimens over the past several years with a growing use of rituximab and a decreasing use of cyclophosphamide. Despite these changes, kidney outcome remains poor and prospective studies should be conducted to assess the most appropriate therapeutic modality for each patient. A higher resolution version of the Graphical abstract is available as Supplementary information.
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7
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Theisen A, Phillips CL, Rodriguez M. ANCA-associated vasculitis with cardiac valve vegetations in two teenage males: two case reports and a literature review. Pediatr Rheumatol Online J 2022; 20:94. [PMID: 36307821 PMCID: PMC9616620 DOI: 10.1186/s12969-022-00750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis is a term used to describe systemic vasculitides that affect small and medium-sized blood vessels. Granulomatosis with Polyangiitis (GPA), a type of ANCA-associated vasculitis (AAV), is rare in children with an estimated prevalence of 3-4 per million, and even more rare is the manifestation of cardiac abnormalities secondary to ANCA-associated vasculitis in the pediatric population. CASE PRESENTATION We discuss the cases of two teenage males who presented with cardiac valvular lesions secondary to GPA in addition to sinus, pulmonary, renal, and cutaneous involvement. These findings of cardiac valvular abnormalities in GPA have rarely been described in the literature in pediatrics. Both patients were treated with rituximab, high-dose methylprednisolone, and therapeutic plasma exchange and showed improvement in their disease manifestations. CONCLUSIONS A review of the literature revealed only five pediatric cases of ANCA-associated vasculitis with cardiac manifestations, and interestingly, three of the five had valvular involvement. Subsequent valvular involvement makes obtaining the diagnosis of ANCA-Associated Vasculitis difficult due to concern for underlying infectious endocarditis and can lead to misdiagnosis given the rarity of cardiac involvement in ANCA-associated vasculitis. Routine echocardiogram is not always completed in newly diagnosed AAV, yet cardiac involvement can lead to severe consequences as was seen with our first patient in the form of thromboembolic stroke. We discuss the importance of keeping AAV on the differential when cardiac lesions are present as well as the importance of regular cardiac screening in newly diagnosed patients with AAV, as it is a major factor of cardiac morbidity and mortality in the adult population and can contribute substantially to management decisions.
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Affiliation(s)
- Alexandra Theisen
- Pediatric Rheumatology, Riley Hospital for Children, Indiana University School of Medicine, 1200 West Michigan Street Suite 201, Indianapolis, Indiana, 46202, USA. .,Pediatric Rheumatology, Saint Louis University, SSM Health Cardinal Glennon Children's Hospital, 1465 South Grand Boulevard, Glennon Hall RM 3713, Saint Louis, Missouri, 63104, USA.
| | - Carrie L. Phillips
- grid.257413.60000 0001 2287 3919Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana 46202 USA
| | - Martha Rodriguez
- grid.257413.60000 0001 2287 3919Pediatric Rheumatology, Riley Hospital for Children, Indiana University School of Medicine, 1200 West Michigan Street Suite 201, Indianapolis, Indiana 46202 USA
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Lipsett B, Lichak B, Kotok I, Helm M, Hahn T. Veiled Vasculitis in a 14-Year-Old Presenting With Chest Pain and Polyarthralgias. Pediatrics 2022; 150:188541. [PMID: 35851615 DOI: 10.1542/peds.2021-055842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare, small-vessel vasculitis that often presents with upper and lower respiratory tract symptoms along with nonspecific symptoms, including fever and weight loss. Although it is more likely to present in adulthood, GPA can present at all ages and affect multiple organ systems, making its recognition exceedingly difficult and leading to delayed diagnosis. This is particularly deleterious in the pediatric population in which delayed diagnosis and treatment are associated with a significantly worse prognosis, significant hematologic complications, and irreversible organ damage. We discuss a 14-year-old boy with GPA who presented with noncardiac chest pain and polyarthralgias in whom a detailed review of systems later revealed a 2-year history of fevers, malaise, and failure to thrive. Our report reveals the importance of early recognition and treatment of GPA during childhood.
