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Yadav D, Mantan M, Mahajan B. Comparison of Urinary Beta-2 Microglobulin Levels in Children with SSNS and Calcineurin Inhibitor-Treated SRNS. Indian J Nephrol 2024; 34:149-154. [PMID: 38681018 PMCID: PMC11044690 DOI: 10.4103/ijn.ijn_339_22] [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: 10/11/2022] [Accepted: 02/01/2023] [Indexed: 05/01/2024] Open
Abstract
Background While the utility of beta-2 microglobulin (β2M) has been explored in various renal conditions to identify tubulointerstitial damage, it has not been adequately studied in nephrotic syndrome. The primary objective of the study was to compare urinary β2M levels in children with steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS) in disease remission. Materials and Methods This cross-sectional study was done at a tertiary care hospital between April 2019 and March 2020. Sixty children (2-18 years) with SSNS and SRNS (30 in each group) in remission were enrolled. SRNS patients were included after ≥1 year of treatment with calcineurin inhibitors (CNIs). Biochemical investigations were done to confirm remission; spot samples for urinary β2M were collected and estimation was done by an enzyme-linked immunosorbent assay (ELISA)-based kit. Results Of the 60 children, 63% were boys. The median (interquartile range [IQR]) age at enrollment for SSNS and SRNS patients was 7 (4.1-9) and 11 (8.3-12) years, respectively. Urinary β2M levels were significantly higher in SRNS patients compared to SSNS patients (2.6 vs. 0.75 mg/ml, P < 0.0001). Patients who received cyclosporine for >2 years had higher median urinary β2M levels compared to those who received it for a shorter period (2.63 vs. 1.83 mg/ml, P = 0.03). Median β2M levels were higher in focal segmental glomerulosclerosis than minimal change disease (3.5 vs. 2.5 mg/ml). Conclusion Urinary β2M levels were higher in SRNS compared to SSNS disease in remission, and β2M levels correlated well with CNI use of >2 years. It appears to be a promising noninvasive tool to identify early tubular damage and progression in patients with nephrotic syndrome, especially SRNS.
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Affiliation(s)
- Deepika Yadav
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Mukta Mantan
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, GIPMER, University of Delhi, New Delhi, India
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2
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Duo L, Chen L, Zuo Y, Guo J, He M, Zhao H, Kang Y, Tang W. Machine learning model to estimate probability of remission in patients with idiopathic membranous nephropathy. Int Immunopharmacol 2023; 125:111126. [PMID: 37913570 DOI: 10.1016/j.intimp.2023.111126] [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: 07/03/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Idiopathic membranous nephropathy (IMN) is a type of nephrotic syndrome and the leading cause of chronic kidney disease. As far as we know, no predictive model for assessing the prognosis of IMN is currently available. This study aims to establish a nomogram to predict remission probability in patients with IMN and assists clinicians to make treatment decisions. METHODS A total of 266 patients with histopathology-proven IMN were included in this study. Least absolute shrinkage and selection operator regression was utilized to identify the most important variables. Subsequently, multivariate Cox regression analysis was conducted to construct a nomogram, and bootstrap resampling was employed for internal validation. Receiver operating characteristic and calibration curves and decision curve analysis (DCA) were utilized to assess the performance and clinical utility of the developed model. RESULTS A prognostic nomogram was established, which incorporated creatinine, glomerular_basement_membrane_thickening, gender, IgG_deposition, low-density lipoprotein cholesterol, and fibrinogen. The areas under the curves of the 3-, 12-, 24-month were 0.751, 0.725, and 0.830 in the training set, and 0.729, 0.730, and 0.948 in the validation set respectively. These results and calibration curves demonstrated the good discrimination and calibration of the nomogram in the training and validation sets. Additionally, DCA indicated that the nomogram was useful for remission prediction in clinical settings. CONCLUSION The nomogram was useful for clinicians to evaluate the prognosis of patients with IMN in early stage.
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Affiliation(s)
- Lijin Duo
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Lei Chen
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yongdi Zuo
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jiulin Guo
- Information Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Manrong He
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hongsen Zhao
- Information Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yingxi Kang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wanxin Tang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
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3
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Pócsi I, Dockrell ME, Price RG. Nephrotoxic Biomarkers with Specific Indications for Metallic Pollutants: Implications for Environmental Health. Biomark Insights 2022; 17:11772719221111882. [PMID: 35859925 PMCID: PMC9290154 DOI: 10.1177/11772719221111882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Environmental and occupational exposure to heavy metals and metalloids is a major global health risk. The kidney is often a site of early damage. Nephrotoxicity is both a major consequence of heavy metal exposure and potentially an early warning of greater damage. A paradigm shift occurred at the beginning of the 21st century in the field of renal medicine. The medical model of kidney failure and treatment began to give way to a social model of risk factors and prevention with important implications for environmental health. This development threw into focus the need for better biomarkers: markers of exposure to known nephrotoxins; markers of early damage for diagnosis and prevention; markers of disease development for intervention and choice of therapy. Constituents of electronic waste, e-waste or e-pollution, such as cadmium (Cd), lead (Pb), mercury (HG), arsenic (As) and silica (SiO2) are all potential nephrotoxins; they target the renal proximal tubules through distinct pathways. Different nephrotoxic biomarkers offer the possibility of identifying exposure to individual pollutants. In this review, a selection of prominent urinary markers of tubule damage is considered as potential tools for identifying environmental exposure to some key metallic pollutants.
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Affiliation(s)
- István Pócsi
- Department of Molecular Biotechnology and Microbiology, Faculty of Science and Technology, University of Debrecen, Debrecen, Hungary
| | - Mark E Dockrell
- SWT Institute of Renal Research, Carshalton, London, UK.,Department of Molecular and Clinical Sciences, St George's University, London, UK
| | - Robert G Price
- Department of Nutrition, Franklin-Wilkins Building, King's College, London, UK
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4
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Zhang Y, Xiang C, Gong L, Zhang Y, Zhen J, Hu Z, Xiao X. Kidney injury molecule-1 levels are associated with therapeutic outcomes and renal tubulointerstitial injury severity in idiopathic membranous nephropathy. Exp Ther Med 2021; 22:1434. [PMID: 34707715 PMCID: PMC8543435 DOI: 10.3892/etm.2021.10869] [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: 07/16/2020] [Accepted: 04/28/2021] [Indexed: 11/06/2022] Open
Abstract
Kidney injury molecule-1 (KIM-1) has an important role in chronic kidney disease development. The present study aimed to retrospectively analyze patients with idiopathic membranous nephrology (IMN) with different therapeutic outcomes to investigate the association between KIM-1 levels and therapeutic outcomes. A total of 51 patients with IMN and 20 healthy controls were included. Patients were classified into three groups: Spontaneous remission, remission with immunosuppressive therapy (IST) and nonremission with IST. Clinical and biochemical variables were collected. Urinary KIM-1 levels were measured by ELISA and renal KIM-1 expression was evaluated by immunohistochemistry. Patients with IMN were characterized as having elevated urinary and renal KIM-1 levels compared with those in the controls. Significantly increased urinary and renal KIM-1 levels were observed in the nonremission with IST group compared with those in the spontaneous remission group, and the same trend was observed for the plasma anti-podocyte antigen phospholipase A2 receptor antibody levels. Patients with more severe tubular injury (T2 index) presented with significantly higher urinary and renal KIM-1 levels than those with the T0 index. Urinary and renal KIM-1 levels were positively correlated with blood urea nitrogen, serum creatinine, serum cystatin-C, urinary albumin/creatinine ratio, urinary β2-microglobulin and the renal interstitial fibrosis index, and they were negatively correlated with serum albumin. Furthermore, urinary KIM-1 levels were positively correlated with the renal KIM-1 levels. In conclusion, the measurement of urinary and renal KIM-1 levels may be helpful in guiding medication selection and predicting therapeutic outcomes for patients with IMN.
