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Willey CJ, Coppo R, Schaefer F, Mizerska-Wasiak M, Mathur M, Schultz MJ. The incidence and prevalence of IgA nephropathy in Europe. Nephrol Dial Transplant 2023; 38:2340-2349. [PMID: 37156519 PMCID: PMC10539204 DOI: 10.1093/ndt/gfad082] [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: 01/30/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND This study aimed to determine the incidence and prevalence of immunoglobulin A nephropathy (IgAN) in Europe based on high-quality data from national registries. METHODS IgAN incidences were obtained from a literature review of European studies of national kidney biopsy registry data in which IgAN diagnosis was biopsy-verified using contemporary techniques. Studies were eligible for the main analysis if published from 1990 to 2020. IgAN point prevalence was defined as the annual IgAN incidence multiplied by the estimated duration of disease. Incidence and prevalence estimates were made for three pooled populations: (i) patients of all ages; (ii) pediatric patients; and (iii) elderly patients. RESULTS Across 10 European countries, the estimated annual IgAN incidence was 0.76 per 100 000 in patients of all ages. The corresponding pooled IgAN point prevalence was 2.53 per 10 000 (95% confidence interval: 2.51-2.55), ranging from 1.14 per 10 000 in Spain to 5.98 per 10 000 in Lithuania. Applied to 2021 population estimates, the number of expected prevalent IgAN cases was 47 027 across all 10 countries and ranged from 577 in Estonia to 16 645 in Italy. Among pediatric patients, IgAN incidence was 0.20 per 100 000 children and IgAN point prevalence was 0.12 per 10 000 children. Among elderly patients, IgAN incidence was 0.30 per 100 000 and IgAN point prevalence was 0.36 per 10 000. CONCLUSIONS Based on high-quality data from European national registries, IgAN point prevalence was estimated at 2.53 per 10 000 in patients of all ages. Prevalence was considerably lower in pediatric and elderly populations.
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Affiliation(s)
- Cynthia J Willey
- College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | | | | | - Michaela J Schultz
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA
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Noor SM, Abuazzam F, Mathew R, Zhang Z, Abdipour A, Norouzi S. IgA nephropathy: a review of existing and emerging therapies. FRONTIERS IN NEPHROLOGY 2023; 3:1175088. [PMID: 37675358 PMCID: PMC10479631 DOI: 10.3389/fneph.2023.1175088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 09/08/2023]
Abstract
IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. Recently, there have been multiple advances in the understanding of IgAN pathophysiology and therapeutic options. Despite the advent of new treatment options, individual risk stratification of the disease course and choosing the best treatment strategy for the patient remains challenging. A multitude of clinical trials is ongoing, opening multiple opportunities for enrollment. In this brief review we discuss the current approach to the management of IgAN and highlight the ongoing clinical trials.
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Affiliation(s)
| | | | | | | | | | - Sayna Norouzi
- Department of Nephrology, Loma Linda University, Loma Linda, CA, United States
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Bobart SA, Portalatin G, Sawaf H, Shettigar S, Carrion-Rodriguez A, Liang H, Herlitz L, Gebreselassie SK. The Cleveland Clinic Kidney Biopsy Epidemiological Project. KIDNEY360 2022; 3:2077-2085. [PMID: 36591368 PMCID: PMC9802556 DOI: 10.34067/kid.0005882022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The kidney biopsy is the gold standard for diagnosing glomerular diseases. Large-scale, epidemiologic studies describing the prevalence of kidney diseases are lacking, especially in the United States. We aimed to determine the spectrum of biopsy-proven kidney disease across the Cleveland Clinic enterprise. METHODS We identified all patients with a native kidney biopsy performed or reviewed at the Cleveland Clinic from January 2015 to September 2021. Retrospective chart review was performed to obtain clinical and demographic characteristics. Results were stratified by age, sex, race, and location to determine epidemiologic trends. RESULTS Of >9600 patients, we excluded transplant and donor biopsies and unavailable records, and included 4128 patients with native kidney biopsy data. The median age was 60 years, with 46% female patients. Self-reported racial demographics included 73% White, 22% Black, 3% multiracial, and 2% Asian background, with 5% Hispanic. Common diagnoses were: FSGS (n=633, 15%), diabetic kidney disease (DKD) (n=602, 15%), IgA nephropathy (n=319, 8%), lupus nephritis (LN) (n=289, 7%), pauci-immune glomerulonephritis (n=275, 7%), membranous nephropathy (n=211, 5%), and amyloidosis (n=110, 3%). There were 3322 patients in Ohio, with 361 patients in Florida. Using multivariate analysis, those aged >70 years were more likely to have FSGS, whereas those <45 years were more likely to have IgA nephropathy or LN. Males were more likely to have FSGS or IgAN, and less likely to have LN. Black patients were more likely to have FSGS, DKD, or LN. Hispanic patients were more likely to have DKD. Finally, patients in Florida were more likely to have LN. There was no change in the disease spectrum before and during the COVID-19 pandemic. CONCLUSION Our study catalogs the spectrum of biopsy-proven kidney disease across the Cleveland Clinic enterprise. This lays the foundation for glomerular disease clinical trials, and highlights the need for a standardized national kidney biopsy registry to bolster glomerular and kidney disease research in the United States.
