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Xu Q, Li J, Yang Y, Zhuo L, Gao H, Jiang S, Li W. Prevalence and prognosis of malignancy in THSD7A-associated membranous nephropathy: a systematic literature review and clinical case study. Ren Fail 2024; 46:2355353. [PMID: 38785304 PMCID: PMC11132978 DOI: 10.1080/0886022x.2024.2355353] [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] [Received: 01/24/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND This study aims to investigate the incidence and prognosis of malignancy in individuals with thrombospondin type-1 domain-containing 7A (THSD7A)-associated membranous nephropathy (MN). METHODS First, we performed a systematic literature review of prevalence of malignancy in THSD7A-associated MN. Then, we conducted a retrospective analysis of 454 patients diagnosed with MN through renal biopsy at our hospital between January 2016 and December 2020. We assessed the presence of serum anti-THSD7A antibodies and performed immunohistochemical staining of renal tissue for THSD7A. Subsequently, we followed patients with THSD7A-associated MN for a minimum of 3-5 years, collecting their clinical, pathological characteristics, and prognosis. Additionally, we conducted a literature review on patients with THSD7A-associated MN in conjunction with malignancy. RESULTS We identified a total of nine articles containing comprehensive data on THSD7A-associated MN and malignancy. Among 235 patients with THSD7A-positive MN, 36 individuals had concurrent malignancies, resulting in a malignancy prevalence of 13.3% (95% CI: 8.9-17.7%). In our center, we followed up with 15 patients diagnosed with THSD7A-associated MN and observed three cases of concomitant tumors: two cases of lung adenocarcinoma and one case of small cell lung cancer with multiple metastases. The prevalence of malignancy in our cohort was 20%. Notably, we detected positive THSD7A staining in both renal and lung cancer tissues in one patient with small cell lung cancer. CONCLUSIONS Patients with THSD7A-associated MN should undergo vigilant follow-up assessments, with a particular focus on actively seeking potential tumorigenic lesions to prevent misdiagnosis or oversight.
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Affiliation(s)
- Qianqian Xu
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Jiayi Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
- Department of Nephrology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yue Yang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Li Zhuo
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Hongmei Gao
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Shimin Jiang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Wenge Li
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
- Department of Nephrology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
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2
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Xu L, Bian X, Yang J, Xu H, Fang Y, Yang J, Jiang L, Wen P. Safety and effectiveness of laparoscopic renal biopsy: a single-center review and meta-analysis. Ren Fail 2024; 46:2312536. [PMID: 38305211 PMCID: PMC10840595 DOI: 10.1080/0886022x.2024.2312536] [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] [Received: 09/22/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND While renal biopsy remains the preferred diagnostic method for assessing proteinuria, hematuria, or renal failure, laparoscopic renal biopsy (LRB) can serve as an alternative for high-risk patients when percutaneous kidney biopsy (PKB) is not recommended. This study was aimed to evaluate the safety of LRB. METHODS In study 1, Fourteen patients from January 2021 to January 2023 had a LRB taken for various indications, such as morbid obesity, abnormal kidney construction, uncontrolled hypertension, and coagulopathy. We also conducted a Meta-analysis of the success rate and complication rate of previous LRB in study 2. RESULTS All the patients completed biopsies and adequate renal tissues were obtained. The success rate was 100%. The median number of glomeruli obtained was 22.5 (range:12.0, 45.0). The complication rate was 7.1% (urinary tract infection). There were no significant differences between levels of hemoglobin, serum creatinine, and urinary NAGL before and after surgery. In the meta-analysis, the success rate of operation, satisfactory rate of sample, and complication rate of surgery were 99.9%, 99.1%, and 2.6% respectively. CONCLUSION LRB can achieve a good success rate and specimen retrieval and does not increase the risk of complications for high-risk patients. It can present as one of the alternative methods for patients with glomerular diseases.
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Affiliation(s)
- Lingling Xu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Xueqin Bian
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Jian Yang
- Department of Urology, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Hongying Xu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Yi Fang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Lei Jiang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Ping Wen
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
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3
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Stea ED, D'Ettorre G, Mitrotti A, Gesualdo L. The complement system in the pathogenesis and progression of kidney diseases: What doesn't kill you makes you older. Eur J Intern Med 2024; 124:22-31. [PMID: 38461065 DOI: 10.1016/j.ejim.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/11/2024]
Abstract
The Complement System is an evolutionarily conserved component of immunity that plays a key role in host defense against infections and tissue homeostasis. However, the dysfunction of the Complement System can result in tissue damage and inflammation, thereby contributing to the development and progression of various renal diseases, ranging from atypical Hemolytic Uremic Syndrome to glomerulonephritis. Therapeutic interventions targeting the complement system have demonstrated promising results in both preclinical and clinical studies. Currently, several complement inhibitors are being developed for the treatment of complement-mediated renal diseases. This review aims to summarize the most recent insights into complement activation and therapeutic inhibition in renal diseases. Furthermore, it offers potential directions for the future rational use of complement inhibitor drugs in the context of renal diseases.
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Affiliation(s)
- Emma Diletta Stea
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | | | - Adele Mitrotti
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy.
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4
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Fehse B, Tomas NM. The authors reply. Kidney Int 2024; 105:1320-1321. [PMID: 38777406 DOI: 10.1016/j.kint.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Boris Fehse
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicola M Tomas
- Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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5
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Hullekes F, Uffing A, Verhoeff R, Seeger H, von Moos S, Mansur J, Mastroianni-Kirsztajn G, Silva HT, Buxeda A, Pérez-Sáez MJ, Arias-Cabrales C, Collins AB, Swett C, Morená L, Loucaidou M, Kousios A, Malvezzi P, Bugnazet M, Russo LS, Muhsin SA, Agrawal N, Nissaisorakarn P, Patel H, Al Jurdi A, Akalin E, Neto ED, Agena F, Ventura C, Manfro RC, Bauer AC, Mazzali M, de Sousa MV, La Manna G, Bini C, Comai G, Reindl-Schwaighofer R, Berger S, Cravedi P, Riella LV. Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study. Am J Transplant 2024; 24:1016-1026. [PMID: 38341027 DOI: 10.1016/j.ajt.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
Membranous nephropathy (MN) is a leading cause of kidney failure worldwide and frequently recurs after transplant. Available data originated from small retrospective cohort studies or registry analyses; therefore, uncertainties remain on risk factors for MN recurrence and response to therapy. Within the Post-Transplant Glomerular Disease Consortium, we conducted a retrospective multicenter cohort study examining the MN recurrence rate, risk factors, and response to treatment. This study screened 22,921 patients across 3 continents and included 194 patients who underwent a kidney transplant due to biopsy-proven MN. The cumulative incidence of MN recurrence was 31% at 10 years posttransplant. Patients with a faster progression toward end-stage kidney disease were at higher risk of developing recurrent MN (hazard ratio [HR], 0.55 per decade; 95% confidence interval [CI], 0.35-0.88). Moreover, elevated pretransplant levels of anti-phospholipase A2 receptor (PLA2R) antibodies were strongly associated with recurrence (HR, 18.58; 95% CI, 5.37-64.27). Patients receiving rituximab for MN recurrence had a higher likelihood of achieving remission than patients receiving renin-angiotensin-aldosterone system inhibition alone. In sum, MN recurs in one-third of patients posttransplant, and measurement of serum anti-PLA2R antibody levels shortly before transplant could aid in risk-stratifying patients for MN recurrence. Moreover, patients receiving rituximab had a higher rate of treatment response.
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Affiliation(s)
- Frank Hullekes
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Audrey Uffing
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rucháma Verhoeff
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Surgery, Erasmus Medical Center Transplant Institute, Erasmus University, Rotterdam, The Netherlands
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Seraina von Moos
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Juliana Mansur
- Division of Nephrology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Anna Buxeda
- Division of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | | | - A Bernard Collins
- Renal Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christie Swett
- Renal Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leela Morená
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Paolo Malvezzi
- Department of Nephrology, Dialysis, Apheresis and Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Mathilde Bugnazet
- Department of Nephrology, Dialysis, Apheresis and Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Luis Sanchez Russo
- Translational Transplant Research Center, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Saif A Muhsin
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikhil Agrawal
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pitchaphon Nissaisorakarn
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Het Patel
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayman Al Jurdi
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Enver Akalin
- Einstein/Montefiore Transplant Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Elias David Neto
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fabiana Agena
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Carlucci Ventura
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Roberto C Manfro
- Division of Nephrology, Hospital de clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrea Carla Bauer
- Division of Nephrology, Hospital de clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marilda Mazzali
- Division of Nephrology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudia Bini
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Stefan Berger
- Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paolo Cravedi
- Translational Transplant Research Center, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Leonardo V Riella
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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6
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Hengel FE, Dehde S, Lassé M, Zahner G, Seifert L, Schnarre A, Kretz O, Demir F, Pinnschmidt HO, Grahammer F, Lucas R, Mehner LM, Zimmermann T, Billing AM, Oh J, Mitrotti A, Pontrelli P, Debiec H, Dossier C, Colucci M, Emma F, Smoyer WE, Weins A, Schaefer F, Alachkar N, Diemert A, Hogan J, Hoxha E, Wiech T, Rinschen MM, Ronco P, Vivarelli M, Gesualdo L, Tomas NM, Huber TB. Autoantibodies Targeting Nephrin in Podocytopathies. N Engl J Med 2024. [PMID: 38804512 DOI: 10.1056/nejmoa2314471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Minimal change disease and primary focal segmental glomerulosclerosis in adults, along with idiopathic nephrotic syndrome in children, are immune-mediated podocytopathies that lead to nephrotic syndrome. Autoantibodies targeting nephrin have been found in patients with minimal change disease, but their clinical and pathophysiological roles are unclear. METHODS We conducted a multicenter study to analyze antinephrin autoantibodies in adults with glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, IgA nephropathy, antineutrophil cytoplasmic antibody-associated glomerulonephritis, and lupus nephritis, as well as in children with idiopathic nephrotic syndrome and in controls. We also created an experimental mouse model through active immunization with recombinant murine nephrin. RESULTS The study included 539 patients (357 adults and 182 children) and 117 controls. Among the adults, antinephrin autoantibodies were found in 46 of the 105 patients (44%) with minimal change disease, 7 of 74 (9%) with primary focal segmental glomerulosclerosis, and only in rare cases among the patients with other conditions. Of the 182 children with idiopathic nephrotic syndrome, 94 (52%) had detectable antinephrin autoantibodies. In the subgroup of patients with active minimal change disease or idiopathic nephrotic syndrome who were not receiving immunosuppressive treatment, the prevalence of antinephrin autoantibodies was as high as 69% and 90%, respectively. At study inclusion and during follow-up, antinephrin autoantibody levels were correlated with disease activity. Experimental immunization induced a nephrotic syndrome, a minimal change disease-like phenotype, IgG localization to the podocyte slit diaphragm, nephrin phosphorylation, and severe cytoskeletal changes in mice. CONCLUSIONS In this study, circulating antinephrin autoantibodies were common in patients with minimal change disease or idiopathic nephrotic syndrome and appeared to be markers of disease activity. Their binding at the slit diaphragm induced podocyte dysfunction and nephrotic syndrome, which highlights their pathophysiological significance. (Funded by Deutsche Forschungsgemeinschaft and others.).
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Affiliation(s)
- Felicitas E Hengel
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Silke Dehde
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Moritz Lassé
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Gunther Zahner
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Larissa Seifert
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Annabel Schnarre
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Oliver Kretz
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Fatih Demir
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Hans O Pinnschmidt
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Florian Grahammer
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Renke Lucas
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Lea Maxima Mehner
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Tom Zimmermann
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Anja M Billing
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Jun Oh
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Adele Mitrotti
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Paola Pontrelli
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Hanna Debiec
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Claire Dossier
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Manuela Colucci
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Francesco Emma
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - William E Smoyer
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Astrid Weins
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Franz Schaefer
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Nada Alachkar
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Anke Diemert
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Julien Hogan
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Elion Hoxha
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Thorsten Wiech
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Markus M Rinschen
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Pierre Ronco
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Marina Vivarelli
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Loreto Gesualdo
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Nicola M Tomas
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
| | - Tobias B Huber
- From the III. Department of Medicine (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., E.H., M.M.R., N.M.T., T.B.H.) and the Departments of Medical Biometry and Epidemiology (H.O.P.), Pathology (T.Z., T.W.), Pediatric Nephrology (J.O.), and Obstetrics and Fetal Medicine (A.D.), Hamburg Center for Kidney Health (F.E.H., S.D., M.L., G.Z., L.S., A.S., O.K., F.G., R.L., L.M.M., J.O., E.H., M.M.R., N.M.T., T.B.H.), and the Hamburg Center for Translational Immunology (N.M.T., T.B.H.), University Medical Center Hamburg-Eppendorf, Hamburg, and the Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg (F.S.) - all in Germany; the Department of Biomedicine, Aarhus University, Aarhus, Denmark (F.D., A.M.B., M.M.R.); the Department of Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis, and Transplantation Unit, University of Bari Aldo Moro, Bari (A.M., P.P., L.G.), and the Division of Nephrology, Bambino Gesù Children's Hospital, IRCC, Rome (M.C., F.E., M.V.) - both in Italy; INSERM, Unité Mixte de Recherche S 1155, Sorbonne Université (H.D., P.R.), and the Pediatric Nephrology Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (C.D., J.H.), Paris, and the Division of Nephrology, Centre Hospitalier du Mans, Le Mans (P.R.) - all in France; the Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Department of Pediatrics, Ohio State University College of Medicine - both in Columbus (W.E.S.); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (A.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (N.A.)