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Affiliation(s)
- Brody Lipsett
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Brooke Lichak
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Irene Kotok
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Matthew Helm
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Timothy Hahn
- Penn State Health Children's Hospital, Hershey, Pennsylvania
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Ottolini MC, Shailam R, Sharma A, Rosales IA. Case 21-2022: A 17-Year-Old Girl with Fever and Cough. N Engl J Med 2022; 387:168-176. [PMID: 35830644 DOI: 10.1056/nejmcpc2115851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mary C Ottolini
- From the Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland (M.C.O.); and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
| | - Randheer Shailam
- From the Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland (M.C.O.); and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
| | - Amita Sharma
- From the Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland (M.C.O.); and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
| | - Ivy A Rosales
- From the Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland (M.C.O.); and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Massachusetts General Hospital, and the Departments of Radiology (R.S.), Pediatrics (A.S.), and Pathology (I.A.R.), Harvard Medical School - both in Boston
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10
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Finkel R, Honig J, Chao CP, Rescoe E, Solomon S. The use of ECMO in pediatric granulomatosis with polyangiitis. Pediatr Rheumatol Online J 2022; 20:35. [PMID: 35538584 PMCID: PMC9092879 DOI: 10.1186/s12969-022-00693-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) vasculitis with pulmonary-renal syndrome rarely presents in children and is associated with high mortality rates. CASE PRESENTATION We present the case of a 13-year-old male with newly diagnosed GPA vasculitis, treated with extracorporeal membrane oxygenation, continuous renal replacement therapy, plasmapheresis, rituximab, cyclophosphamide, and corticosteroids. CONCLUSION This case presentation demonstrates that ECMO can be used as a life supporting therapy in pediatric patients with pulmonary hemorrhage from ANCA vasculitis in conjunction with other therapies.
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Affiliation(s)
- Rachel Finkel
- grid.260917.b0000 0001 0728 151XDepartment of Pediatrics, Maria Fareri Children’s Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York USA
| | - Jesse Honig
- grid.260917.b0000 0001 0728 151XDepartment of Pediatrics, New York Medical College, Valhalla, New York USA
| | - Chun P. Chao
- grid.260917.b0000 0001 0728 151XDivision of Rheumatology, Maria Fareri Children’s Hospital, Westchester Medical Center, Boston Children’s Health Physicians, New York Medical College, Valhalla, New York USA
| | - Erin Rescoe
- grid.260917.b0000 0001 0728 151XDivision of Critical Care Medicine, Maria Fareri Children’s Hospital, Westchester Medical Center, Boston Children’s Health Physicians, New York Medical College, Valhalla, New York USA
| | - Sonia Solomon
- Division of Pediatric Nephrology, Maria Fareri Children's Hospital, Westchester Medical Center, Boston Children's Health Physicians, New York Medical College, Valhalla, NY, USA.
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Balani S, Kizilbash SJ, Kouri AM. Antineutrophilic cytoplasmic antibody-associated vasculitis and the kidney. Curr Opin Pediatr 2022; 34:197-202. [PMID: 34923562 DOI: 10.1097/mop.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight recent studies that have emerged on the topic of ANCA-associated vasculitis with some historical context. The review also discusses how the adult data is relevant to pediatric patients. RECENT FINDINGS Pediatric studies on AAV are lacking. Therapies targeted to the inflammatory cascade specifically implicated in AAV, such as MPO inhibitors and complement mediators, are emerging. The PEXIVAS study recently called into question the routine use of plasma exchange (PLEX) in severe AAV, with no difference in ESKD or mortality found between patients who did or did not receive PLEX. Longer maintenance duration of nearly 48 months is preferred as compared with shorter duration in patients who are not on dialysis because of higher relapse rates in children with AAV. SUMMARY Current treatment in AAV includes corticosteroids, rituximab, and cyclophosphamide for induction. Maintenance therapy commonly consists of azathioprine or rituximab. Plasma exchange (PLEX) is no longer recommended for induction therapy for AAV but some experts still consider this as an option for patients who are not responding to therapy or have severe disease at presentation. However, emerging novel therapies may be on the horizon.