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Affiliation(s)
- Yidan Zhang
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Chunhong Xiang
- Department of Nephrology, The No. 4 Hospital of Jinan, Shandong 250031, P.R. China
| | - Liying Gong
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yuanyuan Zhang
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Junhui Zhen
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaoyan Xiao
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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5
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Liu W, Huang G, Rui H, Geng J, Hu H, Huang Y, Huo G, Liu B, Xu A. Course monitoring of membranous nephropathy: Both autoantibodies and podocytes require multidimensional attention. Autoimmun Rev 2021; 21:102976. [PMID: 34757091 DOI: 10.1016/j.autrev.2021.102976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 01/15/2023]
Abstract
A variety of podocyte antigens have been identified in human membranous nephropathy (MN), which is divided into various antigen-dominated subtypes, confirming the concept that MN is the common pattern of glomerular injury in multiple autoimmune responses. The detection of autoantibodies has been widely used, which promoted the clinical practice of MN toward personalized precision medicine. However, given the potential risks of immunosuppressive therapy, more autoantibodies and biomarkers need to be identified to predict the prognosis and therapeutic response of MN more accurately. In this review, we attempted to summarize the autoantigens/autoantibodies and autoimmune mechanisms that can predict disease states based on the current understanding of MN pathogenesis, especially the podocyte injury manifestations. In conclusion, both the autoimmune response and podocyte injury require multidimensional attention in the disease course of MN.
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Affiliation(s)
- Wenbin Liu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Guangrui Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Hongliang Rui
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jie Geng
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Haikun Hu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yujiao Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Guiyang Huo
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Baoli Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
| | - Anlong Xu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
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6
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Jongvilaikasem S, Sampao S, Kanjanapradit K, Saetang J, Sangkhathat S, Mahattanobon S. Serum β-2 microglobulin levels are associated with distant metastasis in patients with breast cancer. Mol Clin Oncol 2021; 14:118. [PMID: 33903824 DOI: 10.3892/mco.2021.2280] [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: 10/26/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022] Open
Abstract
Serum β-2 microglobulin (β2-M) levels have been identified to be higher in patients with cancer than in healthy individuals. The aim of the present study was to evaluate the association between serum β2-M levels and clinicopathological characteristics of patients with breast cancer in a prospective cohort study, and to evaluate the effect of β2-M on cancer cell migration in vitro. Serum samples from 200 female patients with histologically confirmed invasive breast cancer were collected between 2017 and 2019. Their clinicopathological information was obtained and analyzed. The β2-M levels were identified to be associated with age, histologic subtype and metastatic status. When the diagnostic association of β2-M and metastatic status was analyzed, the area under the receiver operating characteristic curve was 0.78. Using a cut-off serum β2-M level of 1.9 µg/ml, the sensitivity for diagnosing metastatic status was 87.5%, the specificity was 65.0%, and the diagnostic odds ratio was 2.47. Upon age stratification, the association between the β2-M level and metastatic status was significant only in the group aged >55 years. In survival analysis, β2-M levels >1.9 µg/ml were associated with a poor survival outcome. In vitro, the MCF-7 breast cancer cell line exhibited increased cellular migration following treatment with 30 µg/ml β2-M. Serum β2-M may be a predictor of metastatic status in breast cancer.
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Affiliation(s)
- Sorrasit Jongvilaikasem
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Srila Sampao
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Jirakrit Saetang
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.,EZ-Mol-Design Laboratory, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Surasak Sangkhathat
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.,Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Somrit Mahattanobon
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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7
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Funabashi S, Omote K, Nagai T, Honda Y, Nakano H, Honda S, Iwakami N, Hamatani Y, Nakai M, Nishimura K, Asaumi Y, Aiba T, Noguchi T, Kusano K, Yokoyama H, Yasuda S, Ogawa H, Anzai T. Elevated admission urinary N-acetyl-β-D-glucosamidase level is associated with worse long-term clinical outcomes in patients with acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:429-436. [DOI: 10.1177/2048872620901986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
The prognostic significance of urinary N-acetyl-β-D-glucosamidase in acute heart failure has not been fully elucidated. Accordingly, this study investigated whether urinary N-acetyl-β-D-glucosamidase could be associated with subsequent adverse events in acute heart failure patients.
Methods:
We studied 708 consecutive acute heart failure patients who had accessible N-acetyl-β-D-glucosamidase data on admission from the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure registry. We assessed the relationship between the admission N-acetyl-β-D-glucosamidase level and the combined endpoint of all-cause death and worsening heart failure. Worsening heart failure was defined as worsening symptoms and signs of heart failure requiring intensification of intravenous therapy such as diuretics, vasodilators and inotropes or initiation of mechanical support after stabilisation with initial treatment during hospitalisation, or readmission due to heart failure after discharge.
Results:
During a median follow-up period of 763 (interquartile range 431–1028) days, higher urinary N-acetyl-β-D-glucosamidase was significantly related to increased events of all-cause death and worsening heart failure. In addition, patients with higher urinary N-acetyl-β-D-glucosamidase and lower estimated glomerular filtration rate on admission had the worst clinical outcomes. In multivariable Cox regression, urinary N-acetyl-β-D-glucosamidase on admission was independently associated with adverse events (hazard ratio 1.19, 95% confidence interval 1.04–1.35) even after adjustment by covariates including the baseline estimated glomerular filtration rate.
Conclusions:
Higher urinary N-acetyl-β-D-glucosamidase level on admission was independently associated with worse clinical outcomes. Our findings indicate the potential value of assessing urinary N-acetyl-β-D-glucosamidase on admission for further risk stratification in patients with acute heart failure.