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Zhou K, Zhou J, Zhou L, Xue J, Liu B, Zhang Z, Zhang X, Cai T, Shao S, Huang B, Zhang Y, Hu Z, Wang L, Liu X. Predictive value of the domain specific PLA2R antibodies for clinical remission in patients with primary membranous nephropathy: A retrospective study. PLoS One 2024; 19:e0302100. [PMID: 38718066 PMCID: PMC11078387 DOI: 10.1371/journal.pone.0302100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND M-type phospholipase A2 receptor (PLA2R) is a major auto-antigen of primary membranous nephropathy(PMN). Anti-PLA2R antibody levels are closely associated with disease severity and therapeutic effectiveness. Analysis of PLA2R antigen epitope reactivity may have a greater predictive value for remission compared with total PLA2R-antibody level. This study aims to elucidate the relationship between domain-specific antibody levels and clinical outcomes of PMN. METHODS This retrospective analysis included 87 patients with PLA2R-associated PMN. Among them, 40 and 47 were treated with rituximab (RTX) and cyclophosphamide (CTX) regimen, respectively. The quantitative detection of -immunoglobulin G (IgG)/-IgG4 targeting PLA2R and its epitope levels in the serum of patients with PMN were obtained through time-resolved fluorescence immunoassays and served as biomarkers in evaluating the treatment effectiveness. A predictive PMN remission possibility nomogram was developed using multivariate logistic regression analysis. Discrimination in the prediction model was assessed using the area under the receiver operating characteristic curve (AUC-ROC).Bootstrap ROC was used to evaluate the performance of the prediction model. RESULTS After a 6-month treatment period, the remission rates of proteinuria, including complete remission and partial remission in the RTX and CTX groups, were 70% and 70.21% (P = 0.983), respectively. However, there was a significant difference in immunological remission in the PLA2R-IgG4 between the RTX and CTX groups (21.43% vs. 61.90%, P = 0.019). Furthermore, we found differences in PLA2R-CysR-IgG4(P = 0.030), PLA2R-CTLD1-IgG4(P = 0.005), PLA2R-CTLD678-IgG4(P = 0.003), and epitope spreading (P = 0.023) between responders and non-responders in the CTX group. Multivariate logistic analysis showed that higher levels of urinary protein (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.26-0.95; P = 0.035) and higher levels of PLA2R-CTLD1-IgG4 (OR, 0.79; 95%CI,0.62-0.99; P = 0.041) were independent risk factors for early remission. A multivariate model for estimating the possibility of early remission in patients with PMN is presented as a nomogram. The AUC-ROC of our model was 0.721 (95%CI, 0.601-0.840), in consistency with the results obtained with internal validation, for which the AUC-ROC was 0.711 (95%CI, 0.587-0.824), thus, demonstrating robustness. CONCLUSIONS Cyclophosphamide can induce immunological remission earlier than rituximab at the span of 6 months. The PLA2R-CTLD1-IgG4 has a better predict value than total PLA2R-IgG for remission of proteinuria at the 6th month.
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Affiliation(s)
- Kezhi Zhou
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Junyi Zhou
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Leting Zhou
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Jing Xue
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Bin Liu
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Zhijian Zhang
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Xiran Zhang
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Ting Cai
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Sijia Shao
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Biao Huang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, P.R. China
| | - Yi Zhang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, P.R. China
| | - Zhigang Hu
- Medical Laboratory, The Affiliated Wuxi Children’s Hospital of Nanjing Medical University, Wuxi, P.R. China
| | - Liang Wang
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
| | - Xiaobin Liu
- Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, P.R. China
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Kurasawa S, Kato S, Ozeki T, Akiyama S, Ishimoto T, Mizuno M, Tsuboi N, Kato N, Kosugi T, Maruyama S. Rationale and design of the Japanese Biomarkers in Nephrotic Syndrome (J-MARINE) study. Clin Exp Nephrol 2024; 28:431-439. [PMID: 38267800 DOI: 10.1007/s10157-023-02449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Disease subtyping and monitoring are essential for the management of nephrotic syndrome (NS). Although various biomarkers for NS have been reported, their clinical efficacy has not been comprehensively validated in adult Japanese patients. METHODS The Japanese Biomarkers in Nephrotic Syndrome (J-MARINE) study is a nationwide, multicenter, and prospective cohort study in Japan, enrolling adult (≥18 years) patients with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN), C3 glomerulopathy (C3G), and lupus nephritis (LN). Baseline clinical information and plasma and urine samples will be collected at the time of immunosuppressive therapy initiation or biopsy. Follow-up data and plasma and urine samples will be collected longitudinally based on the designated protocols. Candidate biomarkers will be measured: CD80, cytotoxic T-lymphocyte antigen 4, and soluble urokinase plasminogen activator receptor for MCD and FSGS; anti-phospholipase A2 receptor and thrombospondin type-1 domain-containing protein 7A antibodies for MN; fragment Ba, C3a, factor I, and properdin for MPGN/C3G; and CD11b, CD16b, and CD163 for LN. Outcomes include complete and partial remission, relapse of proteinuria, a 30% reduction in estimated glomerular filtration rate (eGFR), eGFR decline, and initiation of renal replacement therapy. The diagnostic accuracy and predictive ability for clinical outcomes will be assessed for each biomarker. RESULTS From April 2019 to April 2023, 365 patients were enrolled: 145, 21, 138, 10, and 51 cases of MCD, FSGS, MN, MPGN/C3G, and LN, respectively. CONCLUSION This study will provide valuable insights into biomarkers for NS and serve as a biorepository for future studies.
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MESH Headings
- Humans
- Biomarkers/blood
- Biomarkers/urine
- Nephrotic Syndrome/urine
- Nephrotic Syndrome/blood
- Nephrotic Syndrome/diagnosis
- Prospective Studies
- Japan
- Glomerulosclerosis, Focal Segmental/urine
- Glomerulosclerosis, Focal Segmental/blood
- Glomerulosclerosis, Focal Segmental/diagnosis
- Receptors, Urokinase Plasminogen Activator/blood
- Glomerulonephritis, Membranous/urine
- Glomerulonephritis, Membranous/blood
- Glomerulonephritis, Membranous/diagnosis
- Adult
- Nephrosis, Lipoid/urine
- Nephrosis, Lipoid/blood
- Nephrosis, Lipoid/diagnosis
- Research Design
- Receptors, Phospholipase A2/immunology
- Thrombospondins/blood
- Glomerulonephritis, Membranoproliferative/blood
- Glomerulonephritis, Membranoproliferative/urine
- Glomerulonephritis, Membranoproliferative/diagnosis
- Male
- Female
- Lupus Nephritis/blood
- Lupus Nephritis/urine
- Lupus Nephritis/diagnosis
- East Asian People
- B7-1 Antigen
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Affiliation(s)
- Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takaya Ozeki
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shin'ichi Akiyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Masashi Mizuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Noritoshi Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoki Kosugi
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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Hu X, Xu J, Wang W, Liu L, Jing Y, Gao C, Yu X, Li Y, Lin L, Tong J, Weng Q, Pan X, Zhang W, Ren H, Li G, Kiryluk K, Chen N, Xie J. Combined Serologic and Genetic Risk Score and Prognostication of Phospholipase A2 receptor-Associated Membranous Nephropathy. Clin J Am Soc Nephrol 2024; 19:573-582. [PMID: 38423528 PMCID: PMC11108243 DOI: 10.2215/cjn.0000000000000422] [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: 08/14/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The aim of this study was to test whether a combined risk score on the basis of genetic risk and serology can improve the prediction of kidney failure in phospholipase A2 receptor (PLA2R)-associated primary membranous nephropathy. METHODS We performed a retrospective analysis of 519 biopsy-proven PLA2R-associated primary membranous nephropathy patients with baseline eGFR ≥25 ml/min per 1.73 m 2 . The combined risk score was calculated by combining the genetic risk score with PLA2R ELISA antibody titers. The primary end point was kidney disease progression defined as a 50% reduction in eGFR or kidney failure. Cox proportional hazard regression analysis and C-statistics were applied to compare the performance of PLA2R antibody, genetic risk score, and combined risk score, as compared with clinical factors alone, in predicting primary outcomes. RESULTS The median age was 56 years (range, 15-82 years); the male-to-female ratio was 1:0.6, the median eGFR at biopsy was 99 ml/min per 1.73 m 2 (range: 26-167 ml/min per 1.73 m 2 ), and the median proteinuria was 5.3 g/24 hours (range: 1.5-25.8 g/24 hours). During a median follow-up of 67 (5-200) months, 66 (13%) had kidney disease progression. In Cox proportional hazard regression models, PLA2R antibody titers, genetic risk score, and combined risk score were all individually associated with kidney disease progression with and without adjustments for age, sex, proteinuria, eGFR, and tubulointerstitial lesions. The best-performing clinical model to predict kidney disease progression included age, eGFR, proteinuria, serum albumin, diabetes, and tubulointerstitial lesions (C-statistic 0.76 [0.69-0.82], adjusted R 2 0.51). Although the addition of PLA2R antibody titer improved the performance of this model (C-statistic: 0.78 [0.72-0.84], adjusted R 2 0.61), replacing PLA2R antibody with the combined risk score improved the model further (C-statistic: 0.82 [0.77-0.87], adjusted R 2 0.69, difference of C-statistics with clinical model=0.06 [0.03-0.10], P < 0.001; difference of C-statistics with clinical-serologic model=0.04 [0.01-0.06], P < 0.001). CONCLUSIONS In patients with PLA2R-associated membranous nephropathy, the combined risk score incorporating inherited risk alleles and PLA2R antibody enhanced the prediction of kidney disease progression compared with PLA2R serology and clinical factors alone.
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Affiliation(s)
- Xiaofan Hu
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Xu
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wang
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lili Liu
- Division of Nephrology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Yuanmeng Jing
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chenni Gao
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xialian Yu
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Li
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Lin
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Tong
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qinjie Weng
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxia Pan
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Zhang
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Ren
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guisen Li
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nan Chen
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, School of Medicine, Institute of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
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10
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Koehler S, Hengel FE, Dumoulin B, Damashek L, Holzman LB, Susztak K, Huber TB. The 14th International Podocyte Conference 2023: from podocyte biology to glomerular medicine. Kidney Int 2024; 105:935-952. [PMID: 38447880 DOI: 10.1016/j.kint.2024.01.042] [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] [Received: 10/30/2023] [Revised: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 03/08/2024]
Abstract
The 14th International Podocyte Conference took place in Philadelphia, Pennsylvania, USA from May 23 to 26, 2023. It commenced with an early-career researchers' meeting on May 23, providing young scientists with a platform to present and discuss their research findings. Throughout the main conference, 29 speakers across 9 sessions shared their insights on podocyte biology, glomerular medicine, novel technologic advancements, and translational approaches. Additionally, the event featured 3 keynote lectures addressing engineered chimeric antigen receptor T cell- and mRNA-based therapies and the use of biobanks for enhanced disease comprehension. Furthermore, 4 brief oral abstract sessions allowed scientists to present their findings to a broad audience. The program also included a panel discussion addressing the challenges of conducting human research within the American Black community. Remarkably, after a 5-year hiatus from in-person conferences, the 14th International Podocyte Conference successfully convened scientists from around the globe, fostering the presentation and discussion of crucial research findings, as summarized in this review. Furthermore, to ensure continuous and sustainable education, research, translation, and trial medicine related to podocyte and glomerular diseases for the benefit of patients, the International Society of Glomerular Disease was officially launched during the conference.
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Affiliation(s)
- Sybille Koehler
- III. Department of Medicine and Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Felicitas E Hengel
- III. Department of Medicine and Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bernhard Dumoulin
- III. Department of Medicine and Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laurel Damashek
- International Society of Glomerular Disease, Florence, Massachusetts, USA
| | - Lawrence B Holzman
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katalin Susztak
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Institute of Diabetes, Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tobias B Huber
- III. Department of Medicine and Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; International Society of Glomerular Disease, Florence, Massachusetts, USA.
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11
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Hu X, Wang G, Cheng H. Specific antigens in malignancy-associated membranous nephropathy. Front Med (Lausanne) 2024; 11:1368457. [PMID: 38686366 PMCID: PMC11056512 DOI: 10.3389/fmed.2024.1368457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Membranous nephropathy (MN) is a glomerular disease mediated by autoimmune complex deposition, with approximately 30% of cases attributed to secondary causes. Among them, malignant tumors are a significant cause of secondary MN. Recent advancements in the identification of MN-specific antigens, such as THSD7A and NELL-1, suggest a potential association with malignant tumors, yet definitive proof of this relationship remains elusive. Therefore, this article aims to review the distribution of MN-specific antigens in patients with MN caused by malignant tumors and the possible role of these antigens in the pathogenesis of the disease.