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Affiliation(s)
- Shanthi Balani
- Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Deng X, Gao J, Zhao F. Identification of differentially expressed genes and pathways in kidney of ANCA-associated vasculitis by integrated bioinformatics analysis. Ren Fail 2022; 44:204-216. [PMID: 35172670 PMCID: PMC8856091 DOI: 10.1080/0886022x.2022.2030755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systematic of relatively rare autoimmune diseases with unknown cause. Kidney involvement is one of the most common clinical manifestations, and the degree of renal damage is closely associated with the development and prognosis of AAV. In this study, we utilized the Robust Rank Aggreg (RRA) method in R to integrate GSE104948, GSE104954, GSE108109, GSE108112, and GSE108113 profile datasets loaded from Gene Expression Omnibus (GEO) database and identified a set of differentially expressed genes (DEGs) in kidney between AAV patients and living donors. Then, the results of gene ontology (GO) functional annotation showed that immunity and metabolism involved process of AAV both in glomerulus and tubulointerstitial. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that following pathways, such as complement and coagulation cascades pathway; Staphylococcus aureus infection; disease-COVID-19; and systemic lupus erythematosus (SLE) pathway play a crucial role in AAV. Next, the results analyzed by protein–protein interaction (PPI) network and Cytoscape software exhibited the hub genes ALB, TYROBP, and CYBB existed in both glomerular and tubulointerstitial compartments datasets. Finally, KEGG analysis using genes of two most important modules also further validated complement and coagulation cascades pathway and S. aureus infection existed both in glomerulus and tubulointerstitial compartments datasets. In conclusion, this study identified key genes and pathways involved in kidney of AAV, which was benefit to further uncover the mechanisms underlying the development and progress of AAV, biomarkers, and potential therapeutic targets as well.
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Affiliation(s)
- Xu Deng
- Department of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, P. R. China
| | - Junying Gao
- Department of Human Anantomy, Nanjing Medical University, Nanjing, P. R. China
| | - Fei Zhao
- Department of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, P. R. China
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13
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Wardinger J, Sussman L, Irish E, Foulke L, Litwa B, Kaslovsky R. Autoimmune overload: An atypical presentation of granulomatosis with polyangiitis in an adolescent with type 1 diabetes mellitus. Pediatr Pulmonol 2022; 57:322-324. [PMID: 34695301 DOI: 10.1002/ppul.25724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/11/2021] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Jamie Wardinger
- Department of Pediatrics, Albany Medical Center, Albany, New York, USA.,Department of Neonatal-Perinatal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Lauren Sussman
- Department of Pediatrics, Albany Medical Center, Albany, New York, USA
| | - Elizabeth Irish
- Shaffer Library of Health Sciences, Albany Medical College, Albany, New York, USA
| | - Llewellyn Foulke
- Department of Pathology, Albany Medical Center, Albany, New York, USA
| | | | - Robert Kaslovsky
- Department of Pediatrics (Pulmonary), Albany Medical College, Albany, New York, USA
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14
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Pediatric cardiothoracic vasculitis: multimodality imaging review. Pediatr Radiol 2022; 52:1895-1909. [PMID: 35790558 PMCID: PMC9256530 DOI: 10.1007/s00247-022-05431-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 10/27/2022]
Abstract
The pediatric vasculitides are a relatively uncommon and heterogeneous group of disorders characterized by vessel inflammation, often with cardiothoracic involvement. Diagnosis and monitoring are often clinically challenging because of the nonspecific symptoms and laboratory markers. Thus, imaging has assumed increasing importance for early detection of disease activity, extent and complications as well as long-term monitoring pre- and post-treatment. Herein, we review the major pediatric vasculitides with frequent chest manifestations, including Takayasu arteritis, Kawasaki disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, Behçet disease and potential mimics. We highlight key clinical features and management considerations, emphasizing the central role of imaging.
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15
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Abstract
Childhood interstitial lung disease (ChILD) is an umbrella term encompassing a diverse group of diffuse lung diseases affecting infants and children. Although the timely and accurate diagnosis of ChILD is often challenging, it is optimally achieved through the multidisciplinary integration of imaging findings with clinical data, genetics, and potentially lung biopsy. This article reviews the definition and classification of ChILD; the role of imaging, pathology, and genetics in ChILD diagnosis; treatment options; and future goals. In addition, a practical approach to ChILD imaging based on the latest available research and the characteristic imaging appearance of ChILD entities are presented.