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Affiliation(s)
- Sayaka Funabashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Hokkaido University, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
- Department of Cardiovascular Medicine, Hokkaido University, Japan
- National Heart and Lung Institute, Imperial College London, UK
- Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Yasuyuki Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hiroki Nakano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Naotsugu Iwakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Japan
| | - Kunihiro Nishimura
- Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hiroyuki Yokoyama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
- Department of Cardiovascular Medicine, Hokkaido University, Japan
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8
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Weng Q, Zhou Q, Tong J, Jin Y, Liu Y, Yu X, Pan X, Ren H, Wang W, Xie J, Chen N. New risk score for predicting steroid resistance in patients with focal segmental glomerulosclerosis or minimal change disease. Clin Proteomics 2020; 17:18. [PMID: 32514258 PMCID: PMC7257237 DOI: 10.1186/s12014-020-09282-x] [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: 10/11/2019] [Accepted: 05/15/2020] [Indexed: 11/28/2022] Open
Abstract
Background Glucocorticosteroid is used for patients with primary nephrotic syndrome. This study aims to identify and validate that biomarkers can be used to predict steroid resistance. Methods Our study contained two stages, discovery and validation stage. In discovery stage, we enrolled 51 minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) patients treated with full dose steroid. Five urinary biomarkers including β2-microglobulin (β2-MG) and α1-microglobulin (α1-MG) were tested and candidates’ biomarkers were selected based on their associations with steroid response. In validation stage, candidates’ biomarkers were validated in two prospectively enrolled cohorts. Validation cohort A included 157 FSGS/MCD patients. Validation cohort B included 59 membranous nephropathy (MN) patients. Patients were classified into response group (RG) or non-response group (NRG) based on their responses to steroid treatment. Results In discovery stage, higher urinary β2-MG was independently associated with response to corticosteroid treatment in MCD/FSGS patients [OR = 1.89, 95% CI 1.02–3.53] after adjusted by age and gender. In validation cohort A, patients in NRG had a significant higher urinary β2-MG [Ln (β2-MG/uCr): 4.6 ± 1.7 vs 3.2 ± 1.5] compared to patients in RG. We then developed a 3-variable risk score in predicting steroid resistance in FSGS/MCD patients based on the best predictive model including Ln(β2-MG/uCr) [OR = 1.76, 95% CI 1.30–2.37], age [OR = 1.005, 95% CI 0.98–1.03] and pathology [MCD vs FSGS, OR = 0.20, 95% CI 0.09–0.46]. The area under the ROC curves of the risk score in predicting steroid response was 0.80 (95% CI 0.65–0.85). However, no such association was found in MN patients. Conclusions Our study identified a 3-variable risk score in predicting steroid resistance in patients with FSGS or MCD.
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Affiliation(s)
- Qinjie Weng
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qiongxiu Zhou
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jun Tong
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yuanmeng Jin
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yunzi Liu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xialian Yu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiaoxia Pan
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hong Ren
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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9
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Stangou MJ, Marinaki S, Papachristou E, Liapis G, Pateinakis P, Gakiopoulou H, Nikolaidou C, Kolovou K, Lampropoulou IT, Zerbala S, Papadea P, Dounousi E, Balafa O, Pavlakou P, Andrikos A, Balassi E, Manolakaki P, Moustakas G, Galitsiou D, Mitsopoulos E, Vourlakou C, Choulitoudi V, Andronikidi PE, Stefanidis I, Golfinopoulos S, Dafnis E, Stylianou K, Panagoutsos S, Papadogianakis A, Tzanakis I, Sioulis A, Vlahakos D, Grapsa I, Tsilivigkou M, Kaperonis N, Paliouras C, Dioudis C, Spaia S, Apostolou T, Iatrou C, Boletis J, Goumenos D, Papagianni A. Histological grading in primary membranous nephropathy is essential for clinical management and predicts outcome of patients. Histopathology 2019; 75:660-671. [PMID: 31318463 PMCID: PMC6856983 DOI: 10.1111/his.13955] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 01/06/2023]
Abstract
Aims Diagnosis of primary membranous nephropathy (PMN) is mainly based on immunofluorescence/immunohistochemistry findings. However, assessment of specific features on optical microscopy can help to estimate the severity of the disease, guide treatment and predict the response. The aim of this study was to identify, classify and grade the precise histological findings in PMN to predict renal function outcome and guide treatment. Methods and results Histological parameters, including focal segmental sclerosis (FSGS), tubular atrophy (TA), interstitial fibrosis (IF) and vascular hyalinosis (VH), were re‐evaluated in 752 patients with PMN. Their predictive value was estimated separately, and also in a combination score (FSTIV) graded from 0 to 4. Finally, the impact of histology was assessed in the response to immunosuppressive treatment. Mean age of patients was 53.3 (15–85) years and most presented with nephrotic syndrome. FSGS was present in 32% and VH in 51% of the patients, while TA and IF were graded as stage ≥1 in 52% and 51.4%, respectively. The follow‐up period was 122.3 (112–376) months. FSGS, TA and IF and VH were associated with impaired renal function at diagnosis (P = 0.02, P < 0.0001, P = 0.001 and P = 0.02, respectively) and at the end of follow‐up (P = 0.004, P < 0.0001, P < 0.0001 and P = 0.04, respectively). In multiple regression and binary logistic analysis, the presence of FSGS and degree of TA were the most significant parameters predicting renal function outcome, defined either by eGFR (end), FSGS (r = 0.6, P < 0.0001) and TA (r = 0.6, P < 0.0001), or by the endpoint of >50% eGFR reduction, FSGS (P = 0.001) and TA (P = 0.02). Also, patients presented with FSGS, IF, VH and/or with FSTIV > 1 could benefit from immunosuppression, regardless of clinical presentation. Conclusions The presence and degree of four histological indices, FSGS, VH, TA and IF, assessed separately or in combination, and FSTIV score not only predict renal function outcome after long‐term follow‐up, but can also help in the choice of appropriate treatment. Decisions concerning immunosuppressive treatment can be guided by pathology regardless of clinical findings.
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Affiliation(s)
- Maria J Stangou
- Hippokration General Hospital, Aristotle University, Thessaloniki, Greece
| | - Smaragdi Marinaki
- National and Kapodistrian University, Laiko General Hospital, Athens, Greece
| | | | - George Liapis
- National and Kapodistrian University, Laiko General Hospital, Athens, Greece
| | | | - Hara Gakiopoulou
- National and Kapodistrian University, Laiko General Hospital, Athens, Greece
| | | | - Kyriaki Kolovou
- National and Kapodistrian University, Laiko General Hospital, Athens, Greece
| | | | | | | | | | - Olga Balafa
- University Hospital of Ioannina, Ioannina, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eugene Dafnis
- University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | | | | | | | - Demetrios Vlahakos
- Attikon University Hospital, National and Kapodistrian University, Athens, Greece
| | - Irene Grapsa
- Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - Sophia Spaia
- General Hospital of Thessaloniki 'Agios Pavlos', Thessaloniki, Greece
| | | | | | - John Boletis
- National and Kapodistrian University, Laiko General Hospital, Athens, Greece
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10
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Koshi-Ito E, Koike K, Tanaka A, Watanabe Y, Kamegai N, Shimogushi H, Shinjo H, Otsuka Y, Inaguma D, Takeda A. Effect of Low-Density Lipoprotein Apheresis for Nephrotic Idiopathic Membranous Nephropathy as Initial Induction Therapy. Ther Apher Dial 2019; 23:575-583. [PMID: 30993827 DOI: 10.1111/1744-9987.12811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/26/2019] [Accepted: 04/15/2019] [Indexed: 12/01/2022]
Abstract
Low-density lipoprotein apheresis (LDL-A) has been used for nephrotic syndrome (NS) caused by focal segmental glomerulosclerosis in Japan. Idiopathic membranous nephropathy (iMN) can also cause treatment-resistant NS. Therefore, we investigated the effect of LDL-A during initial induction for it. This retrospective, observational, and single-center study enrolled consecutive iMN patients who received steroids from March 2000 to May 2015. We compared data between 11 patients treated with LDL-A (LDL-A group) and 27 patients without (non-LDL-A group) at baseline and 4 and 8 weeks later. Reduction rate of proteinuria and increase rate of serum albumin in LDL-A group were significantly higher than the other after 4 weeks (P = 0.036 and 0.030) and 8 weeks (P = 0.030 and <0.001), respectively. There was no adverse event caused by LDL-A and immunosuppressant dose was not significantly different. In conclusion, LDL-A may be an effective choice for initial induction of nephrotic iMN.