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Affiliation(s)
- Shane A. Bobart
- Department of Kidney Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Gilda Portalatin
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Hanny Sawaf
- Department of Kidney Medicine, Cleveland Clinic Ohio, Cleveland, Ohio
| | - Shruti Shettigar
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida
| | | | - Hong Liang
- Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Leal Herlitz
- Department of Anatomic Pathology, Cleveland Clinic Ohio, Cleveland, Ohio
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Deleersnijder D, Laurens W, De Meester J, Cleenders E, Dendooven A, Lerut E, De Vriese AS, Dejagere T, Helbert M, Hellemans R, Koshy P, Maes B, Pipeleers L, Van Craenenbroeck AH, Van Laecke S, Vande Walle J, Couttenye MM, Meeus G, Sprangers B, De Rycke A, Bogaert AM, Woestenburg A, Denys B, Maes B, Peeters D, Vanbelleghem H, Donck J, Scharpé J, De Clippeleir N, Colson A, Meyvis K, Vandepitte K, Reyns LM, Peeters J, Decupere M, Helbert M, Zeegers M, Neirynck N, Bernaert P, Dejagere T, Lemahieu W, Sprangers B, Pipeleers L, Hellemans R, Van Laecke S, Knops N, Levtchenko E, Walle JV, Karamaria S, Van Hoeck K, Trouet D, Mauel R, Dendooven A, Hoorens A, Van Dorpe J, Praet M, Geers C, Lerut E, Koshy P, Roskams T, Aydin S, Siozopoulou V, Schelfhout AM, De Raeve H, Steenkiste E, Dedeurwaerdere F, Dalle I, Cokelaere K, Deloose S, De Paepe P, Van Eyken P. Clinicopathological characteristics and disease chronicity in native kidney biopsies in Flanders. Clin Kidney J 2022; 16:125-137. [PMID: 36726429 PMCID: PMC9871845 DOI: 10.1093/ckj/sfac208] [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: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background The Flemish Collaborative Glomerulonephritis Group (FCGG) registry provides complete population data on kidney disease epidemiology in the region of Flanders (Belgium), as it captures all native kidney biopsies performed in its population of 6.5 million inhabitants. Methods From 2017 until 2019, 2054 adult kidney biopsies were included from 26 nephrology centers (one biopsy per patient). Data on nephrotic and nephritic syndrome were available in 1992 and 2026 biopsies, respectively. In a subgroup of 898 biopsies containing ≥10 glomeruli from 2018 to 2019, disease chronicity was graded using the Mayo Clinic Chronicity Score (MCCS). The association between clinical variables and MCCS was determined using simple and multiple linear regression models. Results Nephrotic syndrome (present in 378 patients, 19.0%) was most frequently caused by minimal change disease in younger patients (18-44 years), membranous nephropathy in older patients (45-74 years) and amyloidosis in the elderly (>75 years). Nephritic syndrome (present in 421 patients, 20.8%) was most frequently caused by immunoglobulin A nephropathy (IgAN) in younger patients (18-64 years) and ANCA-associated vasculitis (AAV) in older patients (>64 years). AAV and IgAN were the most frequent underlying diagnoses in biopsies in which crescents were identified. In multivariable analysis, acute and chronic kidney disease and diagnoses of diabetic kidney disease, nephrosclerosis and hyperoxaluria/hypercalcemic nephropathy were associated with the highest MCCS increases. Conclusions The FCGG registry validates data from previous Western European registries and provides a snapshot of disease chronicity in the whole biopsied Flemish population.