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16
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Meng T, Shen C, Tang R, Lin W, Ooi JD, Eggenhuizen PJ, Zhou YO, Chen J, He F, Xiao Z, Ao X, Peng W, Nie W, Zhou Q, Xiao P, Zhong Y, Xiao X. Clinical features and outcomes of anti-neutrophil cytoplasmic autoantibody-associated vasculitis in Chinese childhood-onset patients. Clin Exp Med 2021; 22:447-453. [PMID: 34550486 DOI: 10.1007/s10238-021-00762-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Data on anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) are limited in children. This study is to determine the clinical features and outcomes of childhood-onset AAV. A retrospective study was performed on patients who were diagnosed with AAV before 18 years old in Xiangya Hospital. Their medical records were analyzed by retrospective review. Sixteen patients were diagnosed with AAV before 18 years old in the past 9 years, with an average age of 13.3 ± 3.3 years and 13 of them were female. There were 15 patients with microscopic polyangiitis (MPA) and 1 with Wegener's granulomatosis. The interval between onset of disease and diagnosis of AAV was 2 (1.5-3) months. Most patients (15/16, 93.8%) had multi-organ involvement, and all patients had renal involvement with 7 (43.8%) patients requiring dialysis at presentation. Eleven patients underwent a renal biopsy, of which mixed class and sclerotic class were the most two common histological types. All patients received immunosuppressive therapy for induction therapy including intravenous administrations of methylprednisolone (MP) pulse therapy for 8 patients. 8 patients (50%) achieved remission after induction therapy. After a median follow-up of 46.3 ± 36.1 months, nine (56.3%) patients progressed to end-stage renal disease (ESRD) and 5 (31.3%) patients died. Childhood-onset AAV showed similar clinical and pathological features compared to those of adults, except that it usually occurs in girls. The most commonly involved organ was the kidney, and it had a high risk of progression to ESRD. Early diagnosis and initiation of appropriate immunomodulatory therapy would be important to improve outcomes.
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Affiliation(s)
- Ting Meng
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Chanjuan Shen
- Department of Hematology, The Affiliated Zhuzhou Hospital Xiangya Medical College, Central South University, Zhuzhou, Hunan Province, China
| | - Rong Tang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Wei Lin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Joshua D Ooi
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Clayton, VIC, Australia
| | - Peter J Eggenhuizen
- Centre for Inflammatory Diseases, Department of Medicine, Monash University, Monash Medical Centre, Clayton, VIC, Australia
| | - Ya-Ou Zhou
- Department of Rheumatology and Immunology, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Jinbiao Chen
- Department of Medical Records and Information, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Zhou Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiang Ao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Weisheng Peng
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Wannian Nie
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Qiaoling Zhou
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ping Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yong Zhong
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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Abstract
Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.
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18
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Sayad E, Vogel TP, Guillerman RP, Spielberg D, McNeill DM, De Guzman M, Orman G, Silva-Carmona M. Pulmonary manifestations and outcomes in paediatric ANCA-associated vasculitis: a single-centre experience. Rheumatology (Oxford) 2021; 60:3199-3208. [PMID: 33355338 DOI: 10.1093/rheumatology/keaa769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/12/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES ANCA-associated vasculitis (AAV) usually involves the renal and respiratory systems, but the paediatric literature on pulmonary manifestations and outcomes is limited. We aimed to describe pulmonary manifestations and outcomes after therapy in a cohort of paediatric AAV (pAAV) patients. METHODS A retrospective chart review of all patients <19 years presenting to our institution with AAV between 1/2008 and 2/2018 was conducted. Patient demographics, clinical presentation, diagnostic testing, therapy and pulmonary outcomes over the first 3 years after presentation were evaluated. RESULTS A total of 38 patients were included; all had ANCA positivity by immunofluorescence. A total of 23 had microscopic polyangiitis (MPA), 13 had granulomatosis with polyangiitis and 2 had eosinophilic granulomatosis with polyangiitis. A total of 30 (79%) had pulmonary manifestations, with cough (73%) and pulmonary haemorrhage (67%) being the most common. Abnormalities were noted in 82% of chest CT scans reviewed, with nodules and ground-glass opacities being the most common. At 6, 12 and 36 months follow-up, respectively, 61.8%, 39.4% and 29% of patients continued to show pulmonary manifestations. Five MPA patients with re-haemorrhage are described in detail. CONCLUSION MPA was more common than granulomatosis with polyangiitis, with pulmonary involvement being common in both. MPA patients had more severe pulmonary manifestations. Chest CT revealed abnormal findings in a majority of cases. A subgroup of young MPA patients experienced repeat pulmonary haemorrhage. Treatment modality and response were comparable in different subtypes of AAV, except for this young MPA group. Additional prospective studies are needed to better understand the different phenotypes of pAAV.