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Affiliation(s)
- Eri Koshi-Ito
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.,Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyomi Koike
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Akihito Tanaka
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Yu Watanabe
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Naoki Kamegai
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroya Shimogushi
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Hibiki Shinjo
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Yasuhiro Otsuka
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Daijo Inaguma
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.,Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
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11
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Tsai SF, Wu MJ, Chen CH. Low serum C3 level, high neutrophil-lymphocyte-ratio, and high platelet-lymphocyte-ratio all predicted poor long-term renal survivals in biopsy-confirmed idiopathic membranous nephropathy. Sci Rep 2019; 9:6209. [PMID: 30996263 PMCID: PMC6470169 DOI: 10.1038/s41598-019-42689-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/05/2019] [Indexed: 01/05/2023] Open
Abstract
Idiopathic membranous nephropathy (iMN) is the major cause of end-stage renal disease (ESRD). Recent guidelines suggest limiting immunosuppressants only to high risk patients for ESRD. The present study is aimed at identifying new predictors for the renal outcome of iMN patients. We conducted a retrospective cohort study covering a period from January 2003 to December 2013. We enrolled participants who had received their first renal biopsy at our medical center in Taiwan with the diagnosis of iMN. Clinical, pathological and laboratory data were collected from medical records. Analyses with Mann-Whitney U test was used for continuous variables and Chi-square test for categorical variables. The Kaplan-Meier curve was used for the analyses of patient survival and renal survival. Youden index was used for evaluating the performance of a dichotomous diagnostic test for renal and patient outcomes. Cox proportional hazard regression was used to determine factors affecting renal survival.A total of 99 patients with renal biopsy-confirmed idiopathic iMNs were enrolled. C3 level ≤114 mg/dl predicted patient outcome (p < 0.001) with good predictive power (AUC = 0.736). The univariate analysis showed that risk factors for poor renal outcome were older age (HR = 1.04, p = 0.002), high BUN (HR = 1.03, p < 0.001), poor baseline renal function (HR = 1.30 and p < 0.001 for higher serum creatinine; HR = 0.97 and p < 0.001 for higher eGFR; HR = 1.06 and p < 0.001 for urine PCR), C3 ≤ 93.4 mg/dl (HR = 2.15, p = 0.017), NLR > 3.34 (HR = 3.30, p < 0.001) and PLR > 14.48 (HR = 2.54, p = 0.003). Stage of iMN did not fully account for the risk of ESRD. This is the first evidence that serum levels of C3 ≤ 93.4 mg/dl predicted poor renal outcomes with good predictive power. Easily obtained markers, NLR > 3.34 also predicted poor renal outcomes.
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Affiliation(s)
- Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Life Science, Tunghai University, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Lilfe Science, National Chung Hsing University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,Department of Life Science, Tunghai University, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Lilfe Science, National Chung Hsing University, Taichung, Taiwan.
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12
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Ali H, Kishore B, Baharani J. Significance of paraprotein gap and β2 microglobulins in predialysis Population with multiple myeloma. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:825-831. [DOI: 10.4103/1319-2442.265458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Uwaezuoke SN. The role of novel biomarkers in childhood idiopathic nephrotic syndrome: a narrative review of published evidence. Int J Nephrol Renovasc Dis 2017; 10:123-128. [PMID: 28615961 PMCID: PMC5459980 DOI: 10.2147/ijnrd.s131869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Two histological subtypes of idiopathic nephrotic syndrome are commonly recognized in children, namely minimal change nephropathy and focal segmental glomerulosclerosis. Children with minimal change nephropathy (the majority of whom are steroid-sensitive) and focal segmental glomerulosclerosis (the majority of whom are steroid-resistant) require early identification in order to ensure appropriate therapeutic intervention and better outcome. Although renal biopsy and histology remain the ideal diagnostic steps to identify these histological subtypes, reports indicate that serum and urinary biomarkers are now being utilized in the investigation of childhood idiopathic nephrotic syndrome. This paper aims to review the diagnostic and prognostic utility of novel biomarkers in childhood idiopathic nephrotic syndrome and to highlight their role in differentiating steroid-sensitive nephrotic syndrome (SRNS) from steroid-resistant nephrotic syndrome (SSNS). Using the terms “idiopathic nephrotic syndrome,” “children,” and “biomarkers” the PubMed database was searched for relevant studies related to the topic. Biomarkers such as adiponectin, neopterin, β2-microglobulin, and N-acetyl-β-D glucosaminidase were reported as diagnostic markers. In addition to neopterin and N-acetyl-β-D glucosaminidase, urine vitamin D-binding protein and α1β-glycoprotein were shown to differentiate SRNS from SSNS while N-acetyl-β-D glucosaminidase and β2-microglobulin could predict steroid responsiveness and renal outcome in SRNS. Although progress has been made in demonstrating the diagnostic and prognostic utility of these biomarkers, their limited availability in most laboratories has precluded a complete paradigm shift from the conventional renal biopsy. Nevertheless, further longitudinal studies are required to establish their usefulness as noninvasive predictors of disease response to immunosuppressive therapy.
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Affiliation(s)
- Samuel N Uwaezuoke
- Department of Pediatrics, Pediatric Nephrology Firm, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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14
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Maas RJH, van den Brand JAJG, Waanders F, Meijer E, Goor van H, Peters HP, Hofstra JM, Wetzels JFM. Kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin as prognostic markers in idiopathic membranous nephropathy. Ann Clin Biochem 2015; 53:51-7. [DOI: 10.1177/0004563215579694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 01/27/2023]
Abstract
Background Urinary excretion of alpha-1-microglobulin and beta-2-microglobulin reflects tubular damage and predicts outcome in patients with idiopathic membranous nephropathy with reasonable accuracy. Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin are novel biomarkers of tubular damage. We investigated if these markers could improve prediction of outcome in idiopathic membranous nephropathy. Methods We measured kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in urine samples from patients with idiopathic membranous nephropathy, who had nephrotic proteinuria and normal renal function. Excretion of alpha-1-microglobulin and beta-2-microglobulin had been measured previously. Progression was defined as a serum creatinine rise >30%, a rise in serum creatinine to an absolute value of ≥135 µmol/L, or a clinical decision to start immunosuppressive therapy. Remission was defined as proteinuria <3.5 g/day and >50% reduction from baseline. Results Sixty-nine patients were included. Median follow-up was 35 months (interquartile range 18–63 months). Progression occurred in 30 patients (44%), and spontaneous remission in 36 (52%). Kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin excretion rates were significantly correlated with each other, and with alpha-1-microglobulin and beta-2-microglobulin. The areas under the receiver operating characteristic curves for progression were 0.75 (0.62–0.87) for kidney injury molecule-1 and 0.74 (0.62–0.87) for neutrophil gelatinase-associated lipocalin. In multivariate analysis with either alpha-1-microglobulin and beta-2-microglobulin, kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin did not independently predict outcome. Conclusion Kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin excretion rates correlated with excretion rates of other tubular damage markers and predicted outcome in patients with idiopathic membranous nephropathy. They did not add prognostic value compared to measurement of either alpha-1-microglobulin or beta-2-microglobulin.