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Affiliation(s)
| | | | - Johan De Meester
- Department of Nephrology and Dialysis, VITAZ Hospital, Sint-Niklaas, Belgium
| | - Evert Cleenders
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Amélie Dendooven
- Division of Pathology, University Hospital Ghent, Ghent, Belgium,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - An S De Vriese
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium,Department of Nephrology and Infectious Diseases, AZ Sint-Jan, Brugge, Belgium
| | - Tom Dejagere
- Department of Nephrology, Jessa Hospital, Hasselt, Belgium
| | - Mark Helbert
- Department of Nephrology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Rachel Hellemans
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium,Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Priyanka Koshy
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Maes
- Department of Nephrology, AZ Delta, Roeselare, Belgium
| | - Lissa Pipeleers
- Department of Nephrology, University Hospital Brussels, Brussels, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium,Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Steven Van Laecke
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Marie M Couttenye
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium,Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Gert Meeus
- Department of Nephrology, AZ Groeninge Hospital, Kortrijk, Belgium
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Laurens W, Deleersnijder D, Dendooven A, Lerut E, De Vriese AS, Dejagere T, Helbert M, Hellemans R, Koshy P, Maes B, Pipeleers L, Van Craenenbroeck AH, Van Laecke S, Walle JV, Coutteneye MM, De Meester J, Sprangers B, De Vriese A, De Rycke A, Bogaert AM, Woestenburg A, Denys B, Maes B, Peeters D, Vanbelleghem H, Donck J, Scharpé J, De Clippeleir N, Vanparys J, Meyvis K, Vandepitte K, Reyns LM, Verresen L, Decupere M, Helbert M, Zeegers M, Neirynck N, Bernaert P, Dejagere T, Lemahieu W, Sprangers B, Pipeleers L, Hellemans R, Van Laecke S, Levtchenko E, Karamaria S, Van Hoeck K, Trouet D, Mauel R, Dendooven A, Hoorens A, Van Dorpe J, Praet M, Geers C, Lerut E, Koshy P, Roskams T, Aydin S, Siozopoulou V, Schelfhout AM, De Raeve H, Steenkiste E, Dedeurwaerdere F, Dalle I, Cokelaere K, Deloose S, De Paepe P, Van Eyken P. Epidemiology of native kidney disease in Flanders: results from the FCGG kidney biopsy registry. Clin Kidney J 2022; 15:1361-1372. [PMID: 35756729 PMCID: PMC9217646 DOI: 10.1093/ckj/sfac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Flemish Collaborative Glomerulonephritis Group (FCGG) registry is the first population-based native kidney biopsy registry in Flanders, Belgium. In this first analysis, we report on patient demographics, frequency distribution and incidence rate of biopsied kidney disease in adults in Flanders. Methods From January 2017 to December 2019, a total of 2054 adult first native kidney biopsies were included. A ‘double diagnostic coding’ strategy was used, in which every biopsy sample received a histopathological and final clinical diagnosis. Frequency distribution and incidence rate of both diagnoses were reported and compared with other European registries. Results The median age at biopsy was 61.1 years (interquartile range, 46.1–71.7); male patients were more prevalent (62.1%) and biopsy incidence rate was 129.3 per million persons per year. Immunoglobulin A nephropathy was the most frequently diagnosed kidney disease (355 biopsies, 17.3% of total) with a similar frequency as in previously published European registries. The frequency of tubulointerstitial nephritis (220 biopsies, 10.7%) and diabetic kidney disease (154 biopsies, 7.5%) was remarkably higher, which may be attributed to changes in disease incidence as well as biopsy practices. Discordances between histopathological and final clinical diagnoses were noted and indicate areas for improvement in diagnostic coding systems. Conclusions The FCGG registry, with its ‘double diagnostic coding’ strategy, provides useful population-based epidemiological data on a large Western European population and allows subgroup selection for future research.