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Affiliation(s)
| | | | - Hong Cheng
- Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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12
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Xia X, Li S, Wang Z, Ye S, Fan Y, Peng W, Chen W, Huang F, Tang R, Chen W. Glomerular Exostosin-Positivity is Associated With Disease Activity and Outcomes in Patients With Membranous Lupus Nephritis. Kidney Int Rep 2024; 9:1040-1046. [PMID: 38765564 PMCID: PMC11101748 DOI: 10.1016/j.ekir.2024.01.008] [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: 11/13/2023] [Revised: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The relationship of exostosin 1 and exostosin 2 (EXT1/EXT2) expression and outcomes in membranous lupus nephritis (MLN) was controversial. Methods EXT1/EXT2 was performed by immunohistochemistry (IHC) in 283 consecutive patients with MLN. Clinicopathological characteristics and outcomes of EXT1/EXT2-positive patients were compared with EXT1/EXT2-negative patients. The primary end points were adverse renal events, including death, dialysis, and renal transplantation. Results Of the patients with MLN, 29.3% were positive for EXT1/EXT2. The prevalence of EXT1/2-positive MLN was significantly higher in pure class V MLN than those for mixed class V MLN (44.2% vs. 19.4%, P < 0.001). For EXT1/EXT2-positive patients, the median time between onset of lupus and renal biopsy, and lupus nephritis and renal biopsy is shorter (6 [interquartile range, IQR: 2-25] months vs. 12 [IQR: 3-49] months, P = 0.008 and 3 [IQR: 2-18] months vs. 6 [IQR: 2-23] months, P = 0.039) and they had significantly lower systemic lupus erythematosus Disease Activity Index (SLEDAI) scores (P = 0.015) and lower serum creatinine levels (P < 0.001), higher hemoglobin (P = 0.006) as well as lower blood pressure. The EXT1/EXT2-positive patients had significantly fewer chronicity features (glomerulosclerosis, P < 0.001; interstitial fibrosis, P = 0.006; and tubular atrophy, P = 0.002) and fewer activity indicators (endocapillary hypercellularity, P = 0.012; cellular crescents, P = 0.007; and fibrocellular crescents, P < 0.001) on renal biopsy. After a median follow-up of 65 (28-126) months, EXT1/EXT2-positive patients were less likely to experience adverse renal events (2.4% vs. 16.0%, P = 0.001). Conclusion Compared with EXT1/EXT2-negative patients, the EXT1/EXT2-positive patients presented with lower disease activity and were less likely to experience adverse renal events in relationship with the chronicity index.
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Affiliation(s)
- Xi Xia
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Suchun Li
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Zhipeng Wang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Siyang Ye
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Yuting Fan
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Wenxing Peng
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Wenfang Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Ruihan Tang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People’s Republic of China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People’s Republic of China
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13
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Seifert L, Riecken K, Zahner G, Hambach J, Hagenstein J, Dubberke G, Huber TB, Koch-Nolte F, Fehse B, Tomas NM. An antigen-specific chimeric autoantibody receptor (CAAR) NK cell strategy for the elimination of anti-PLA2R1 and anti-THSD7A antibody-secreting cells. Kidney Int 2024; 105:886-889. [PMID: 38309682 DOI: 10.1016/j.kint.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/20/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Larissa Seifert
- III: Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristoffer Riecken
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunther Zahner
- III: Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Hambach
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Hagenstein
- III: Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Dubberke
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B Huber
- III: Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Boris Fehse
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicola M Tomas
- III: Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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14
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Sethi S, Fervenza FC. Membranous nephropathy-diagnosis and identification of target antigens. Nephrol Dial Transplant 2024; 39:600-606. [PMID: 37863839 DOI: 10.1093/ndt/gfad227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Indexed: 10/22/2023] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults. MN is characterized by subepithelial accumulation of immune complexes along the glomerular basement membrane. The immune complexes are composed of immunoglobulin G and a target antigen. PLA2R is the target antigen in approximately 60% of MN cases, and MN is traditionally classified as PLA2R-positive or PLA2R-negative MN. Over the last 7 years, additional target antigens have been identified, which have specific disease associations, distinctive clinical and pathologic findings, and therapeutic implications. The newly discovered target antigens include NELL1, EXT1/EXT2, NCAM1, SEMA3B, PCDH7, FAT1, CNTN1, NTNG1, PCSK6 and NDNF. To group all these antigens into a generic 'PLA2R-negative' MN group is imprecise and un-informative. We propose a logical approach for detection of the target antigen which includes (i) currently available serology-based testing to detect anti-PLA2R and anti-THSD7A antibodies; and (ii) kidney biopsy testing to detect the target antigens. Determination of the antigen on kidney biopsy can be done by immunohistochemistry or immunofluorescence studies. Alternatively, laser capture microdissection (LCM) of glomeruli followed by mass spectrometry (MS) can be used to identify a target antigen. LCM/MS has the advantage of being a one-stop test and is particularly useful for detection of rare target antigens. At the current time, while it is possible to detect the newer antigens by immunohistochemistry/immunofluorescence/LCM/MS, serology-based tests to detect serum antibodies to the new antigens are not yet available. It is critical that serology-based tests should be developed not just for accurate diagnosis, but as a guide for treatment. We review the current methodology and propose an algorithm for diagnosis and detection of target antigens in MN that may shape the current practice in the future. Membranous nephropathy (MN) results from accumulation of subepithelial immune complexes along the glomerular basement membrane.PLA2R is the most common target antigen, but newly discovered target antigens have filled the void of PLA2R-negative MN.MN associated with the newly discovered target antigens have distinctive clinical and pathologic findings, treatment and prognostic implications. These include NELL1, EXT1/EXT2, NCAM1, PCDH7, SEMA3B, CNTN1, FAT1, NDNF and PCSK6.Immunohistochemistry/immunofluorescence methodology is currently in use for detecting target antigens in kidney biopsy tissue, although we anticipate laser capture microdissection of glomeruli followed by mass spectrometry will become available soon.Serologic testing is currently available for only detecting antibodies to PLA2R and THSD7A. It is critical that serologic tests become available for detecting antibodies to the newly discovered antigens.
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Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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15
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Andeen NK, Kung VL, Avasare RS. NELL1 membranous nephropathy: clinical associations provide mechanistic clues. FRONTIERS IN NEPHROLOGY 2024; 4:1323432. [PMID: 38596642 PMCID: PMC11002321 DOI: 10.3389/fneph.2024.1323432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
Neural epidermal growth factor-like 1 (NELL1) membranous nephropathy (MN) is notable for its segmental deposit distribution, IgG1 dominant deposits, and comparatively high rate of spontaneous remission. It has been associated with a variety of exposures and secondary conditions, specifically use of thiol-containing medications - including lipoic acid, bucillamine, and tiopronin - as well as traditional indigenous medications (TIM) particularly those with high mercury content, and non-steroid anti-inflammatory drugs (NSAIDs). Malignancies, graft vs. host disease (GVHD), infection, and autoimmune conditions have also been associated with NELL1 MN. Herein, we provide a detailed summary of the clinicopathologic features of NELL1 and associations with underlying conditions, with a focus on treatment and outcomes. Rare cases of dual NELL1 and phospholipase A2 receptor (PLA2R) positive MN are reviewed. Genome-wide association study of NELL1, role of NELL1 in other physiologic and pathologic processes, and connection between NELL1 MN and malignancy with relevance of NELL1 tumor staining are examined. Finally, relationships and potential disease mechanisms of thiol- and mercury- associated NELL1 MN are discussed.
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Affiliation(s)
- Nicole K. Andeen
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Vanderlene L. Kung
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Rupali S. Avasare
- Department of Medicine, Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, OR, United States
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16
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Wei X, Long M, Fan Z, Hou Y, Zhu X, Qu Z, Du Y. Prediction of immunotherapy response in idiopathic membranous nephropathy using deep learning-pathological and clinical factors. Front Endocrinol (Lausanne) 2024; 15:1328579. [PMID: 38524629 PMCID: PMC10958378 DOI: 10.3389/fendo.2024.1328579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background Owing to individual heterogeneity, patients with idiopathic membranous nephropathy (IMN) exhibit varying sensitivities to immunotherapy. This study aimed to establish and validate a model incorporating pathological and clinical features using deep learning training to evaluate the response of patients with IMN to immunosuppressive therapy. Methods The 291 patients were randomly categorized into training (n = 219) and validation (n = 72) cohorts. Patch-level convolutional neural network training in a weakly supervised manner was utilized to analyze whole-slide histopathological features. We developed a machine-learning model to assess the predictive value of pathological signatures compared to clinical factors. The performance levels of the models were evaluated using the area under the receiver operating characteristic curve (AUC) on the training and validation tests, and the prediction accuracies of the models for immunotherapy response were compared. Results Multivariate analysis indicated that diabetes and smoking were independent risk factors affecting the response to immunotherapy in IMN patients. The model integrating pathologic features had a favorable predictive value for determining the response to immunotherapy in IMN patients, with AUCs of 0.85 and 0.77 when employed in the training and test cohorts, respectively. However, when incorporating clinical features into the model, the predictive efficacy diminishes, as evidenced by lower AUC values of 0.75 and 0.62 on the training and testing cohorts, respectively. Conclusions The model incorporating pathological signatures demonstrated a superior predictive ability for determining the response to immunosuppressive therapy in IMN patients compared to the integration of clinical factors.
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Affiliation(s)
| | | | | | | | | | - Zhihui Qu
- *Correspondence: Zhihui Qu, ; Yujun Du,
| | - Yujun Du
- *Correspondence: Zhihui Qu, ; Yujun Du,
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17
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Albertazzi V, Fontana F, Giberti S, Aiello V, Battistoni S, Catapano F, Graziani R, Cimino S, Scichilone L, Forcellini S, De Fabritiis M, Sara S, Delsante M, Fiaccadori E, Mosconi G, Storari A, Mandreoli M, Bonucchi D, Buscaroli A, Mancini E, Rigotti A, La Manna G, Gregorini M, Donati G, Cappelli G, Scarpioni R. Primary membranous nephropathy in the Italian region of Emilia Romagna: results of a multicenter study with extended follow-up. J Nephrol 2024; 37:471-482. [PMID: 37957455 DOI: 10.1007/s40620-023-01803-9] [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] [Received: 04/09/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Since primary membranous nephropathy is a heterogeneous disease with variable outcomes and multiple possible therapeutic approaches, all 13 Nephrology Units of the Italian region Emilia Romagna decided to analyze their experience in the management of this challenging glomerular disease. METHODS We retrospectively studied 205 consecutive adult patients affected by biopsy-proven primary membranous nephropathy, recruited from January 2010 through December 2017. The primary outcome was patient and renal survival. The secondary outcome was the rate of complete remission and partial remission of proteinuria. Relapse incidence, treatment patterns and adverse events were also assessed. RESULTS Median (IQR) follow-up was 36 (24-60) months. Overall patient and renal survival were 87.4% after 5 years. At the end of follow-up, 83 patients (40%) had complete remission and 72 patients (35%) had partial remission. Among responders, less than a quarter (23%) relapsed. Most patients (83%) underwent immunosuppressive therapy within 6 months of biopsy. A cyclic regimen of corticosteroid and cytotoxic agents was the most commonly used treatment schedule (63%), followed by rituximab (28%). Multivariable analysis showed that the cyclic regimen significantly correlates with complete remission (odds ratio 0.26; 95% CI 0.08-0.79) when compared to rituximab (p < 0.05). CONCLUSIONS In our large study, both short- and long-term outcomes were positive and consistent with those published in the literature. Our data suggest that the use of immunosuppressive therapy within the first 6 months after biopsy appears to be a winning strategy, and that the cyclic regimen also warrants a prominent role in primary membranous nephropathy treatment, since definitive proof of rituximab superiority is lacking.
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Affiliation(s)
- Vittorio Albertazzi
- Nephrology and Dialysis Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Via Taverna 49, 29121, Piacenza, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Stefania Giberti
- Nephrology and Dialysis Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Valeria Aiello
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Sara Battistoni
- Unit of Nephrology and Dialysis, Ospedale Infermi, Rimini, Italy
| | - Fausta Catapano
- Unit of Nephrology, Dialysis and Hypertension, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Romina Graziani
- Unit of Nephrology and Dialysis, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Simonetta Cimino
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale di Modena, Ospedale Ramazzini, Carpi, Italy
| | - Laura Scichilone
- Nephrology and Dialysis Unit, Azienda USL Imola, Ospedale S. Maria Scaletta, Imola, Italy
| | | | - Marco De Fabritiis
- Unit of Nephrology and Dialysis, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Signorotti Sara
- Unit of Nephrology and Dialysis, Ospedale Bufalini, Cesena, Italy
| | - Marco Delsante
- Nephrology Unit, Parma University Hospital, University of Parma, Parma, Italy
| | - Enrico Fiaccadori
- Nephrology Unit, Parma University Hospital, University of Parma, Parma, Italy
| | - Giovanni Mosconi
- Unit of Nephrology and Dialysis, Ospedale Morgagni-Pierantoni, Forlì, Italy
- Unit of Nephrology and Dialysis, Ospedale Bufalini, Cesena, Italy
| | - Alda Storari
- Unit of Nephrology, University Hospital of Ferrara, Ferrara, Italy
| | - Marcora Mandreoli
- Nephrology and Dialysis Unit, Azienda USL Imola, Ospedale S. Maria Scaletta, Imola, Italy
| | - Decenzio Bonucchi
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale di Modena, Ospedale Ramazzini, Carpi, Italy
| | - Andrea Buscaroli
- Unit of Nephrology and Dialysis, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Elena Mancini
- Unit of Nephrology, Dialysis and Hypertension, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Angelo Rigotti
- Unit of Nephrology and Dialysis, Ospedale Infermi, Rimini, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Scarpioni
- Nephrology and Dialysis Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Via Taverna 49, 29121, Piacenza, Italy.