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Affiliation(s)
- Rutger JH Maas
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan AJG van den Brand
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femke Waanders
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Meijer
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry Goor van
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hilde P Peters
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Julia M Hofstra
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jack FM Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Sui W, Zhang R, Chen J, He H, Cui Z, Ou M, Guo L, Cong S, Xue W, Dai Y. Comparative proteomic analysis of membranous nephropathy biopsy tissues using quantitative proteomics. Exp Ther Med 2015; 9:805-810. [PMID: 25667632 PMCID: PMC4316945 DOI: 10.3892/etm.2015.2197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 11/18/2014] [Indexed: 11/13/2022] Open
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults and the second leading cause of end-stage renal disease due to primary glomerulonephritis. The aim of the present study was to identify potential biomarkers of MN and further characterize these proteins by Gene Ontology (GO) analysis. Isobaric tags for relative and absolute quantification were used to compare the protein levels in tissues from MN patients and healthy individuals, and the combined samples were subsequently separated by specialized communications exchange. Mass spectrometry data acquisition was conducted using a 4800 Plus MALDI TOF/TOF tandem mass spectrometry device, and the results were subjected to statistical analysis. A total of 1,903 proteins were identified, with 423 proteins exhibiting a difference of >1.5-fold compared with the control group. Of these, 202 proteins were upregulated, while 221 proteins were downregulated. In conclusion, GO enrichment analysis revealed that the differentially expressed proteins were primarily mapped to the following GO terms: ‘Immune response’, ‘immune effector process’, ‘activation of immune response’ and ‘positive regulation of immune system process’. The affected proteins may be associated with the pathogenesis of MN; thus, may represent candidate MN biomarkers.
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Affiliation(s)
- Weiguo Sui
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Ruohan Zhang
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Jiejing Chen
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Huiyan He
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Zhenzhen Cui
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China ; College of Life Science, Guangxi Normal University, Guilin, Guangxi 541004, P.R. China
| | - Minglin Ou
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Li Guo
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Shan Cong
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Wen Xue
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China
| | - Yong Dai
- Nephrology Department, Guilin 181 Hospital, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, Guangxi 541002, P.R. China ; Clinical Medical Research Center, The Second Clinical Medical College of Jinan University (Shenzhen People's Hospital), Shenzhen, Guangdong 518020, P.R. China
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16
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Lai WL, Yeh TH, Chen PM, Chan CK, Chiang WC, Chen YM, Wu KD, Tsai TJ. Membranous nephropathy: a review on the pathogenesis, diagnosis, and treatment. J Formos Med Assoc 2015; 114:102-11. [PMID: 25558821 DOI: 10.1016/j.jfma.2014.11.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 11/07/2014] [Accepted: 11/12/2014] [Indexed: 11/25/2022] Open
Abstract
In adults, membranous nephropathy (MN) is a major cause of nephrotic syndrome. However, the etiology of approximately 75% of MN cases is idiopathic. Secondary causes of MN are autoimmune diseases, infection, drugs, and malignancy. The pathogenesis of MN involves formation of immune complex in subepithelial sites, but the definite mechanism is still unknown. There are three hypotheses about the formation of immune complex, including preformed immune complex, in situ immune-complex formation, and autoantibody against podocyte membrane antigen. The formation of immune complex initiates complement activation, which subsequently leads to glomerular damage. Recently, the antiphospholipase A2 receptor antibody was found to be associated with idiopathic MN. This finding may be useful in the diagnosis and prognosis of MN. The current treatment includes best supportive care, which consists of the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, lipid-lowering agents, and optimal control of blood pressure. Immunosuppressive agents should be used for patients who suffer from refractory proteinuria or complications associated with nephrotic syndrome. Existing evidence supports the use of a combination of steroid and alkylating agents. This article reviews the epidemiology, pathogenesis, diagnosis, and the treatment of MN.
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Affiliation(s)
- Wei Ling Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting Hao Yeh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping Min Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen Chih Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yung Ming Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kwan Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tun Jun Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Evaluation of urinary biomarkers for the prognosis of drug-associated chronic tubulointerstitial nephritis. Am J Med Sci 2013; 346:283-8. [PMID: 23147380 DOI: 10.1097/maj.0b013e318271f910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The efficacy of urinary biomarkers for predicting adverse clinical outcomes in drug-induced chronic tubulointerstitial nephritis (D-CTIN) has not been well described. METHODS A total of 54 patients with D-CTIN were prospectively followed-up in this study. The urinary excretion of α1-microglobulin and transforming growth factor-β1 and the activity of urinary N-acetyl-β-D-glucosaminidase (NAG) and matrix metalloproteinases (MMPs) 2 and 9 at baseline were measured. Changes in the estimated glomerular filtration rate (GFR) over a period of 11 to 54 months (median, 38 months) of follow-up were recorded. The efficacy of urinary biomarkers for differentiating patients with various outcomes was tested. Ten patients with IgA nephropathy and 20 healthy volunteers were enrolled as controls. RESULTS The areas under the receiver operating characteristic curve for urinary NAG, MMP-9, MMP-2 and α1-microglobulin for predicting deterioration of the estimated GFR were 0.879, 0.867, 0.735 and 0.709, respectively (P < 0.05 for all). Partial regression coefficient results demonstrated that urinary NAG (P = 0.02), MMP-2 (P = 0.046) and MMP-9 (P = 0.041) were inversely correlated with the rate of GFR decline. CONCLUSIONS Urinary NAG, MMP-2 and MMP-9 may be considered as possible candidates for forecasting the progression rate of D-CTIN.
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18
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Rituximab-based novel strategies for the treatment of immune-mediated glomerular diseases. Autoimmun Rev 2013; 12:854-9. [DOI: 10.1016/j.autrev.2012.09.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 11/23/2022]
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19
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Otaki Y, Watanabe T, Shishido T, Takahashi H, Funayama A, Narumi T, Kadowaki S, Hasegawa H, Honda S, Netsu S, Ishino M, Arimoto T, Miyashita T, Miyamoto T, Konta T, Kubota I. The impact of renal tubular damage, as assessed by urinary β2-microglobulin-creatinine ratio, on cardiac prognosis in patients with chronic heart failure. Circ Heart Fail 2013; 6:662-8. [PMID: 23674363 DOI: 10.1161/circheartfailure.112.000089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Renal dysfunction was reported to be closely associated with clinical outcomes in patients with chronic heart failure (CHF). Renal tubulointerstitial damage has been shown to be an important factor in the development of renal dysfunction as well as glomerular damage. However, the impact of renal tubular damage on clinical outcomes in patients with CHF remains to be determined. METHODS AND RESULTS Urinary β2-microglobulin-creatinine ratio was measured in 315 patients with CHF. Renal tubular damage was defined as a urinary β2-microglobulin-creatinine ratio ≥ 300 μg/g, as previously reported. Patients were prospectively followed up for a median period of 1097 days. There were 91 cardiac events, including 16 cardiac deaths and 75 rehospitalizations for worsening heart failure. Log10 urinary β2-microglobulin-creatinine ratio was increased with worsening New York Heart Association functional class. Multivariate analysis revealed that renal tubular damage was an independent predictor of cardiac events. Kaplan-Meier analysis demonstrated that the rate of cardiac events was higher in patients with renal tubular damage compared with those without it. Patients were divided into 4 groups according to the presence of chronic kidney disease and renal tubular damage. The Cox proportional hazard analysis revealed that comorbidity of chronic kidney disease and renal tubular damage was associated with the highest risk for cardiac events compared with other groups. CONCLUSIONS Renal tubular damage was related to the severity of heart failure and was associated with poor outcomes in patients with CHF. Renal tubular damage could add clinical information to chronic kidney disease in patients with CHF.