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Affiliation(s)
- Wim Laurens
- Department of Nephrology and Dialysis, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium
| | - Dries Deleersnijder
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Amélie Dendooven
- Division of Pathology, University Hospital Ghent, Ghent, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - An S De Vriese
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan, Brugge, Belgium
| | - Tom Dejagere
- Department of Nephrology, Jessa Hospital, Hasselt, Belgium
| | - Mark Helbert
- Department of Nephrology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Rachel Hellemans
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Priyanka Koshy
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Maes
- Department of Nephrology, AZ Delta, Roeselare, Belgium
| | - Lissa Pipeleers
- Department of Nephrology, University Hospital Brussels, Brussels, Belgium
| | - Amaryllis H Van Craenenbroeck
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Steven Van Laecke
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Marie M Coutteneye
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Johan De Meester
- Department of Nephrology and Dialysis, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
| | - Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
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Molnár A, Thomas MJ, Fintha A, Kardos M, Dobi D, Tislér A, Ledó N. Kidney biopsy-based epidemiologic analysis shows growing biopsy rate among the elderly. Sci Rep 2021; 11:24479. [PMID: 34966177 PMCID: PMC8716536 DOI: 10.1038/s41598-021-04274-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
AbstractSystematic registration and examination of biopsy-related data in Central and Eastern Europe are scarce, while the health condition of the population is worse compared to other more developed countries. We aim to create a database and analyze the distribution and temporal variation of the renal biopsy diagnoses in Hungary, including the effect of the recent coronavirus pandemic. The diagnoses were standardized according to the recommendation of the European Renal Association. Native biopsy samples processed between January 1, 2006, and December 31, 2020, were analyzed. During the 15 years, 2140 native kidney biopsies were performed. The number of samples increased from 24.5 to 57.9 per million person-years and the median age from 37 to 51 years (p < 0.0001). The predominance of glomerular diseases was stable. The most frequent glomerulopathy was IgA nephropathy (21.5%), followed by focal segmental glomerulosclerosis (17.7%), and membranous nephropathy (15.7%). Trends showed the rise of ANCA-associated vasculitis. During the coronavirus pandemic, there was a decrease in the number of kidney biopsies and the proportion of membranous nephropathies. The diagnostic trends in our database showed increasing biopsy rates among the elderly and the growing frequencies of age-related diseases, which emphasizes the importance of altering medical focus according to demographic changes in this area.
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Asgarali E, Gayon J, Viallet N, Vacher-Coponat H. [Kidney biopsy in Reunion Island between 2015 and 2017, an epidemiological study]. Nephrol Ther 2021; 17:512-519. [PMID: 34548266 DOI: 10.1016/j.nephro.2021.06.006] [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: 10/12/2020] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Reunion Island's population is characterized by a multiethnic origin, which makes it impossible to transpose epidemiological data of Metropolitan France. Only REIN Registry provides a macroscopic view of kidney disease, limited to the causes of end stage renal disease. METHODS This is a regional retrospective study whose main objective is to describe renal pathologies in Reunion Island's adults over a period of 3 years. Kidney transplants are excluded. RESULTS Between 2015 and 2017, 338 native adult kidney biopsies performed on the island are collected. The annual biopsy rate is 132/million/year with preponderance in the northern part of the island due to a higher density of nephrologists. Nephrotic syndrome is the first indication with 30% of cases. The four main results are represented by IgA nephropathy (16%), diabetic nephropathy (12.4%), lupus nephropathy (11.2%) and isolated vascular nephropathy (11%). Incidence of glomerulopathies is similar to the worldwide incidence, nevertheless a preponderant place of diabetic nephropathy is found. On the biopsies performed, incidence of complications is evaluated at 7.5%, with no difference between the detection technique used. CONCLUSION This is the first study illustrating main renal pathologies in Reunion Island. Diabetes' frequency in general population is a major confounding factor in diagnosis and management of kidney diseases on the island.
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Affiliation(s)
- Ehshan Asgarali
- Service de néphrologie, CHU Félix-Guyon , allée des Topazes, 97400 Saint-Denis-La Réunion, France.
| | - Julien Gayon
- Service de néphrologie, CHU Félix-Guyon , allée des Topazes, 97400 Saint-Denis-La Réunion, France
| | - Nicolas Viallet
- Service de néphrologie, CHU Félix-Guyon , allée des Topazes, 97400 Saint-Denis-La Réunion, France
| | - Henri Vacher-Coponat
- Service de néphrologie, CHU Félix-Guyon , allée des Topazes, 97400 Saint-Denis-La Réunion, France; UFR Santé, Saint-Pierre, 97410 La-Réunion, France
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Dendooven A, Peetermans H, Helbert M, Nguyen TQ, Marcussen N, Nagata M, Gesualdo L, Perkowska-Ptasinska A, Capusa C, López-Gómez JM, Geddes C, Abdul-Hamid MA, Segelmark M, Yahya R, Garau M, Villanueva R, Dorman A, Barbour S, Cornet R, Hopfer H, Amann K, Leh S. Coding practice in national and regional kidney biopsy registries. BMC Nephrol 2021; 22:193. [PMID: 34030637 PMCID: PMC8146626 DOI: 10.1186/s12882-021-02365-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Kidney biopsy registries all over the world benefit research, teaching and health policy. Comparison, aggregation and exchange of data is however greatly dependent on how registration and coding of kidney biopsy diagnoses are performed. This paper gives an overview over kidney biopsy registries, explores how these registries code kidney disease and identifies needs for improvement of coding practice. Methods A literature search was undertaken to identify biopsy registries for medical kidney diseases. These data were supplemented with information from personal contacts and from registry websites. A questionnaire was sent to all identified registries, investigating age of registries, scope, method of coding, possible mapping to international terminologies as well as self-reported problems and suggestions for improvement. Results Sixteen regional or national kidney biopsy registries were identified, of which 11 were older than 10 years. Most registries were located either in Europe (10/16) or in Asia (4/16). Registries most often use a proprietary coding system (12/16). Only a few of these coding systems were mapped to SNOMED CT (1), older SNOMED versions (2) or ERA-EDTA PRD (3). Lack of maintenance and updates of the coding system was the most commonly reported problem. Conclusions There were large gaps in the global coverage of kidney biopsy registries. Limited use of international coding systems among existing registries hampers interoperability and exchange of data. The study underlines that the use of a common and uniform coding system is necessary to fully realize the potential of kidney biopsy registries. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02365-3.