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Affiliation(s)
- Edouard Sayad
- Division of Pulmonary Medicine, Baylor College of Medicine.,Texas Children's Hospital
| | - Tiphanie P Vogel
- Texas Children's Hospital.,Division of Rheumatology, Department of Pediatrics
| | - R Paul Guillerman
- Texas Children's Hospital.,Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - David Spielberg
- Division of Pulmonary Medicine, Baylor College of Medicine.,Texas Children's Hospital
| | - David Moreno McNeill
- Division of Pulmonary Medicine, Baylor College of Medicine.,Texas Children's Hospital
| | - Marietta De Guzman
- Texas Children's Hospital.,Division of Rheumatology, Department of Pediatrics
| | - Gunes Orman
- Texas Children's Hospital.,Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Manuel Silva-Carmona
- Division of Pulmonary Medicine, Baylor College of Medicine.,Texas Children's Hospital
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Arfaoui H, Elkihal H, Jabri H, Elkhattabi W, Afif H. Adolescent with severe granulomatosis with polyangiitis: a case report. Pan Afr Med J 2021; 38:285. [PMID: 34122712 PMCID: PMC8179993 DOI: 10.11604/pamj.2021.38.285.26893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/07/2021] [Indexed: 12/04/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare vasculitis among adolescents. Its pulmonary manifestations may mimic tuberculosis. We report the case of a 16-years-old female patient with multiple excavated lung nodules revealed by a chronic cough, hemoptysis, epistaxis and weight loss. The diagnosis of GPA was achieved due to systemic pulmonary, ENT and renal involvement, the positivity of anti-neutrophil cytoplasmic antibody directed against proteinase 3 (C-ANCA) and bronchial and nasal biopsies showing granulomatous inflammation with a dense perivascular infiltrate destroying the vessel wall. Bolus of glucocorticoids and immunosuppressants reversed her symptoms. Although GPA is a rare disease in teenagers, it should be considered as one of the differential diagnosis in adolescents presenting with excavated pulmonary nodules.
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Affiliation(s)
- Hajar Arfaoui
- Department of Respiratory Diseases, Hospital 20 Août 1953, University of Hassan II, University Hospital Center Ibn Rochd, Casablanca, Morocco
| | - Hamza Elkihal
- Department of Respiratory Diseases, Hospital 20 Août 1953, University of Hassan II, University Hospital Center Ibn Rochd, Casablanca, Morocco
| | - Hasna Jabri
- Department of Respiratory Diseases, Hospital 20 Août 1953, University of Hassan II, University Hospital Center Ibn Rochd, Casablanca, Morocco
| | - Wiam Elkhattabi
- Department of Respiratory Diseases, Hospital 20 Août 1953, University of Hassan II, University Hospital Center Ibn Rochd, Casablanca, Morocco
| | - Hicham Afif
- Department of Respiratory Diseases, Hospital 20 Août 1953, University of Hassan II, University Hospital Center Ibn Rochd, Casablanca, Morocco
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20
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Wu J, Pei Y, Rong L, Zhuang H, Zeng S, Chen L, Jiang X. Clinicopathological Analysis of 34 Cases of Primary Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in Chinese Children. Front Pediatr 2021; 9:656307. [PMID: 33981654 PMCID: PMC8107380 DOI: 10.3389/fped.2021.656307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background: This study aimed to summarize the clinicopathological features and prognostic risk factors of primary antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in children. Methods: Clinical and prognostic data for children admitted to our center with AAV between September 2003 and September 2020 were studied retrospectively. The incidence and risk factors of end-stage renal disease (ESRD) were calculated and analyzed. Results: Thirty-four children were enrolled; 28 were female, with a median onset age of 10 years. Except for one case negative for ANCA, the other 33 patients were diagnosed with microscopic polyangiitis (MPA). The most frequently involved organ was the kidney (100.0%), followed by the lungs (58.8%) and heart (50.0%). Twenty children (58.8%) progressed to ESRD with a median course of 3 months, and they were more likely to present respiratory and cardiovascular system involvement than were the non-ESRD group (P < 0.05). Patients