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Efe O, So PNH, Anandh U, Lerma EV, Wiegley N. An Updated Review of Membranous Nephropathy. Indian J Nephrol 2024; 34:105-118. [PMID: 38681023 PMCID: PMC11044666 DOI: 10.25259/ijn_317_23] [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: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults. The discovery of phospholipase A2 receptor (PLA2R) as a target antigen has led to a paradigm shift in the understanding and management of MN. At present, serum PLA2R antibodies are used for diagnosis, prognostication, and guiding treatment. Now, with the discovery of more than 20 novel target antigens, antigen mapping is almost complete. The clinical association of certain antigens provides clues for clinicians, such as the association of nerve epidermal growth factor-like 1 with malignancies and indigenous medicines. Serum antibodies are detected for most target antigens, except exostosin 1 and 2 and transforming growth factor-beta receptor 3, but their clinical utility is yet to be defined. Genome-wide association studies and studies investigating environmental factors, such as air pollution, shed more light on the underpinnings of MN. The standard therapy of MN diversified from cyclical cyclophosphamide and steroids to include rituximab and calcineurin inhibitors over the past decades. Here, we provide a cutting-edge review of MN, focusing on genetics, immune system and environmental factors, novel target antigens and their clinical characteristics, and currently available and emerging novel therapies in MN.
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Affiliation(s)
- Orhan Efe
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, USA
| | | | - Urmila Anandh
- Department of Nephrology, Amrita Hospitals, Faridabad, Delhi, NCR, India
| | - Edgar V. Lerma
- Department of Medicine, University of Illinois at Chicago; Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Nasim Wiegley
- Division of Nephrology, Department of Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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19
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Kistler AD, Salant DJ. Complement activation and effector pathways in membranous nephropathy. Kidney Int 2024; 105:473-483. [PMID: 38142037 DOI: 10.1016/j.kint.2023.10.035] [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] [Received: 08/01/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 12/25/2023]
Abstract
Complement activation has long been recognized as a central feature of membranous nephropathy (MN). Evidence for its role has been derived from the detection of complement products in biopsy tissue and urine from patients with MN and from mechanistic studies primarily based on the passive Heymann nephritis model. Only recently, more detailed insights into the exact mechanisms of complement activation and effector pathways have been gained from patient data, animal models, and in vitro models based on specific target antigens relevant to the human disease. These data are of clinical relevance, as they parallel the recent development of numerous specific complement therapeutics for clinical use. Despite efficient B-cell depletion, many patients with MN achieve only partial remission of proteinuria, which may be explained by the persistence of subepithelial immune complexes and ongoing complement-mediated podocyte injury. Targeting complement, therefore, represents an attractive adjunct treatment for MN, but it will need to be tailored to the specific complement pathways relevant to MN. This review summarizes the different lines of evidence for a central role of complement in MN and for the relevance of distinct complement activation and effector pathways, with a focus on recent developments.
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Affiliation(s)
- Andreas D Kistler
- Department of Medicine, Cantonal Hospital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - David J Salant
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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Schindler M, Endlich N. Zebrafish as a model for podocyte research. Am J Physiol Renal Physiol 2024; 326:F369-F381. [PMID: 38205541 DOI: 10.1152/ajprenal.00335.2023] [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: 10/18/2023] [Revised: 12/25/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Podocytes, specialized postmitotic cells, are central players in various kidney-related diseases. Zebrafish have become a valuable model system for studying podocyte biology because they are genetically easy to manipulate, transparent, and their glomerular structure is similar to that of mammals. This review provides an overview of the knowledge of podocyte biology in zebrafish larvae, with particular focus on their essential contribution to understanding the mechanisms that underlie kidney diseases as well as supporting drug development. In addition, special attention is given to advances in live-imaging techniques allowing the observation of dynamic processes, including podocyte motility, podocyte process behavior, and glomerulus maturation. The review further addresses the functional aspects of podocytes in zebrafish larvae. This includes topics such as glomerular filtration, ultrastructural analyses, and evaluation of podocyte response to nephrotoxic insults. Studies presented in this context have provided important insights into the maintenance and resistance of the glomerular filtration barrier in zebrafish larvae and explored the potential transferability of these findings to mammals such as mice, rats, and most importantly, humans. The recent ability to identify potential therapeutic targets represents a promising new way to identify drugs that could effectively treat podocyte-associated glomerulopathies in humans. In summary, this review gives an overview about the importance of zebrafish as a model for podocyte-related disease and targeted drug development. It also highlights the key role of advanced imaging techniques in transparent zebrafish larvae, improving our understanding of glomerular diseases and the significant potential for translation of these findings to humans.
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Affiliation(s)
- Maximilian Schindler
- Department of Anatomy and Cell Biology, University Medicine Greifswald, Greifswald, Germany
| | - Nicole Endlich
- Department of Anatomy and Cell Biology, University Medicine Greifswald, Greifswald, Germany
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21
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Garnier AS, Laubacher H, Briet M. Drug-induced glomerular diseases. Therapie 2024; 79:271-281. [PMID: 37973491 DOI: 10.1016/j.therap.2023.10.010] [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] [Received: 06/30/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
Drug-induced kidney diseases represent a wide range of diseases that are responsible for a significant proportion of all acute kidney injuries and chronic kidney diseases. In the present review, we focused on drug-induced glomerular diseases, more precisely podocytopathies - minimal change diseases (MCD), focal segmental glomerulosclerosis (FSGS) - and membranous nephropathies (MN), from a physiological and a pharmacological point of view. The glomerular filtration barrier is composed of podocytes that form foot processes tightly connected and directly in contact with the basal membrane and surrounding capillaries. The common clinical feature of these diseases is represented by the loss of the ability of the filtration barrier to retain large proteins, leading to massive proteinuria and nephrotic syndrome. Drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), D-penicillamine, tiopronin, trace elements, bisphosphonate, and interferons have been historically associated with the occurrence of MCD, FSGS, and MN. In the last ten years, the development of new anti-cancer agents, including tyrosine kinase inhibitors and immune checkpoint inhibitors, and research into their renal adverse effects highlighted these issues and have improved our comprehension of these diseases.
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Affiliation(s)
- Anne-Sophie Garnier
- Service de néphrologie-dialyse-transplantation, CHU d'Angers, 49000 Angers, France; UFR Santé, université d'Angers, 49000 Angers, France; Université d'Angers, UMR CNRS 6015, Inserm U1083, unité MitoVasc, Team Carme, SFR ICAT, 49000 Angers, France; Laboratoire MitoVasc, UMR Inserm 1083 CNRS 6215, 49000 Angers, France
| | - Hélène Laubacher
- UFR Santé, université d'Angers, 49000 Angers, France; Laboratoire MitoVasc, UMR Inserm 1083 CNRS 6215, 49000 Angers, France
| | - Marie Briet
- UFR Santé, université d'Angers, 49000 Angers, France; Université d'Angers, UMR CNRS 6015, Inserm U1083, unité MitoVasc, Team Carme, SFR ICAT, 49000 Angers, France; Laboratoire MitoVasc, UMR Inserm 1083 CNRS 6215, 49000 Angers, France; Service de pharmacologie - toxicologie et pharmacovigilance, CHU d'Angers, 49000 Angers, France.
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22
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Radhakrishnan Y, Zand L, Sethi S, Fervenza FC. Membranous nephropathy treatment standard. Nephrol Dial Transplant 2024; 39:403-413. [PMID: 37934599 DOI: 10.1093/ndt/gfad225] [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: 08/09/2023] [Indexed: 11/09/2023] Open
Abstract
Membranous nephropathy (MN) is characterized by deposition of immune complexes leading to thickening of glomerular basement membranes. Over time, the understanding of MN has evolved, with the identification of specific autoantibodies against novel podocyte antigens and the unraveling of intricate pathogenic pathways. Although the anti-CD20 monoclonal antibody rituximab is favored as part of the initial therapy in MN, a subgroup of MN patients may be resistant to rituximab necessitating the use of alternative agents such as cytotoxic therapies. In addition, newer agents such as novel anti-CD20 monoclonal antibodies, therapies targeting the CD38-positive plasma cells and anti-complement therapy are being studied in patients who are resistant to traditional treatment strategies. This manuscript furnishes a review of the novel developments in the pathophysiology of MN including the identification of target antigens and current treatment standards for MN, concentrating on evidenced-based interventions designed to attain remission and to prevent disease progression.
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Affiliation(s)
- Yeshwanter Radhakrishnan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ladan Zand
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sanjeev Sethi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Nell D, Wolf R, Podgorny PM, Kuschnereit T, Kuschnereit R, Dabers T, Stracke S, Schmidt T. Complement Activation in Nephrotic Glomerular Diseases. Biomedicines 2024; 12:455. [PMID: 38398059 PMCID: PMC10886869 DOI: 10.3390/biomedicines12020455] [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: 12/30/2023] [Revised: 01/23/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The nephrotic syndrome holds significant clinical importance and is characterized by a substantial protein loss in the urine. Damage to the glomerular basement membrane or podocytes frequently underlies renal protein loss. There is an increasing belief in the involvement of the complement system, a part of the innate immune system, in these conditions. Understanding the interactions between the complement system and glomerular structures continually evolves, challenging the traditional view of the blood-urine barrier as a passive filter. Clinical studies suggest that a precise inhibition of the complement system at various points may soon become feasible. However, a thorough understanding of current knowledge is imperative for planning future therapies in nephrotic glomerular diseases such as membranous glomerulopathy, membranoproliferative glomerulonephritis, lupus nephritis, focal segmental glomerulosclerosis, and minimal change disease. This review provides an overview of the complement system, its interactions with glomerular structures, and insights into specific glomerular diseases exhibiting a nephrotic course. Additionally, we explore new diagnostic tools and future therapeutic approaches.
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Avasare R, Andeen N, Beck L. Novel Antigens and Clinical Updates in Membranous Nephropathy. Annu Rev Med 2024; 75:219-332. [PMID: 37552894 DOI: 10.1146/annurev-med-050522-034537] [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: 08/10/2023]
Abstract
Membranous nephropathy (MN), an autoimmune kidney disease and leading cause of nephrotic syndrome, leads to kidney failure in up to one-third of affected individuals. Most MN cases are due to an autoimmune reaction against the phospholipase A2 receptor (PLA2R) located on kidney podocytes. Serum PLA2R antibody quantification is now part of routine clinical practice because antibody titers correlate with disease activity and treatment response. Recent advances in target antigen detection have led to the discovery of more than 20 other podocyte antigens, yet the clinical impact of additional antigen detection remains unknown and is under active investigation. Here we review recent findings and hypothesize how current research will inform future care of patients with MN.
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Affiliation(s)
- Rupali Avasare
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA;
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA;
| | - Laurence Beck
- Section of Nephrology, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Section of Nephrology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Miyasaka R, Wada Y, Takeuchi K, Abe T, Uchitsubo R, Kawamura S, Sakurabayashi S, Naito S, Aoyama T, Shimizu A, Takeuchi Y. Lupus-like membranous nephropathy during the postpartum period expressing glomerular antigens exostosin 1/exostosin 2 and phospholipase A2 receptor: a case report. CEN Case Rep 2024:10.1007/s13730-023-00848-w. [PMID: 38280123 DOI: 10.1007/s13730-023-00848-w] [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: 11/16/2023] [Accepted: 12/24/2023] [Indexed: 01/29/2024] Open
Abstract
Recently, several target antigens of membranous nephropathy (MN), such as phospholipase A2 receptor (PLA2R) and exostosin 1/exostosin 2 (EXT1/2), have been discovered. A 30-year-old woman was referred to our hospital with nephrotic range proteinuria and microscopic hematuria. She was first noted to have proteinuria before pregnancy, and her proteinuria worsened in the postpartum period. A renal biopsy showed MN. Immunofluorescence microscopy showed IgG, IgA, IgM, C3, C4, and C1q depositions in the mesangial area and glomerular capillary walls (GCWs). Regarding the IgG subclass, IgG1 and IgG3 were detected on glomeruli. Electron microscopy showed subepithelial electron-dense deposits (EDDs). EDDs were also detected in paramesangial and subendothelial areas. The diagnosis of membranous lupus nephritis (MLN) was suspected, but she did not fulfill the criteria for systemic lupus erythematosus. Neither anti-nuclear antibody nor hypocomplementemia were detected. We further evaluated glomerular EXT1/2 expressions, which were evident on GCWs. In addition, PLA2R was also detected on GCWs, although serum antibody for PLA2R was negative. She responded to immunosuppressive therapy with decreased proteinuria. In the present case, glomerular PLA2R expression implied the possibility of primary MN. However, pathological findings with a full-house staining pattern and glomerular EXT1/2 expressions were very similar to those of lupus-associated MN. Glomerular PLA2R expression appeared not to reflect immunocomplexes of PLA2R and autoantibody when considering the results for glomerular IgG subclass and the absence of serum anti-PLA2R antibody. Collectively, it is plausible that this was a case of a relatively young postpartum female who developed latent MLN rather than primary MN.
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Affiliation(s)
- Ryoma Miyasaka
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yukihiro Wada
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Kazuhiro Takeuchi
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Tetsuya Abe
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ryota Uchitsubo
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Sayumi Kawamura
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Shun Sakurabayashi
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Shokichi Naito
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Togo Aoyama
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Yasuo Takeuchi
- Department of Nephrology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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26
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Jiang H, Shen Z, Zhuang J, Lu C, Qu Y, Xu C, Yang S, Tian X. Understanding the podocyte immune responses in proteinuric kidney diseases: from pathogenesis to therapy. Front Immunol 2024; 14:1335936. [PMID: 38288116 PMCID: PMC10822972 DOI: 10.3389/fimmu.2023.1335936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
The glomerular filtration barrier, comprising the inner layer of capillary fenestrated endothelial cells, outermost podocytes, and the glomerular basement membrane between them, plays a pivotal role in kidney function. Podocytes, terminally differentiated epithelial cells, are challenging to regenerate once injured. They are essential for maintaining the integrity of the glomerular filtration barrier. Damage to podocytes, resulting from intrinsic or extrinsic factors, leads to proteinuria in the early stages and eventually progresses to chronic kidney disease (CKD). Immune-mediated podocyte injury is a primary pathogenic mechanism in proteinuric glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and lupus nephritis with podocyte involvement. An extensive body of evidence indicates that podocytes not only contribute significantly to the maintenance of the glomerular filtration barrier and serve as targets of immune responses but also exhibit immune cell-like characteristics, participating in both innate and adaptive immunity. They play a pivotal role in mediating glomerular injury and represent potential therapeutic targets for CKD. This review aims to systematically elucidate the mechanisms of podocyte immune injury in various podocyte lesions and provide an overview of recent advances in podocyte immunotherapy. It offers valuable insights for a deeper understanding of the role of podocytes in proteinuric glomerular diseases, and the identification of new therapeutic targets, and has significant implications for the future clinical diagnosis and treatment of podocyte-related disorders.