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Affiliation(s)
- Amélie Dendooven
- Ghent University Hospital, Ghent, Belgium. .,Antwerp University, Antwerp, Belgium.
| | | | | | - Tri Q Nguyen
- University Medical Center, Utrecht, The Netherlands
| | | | | | | | | | - Cristina Capusa
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | | | | | | | | | | | - Sean Barbour
- University of British Columbia, Vancouver, Canada
| | - Ronald Cornet
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Sabine Leh
- Haukeland University Hospital, Bergen, Norway
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Covic A, Vlad CE, Căruntu ID, Voroneanu L, Hogas S, Cusai S, Florea L, Covic A. Epidemiology of biopsy-proven glomerulonephritis in the past 25 years in the North-Eastern area of Romania. Int Urol Nephrol 2021; 54:365-376. [PMID: 33991297 DOI: 10.1007/s11255-021-02881-z] [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: 12/04/2020] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this retrospective study was: to analyze the epidemiological patterns of the kidney disease based on clinical and histological features in a single-center in the N-E region of Romania, between 2011 and 2019 and to compare the biopsy results with the others periods, as well as the results from other countries. METHODS We studied 442 renal biopsies. The indications for renal biopsy were represented by the clinical features: nephrotic syndrome, nephritic syndrome, asymptomatic urinary abnormalities, acute kidney injury, and chronic kidney disease of unknown etiology. RESULTS During the past 8 years, the annual incidence of renal biopsies was constant, albeit this incidence remained lower than in other countries. Nephrotic syndrome was the most common indication for renal biopsy (47.6%). Primary glomerulonephritis (GN) was the most common diagnosis in each of the three periods, followed by secondary GN. Vascular nephropathy and TIN were constant as a proportion from the overall biopsies in each of the three periods. The membranoproliferative GN (24.4%) and membranous nephropathy (MN) (21.9%) were the most prevalent primary GN, while lupus nephritis (LN) was the most common secondary glomerular disease in young female patients (7.5%). Compared to 1994-2004 period, we observed a significant decrease of incidence of focal segmental glomerulosclerosis (FSGS) and mesangial proliferative GN, and a significant increases in the frequency of MN. CONCLUSION The results of this study show that the GN distribution model was constant in N-E Romania and became similar to that observed in many countries with high socio-economic status.
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Affiliation(s)
- Andreea Covic
- Department of Internal Medicine-Nephrology, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Cristiana-Elena Vlad
- Department of Internal Medicine-Nephrology, "Grigore T. Popa" University of Medicine, Iasi, Romania.