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Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Fervenza FC, Glassock RJ, Bleyer AJ. American Society of Nephrology Quiz and Questionnaire 2012: glomerulonephritis. Clin J Am Soc Nephrol 2013; 8:1460-5. [PMID: 23539226 DOI: 10.2215/cjn.00440113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Presentation of the Nephrology Quiz and Questionnaire (NQQ) has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session, judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire. The topic presented here is GN. Cases representing this category, along with single best answer questions, were prepared by a panel of experts (Drs. Fervenza, Glassock, and Bleyer). The correct and incorrect answers were then briefly discussed after the audience responses and the results of the questionnaire were displayed. This article recapitulates the session and reproduces its educational value for a larger audience--that of the readers of the Clinical Journal of the American Society of Nephrology. Have fun.
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Affiliation(s)
- Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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21
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Real de Asúa D, Puchades R, García-Polo I, Suárez C. A Study on the Relationship between Serum Beta 2-Microglobulin Levels, Underlying Chronic Kidney Disease, and Peripheral Arterial Disease in High-Vascular-Risk Patients. Int Cardiovasc Res J 2012; 6:107-12. [PMID: 24757603 PMCID: PMC3987415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 10/18/2012] [Accepted: 11/23/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Serum beta 2-microglobulin (B2M) levels have been found to be increased in patients with peripheral arterial disease (PAD), yet it is still unknown whether B2M correlates with PAD intensity. OBJECTIVES We aim to evaluate the correlation between B2M and the ankle-brachial index (ABI) values in high-vascular-risk patients. METHODS This is a cross-sectional study of 63 high-vascular-risk patients admitted to the Cardiology Department or evaluated as outpatients in the Internal Medicine Department of our institution. Patients were classified into two groups according to their ABI: patients without PAD (n = 44, ABI values between 0.9 and 1.4) and patients with PAD (n = 19, ABI values lower than 0.9 or higher than 1.4). We performed univariate and multivariate analysis based on a multiple linear regression model. RESULTS Serum B2M levels were higher in patients with pathological ABI values than in those without PAD (2.36 ± 1.13 vs. 1.80 ± 0.65 mg/L; P<0.05). We found no correlation between B2M and ABI in our total population (r = -0.12) or in patients with PAD (r = -0.09; NS for both comparisons). Age, gender, arterial hypertension, estimated glomerular filtration rate (eGFR), uric acid, total cholesterol, and LDL-cholesterol correlated with B2M in the univariate analysis. In the final linear regression model, eGFR, uric acid and total cholesterol correlated independently with B2M (P<0.01). CONCLUSION We found no correlation between B2M levels and ABI values in high-vascular-risk patients that could usefully help in the subsequent diagnosis of PAD. However, we observed a significant correlation between B2M and eGFR, even when renal function was only slightly impaired.
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Affiliation(s)
- Diego Real de Asúa
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain,Corresponding author: Diego Real de Asúa, Department of Internal Medicine, Hospital Universitario La Princesa C/ Diego de León 62, 28006 Madrid, Spain. Tel: +34-915-202 222, Fax:+34-915-202 209.
| | - Ramón Puchades
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain
| | - Iluminada García-Polo
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain
| | - Carmen Suárez
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain
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Irazabal MV, Eirin A, Lieske J, Beck LH, Sethi S, Borland TM, Dillon JJ, Nachman PH, Nasr SH, Cornell LD, Leung N, Cattran DC, Fervenza FC. Low- and high-molecular-weight urinary proteins as predictors of response to rituximab in patients with membranous nephropathy: a prospective study. Nephrol Dial Transplant 2012; 28:137-46. [PMID: 22987142 DOI: 10.1093/ndt/gfs379] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Selective urinary biomarkers have been considered superior to total proteinuria in predicting response to treatment and outcome in patients with membranous nephropathy (MN). METHODS We prospectively tested whether urinary (U) excretion of retinol-binding protein (RBP), α1-microglobulin (α1M), albumin, immunoglobulin IgG and IgM and/or anti-phospholipase 2 receptor (PLA(2)R) levels could predict response to rituximab (RTX) therapy better than standard measures in MN. We also correlated changes in antibodies to PLA(2)R with these urinary biomarkers. RESULTS Twenty patients with MN and proteinuria (P) >5 g/24 h received RTX (375 mg/m(2) × 4) and at 12 months, 1 patient was in complete remission (CR), 9 were in partial remission (PR), 5 had a limited response (LR) and 4 were non-responders (NR). At 24 months, CR occurred in 4, PR in 12, LR in 1, NR in 2 and 1 patient relapsed. By simple linear regression analysis, UIgG at baseline (mg/24 h) was a significant predictor of change in proteinuria at 12 months (Δ urinary protein) (P = 0.04). In addition, fractional excretion (FE) of IgG, urinary alpha 1 microglobulin (Uα1M) (mg/24 h) and URBP (μg/24 h) were also predictors of response (P = 0.05, 0.04, and 0.03, respectively). On the other hand, UIgM, FEIgM, albumin and FE albumin did not predict response (P = 0.10, 0.27, 0.22 and 0.20, respectively). However, when results were analyzed in relation to proteinuria at 24 months, none of the U markers that predicted response at 12 m could predict response at 24 m (P = 0.55, 0.42, 0.29 and 0.20). Decline in anti-PLA(2)R levels was associated with and often preceded urinary biomarker response but positivity at baseline was not a predictor of proteinuria response. CONCLUSIONS The results suggest that in patients with MN, quantification of low-, medium- and high-molecular-weight urinary proteins may be associated with rate of response to RTX, but do not correlate with longer term outcomes.
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Affiliation(s)
- Maria V Irazabal
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
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Cattran DC, Kim J. Is Long-Term Prediction in Membranous Nephropathy (MGN) Better Than the Weatherman's Forecast Capacity? Clin J Am Soc Nephrol 2012; 7:1203-5. [DOI: 10.2215/cjn.06600712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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van den Brand JAJG, Hofstra JM, Wetzels JFM. Prognostic value of risk score and urinary markers in idiopathic membranous nephropathy. Clin J Am Soc Nephrol 2012; 7:1242-8. [PMID: 22595828 DOI: 10.2215/cjn.00670112] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Accurate prediction of prognosis may improve management of patients with idiopathic membranous nephropathy. This study compared the Toronto Risk Score and urinary low-molecular weight proteins. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS One hundred four patients with biopsy-proven idiopathic membranous nephropathy who presented between 1995 and 2008 with a well-preserved kidney function and nephrotic range proteinuria were included. Urinary β2-microglobulin and α1-microglobulin measurements were obtained by timed standardized measurements, and the Toronto Risk Score was calculated using data obtained from medical records. The endpoint was progression, which was defined as an increase in serum creatinine > 50% or > 25% with a concentration > 135 μmol/L. RESULTS Forty-nine patients showed progression. The area under the receiver-operating characteristics curve was 0.78 (95% confidence interval = 0.69-0.88) for the risk score versus 0.80 (0.71-0.89) and 0.79 (0.71-0.88) for urinary β2- and α1-microglobulin, respectively. Differences were not significant. Persistent proteinuria did not add accuracy to the Toronto Risk Score. Conversely, its accuracy was not reduced when data from the first 6 months of follow-up were used. Furthermore, a score based on GFR estimated with the six-variable Modification of Diet in Renal Disease equation, calculated in the first 6 months of follow-up, gave an area under the receiver-operating characteristics curve of 0.83 (0.74-0.92), which was not statistically different from other markers. CONCLUSIONS The prognostic accuracies of the Toronto Risk Score and urinary low-molecular weight proteins were not significantly different. The risk score can be calculated within 6 months of diagnosis, and a simplified risk score using estimated GFR-Modification of Diet in Renal Disease may be sufficient.