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Affiliation(s)
- Hong Jiang
- Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhirang Shen
- Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jing Zhuang
- Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Chen Lu
- Division of Nephrology, Department of Internal Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yue Qu
- Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Chengren Xu
- Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shufen Yang
- Division of Nephrology, Department of Internal Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xuefei Tian
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
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Yang L, Wang G, Ye N, Xu X, Cheng W, Sun L, Dong H, Kong L, Zhao X, Geng Y, Cheng H. Clinicopathological and prognostic characteristics of idiopathic membranous nephropathy with dual antigen positivity. Front Immunol 2024; 14:1297107. [PMID: 38250076 PMCID: PMC10796489 DOI: 10.3389/fimmu.2023.1297107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Background Idiopathic membranous nephropathy (IMN) is the most common pathological type in adults with nephrotic syndrome. Many target antigens have been discovered. However, dual antigen-positive IMN patients are very rare, with only a few such cases being briefly described in various studies. There is no specific study on the clinicopathological and prognostic characteristics of dual antigen-positive IMN patients, and the disease characteristics of such patients remain unclear. Methods Immunohistochemical staining of PLA2R, THSD7A, and NELL-1 was conducted on kidney tissue samples obtained from patients diagnosed with IMN. Simultaneously, the presence of corresponding serum antibodies was determined. Patients exhibiting positivity for dual antigens were included in the study, identified either through tissue staining or serum antibody detection. We retrospectively collected their clinical, pathological, and follow-up data and measured their serum antibody levels at multiple time points. Additionally, the same type of dual antigen-positive IMN cases reported in the literature were reviewed to extract clinical, pathological, and prognostic information. We compared the data for all of the above dual antigen-positive and PLA2R single-positive IMN cases at our center. Results We identified 6 IMN patients with dual antigen positivity at our center, approximately 0.7% of whole MN series; the previous literature reports 43 IMN patients with dual antigen positivity, the proportion ranged from 0.2% to 2.8%. The IgG1 positivity rate in the renal tissue of the dual antigen-positive patients at our center was significantly lower than that of dual antigen-positive patients previously reported (16.7% vs. 100.0%, p=0.015), but there was no significant difference in clinical or prognostic aspects. Patients with dual antigen positivity reported at our center and in the literature were combined and compared with PLA2R single-positive IMN reported at our center. Compared with PLA2R single-positive IMN patients, dual antigen-positive IMN patients had a higher renal tissue IgG1 positivity rate (58.3% vs. 22.3%, p=0.016), and the time required to achieve remission was longer [13.5 (3.3,35.0) vs. 3.0 (1.0,8.0), p=0.052]. Overall, The changes in urine protein were consistent with the changes in serum PLA2R antibody levels in dual antigen-positive IMN patients. Conclusions For patients with primary membranous nephropathy who did not attain remission following prolonged treatment, multiple target antigen staining should still be actively performed, even with positivity for the PLA2R target antigen.
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Affiliation(s)
- Lei Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guoqin Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Ye
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyi Xu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenrong Cheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijun Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongrui Dong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lingqiang Kong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyi Zhao
- Division of Nephrology, Affiliated Hospital of Chifeng University, Neimenggu, China
| | - Yanqiu Geng
- Division of Nephrology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hong Cheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Tang X, Dai H, Hu Y, Liu W, Zhao Q, Jiang H, Feng Z, Zhang N, Rui H, Liu B. Experimental models for elderly patients with membranous nephropathy: Application and advancements. Exp Gerontol 2024; 185:112341. [PMID: 38042380 DOI: 10.1016/j.exger.2023.112341] [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] [Received: 10/14/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023]
Abstract
Membranous nephropathy (MN) occurs predominantly in middle-aged and elderly individuals and ranks among the most prevalent etiologies of elderly nephrotic syndrome. As an autoimmune glomerular disorder characterized by glomerular basement membrane thickening and immune complex deposition, conventional MN animal models, including the Heymann nephritis rat model and the c-BSA mouse model, have laid a foundation for MN pathogenesis research. However, differences in target antigens between rodents and humans have impeded this work. In recent years, researchers have created antigen-specific MN animal models, primarily centered on PLA2R1 and THSD7A, employing diverse techniques that provide innovative in vivo research platforms for MN. Furthermore, significant advancements have been made in the development of in vitro podocyte models relevant to MN. This review compiles recent antigen-specific MN animal models and podocyte models, elucidates their immune responses and pathological characteristics, and offers insights into the future of MN experimental model development. Our aim is to provide a comprehensive resource for research into the pathogenesis of MN and the development of targeted therapies for older patients with MN to prolong lifespan and improve quality of life.
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Affiliation(s)
- Xinyue Tang
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Haoran Dai
- Department of Nephrology, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Station East 5, Shunyi District, Beijing 101300, China
| | - Yuehong Hu
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Wenbin Liu
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, No. 11, North Third Ring Road, Chaoyang District, Beijing 100029, China
| | - Qihan Zhao
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Hanxue Jiang
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Zhendong Feng
- Pinggu Hospital, Beijing Hospital of Traditional Chinese Medicine, No. 6, Pingxiang Road, Pinggu District, Beijing 101200, China
| | - Naiqian Zhang
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
| | - Hongliang Rui
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China; Beijing Institute of Chinese Medicine, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China.
| | - Baoli Liu
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing 100069, China.
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29
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Sethi S, Theis JD, Palma LM, Madden B. From Patterns to Proteins: Mass Spectrometry Comes of Age in Glomerular Disease. J Am Soc Nephrol 2024; 35:117-128. [PMID: 37749770 PMCID: PMC10786612 DOI: 10.1681/asn.0000000000000221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/17/2023] [Indexed: 09/27/2023] Open
Abstract
Laser capture microdissection and mass spectrometry (LCM/MS) is a technique that involves dissection of glomeruli from paraffin-embedded biopsy tissue, followed by digestion of the dissected glomerular proteins by trypsin, and subsequently mass spectrometry to identify and semiquantitate the glomerular proteins. LCM/MS has played a crucial role in the identification of novel types of amyloidosis, biomarker discovery in fibrillary GN, and more recently discovery of novel target antigens in membranous nephropathy (MN). In addition, LCM/MS has also confirmed the role for complement proteins in glomerular diseases, including C3 glomerulopathy. LCM/MS is now widely used as a clinical test and considered the gold standard for diagnosis and typing amyloidosis. For the remaining glomerular diseases, LCM/MS has remained a research tool. In this review, we discuss the usefulness of LCM/MS in other glomerular diseases, particularly MN, deposition diseases, and diseases of complement pathways, and advocate more routine use of LCM/MS at the present time in at least certain diseases, such as MN, for target antigen detection. We also discuss the limitations of LCM/MS, particularly the difficulties faced from moving from a research-based technique to a clinical test. Nonetheless, the role of LCM/MS in glomerular diseases is expanding. Currently, LCM/MS may be used to identify the etiology in certain glomerular diseases, but in the future, LCM/MS can play a valuable role in determining pathways of complement activation, inflammation, and fibrosis.
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Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jason D. Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lilian M.P. Palma
- Pediatric Nephrology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Benjamin Madden
- Mayo Clinic Proteomics Core, Mayo Clinic, Rochester, Minnesota
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30
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Murtas C, Bruschi M, Spinelli S, Kajana X, Verrina EE, Angeletti A, Caridi G, Candiano G, Feriozzi S, Prunotto M, Ghiggeri GM. Novel biomarkers and pathophysiology of membranous nephropathy: PLA2R and beyond. Clin Kidney J 2024; 17:sfad228. [PMID: 38213493 PMCID: PMC10783244 DOI: 10.1093/ckj/sfad228] [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: 07/07/2023] [Indexed: 01/13/2024] Open
Abstract
Research on membranous nephropathy truly exploded in the last 15 years. This happened because of the application of new techniques (laser capture microdissection, mass spectrometry, protein G immunoprecipitation, arrays) to the study of its pathogenesis. After the discovery of PLA2R as the major target antigen, many other antigens were identified and others are probably ongoing. Clinical and pathophysiology rebounds of new discoveries are relevant in terms of diagnosis and prognosis and it is time to make a first assessment of the innovative issues. In terms of classification, target antigens can be divided into: 'membrane antigens' and 'second wave' antigens. The first group consists of antigens constitutionally expressed on the podocyte membrane (as PLA2R) that may become a target of an autoimmune process because of perturbation of immune-tolerance. 'Second wave' antigens are antigens neo-expressed by the podocyte or by infiltrating cells after a stressing event: this allows the immune system to produce antibodies against them that intensify and maintain glomerular damage. With this abundance of target antigens it is not possible, at the moment, to test all antibodies at the bedside. In the absence of this possibility, the role of histological evaluation is still irreplaceable.
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Affiliation(s)
- Corrado Murtas
- Nephrology and Dialysis Unit, Ospedale Belcolle, ASL Viterbo, Viterbo, Italy
| | - Maurizio Bruschi
- Department of Experimental Medicine (DIMES) University of Genoa, Italy
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Sonia Spinelli
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Xhuliana Kajana
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Enrico E Verrina
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Angeletti
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gianluca Caridi
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giovanni Candiano
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Sandro Feriozzi
- Nephrology and Dialysis Unit, Ospedale Belcolle, ASL Viterbo, Viterbo, Italy
| | - Marco Prunotto
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Gian Marco Ghiggeri
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Wang B, Fu YQ, Xie LJ, Cao JY, Yang M, Li M, Chen TL, Zhang XL, Luo Q, Lv LL, Liu BC. Measurement of urinary exosomal phospholipase A2 receptor is a sensitive method for diagnosis of PLA2R-associated membranous nephropathy. Clin Kidney J 2024; 17:sfad191. [PMID: 38186888 PMCID: PMC10768785 DOI: 10.1093/ckj/sfad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Indexed: 01/09/2024] Open
Abstract
Background The discovery of phospholipase A2 receptor (PLA2R) and its antibody (aPLA2Rab) has paved the way for diagnosing PLA2R-associated membranous nephropathy (PLA2R-MN) with a high specificity of 98%. However, the sensitivity was only 40% to 83.9%, and there is ongoing discussion around determining the optimal threshold for diagnosis. Recent advancements in the use of exosomes, a novel form of "liquid biopsy," have shown great promise in identifying markers for various medical conditions. Methods Protein mass spectrometry and western blot were applied to verify the existence of PLA2R antigen in the urine exosome. We then evaluated the efficacy of urinary exosomal PLA2R antigen alone or combined with serum aPLA2Rab level to diagnose PLA2R-MN. Results The urinary exosomes contained a high abundance of PLA2R antigen as evidenced by protein mass spectrometry and western blot in 85 PLA2R-MN patients vs the disease controls (14 secondary MN patients, 22 non-MN patients and 4 PLA2R-negative MN patients) and 20 healthy controls. Of note, urinary exosomal PLA2R antigen abundance also had a good consistency with the PLA2R antigen level in the renal specimens of PLA2R-MN patients. The sensitivity of urinary exosomal PLA2R for diagnosing PLA2R-MN reached 95.4%, whereas the specificity was 63.3%. Combining detection of the urinary exosomal PLA2R and serum aPLA2Rab could develop a more sensitive diagnostic method for PLA2R-MN, especially for patients with serum aPLA2Rab ranging from 2 to 20 RU/mL. Conclusions Measurement of urinary exosomal PLA2R could be a sensitive method for the diagnosis of PLA2R-MN.