| | - Irina-Draga Căruntu
- Department of Morphofunctional Sciences-Histology, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Luminita Voroneanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. Parhon' University Hospital, and "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Simona Hogas
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. Parhon' University Hospital, and "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Silvia Cusai
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. Parhon' University Hospital, and "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Laura Florea
- Department of Internal Medicine-Nephrology, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. Parhon' University Hospital, and "Grigore T. Popa" University of Medicine, Iasi, Romania.,The Academy of Romanian Scientists (AOSR), Bucharest, Romania
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Kolb A, Gallacher PJ, Campbell J, O'Neill M, Smith JR, Bell S, Conway BR, Metcalfe W, Joss N, Dey V, Alfonzo A, Kelly M, Shah S, McQuarrie E, Geddes C, Traynor J, Hunter RW. A National Registry Study of Patient and Renal Survival in Adult Nephrotic Syndrome. Kidney Int Rep 2020; 6:449-459. [PMID: 33615070 PMCID: PMC7879209 DOI: 10.1016/j.ekir.2020.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction We aimed to determine the mortality rate, cause of death, and rate of end-stage kidney disease (ESKD) in adults with nephrotic syndrome (NS). Methods We conducted a national registry–based study, including all 522 adults who had a kidney biopsy for NS in Scotland in 2014–2017. We linked the Scottish Renal Registry to death certificate data. We performed survival and Cox proportional hazards analyses, accounting for competing risks of death and ESKD. We compared mortality rates with those in the age- and sex-matched general population. Results A total of 372 patients had primary NS; 150 had secondary NS. Over a median follow-up of 866 days, 110 patients (21%) died. In patients with primary NS, observed versus population 3-year mortality was 2.1% (95% CI 0.0%–4.6%) versus 0.9% (0.8%–1.0%) in patients aged <60 years and 24.9% (18.4%–30.8%) versus 9.4% (8.3%–10.5%) in those aged ≥60 years. In secondary NS, this discrepancy was 17.1% (5.6%–27.2%) versus 1.1% (0.9%–1.2%) in <60-year-olds and 49.4% (36.6%–59.7%) versus 8.1% (6.6%–9.6%) in ≥60-year-olds. In primary NS, cardiovascular causes accounted for 28% of deaths, compared with 18% in the general population. Eighty patients (15%) progressed to ESKD. Incidence of ESKD by 3 years was 8.4% (95% CI 4.9%–11.7%) in primary and 35.1% (24.3%–44.5%) in secondary NS. Early remission of proteinuria and the absence of early acute kidney injury (AKI) were associated with lower rates of death and ESKD. Conclusions Adults with NS have high rates of death and ESKD. Cardiovascular causes account for excess mortality in primary NS.
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Affiliation(s)
- Anna Kolb
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh Bioquarter, Edinburgh, Scotland, UK
| | - Peter J Gallacher
- Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jacqueline Campbell
- The Scottish Renal Registry, Scottish Health Audits, Public Health & Intelligence, Information Services, Glasgow, Scotland, UK
| | - Martin O'Neill
- The Scottish Renal Registry, Scottish Health Audits, Public Health & Intelligence, Information Services, Glasgow, Scotland, UK
| | - James R Smith
- Department of Renal Medicine, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, Scotland, UK
| | - Samira Bell
- Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, Scotland, UK.,Division of Population Health and Genomics, University of Dundee, Dundee, Scotland, UK
| | - Bryan R Conway
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh Bioquarter, Edinburgh, Scotland, UK.,Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, Scotland, UK
| | - Wendy Metcalfe
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh Bioquarter, Edinburgh, Scotland, UK
| | - Nicola Joss
- Department of Renal Medicine, Raigmore Hospital, Inverness, Scotland, UK
| | - Vishal Dey
- Department of Renal Medicine, University Hospital, Crosshouse, Kilmarnock, Scotland, UK
| | - Annette Alfonzo
- Department of Renal Medicine, Victoria Hospital, Kirkcaldy, Scotland, UK
| | - Michael Kelly
- Department of Renal Medicine, Dumfries & Galloway Royal Infirmary, Dumfries, Scotland, UK
| | - Shahzad Shah
- Department of Renal Medicine, University Hospital Monklands, Airdrie, Scotland, UK
| | - Emily McQuarrie
- The Scottish Renal Registry, Scottish Health Audits, Public Health & Intelligence, Information Services, Glasgow, Scotland, UK.,Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Colin Geddes
- The Scottish Renal Registry, Scottish Health Audits, Public Health & Intelligence, Information Services, Glasgow, Scotland, UK.,Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Jamie Traynor
- The Scottish Renal Registry, Scottish Health Audits, Public Health & Intelligence, Information Services, Glasgow, Scotland, UK.,Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Robert W Hunter
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh Bioquarter, Edinburgh, Scotland, UK.,Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, Scotland, UK
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11