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Fuchs TC, Frick K, Emde B, Czasch S, Landenberg FV, Hewitt P. Evaluation of Novel Acute Urinary Rat Kidney Toxicity Biomarker for Subacute Toxicity Studies in Preclinical Trials. Toxicol Pathol 2012; 40:1031-48. [DOI: 10.1177/0192623312444618] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Barbara Emde
- Merck KGaA, Merck Serono, Toxicology, Darmstadt, Germany
| | | | | | - Philip Hewitt
- Merck KGaA, Merck Serono, Toxicology, Darmstadt, Germany
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van den Brand JAJG, Hofstra JM, Wetzels JFM. Low-molecular-weight proteins as prognostic markers in idiopathic membranous nephropathy. Clin J Am Soc Nephrol 2012; 6:2846-53. [PMID: 22157712 DOI: 10.2215/cjn.04020411] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Accurate prediction of prognosis in idiopathic membranous nephropathy (iMN) allows restriction of immunosuppressive therapy to patients at high risk for ESRD. Here we re-evaluate urinary low-molecular-weight proteins as prognostic markers and explore causes of misclassification. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a cohort of 129 patients with serum creatinine concentration <135 μmol/L and proteinuria ≥3.0 g/10 mmol, urinary α1- (uα1m) and β2-microglobulin (uβ2m) excretion rate was determined. Urinary α1m and uβ2m-creatinine ratio was also obtained. We defined progression as a rise in serum creatinine ≥50% or ≥25% and an absolute level ≥135 μmol/L. RESULTS Median survival time was 25 months, and 47% of patients showed progression. The area under the receiver operating characteristic curve for uβ2m was 0.81 (95% CI: 0.73 to 0.89). Using a threshold value of 1.0 μg/min, sensitivity and specificity were 73% and 75%, respectively. Similar accuracy was observed for the uβ2m-creatinine ratio with sensitivity and specificity of 75% and 73%, respectively, at a threshold of 1.0 μg/10 mmol creatinine. Similar accuracy was found for uα1m and uα1m-creatinine ratio. Blood Pressure and cholesterol contributed to misclassification. Repeated measurements improved accuracy in patients with persistent proteinuria: the positive predictive value of uβ2m increased from 72% to 89% and the negative predictive value from 76% to 100%. CONCLUSIONS Urinary excretion of uα2m and uβ2m predict prognosis in iMN. A spot urine sample can be used instead of a timed sample. A repeated measurement after 6 to 12 months increases prognostic accuracy.
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Affiliation(s)
- Jan A J G van den Brand
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Fuchs TC, Hewitt P. Preclinical perspective of urinary biomarkers for the detection of nephrotoxicity: what we know and what we need to know. Biomark Med 2012; 5:763-79. [PMID: 22103611 DOI: 10.2217/bmm.11.86] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The assessment of kidney damage is a challenge and must incorporate assessment of the functional capacity of the kidney, as well as a comprehensive understanding of the kidney's role. Multiple parameters have been used for many years to measure renal functionality to assess renal damage. It is astonishing that, beside histopathology, the most common traditional parameters are serum based. However, urine is also used to obtain additional information regarding the health status of the kidneys. Since 2008, several novel urinary protein biomarkers have been qualified by the US FDA and the European Medicines Agency in conjunction with the Predictive Safety Testing Consortium in a specially developed qualification process. Subsequently, the Pharmaceuticals and Medical Devices Agency accepted the qualification of these seven urinary biomarkers. This review will give an overview of the state-of-the-art detection based on urinary biomarkers, which will enhance toxicological research in the future. In addition, the qualification process that leads to acceptance of these biomarkers will be described because of its uniqueness and importance for the field of biomarker research.
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Fuchs TC, Hewitt P. Biomarkers for drug-induced renal damage and nephrotoxicity-an overview for applied toxicology. AAPS JOURNAL 2011; 13:615-31. [PMID: 21969220 DOI: 10.1208/s12248-011-9301-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/12/2011] [Indexed: 01/08/2023]
Abstract
The detection of acute kidney injury (AKI) and the monitoring of chronic kidney disease (CKD) is becoming more important in industrialized countries. Because of the direct relation of kidney damage to the increasing age of the population, as well as the connection to other diseases like diabetes mellitus and congestive heart failure, renal diseases/failure has increased in the last decades. In addition, drug-induced kidney injury, especially of patients in intensive care units, is very often a cause of AKI. The need for diagnostic tools to identify drug-induced nephrotoxicity has been emphasized by the ICH-regulated agencies. This has lead to multiple national and international projects focusing on the identification of novel biomarkers to enhance drug development. Several parameters related to AKI or CKD are known and have been used for several decades. Most of these markers deliver information only when renal damage is well established, as is the case for serum creatinine. The field of molecular toxicology has spawned new options of the detection of nephrotoxicity. These new developments lead to the identification of urinary protein biomarkers, including Kim-1, clusterin, osteopontin or RPA-1, and other transcriptional biomarkers which enable the earlier detection of AKI and deliver further information about the area of nephron damage or the underlying mechanism. These biomarkers were mainly identified and qualified in rat but also for humans, several biomarkers have been described and now have to be validated. This review will give an overview of traditional and novel tools for the detection of renal damage.
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Nauta FL, Boertien WE, Bakker SJL, van Goor H, van Oeveren W, de Jong PE, Bilo H, Gansevoort RT. Glomerular and tubular damage markers are elevated in patients with diabetes. Diabetes Care 2011; 34:975-81. [PMID: 21307379 PMCID: PMC3064060 DOI: 10.2337/dc10-1545] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated in a cross-sectional study the levels of serum and urinary damage markers in diabetic patients (n = 94) and nondiabetic control subjects (n = 45) to study the association of glomerular (IgG), proximal tubular (kidney injury molecule [KIM]-1, N-acetyl-β-d-glucosaminidase [NAG], neutrophil gelatinase-associated lipocalin [NGAL], and cystatin C), and distal tubular (heart fatty acid-binding protein [H-FABP]) damage markers with kidney disease severity, as assessed by albuminuria and estimated glomerular filtration rate (eGFR). RESEARCH DESIGN AND METHODS Damage markers were measured in triplicate in fresh morning urine samples and in plasma. RESULTS Of the diabetic patients, 41 were normoalbuminuric, 41 were microalbuminuric, and 12 were macroalbuminuric. Urinary NAG (ninefold), NGAL (1.5-fold), and H-FABP (3.5-fold) were significantly elevated in normoalbuminuric diabetic patients compared with nondiabetic control subjects. Urinary concentrations of all markers increased per albuminuria stratum, except KIM-1. All urinary damage markers, except KIM-1, were significantly associated with albuminuria, independent of age, sex, and plasma concentrations of the corresponding biomarker (standard βs between 0.35 and 0.87; all P ≤ 0.001). All urinary damage markers, except KIM-1, were significantly associated with the eGFR in univariate models (standard βs between -0.38 and -0.21; all P < 0.04). After adjusting for age, sex, plasma concentration of the corresponding damage marker, and albuminuria, only the association of H-FABP with eGFR remained significant (standard β -0.26; P = 0.037). CONCLUSIONS Glomerular and tubular markers are associated with albuminuria, independently of eGFR, suggesting that albuminuria reflects both glomerular and tubulointerstitial damage. Only urinary H-FABP is associated with eGFR independently of albuminuria and, therefore, may be a promising urinary damage marker to assess diabetic kidney disease.