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Affiliation(s)
- Bin Wang
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
| | - Yu-Qi Fu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
| | - Li-jun Xie
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
| | - Jin-Yuan Cao
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
- Department of Nephrology, Fifth Affiliated Hospital of Nantong University, Taizhou, China
| | - Min Yang
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Min Li
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Tian-Lei Chen
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao-Liang Zhang
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
| | - Qian Luo
- Bionic Sensing and Intelligence Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Lin-Li Lv
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
| | - Bi-Cheng Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China
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Liu Z, Wan C, Cao Y, Liu S, Xu Z, Zhang C, Su H. Distribution spectrum and clinical significance of glomerular exostosin (EXT1) deposits in PLA2R-positive membranous nephropathy. J Nephrol 2024; 37:149-158. [PMID: 37882962 DOI: 10.1007/s40620-023-01779-6] [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: 05/01/2023] [Accepted: 09/03/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The discovery of antigen phospholipase A2 receptor (PLA2R) in 2009 ushered in the antigen-based study of membranous nephropathy. The further putative antigen exostosin 1/2 (EXT1/2) was described in 2019. However, the distribution spectrum of glomerular EXT1 deposits in membranous nephropathy has not been fully elucidated. METHODS We conducted a retrospective cohort study of biopsy-proven membranous nephropathy patients. Patients with complete baseline data and adequate tissue specimens were included in this study. Tests for glomerular expression of PLA2R and EXT1 and circulating anti-PLA2R antibodies were performed. Clinicopathological and outcome data were reviewed. RESULTS We included 626 patients, namely, 487 (77.8%) PLA2R-positive patients and 54 (8.6%) EXT1-positive patients; 32 (5.1%) patients were dual-positive for PLA2R and EXT1 (PLA2R + /EXT1 +). A higher percentage of dual-positive patients had low C3 levels (P < 0.001) and were more likely to have autoimmune diseases (P = 0.013) than PLA2R-positive and EXT1-negative (PLA2R + /EXT1-) patients. Kidney biopsy findings revealed that there was a higher percentage of glomerular IgG1, IgG2, IgA, C4, and C1q deposits (P < 0.05), "full-house" staining (P < 0.001), and stronger intensity of C1q staining (P = 0.002) in PLA2R + /EXT1 + patients. Based on Kaplan-Meier analysis, a higher percentage of PLA2R + /EXT1 + patients exhibited partial or complete remission of proteinuria. Furthermore, EXT1-positive expression was a favourable predictor for proteinuria remission, whereas interstitial fibrosis/tubular atrophy was an unfavourable predictor. A complement C3 level < 0.79 g/L was independently associated with EXT1 positivity in PLA2R-positive membranous nephropathy. CONCLUSIONS We describe a subgroup of PLA2R and EXT1 dual-positive patients. Patients in this subset exhibited more signs of autoimmunity and more frequent clinical remission. In PLA2R-positive membranous nephropathy, a complement C3 level < 0.79 g/L was independently associated with EXT1 positivity, which was a favourable predictor for proteinuria remission.
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Affiliation(s)
- Zezhou Liu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Wan
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiling Cao
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saiji Liu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyu Xu
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Fu N, Yuan S, Yang G, Li H, Wang T. Concurrent glomerular PCDH7 deposits in PLA2R-associated membranous nephropathy. CEN Case Rep 2023:10.1007/s13730-023-00842-2. [PMID: 38145434 DOI: 10.1007/s13730-023-00842-2] [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: 09/27/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
The understanding of membranous nephropathy (MN) has undergone impressive advancements in the last 5 years, particularly due to identification of novel antigenic targets. M-type phospholipase A2 receptor (PLA2R) and thrombospondin type 1 domain-containing 7A (THSD7A) account for approximately 70% and 1-5% of the target antigens in primary MN, respectively. Recently, more novel/putative antigens have been identified in the remaining cases of MN that include exostosin 1/exostosin 2 (EXT1/EXT2), neural epidermal growth factor-like 1 protein (NELL-1), semaphorin 3B (SEMA3B) and protocadherin 7 (PCDH7). However, comparatively little is known about the PCDH7 among these novel antigens. As such, we herein described a unique case of positive glomerular PCDH7 deposits in PLA2R-associated MN, which may offer a deeper insight into the role of PCDH7 in MN and improve our understanding of glomerular diseases in the post-COVID era, particularly with the emerging variants.
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Affiliation(s)
- NaNa Fu
- Department of Nephrology, ShouGuang Chinese Medicine Hospital, No.3353 ShengCheng Street, ShouGuang, 262700, People's Republic of China
| | - Shuang Yuan
- Graduate School of HeBei Medical University, No.361 East ZhongShan Boulevard, Shijiazhuang, 050011, People's Republic of China
| | - Guang Yang
- TaiYuan KingMed Center for Clinical Laboratory, No.2 LongSheng Street, Taiyuan, 030000, People's Republic of China
| | - Hang Li
- Department of Nephrology, Peking Union Medical College Hospital, No.1 ShuaiFuYuan, Beijing, 100010, People's Republic of China
| | - Tao Wang
- Department of Nephrology, The First Hospital of HeBei Medical University, No.89 DongGang Road, Shijiazhuang, 050030, People's Republic of China.
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Hu X, Wang X, Yu X, Ni L, Gao C, Pan X, Ren H, Xu J, Ma J. The Role of Renal PLA2R Staining Combined with Serum PLA2R Antibody in Membranous Nephropathy Risk Stratification. J Clin Med 2023; 13:68. [PMID: 38202076 PMCID: PMC10779831 DOI: 10.3390/jcm13010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND This study aimed to examine the clinicopathological profiles and prognosis of membranous nephropathy in different subtypes classified by serum PLA2R antibody (SAb) and glomerular PLA2R antigen staining (GAg). METHODS A total of 372 biopsy-proven membranous nephropathy (MN) cases, unrelated to lupus, with urine protein > 2 g/24 h and eGFR > 25 mL/min/1.73 m2 were included and categorized into four groups according to the presence or absence of PLA2R antibody and glomerular PLA2R antigen staining. Clinical profiles were compared among four subtypes. Treatment response and renal outcomes were compared among four groups with primary MN. Cox and logistic regression models were used to examine the association between time-to-renal progression and early remission within 6 months in the four subgroups with primary MN. RESULTS MN patients who were SAb-/GAg+ presented with a more severe disease onset, whereas those who were SAb-/GAg- had a mild clinical manifestation with a higher prevalence of MN-associated secondary causes. During a median follow-up of 79.2 months (IQR: 48.70-97.40), SAb+/GAg- was identified as an independent risk factor for renal progression [HR: 9.17, 95% CI: 2.26-37.16, p < 0.01] and early remission [OR: 0.06, 95% CI: 0.01-0.56, p = 0.01] in primary MN. Additionally, SAb-/GAg- with primary MN showed an independent association with spontaneous remission after adjusting for age, sex, baseline proteinuria, and eGFR (Before adjustment: OR: 8.33, 95% CI: 1.89-36.76, p = 0.0; after adjustment: OR: 12.25, 95% CI: 2.48-60.53, p < 0.01). CONCLUSION Our findings indicated that SAb+/GAg-MN patients exhibited a more severe disease onset and had a poorer prognosis, necessitating an aggressive treatment approach. On the other hand, in the SAb-/GAg- group, the elimination of secondary causes should be considered, and a watchful waiting approach may be appropriate.
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Affiliation(s)
| | | | | | | | | | | | | | - Jing Xu
- Correspondence: (J.X.); (J.M.); Tel.: +021-64370045-665275 (J.X.); +021-64370045-665275 (J.M.)
| | - Jun Ma
- Correspondence: (J.X.); (J.M.); Tel.: +021-64370045-665275 (J.X.); +021-64370045-665275 (J.M.)
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Liu X, Zhao Y, Niu Y, Xie Q, Nie H, Jin Y, Zhang Y, Lu Y, Zhu S, Zuo W, Yu C. Urinary single-cell sequence analysis of the urinary macrophage in different outcomes of membranous nephropathy. Clin Kidney J 2023; 16:2405-2416. [PMID: 38046013 PMCID: PMC10689170 DOI: 10.1093/ckj/sfad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 12/05/2023] Open
Abstract
Background Great progress has been made in the diagnosis and treatment of membranous nephropathy (MN). However, a significant number of patients do not respond to immunosuppressive therapy and eventually progress to end-stage kidney disease. To investigate the mechanism of different outcome of MN, we performed single-cell sequencing to analyze the urine cells of patients with and without complete remission of MN. Methods Urine single-cell RNA sequencing was performed on 12 healthy controls (HC) and 15 patients with MN. The patients were divided into a complete remission group (CR, n = 9) and a no remission group (NR, n = 6). Results (i) Macrophages were the largest group in urine cells, comprising 48.02%, 68.96% and 20.95% in the HC, CR and NR groups, respectively. (ii) Urinary macrophages expressing FIColin-1 and S100 calcium-binding protein A8 were mainly found in the HC and CR groups, indicating that they were derived from bone marrow and peripheral blood, while the urinary macrophages expressing the regulator of G-protein signaling 1 (RGS1) and HLA-DPA1, mainly found in the NR group, were derived from renal resident macrophages. (iii) In healthy adults, urine macrophages expressed the metallothionein family, indicating that they can regulate anti-inflammatory and proinflammatory functions bidirectionally. In the CR group, the urine macrophages showed strong proinflammatory properties. In the NR group, the urinary macrophages mainly associated with the level of proteinuria and the impaired renal function. Conclusions Our study firstly delineated the differences in urinary cell maps between healthy individuals and MN patients with CR or NR outcomes. Not only the origin but also the function of urine macrophages were different in the HC, CR and NR groups.
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Affiliation(s)
- Xi Liu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu Zhao
- Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yangyang Niu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, and Nephrology Research Institute, Fudan University, Shanghai, China
| | - Hao Nie
- Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yun Jin
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Zhang
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuqiu Lu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Saiya Zhu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Zuo
- Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Sethi S, Beck LH, Glassock RJ, Haas M, De Vriese AS, Caza TN, Hoxha E, Lambeau G, Tomas NM, Madden B, Debiec H, D'Agati VD, Alexander MP, Amer H, Appel GB, Barbour SJ, Caravaca-Fontan F, Cattran DC, Casal Moura M, D'Avila DO, Eick RG, Garovic VD, Greene EL, Herrera Hernandez LP, Jennette JC, Lieske JC, Markowitz GS, Nath KA, Nasr SH, Nast CC, Pani A, Praga M, Remuzzi G, Rennke HG, Ruggenenti P, Roccatello D, Soler MJ, Specks U, Stahl RAK, Singh RD, Theis JD, Velosa JA, Wetzels JFM, Winearls CG, Yandian F, Zand L, Ronco P, Fervenza FC. Mayo Clinic consensus report on membranous nephropathy: proposal for a novel classification. Kidney Int 2023; 104:1092-1102. [PMID: 37795587 DOI: 10.1016/j.kint.2023.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 10/06/2023]
Abstract
Membranous nephropathy (MN) is a pattern of injury caused by autoantibodies binding to specific target antigens, with accumulation of immune complexes along the subepithelial region of glomerular basement membranes. The past 20 years have brought revolutionary advances in the understanding of MN, particularly via the discovery of novel target antigens and their respective autoantibodies. These discoveries have challenged the traditional classification of MN into primary and secondary forms. At least 14 target antigens have been identified, accounting for 80%-90% of cases of MN. Many of the forms of MN associated with these novel MN target antigens have distinctive clinical and pathologic phenotypes. The Mayo Clinic consensus report on MN proposes a 2-step classification of MN. The first step, when possible, is identification of the target antigen, based on a multistep algorithm and using a combination of serology, staining of the kidney biopsy tissue by immunofluorescence or immunohistochemistry, and/or mass spectrometry methodology. The second step is the search for a potential underlying disease or associated condition, which is particularly relevant when knowledge of the target antigen is available to direct it. The meeting acknowledges that the resources and equipment required to perform the proposed testing may not be generally available. However, the meeting consensus was that the time has come to adopt an antigen-based classification of MN because this approach will allow for accurate and specific MN diagnosis, with significant implications for patient management and targeted treatment.
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Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Laurence H Beck
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Richard J Glassock
- Department of Medicine, Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, USA
| | - Mark Haas
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium
| | | | - Elion Hoxha
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gérard Lambeau
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne Sophia Antipolis, France
| | - Nicola M Tomas
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Madden
- Mayo Clinic Proteomics Core, Mayo Clinic, Rochester, Minnesota, USA
| | - Hanna Debiec
- Sorbonne Université, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, Paris, France
| | - Vivette D D'Agati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Gerald B Appel
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sean J Barbour
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fernando Caravaca-Fontan
- Department of Medicine, Complutense University, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel C Cattran
- Toronto General Research Institute, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Marta Casal Moura
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Domingos O D'Avila
- Serviço de Nefrologia, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renato G Eick
- Serviço de Nefrologia, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Eddie L Greene
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Glen S Markowitz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Karl A Nath
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia C Nast
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Antonello Pani
- Nephrology, Dialysis and Transplantation, Arnas Brotzu, Cagliari, Italy; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Manuel Praga
- Department of Medicine, Complutense University, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Helmut G Rennke
- Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy; Unit of Nephrology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Dario Roccatello
- Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, ASL Città di Torino, Turin, Italy; Center of Immuno-Rheumatology and Rare Diseases (CMID), Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Maria Jose Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain; Centro de Referencia en Enfermedad, Glomerular Compleja del Sistema Nacional de Salud de España (CSUR), Barcelona, Spain
| | - Ulrich Specks
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rolf A K Stahl
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raman Deep Singh
- Renal Pathophysiology Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason D Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge A Velosa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack F M Wetzels
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Federico Yandian
- Department of Nephrology, Hospital de Clinicas Universidad de la Republica, Montevideo, Uruguay
| | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Pierre Ronco
- Sorbonne Université, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, Paris, France; Division of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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Fujii A, Hayashi N, Fujita H, Yokoyama H, Furuichi K. A Case of Spontaneous Remission of Membranous Nephropathy After the Removal of Nerve Epidermal Growth Factor-Like 1 Positive Sigmoid Colon Carcinoma. Cureus 2023; 15:e49892. [PMID: 38174198 PMCID: PMC10762652 DOI: 10.7759/cureus.49892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Recently, the association between membranous nephropathy (MN) and malignancy has been recognized in about 30% of epidermal growth factor-like 1 (NELL-1) positive cases. However, the mechanism of association with MN and malignancy remains under search. In this report, we present a unique case of MN with positive staining for both thrombospondin type-1 domain-containing 7A (THSD7A) and NELL-1. An 80-year-old Japanese woman with nephrotic syndrome (NS) was diagnosed as an immunoglobulin (Ig)G1 subclass predominant secondary MN with weakly positive for THSD7A staining. Then, advanced cancer in the sigmoid colon was found during screening tests for malignancy. After the removal of colon carcinoma, complete remission was achieved at 28 weeks follow-up after operation. Five years later, she remained in remission and passed without recurrence. Thereafter, we examined again newly reported NELL-1 in renal biopsy specimens and found very strong staining along the glomerular capillary walls. Moreover, in resected tumor tissues, NELL-1 was strongly positive at the basal side of adenocarcinoma cells, but THSD7A staining was negative. This case report provides clinical details and highlights the utility of autoantibodies, especially NELL-1, in the diagnosis and treatment of secondary MN with malignancy.