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López-Gómez JM, Rivera F. Spanish Registry of glomerulonephritis 2020 revisited: past, current data and new challenges. Nefrologia 2020; 40:371-383. [PMID: 32646677 DOI: 10.1016/j.nefro.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/16/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Francisco Rivera
- Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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12
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Yim T, Kim SU, Park S, Lim JH, Jung HY, Cho JH, Kim CD, Kim YL, Han MH, Kim YJ, Choi JY, Park SH. Patterns in renal diseases diagnosed by kidney biopsy: A single-center experience. Kidney Res Clin Pract 2020; 39:60-69. [PMID: 31955562 PMCID: PMC7105626 DOI: 10.23876/j.krcp.19.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 01/13/2023] Open
Abstract
Background The worldwide incidence of renal disease diagnosed by a kidney biopsy varies with age, race, sex, and region. Owing to a lack of studies and limited research resources for this disease in Korea, we investigated renal disease patterns by analyzing data from kidney biopsies performed over 13 years in a university-based teaching hospital in Korea. Methods Among 2,053 kidney biopsies performed from 2001 to 2013 at Kyungpook National University Hospital, 1,924 were retrospectively analyzed for histopathologic, demographic, and clinical data as well as laboratory results. Results Among the 1,924 studied kidney biopsies, 1,078 were males (56.0%) and the mean age was 37.7 ± 16.5 years. Asymptomatic urinary abnormalities were the most common clinical manifestation (62.5%). Immunoglobulin A nephropathy (IgAN) was the most common primary glomerular disease (37.4%), followed by minimal change disease (MCD), membranous nephropathy (MN), focal segmental glomerulonephritis and crescentic glomerulonephritis. Secondary glomerular diseases accounted for 10.3% of the total biopsies, with lupus nephritis being the most common (4.6%) followed by Henoch-Schönlein purpura nephritis and diabetic nephropathy. The most common cause of nephrotic syndrome was MCD (42.1%) followed by MN. Among patients seropositive for hepatitis B or C, IgAN (28.3% and 21.4%, respectively) was the most common cause. Conclusion IgAN and lupus nephritis were the most common primary and secondary glomerular diseases, respectively. Race, region, and practice patterns may affect renal disease patterns in different cohorts.
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Affiliation(s)
- Taehoon Yim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sang-Un Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sangmi Park
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jeong-Hoon Lim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Yeon Jung
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jang-Hee Cho
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chan-Duck Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Man-Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Jin Kim
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Hee Park
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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13
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Weiner M, Bjørneklett R, Hrušková Z, Mackinnon B, Poulton CJ, Sindelar L, Mohammad AJ, Eriksson P, Gesualdo L, Geetha D, Crnogorac M, Jayne D, Hogan SL, Geddes C, Tesar V, Aasarød K, Segelmark M. Proteinase-3 and myeloperoxidase serotype in relation to demographic factors and geographic distribution in anti-neutrophil cytoplasmic antibody-associated glomerulonephritis. Nephrol Dial Transplant 2020; 34:301-308. [PMID: 29718465 DOI: 10.1093/ndt/gfy106] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/21/2018] [Indexed: 01/29/2023] Open
Abstract
Background In anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis, antigen specificity varies between myeloperoxidase (MPO) and proteinase 3 (PR3). This has been reported to vary in relation to age, gender, geography and extrarenal manifestations. However, studies are difficult to compare as criteria for inclusion vary. The aim of this study was to investigate the relationship between ANCA serotype, latitude, ultraviolet (UV) radiation levels, age, gender and renal function at diagnosis in a large study with uniform inclusion criteria. Methods Patients with biopsy-proven ANCA-associated glomerulonephritis were identified from regional or nationwide registries in 14 centres in Norway, Sweden, the UK, the Czech Republic, Croatia, Italy and the USA during the period 2000-13. UV radiation levels for 2000-13 in Europe were obtained from the Swedish Meteorological and Hydrological Institute. Results A total of 1408 patients (45.2% PR3-ANCA) were included in the study. In univariable analysis, PR3-ANCA was significantly associated with male gender {odds ratio [OR] 2.12 [95% confidence interval (CI) 1.71-2.62]}, younger age [OR per year 0.97 (95% CI 0.96-0.98)] and higher glomerular filtration rate [OR per mL/min 1.01 (95% CI 1.01-1.02); P < 0.001] at diagnosis but not with latitude or UV radiation. In multivariable logistic regression analysis, latitude and UV radiation also became significant, with higher odds for PR3-ANCA positivity at northern latitudes/lower UV radiation levels. However, the latitudinal difference in MPO:PR3 ratio is smaller than differences previously reported concerning microscopic polyangiitis and granulomatosis with polyangiitis. Conclusions The ratio between PR3-ANCA and MPO-ANCA varies in glomerulonephritis with respect to age, gender, renal function and geographic latitude/UV radiation levels.