in the ESRD group also had a higher serum creatinine level, 24-h protein excretion, Pediatric Vasculitis Activity Score (PVAS), and a lower level of estimated glomerular filtration rate (eGFR), hemoglobin, and complement C3 than had those in the non-ESRD group (P < 0.05). The main pathological manifestations were crescentic and sclerotic classes in the ESRD group and focal class in the non-ESRD group. After 6 months of induction therapy, 90.0% of cases achieved complete or partial remission. The multivariate logistic regression model showed that baseline eGFR < 60 ml/min/1.73 m2 was an independent risk factor for progressing to ESRD (OR = 0.016, 95% CI = 0.001~0.412, P = 0.012). Conclusions: AAV in children usually occurs in teenage girls, and the most commonly involved organ is the kidney, of which hematuria is the most common symptom, followed by proteinuria, abnormal renal function (eGFR < 90 ml/min/1.73 m2), etc. The primary type of AAV is MPA. Nearly 60% of patients progressed to ESRD with a median course of 3 months. Baseline eGFR < 60 ml/min/1.73 m2 is an independent risk factor for ESRD progression in AAV children.
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Affiliation(s)
- Jingyi Wu
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuxin Pei
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liping Rong
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongjie Zhuang
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuhan Zeng
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lizhi Chen
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Jiang
- Department of Pediatric Nephrology and Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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21
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McCann LJ, Hedrich CM. Is it time to re-think juvenile-onset Rheumatic and Musculoskeletal Diseases? - First steps towards individualised treatments to meet agreed targets. Clin Immunol 2020; 223:108647. [PMID: 33310069 DOI: 10.1016/j.clim.2020.108647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Christian M Hedrich
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK.
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22
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Trapani S, Rubino C, Indolfi G. Gastrointestinal involvement in childhood vasculitides. Acta Paediatr 2020; 109:2226-2236. [PMID: 32479665 DOI: 10.1111/apa.15381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 02/01/2023]
Abstract
AIM The aim of this narrative review was to provide a comprehensive summary of the characteristics of gastrointestinal (GI) involvement in the most common paediatric primary vasculitides. METHODS We used PubMed to primarily identify papers, reviews, case series and editorials published in English from 2000 until 31 January 2020. Based on this, we report the prevalence, clinical manifestations, diagnostic approaches and management of GI involvement in each vasculitis. RESULTS Vasculitides are inflammatory blood vessel diseases, and the majority can affect the GI system with vascular, GI tract or solid organ involvement. GI involvement can sometimes complicate and delay the correct diagnosis. Clinical findings are usually nonspecific symptoms, such as fever, abdominal pain, nausea, vomiting and diarrhoea. Bleeding should alert paediatricians to the possibility of severe complicated vasculitis. Diagnosis relies mostly on imaging. If it goes unrecognised, GI involvement in paediatric vasculitis is a serious cause of morbidity and even mortality, related to bowel ischaemia and perforation. Treatment of GI symptoms depends on the type of vasculitis and usually involves high-dose steroids and immunosuppressants. CONCLUSION GI manifestations in the most common paediatric primary vasculitides were usually nonspecific, diagnosis mostly relied on imaging, and treatment usually involved high-dose corticosteroids and immunosuppressants.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, University of Florence and Meyer Children's University Hospital, Florence, Italy
| | - Chiara Rubino
- Post-graduate School of Pediatrics, University of Florence, Florence, Italy
| | - Giuseppe Indolfi
- Meyer Children's University Hospital and Department, NEUROFARBA, University of Florence, Florence, Italy
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