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Affiliation(s)
- Ai Fujii
- Nephrology, Kanazawa Medical University, Kanazawa, JPN
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Duan S, Sun L, Zhang C, Zeng M, Sun B, Yuan Y, Mao H, Xing C, Zhang B. The thickness of glomerular basement membrane predicts complete remission in primary membranous nephropathy. Ren Fail 2023; 45:2179335. [PMID: 36856323 PMCID: PMC9980401 DOI: 10.1080/0886022x.2023.2179335] [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] [Indexed: 03/02/2023] Open
Abstract
Objective: Glomerular basement membrane (GBM) thickening is a typical and essential histopathological characteristic for the diagnosis of primary membranous nephropathy (PMN). The present study aimed to explore the relationship between GBM thickness and treatment response in PMN patients.Methods: A total of 128 patients with nephrotic syndrome concurrent with PMN were studied. The highest GBM thickness was measured from at least five glomerular capillary loops using an electron microscope, and the mean value was obtained. Patients were categorized into three groups according to the tertiles of GBM thickness as follows: Group 1 (GBM thickness ≤ 1100 nm, n = 48), Group 2 (1100 nm < GBM thickness ≤ 1300 nm, n = 40), Group 3 (GBM thickness >1300 nm, n = 40). Clinicopathological features and treatment response were compared among the three groups. The associations of GBM thickness with complete remission (CR) were assessed by Cox proportional hazard analyses and a cubic spline curve.Results: During a median follow-up period of 25.80 months, 69 (53.9%) patients achieved CR. Kaplan-Meier analysis showed that the non-CR probability was significantly higher in the highest tertile of GBM thickness (p˂0.001). Univariate Cox proportional hazard analysis indicated that GBM thickness was associated with CR (HR per SD 0.617, 95% CI [0.471-0.809], p˂0.001). After adjusting for age, duration of PMN, estimated glomerular filtration rate (eGFR), urinary protein excretion, grade of C3 deposition, and titer of serum anti-phospholipase A2 receptor (PLA2R) antibody, GBM thickness remained an independent predictor of CR (HR per SD 0.580, 95% CI [0.436-0.772], p˂0.001). Further multivariable-adjusted restricted cubic spline analysis confirmed a significant reverse linear association between GBM thickness and CR (p for nonlinear = 0.1261).Conclusions: GBM thickness is an independent risk factor of CR. PMN patients with an increased level of GBM thickening at diagnosis have a lower probability of achieving CR.
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Affiliation(s)
- Suyan Duan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China
| | - Lianqin Sun
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China
| | - Chengning Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China
| | - Ming Zeng
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China
| | - Bin Sun
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China
| | - Yanggang Yuan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China
| | - Huijuan Mao
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China,Changying Xing, Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, P. R. China
| | - Bo Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, P.R. China,Department of Nephrology, Pukou Branch of JiangSu Province Hospital (Nanjing Pukou Central Hospital), Nanjing, P.R. China,CONTACT Bo Zhang
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Solà-Porta E, Buxeda A, Lop J, Naranjo-Hans D, Gimeno J, Lloveras-Rubio B, Pérez-Sáez MJ, Redondo-Pachón D, Crespo M. THSD7A-positive membranous nephropathy after kidney transplantation: A case report. Nefrologia 2023; 43 Suppl 2:85-90. [PMID: 36681516 DOI: 10.1016/j.nefroe.2022.09.005] [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] [Received: 04/12/2022] [Accepted: 09/03/2022] [Indexed: 06/17/2023] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome after kidney transplantation (KT); however, scarce is known regarding post-KT thrombospondin type-1 domain-containing 7A (THSD7A)-positive MN. Herein, we report on a 72-year-old woman with end-stage kidney disease due to chronic interstitial nephritis (1996). In February 2020, she received a second deceased-donor KT, achieving optimal kidney function but presenting early post-KT proteinuria, reaching up to 1800mg/24h six months after transplantation, controlled with renin-angiotensin-aldosterone system (RAAS) blockade. In July 2021, a kidney allograft biopsy revealed features consistent with MN. Immunohistochemical stains showed diffuse and granular THSD7A and C4d deposition in glomerular capillary walls and negative PLA2R and IgG4 staining. No anti-THSD7A antibodies were detected in the serum. The pre-implantation biopsy showed no MN-associated lesions and negative THSD7A staining. Secondary triggers such as malignancy were discarded. The present report illustrates a THSD7A-positive MN in a KT recipient. Despite lacking native kidney biopsy and early presentation, a recurrent MN seemed unprovable due to documented native kidney disease and a long time span between native kidney disease and MN diagnosis. We, therefore, presumed primary de novo disease. Two years after KT, kidney function remains stable, and the patient has reached complete remission of proteinuria.
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Affiliation(s)
| | - Anna Buxeda
- Department of Nephrology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Joan Lop
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | | | - Javier Gimeno
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Department of Pathology, Hospital del Mar, Barcelona, Spain
| | | | - María José Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Dolores Redondo-Pachón
- Department of Nephrology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
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Feng X, Chen Q, Zhong J, Yu S, Wang Y, Jiang Y, Wan J, Li L, Jiang H, Peng L, Wang A, Zhang G, Wang M, Yang H, Li Q. Molecular characteristics of circulating B cells and kidney cells at the single-cell level in special types of primary membranous nephropathy. Clin Kidney J 2023; 16:2639-2651. [PMID: 38046035 PMCID: PMC10689139 DOI: 10.1093/ckj/sfad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Indexed: 12/05/2023] Open
Abstract
Background Although primary membranous nephropathy (pMN) associated with podocyte autoantibodies (POS) is becoming well-known, the molecular characteristics of the specific type of pMN that is negative for podocyte autoantibodies (NEG) is still unclear. Methods We performed single-cell transcriptome sequencing and single-cell B cell receptor sequencing on circulating CD19+ cells and kidney cells of a NEG paediatric patient with pMN. The single-cell datasets of POS patients and healthy control individuals were included for integrative analysis. Results The gene expression characteristics and clonal expansion of naïve and memory B cells in the NEG patient changed significantly. We found that a group of CD38+ naïve B cells expanded in the NEG patient, which had the functional characteristics of cell activation. In addition, the conversion between immunoglobulin M (IgM)/IgD and IgG1 in the NEG patient was increased. Parietal epithelial cells (PECs) and podocytes shared similar signature genes (WT1, CLIC5), and new candidate marker genes for PECs, such as NID2, CAV1 and THY1, might contribute to the definition of cell subsets. PECs might have undergone significant changes in the disease, mainly manifested by changes in the expression of CCN2, PLAAT4 and SEPTIN2. The scores of gene sets related to extracellular matrix, cell adhesion and calcium channel in podocytes of the NEG patient was significantly increased. The gene expression of sodium transporter in a group of proximal tubule cells in the disease was significantly increased, especially SLC5A12, which might be related to the oedema of patients. Conclusions Our research demonstrated the cell type-specific molecular features in the circulation and kidney of the NEG pMN patient.
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Affiliation(s)
- Xiaoqian Feng
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qilin Chen
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jinjie Zhong
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Sijie Yu
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue Wang
- Nanjing Jiangbei New Area Biopharmaceutical Public Service Platform, Nanjing, Jiangsu, China
| | - Yaru Jiang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Junli Wan
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Longfei Li
- Nanjing Jiangbei New Area Biopharmaceutical Public Service Platform, Nanjing, Jiangsu, China
| | - Huimin Jiang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Liping Peng
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Anshuo Wang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gaofu Zhang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mo Wang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Haiping Yang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qiu Li
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Bonilla M, Hassanein M, Caza T, Jhaveri KD. Hope or hype? Clinicians' dilemma in the era of ever-expanding antigens in membranous nephropathy. Nephrol Dial Transplant 2023; 38:2666-2669. [PMID: 37442615 DOI: 10.1093/ndt/gfad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Marco Bonilla
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mohamed Hassanein
- Division of Nephrology and Hypertension, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Kenar D Jhaveri
- Department of Medicine, Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
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Ai S, Yan X, Zhao X, Ye W, Wen Y, Wang J, Pan B, Dong J, Li X, Qin Y. Malignancy-associated membranous nephropathy: focus on diagnosis and treatment. J Nephrol 2023; 36:2355-2363. [PMID: 37713160 DOI: 10.1007/s40620-023-01751-4] [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: 03/13/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The clinicopathological features of malignancy-associated membranous nephropathy have been described previously, but information about diagnosis and treatment remains limited. METHODS Patients with malignancy-associated membranous nephropathy in a tertiary hospital in China between June 2012 and October 2021 were retrospectively reviewed. RESULTS Forty-two patients with malignancy-associated membranous nephropathy were identified. Compared to patients with idiopathic membranous nephropathy, patients with malignancy-associated membranous nephropathy were older and less frequently showed glomerular phospholipase A2 receptor staining (37.9% vs 85.0%) and IgG4 predominant deposition (66.7% vs 95.0%). At diagnosis of membranous nephropathy, the malignancy was unknown in 67% (28/42) of patients and was detected only by tumor screening. Among the 19 patients with concurrent diagnosis of cancer and biopsy-proven membranous nephropathy, 15 received anticancer treatment alone initially. Six of the 10 patients who attained cancer remission achieved remission of membranous nephropathy, while none of the 5 patients without remission of cancer did, suggesting a causal relationship between the two diseases. Some patients with persistent or relapsing membranous nephropathy following cancer remission achieved remission of membranous nephropathy after immunosuppressive therapy. Over a median follow-up of 24 months, 25% (10/40) of patients died, mainly due to neoplasia. CONCLUSIONS Tumor screening is important in patients with membranous nephropathy, especially in elderly patients and patients with negative phospholipase A2 receptor or non-IgG4 predominant deposition. Remission of membranous nephropathy can be observed following remission of cancer in some cases. Immunosuppressive therapy may be considered if membranous nephropathy does not remit after remission of cancer.
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Affiliation(s)
- SanXi Ai
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - XiWei Yan
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - XueSong Zhao
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - WenLing Ye
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - YuBing Wen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Jing Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - BoJu Pan
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - XueMei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yan Qin
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.
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Tomas NM, Schnarre A, Dehde S, Lucas R, Hermans-Borgmeyer I, Kretz O, Koellner SMS, Wiech T, Koch-Nolte F, Seifert L, Huber TB, Zahner G. Introduction of a novel chimeric active immunization mouse model of PLA2R1-associated membranous nephropathy. Kidney Int 2023; 104:916-928. [PMID: 37598854 DOI: 10.1016/j.kint.2023.07.024] [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] [Received: 01/31/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023]
Abstract
The phospholipase A2 receptor 1 (PLA2R1) is the major target antigen in patients with membranous nephropathy (MN), an antibody-mediated autoimmune glomerular disease. Investigation of MN pathogenesis has been hampered by the lack of reliable animal models. Here, we overcome this issue by generating a transgenic mouse line expressing a chimeric PLA2R1 (chPLA2R1) consisting of three human PLA2R1 domains (cysteine-rich, fibronectin type-II and CTLD1) and seven murine PLA2R1 domains (CTLD2-8) specifically in podocytes. Mice expressing the chPLA2R1 were healthy at birth and showed no major glomerular alterations when compared to mice with a wild-type PLA2R1 status. Upon active immunization with human PLA2R1 (hPLA2R1), chPLA2R1-positive mice developed anti-hPLA2R1 antibodies, a nephrotic syndrome, and all major histological features of MN, including granular deposition of mouse IgG and complement components in immunofluorescence and subepithelial electron-dense deposits and podocyte foot process effacement in electron microscopy. In order to investigate the role of the complement system in this model, we further crossed chPLA2R1-positive mice with mice lacking the central complement component C3 (C3-/- mice). Upon immunization with hPLA2R1, chPLA2R1-positive C3-/- mice had substantially less severe albuminuria and nephrotic syndrome when compared to chPLA2R1-positive mice with a wild-type C3 status. In conclusion, we introduce a novel active immunization model of PLA2R1-associated MN and demonstrate a pathogenic role of the complement system in this model.
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Affiliation(s)
- Nicola M Tomas
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Annabel Schnarre
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Dehde
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renke Lucas
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Irm Hermans-Borgmeyer
- Center of Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Kretz
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah M S Koellner
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Wiech
- Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Pathology, Nephropathology Section, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Larissa Seifert
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias B Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunther Zahner
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Kouri AM, Caza TN, Beck LH, Misurac JM, Evans MD, Phillips CL, Eadon MT, Larsen CP, Andreoli SP, Bu L, Rheault MN, Khalid M. Clinical and Histopathologic Characteristics of Pediatric Patients With Primary Membranous Nephropathy. Kidney Int Rep 2023; 8:2368-2375. [PMID: 38025223 PMCID: PMC10658230 DOI: 10.1016/j.ekir.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Primary membranous nephropathy (PMN) is uncommon in children. Therefore, data on the clinical course of affected children are scarce. In recent years, several novel antigens have been implicated in the pathogenesis of PMN. However, the histopathologic characteristics of pediatric patients with PMN remain poorly represented in the literature. Methods We have retrospectively analyzed the clinical presentation and outcomes data of 21 children with PMN from 3 centers in the United States. In addition, we have identified novel antigens in biopsy specimens from these patients and correlated their presence or absence to clinical outcomes. Finally, we compared the results of the novel antigen staining from our clinical cohort to a validation cohort of 127 biopsy specimens from children with PMN at Arkana Laboratories. Results The data from the 2 cohorts demonstrated similar overall antigen positivity rates of 62% to 63%, with phospholipase A2 receptor (PLA2R) and exostosin 1 (EXT1) being the most commonly found antigens. Results from the clinical cohort showed that overall, the kidney prognosis for children with PMN was good, with 17 of 21 patients entering a complete or partial remission. Children who were positive for PLA2R or EXT1 were significantly more likely to enter remission than those in the antigen negative group. Conclusion Approximately 60% of pediatric membranous cases are positive for a novel antigen on kidney biopsy and the clinical prognosis is generally favorable. More studies are needed to understand the clinical implications of each specific novel antigen.