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Affiliation(s)
- Ferdau L Nauta
- Department of Nephrology, University Medical Center Groningen, University of Groningen,Groningen, the Netherlands.
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Oikonomou K, Kapsoritakis A, Eleftheriadis T, Stefanidis I, Potamianos S. Renal manifestations and complications of inflammatory bowel disease. Inflamm Bowel Dis 2011; 17:1034-45. [PMID: 20842645 DOI: 10.1002/ibd.21468] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 12/11/2022]
Abstract
Renal manifestations and complications are not rare in patients with inflammatory bowel disease (IBD) and may present as nephrolithiasis, amyloidosis, tubulointerstitial nephritis, and glomerulonephritis. Symptoms of renal impairment are not always specific and since the underlying bowel disease is preponderant, renal function deterioration may be underestimated. Additionally, medical treatment of patients with IBD such as aminosalicylates, cyclosporine, and tumor necrosis factor-α inhibitors can cause renal complications, although direct correlation to bowel disease is not always clear. The well-documented renal manifestations and complications of IBD, as well as the possible renal side effects of new drugs, emphasize the need for periodic evaluation of renal function. New markers of renal function may facilitate early diagnosis and unravel the complex mechanisms responsible for kidney damage. The purpose of this review is to summarize the renal manifestations and complications as well as the markers of renal function utilized in IBD, attempting to shed more light on the pathophysiology of renal damage in IBD.
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Affiliation(s)
- Konstantinos Oikonomou
- Department of Gastroenterology, University of Thessaly, School of Medicine, Larissa, Greece.
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Hoffmann D, Fuchs TC, Henzler T, Matheis KA, Herget T, Dekant W, Hewitt P, Mally A. Evaluation of a urinary kidney biomarker panel in rat models of acute and subchronic nephrotoxicity. Toxicology 2010; 277:49-58. [DOI: 10.1016/j.tox.2010.08.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 08/23/2010] [Accepted: 08/24/2010] [Indexed: 01/12/2023]
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Is the reno-protective effect of valsartan dose dependent? A comparative study of 80 and 160 mg day(-1). Hypertens Res 2010; 33:886-91. [PMID: 20555331 DOI: 10.1038/hr.2010.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Whether the reno-protective effect of angiotensin receptor blockers is dose dependent is unknown for the Japanese population. We sought to elucidate the dose-dependent reno-protective effects of valsartan in Japanese hypertensive patients with albuminuria. This was a multi-center, open-label, parallel-group trial. A total of 181 patients were randomized to receive either 80 (n=89) or 160 mg day(-1) (n=92) of valsartan for 24 weeks. Then, the effects on blood pressure, urinary albumin excretion (UAE), type IV collagen and beta(2)-microglobulin (beta2MG) were determined. Systolic and diastolic blood pressures decreased substantially by almost the same extent in the low-dose and high-dose groups, showing no inter-group difference during the treatment. The UAE value decreased significantly by 35% in both groups. Urinary excretion of beta2MG was significantly decreased in the high-dose group (17%), but not in the low-dose group (13%), although the decrease was not significantly different between the two groups (P=0.74). Urinary excretion of type IV collagen decreased non-significantly by 10% in the low-dose group and by 8% in the high-dose group, showing no significant inter-group difference (P=0.78). Low (80 mg day(-1)) and high (160 mg day(-1)) doses of valsartan showed a similar effect of lowering blood pressure. The high dose of valsartan resulted in a slightly greater decrease in urinary beta2MG, but it was inconclusive whether the high dose was more reno-protective as compared with the low dose.
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Bolignano D, Lacquaniti A, Coppolino G, Donato V, Campo S, Fazio MR, Nicocia G, Buemi M. Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease. Clin J Am Soc Nephrol 2009; 4:337-44. [PMID: 19176795 DOI: 10.2215/cjn.03530708] [Citation(s) in RCA: 388] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) has recently assumed epidemic proportion, becoming a troubling emerging cause of morbidity, especially if it progresses to terminal stage (ESRD). The authors aimed to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL), a novel specific biomarker of acute kidney injury, could predict the progression of CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Serum and urinary NGAL levels, together with a series of putative progression factors, were evaluated in a cohort of 96 patients (mean age: 57 +/- 16 years) affected by nonterminal CKD (eGFR > or =15 ml/min/1.73 m(2)) of various etiology. Progression of CKD, assessed as doubling of baseline serum creatinine and/or onset of ESRD, was evaluated during follow-up. RESULTS At baseline, both serum and urinary NGAL were inversely, independently, and closely related to eGFR. After a median follow-up of 18.5 mo (range 1.01 to 20), 31 patients (32%) reached the composite endpoint. At baseline, these patients were significantly older and showed increased serum creatinine, calcium-phosphate product, C-reactive protein, fibrinogen, daily proteinuria, and NGAL levels, whereas eGFR values were significantly lower. Univariate followed by multivariate Cox proportional hazard regression analysis showed that urinary NGAL and sNGAL predicted CKD progression independently of other potential confounders, including eGFR and age. CONCLUSION In patients with CKD, NGAL closely reflects the entity of renal impairment and represents a strong and independent risk marker for progression of CKD.
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Affiliation(s)
- Davide Bolignano
- Department of Internal Medicine, University of Messina, Messima, Italy
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Bolignano D, Lacquaniti A, Coppolino G, Donato V, Campo S, Fazio MR, Nicocia G, Buemi M. Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease. Clin J Am Soc Nephrol 2009. [PMID: 19176795 DOI: 10.2215/cjn03530708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) has recently assumed epidemic proportion, becoming a troubling emerging cause of morbidity, especially if it progresses to terminal stage (ESRD). The authors aimed to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL), a novel specific biomarker of acute kidney injury, could predict the progression of CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Serum and urinary NGAL levels, together with a series of putative progression factors, were evaluated in a cohort of 96 patients (mean age: 57 +/- 16 years) affected by nonterminal CKD (eGFR > or =15 ml/min/1.73 m(2)) of various etiology. Progression of CKD, assessed as doubling of baseline serum creatinine and/or onset of ESRD, was evaluated during follow-up. RESULTS At baseline, both serum and urinary NGAL were inversely, independently, and closely related to eGFR. After a median follow-up of 18.5 mo (range 1.01 to 20), 31 patients (32%) reached the composite endpoint. At baseline, these patients were significantly older and showed increased serum creatinine, calcium-phosphate product, C-reactive protein, fibrinogen, daily proteinuria, and NGAL levels, whereas eGFR values were significantly lower. Univariate followed by multivariate Cox proportional hazard regression analysis showed that urinary NGAL and sNGAL predicted CKD progression independently of other potential confounders, including eGFR and age. CONCLUSION In patients with CKD, NGAL closely reflects the entity of renal impairment and represents a strong and independent risk marker for progression of CKD.
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Affiliation(s)
- Davide Bolignano
- Department of Internal Medicine, University of Messina, Messima, Italy
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