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Affiliation(s)
- Anne M. Kouri
- Division of Pediatric Nephrology, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota, USA
| | | | - Laurence H. Beck
- Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Jason M. Misurac
- Division of Pediatric Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carrie L. Phillips
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Michael T. Eadon
- Division of Nephrology, Indiana University, Indianapolis, Indiana, USA
| | | | - Sharon P. Andreoli
- Riley Hospital for Children at IU Health, Division of Pediatric Nephrology and Hypertension, Indianapolis, Indiana, USA
| | - Lihong Bu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle N. Rheault
- Division of Pediatric Nephrology, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota, USA
| | - Myda Khalid
- Riley Hospital for Children at IU Health, Division of Pediatric Nephrology and Hypertension, Indianapolis, Indiana, USA
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Zappi S, Bernasconi L, Fischer I, Hoxha E, Wiech T, Minzer A, Irani S, Moosmann P, Kim MJ. Lesson for the clinical nephrologist: thrombospondin type-1 domain-containing protein 7A-associated membranous nephropathy and Fanconi syndrome in a patient with a squamous cell lung cancer. J Nephrol 2023; 36:2395-2399. [PMID: 37294401 DOI: 10.1007/s40620-023-01630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Stephanie Zappi
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Ingeborg Fischer
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Elion Hoxha
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torsten Wiech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sarosh Irani
- Clinic for Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Peter Moosmann
- Division of Oncology, Hematology and Transfusion Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Min Jeong Kim
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
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Sethi S, Beck LH, Glassock RJ, Haas M, De Vriese AS, Caza TN, Hoxha E, Lambeau G, Tomas NM, Madden B, Debiec H, D'Agati VD, Alexander MP, Amer H, Appel GB, Barbour SJ, Caravaca-Fontan F, Cattran DC, Casal Moura M, D'Avila DO, Eick RG, Garovic VD, Greene EL, Herrera Hernandez LP, Jennette JC, Lieske JC, Markowitz GS, Nath KA, Nasr SH, Nast CC, Pani A, Praga M, Remuzzi G, Rennke HG, Ruggenenti P, Roccatello D, Soler MJ, Specks U, Stahl RAK, Singh RD, Theis JD, Velosa JA, Wetzels JFM, Winearls CG, Yandian F, Zand L, Ronco P, Fervenza FC. Mayo Clinic Consensus Report on Membranous Nephropathy: Proposal for a Novel Classification. Mayo Clin Proc 2023; 98:1671-1684. [PMID: 37804268 DOI: 10.1016/j.mayocp.2023.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 10/09/2023]
Abstract
Membranous nephropathy (MN) is a pattern of injury caused by autoantibodies binding to specific target antigens, with accumulation of immune complexes along the subepithelial region of glomerular basement membranes. The past 20 years have brought revolutionary advances in the understanding of MN, particularly via the discovery of novel target antigens and their respective autoantibodies. These discoveries have challenged the traditional classification of MN into primary and secondary forms. At least 14 target antigens have been identified, accounting for 80%-90% of cases of MN. Many of the forms of MN associated with these novel MN target antigens have distinctive clinical and pathologic phenotypes. The Mayo Clinic consensus report on MN proposes a 2-step classification of MN. The first step, when possible, is identification of the target antigen, based on a multistep algorithm and using a combination of serology, staining of the kidney biopsy tissue by immunofluorescence or immunohistochemistry, and/or mass spectrometry methodology. The second step is the search for a potential underlying disease or associated condition, which is particularly relevant when knowledge of the target antigen is available to direct it. The meeting acknowledges that the resources and equipment required to perform the proposed testing may not be generally available. However, the meeting consensus was that the time has come to adopt an antigen-based classification of MN because this approach will allow for accurate and specific MN diagnosis, with significant implications for patient management and targeted treatment.
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Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Laurence H Beck
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Richard J Glassock
- Department of Medicine, Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, USA
| | - Mark Haas
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium
| | | | - Elion Hoxha
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gérard Lambeau
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne Sophia Antipolis, France
| | - Nicola M Tomas
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Hamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Madden
- Mayo Clinic Proteomics Core, Mayo Clinic, Rochester, Minnesota, USA
| | - Hanna Debiec
- Sorbonne Université, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, Paris, France
| | - Vivette D D'Agati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Gerald B Appel
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sean J Barbour
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fernando Caravaca-Fontan
- Department of Medicine, Complutense University, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel C Cattran
- Toronto General Research Institute, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Marta Casal Moura
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Domingos O D'Avila
- Serviço de Nefrologia, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renato G Eick
- Serviço de Nefrologia, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Eddie L Greene
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Glen S Markowitz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Karl A Nath
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia C Nast
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Antonello Pani
- Nephrology, Dialysis and Transplantation, Arnas Brotzu, Cagliari, Italy; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Manuel Praga
- Department of Medicine, Complutense University, Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Helmut G Rennke
- Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy; Unit of Nephrology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Dario Roccatello
- Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, ASL Città di Torino, Turin, Italy; Center of Immuno-Rheumatology and Rare Diseases (CMID), Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Maria Jose Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain; Centro de Referencia en Enfermedad, Glomerular Compleja del Sistema Nacional de Salud de España (CSUR), Barcelona, Spain
| | - Ulrich Specks
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rolf A K Stahl
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raman Deep Singh
- Renal Pathophysiology Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason D Theis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge A Velosa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack F M Wetzels
- Department of Nephrology, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Federico Yandian
- Department of Nephrology, Hospital de Clinicas Universidad de la Republica, Montevideo, Uruguay
| | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Pierre Ronco
- Sorbonne Université, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, Paris, France; Division of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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Deepthi RV, George S, Mathew G, Roy S, Bindra M, Rebekah G, Agarwal I. The Clinical Profile and Long-Term Outcome of Children with Membranous Nephropathy, and the Evaluation of Anti-Phospholipase A2 Receptor Antibody Immunohistochemistry in Kidney Biopsy. Indian J Nephrol 2023; 33:432-439. [PMID: 38174298 PMCID: PMC10752404 DOI: 10.4103/ijn.ijn_228_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 01/05/2024] Open
Abstract
Introduction Idiopathic membranous nephropathy (iMN) is a rare cause of nephrotic syndrome in children (1%-7%). Anti-phospholipase A2 receptor (PLA2R) antibody positivity in kidney biopsy is observed in 52%-78% of adults and 45% of children with iMN. The objectives of the study are to analyze the clinical profile and outcome of membranous nephropathy in children, to assess the prevalence of anti-PLA2R immunohistochemistry (IHC) in kidney biopsy, and to correlate their presence with disease characteristics. Methods We are reporting a single-center retrospective study conducted in pediatric nephrology division. Clinical data and outcome parameters of children with membranous nephropathy were analyzed. PLA2R IHC was performed in kidney biopsy specimens retrospectively. Results We analyzed 43 children with membranous nephropathy (MN) from a single center. 18 (42%) had idiopathic MN (iMN). PLA2R IHC was performed in kidney biopsy specimens in 14/18 (78%) patients with iMN and 7/9 (78%) non-lupus secondary membranous nephropathy (SMN) patients. The most common cause of SMN was lupus nephritis in 16 patients (64%). The mean estimated glomerular filtration rate (eGFR) at onset was 156 ± 81 ml/min/1.73m2. The sensitivity and specificity of PLA2R IHC in diagnosing pediatric MN was 50% and 57%, respectively; positive and negative predictive values were 70% and 36%, respectively. At the final follow-up, chronic kidney disease stage 5 (CKD 5) developed in 2/14 (14.3%) iMN patients. Conclusions IHC PLA2R staining of glomerular tissue is a useful diagnostic marker of IMN. Though PLA2R prevalence is lower in children, its role in guiding treatment needs further exploration.
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Affiliation(s)
- RV Deepthi
- Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sachin George
- Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Georgie Mathew
- Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjeet Roy
- Department of General Pathology, Division of Renal Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mandeep Bindra
- Consultant in Pathology, Naruvi Hospital, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Indira Agarwal
- Departments of Child Health, Division of Pediatric Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Nath KA, Erickson LA, Garovic VD. Primary and Secondary Diagnoses in Medicine: Insights From Mayo Clinic Consensus Report on Membranous Nephropathy--Executive Summary. Mayo Clin Proc 2023; 98:1599-1601. [PMID: 37804269 DOI: 10.1016/j.mayocp.2023.08.010] [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] [Received: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Karl A Nath
- Division of Nephrology & Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Vesna D Garovic
- Division of Nephrology & Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
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Zhang Y, Chen P, Wang B, Tang X, Wei Y, Cao W, Tang L, Wang Z, Zhao N. Containing anti-PLA2R IgG antibody induces podocyte injury in idiopathic membranous nephropathy. Ren Fail 2023; 45:2271986. [PMID: 37905942 PMCID: PMC11001355 DOI: 10.1080/0886022x.2023.2271986] [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] [Received: 02/16/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
Background: Idiopathic membranous nephropathy is widely recognized as an autoimmune kidney disease that is accompanied by the discovery of several autoantibodies, and the antibody subclass in the circulation of patients with iMN is mainly IgG. However, the direct pathogenic effect of the containing anti-PLA2R IgG antibody on podocytes is not clear.Method: A protein G affinity chromatography column was used to purify serum IgG antibodies. Containing anti-PLA2R IgG antibodies from iMN patients and IgG from healthy controls were also obtained. Based on the established in vitro podocyte culture system, purified IgG antibodies from the two groups were used to stimulate podocytes, and the expression of essential podocyte proteins (podocin), the levels of inflammatory cytokines in the cell supernatant, cytoskeletal disorders, and podocyte apoptosis were analyzed.Results: Compared with that in the normal IgG group, the expression of podocin and podocin mRNA was reduced (p = 0.016 and p = 0.005, respectively), the fluorescence intensity of podocin on the surface of podocytes was reduced, the cytoskeleton of podocytes was disordered and reorganized, and the ratio of podocyte apoptosis was increased in the iMN group (p = 0.008).Conclusion: The containing anti-PLA2R IgG antibody might have a direct damaging effect on podocytes in idiopathic membranous nephropathy.
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Affiliation(s)
- Ying Zhang
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Ping Chen
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Baobao Wang
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Xueqing Tang
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Yong Wei
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Wei Cao
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Lijun Tang
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Zunsong Wang
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
| | - Na Zhao
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China
- Nephrology Research Institute of Shandong Province, Jinan, China
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Jiang S, Jiang D, Lian Z, Huang X, Li T, Zhang Y. THSD7A as a Promising Biomarker for Membranous Nephrosis. Mol Biotechnol 2023:10.1007/s12033-023-00934-5. [PMID: 37884765 DOI: 10.1007/s12033-023-00934-5] [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: 07/10/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023]
Abstract
Membranous nephropathy (MN) is an autoimmune disease of the kidney glomerulus and one of the leading causes of nephrotic syndrome. The disease exhibits heterogeneous outcomes with approximately 30% of cases progressing to end-stage renal disease. Traditionally, the standard approach of diagnosing MN involves performing a kidney biopsy. Nevertheless, kidney biopsy is an invasive procedure that poses risks for the patient including bleeding and pain, and bears greater costs for the health system. The clinical management of MN has steadily advanced owing to the identification of autoantibodies to the phospholipase A2 receptor (PLA2R) in 2009 and thrombospondin domain-containing 7A (THSD7A) in 2014 on the podocyte surface. At present, serum anti-PLA2R antibody detection and glomerular PLA2R antigen staining have been used for clinical diagnosis and prognosis, but the related detection of THSD7A has not been widely used in clinical practice. Here, we summarized the emerging knowledge regarding the roles THSD7A plays in MN and its clinical implications as diagnostic, prognostic, and therapeutic response as well as Methods for detecting serum THSD7A antibodies.
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Affiliation(s)
- Shuiqing Jiang
- Fujian Key Laboratory of Developmental and Neural Biology, College of Life Science, Fujian Normal University, Fuzhou, 350117, Fujian, China.
| | - Dehua Jiang
- Kangrun Biotech LTD, Guangzhou, 511400, Guangdong, China
| | - Zhiyuan Lian
- Kangrun Biotech LTD, Guangzhou, 511400, Guangdong, China
| | - Xiaohong Huang
- Fujian Key Laboratory of Developmental and Neural Biology, College of Life Science, Fujian Normal University, Fuzhou, 350117, Fujian, China
| | - Ting Li
- Fujian Key Laboratory of Developmental and Neural Biology, College of Life Science, Fujian Normal University, Fuzhou, 350117, Fujian, China
| | - Yinan Zhang
- Fujian Key Laboratory of Developmental and Neural Biology, College of Life Science, Fujian Normal University, Fuzhou, 350117, Fujian, China
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