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Affiliation(s)
- Maria Weiner
- Department of Nephrology and Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Rune Bjørneklett
- Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Zdenka Hrušková
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Bruce Mackinnon
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Caroline J Poulton
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Division of Nephrology and Hypertension, Department of Medicine UNC Kidney Center, Chapel Hill, NC, USA
| | - Leo Sindelar
- Department of Nephrology and Medical and Health Sciences, Linköping University, Linköping, Sweden.,Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Per Eriksson
- Department of Rheumatology and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Matija Crnogorac
- Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Susan L Hogan
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Division of Nephrology and Hypertension, Department of Medicine UNC Kidney Center, Chapel Hill, NC, USA
| | - Colin Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Knut Aasarød
- Department of Nephrology, Saint Olavs University Hospital, Trondheim, Norway.,Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mårten Segelmark
- Department of Nephrology and Medical and Health Sciences, Linköping University, Linköping, Sweden
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14
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Su S, Yu J, Wang Y, Wang Y, Li J, Xu Z. Clinicopathologic correlations of renal biopsy findings from northeast China: A 10-year retrospective study. Medicine (Baltimore) 2019; 98:e15880. [PMID: 31169695 PMCID: PMC6571388 DOI: 10.1097/md.0000000000015880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Renal biopsy is the cornerstone of diagnostic approaches in nephrology, as they provide invaluable diagnostic information. In this study, we analyzed and reported renal biopsy results from northeast China from the past 10 years to describe the epidemiological trend.We analyzed clinical features, indications, and histological diagnoses of renal biopsies collected between January 1, 2007, and December 31, 2016.There were 2725 identified cases (with a mean age of 41.24 ± 15.18 years, 55% male) during the study period. The main clinical indication was nephrotic syndrome (59.9%). Membranous nephropathy (29.1%) was the most common pathological finding in the entire study population, followed by IgA nephropathy (23.4%), minimal change disease (12.7%), and mesangio-proliferative glomerulonephritis (7.4%).We divided the study period into 2 subperiods: 2007 to 2011 (period 1) and 2012 to 2016 (period 2). Membranous nephropathy and minimal change disease were more frequent in period 2 than in period 1. Conversely, IgAN and non-IgA mesangio-proliferative glomerulonephritis were less frequent in period 2 than in period 1. Cases of Henöch-Schönlein purpura nephritis and lupus nephritis were observed less over time, while cases of nephroangiosclerosis increased significantly over time. Finally, there was a significant increase in the number of tubulointerstitial diseases observed over time, while there was a significant decrease in glomerulosclerosis and unclassified findings over time.Membranous nephropathy was the most common pathological finding from renal biopsy and the prevalence has increased significantly in recent years in northeast China.
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15
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Yeo SC, Goh SM, Barratt J. Is immunoglobulin A nephropathy different in different ethnic populations? Nephrology (Carlton) 2019; 24:885-895. [PMID: 30977248 DOI: 10.1111/nep.13592] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 02/06/2023]
Abstract
Immunoglobulin A nephropathy (IgAN) is one of the commonest global patterns of primary glomerulonephritis and remains a leading cause of chronic kidney disease and end-stage renal disease. The sole diagnostic criterion of IgAN remains the presence of dominant mesangial immunoglobulin A deposits on kidney biopsy. Beyond this defining feature, there is significant heterogeneity in the epidemiology, clinical presentation, renal progression and long-term outcomes of IgAN in different ethnic populations. Mirroring this heterogeneity in clinical phenotypes, there is also marked ethnic variation in the extent of histopathological lesions observed on kidney biopsy, which may partly explain the well-documented differences in response to immunomodulatory agents reported in different regions of the world. In parallel, disparities have been identified in genetic association studies and key pathogenic pathways in different ethnic populations. Understanding the basis for these differences in IgAN has important implications for both clinical care and future research. In this review, we will examine the impact of ethnicity on the epidemiology, clinical presentation and outcomes, pathogenesis and genetic associations in IgAN.
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Affiliation(s)
- See Cheng Yeo
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Su Mein Goh
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore
| | - Jonathan Barratt
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.,The John Walls Renal Unit, Leicester General Hospital, Leicester, UK
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16
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West M, Nash MM, Rapi L, Krizova A, Prasad GR. Monitoring Kidney Dysfunction in Kugelberg-Welander Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:441-446. [PMID: 30943186 PMCID: PMC6459160 DOI: 10.12659/ajcr.914458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Kugelberg-Welander (K-W) syndrome is a type of spinal muscular atrophy that causes weakness of the hip-girdle muscles. If severe enough, this weakness can confine patients to a wheelchair in adult life. Proteinuria, a manifestation of kidney dysfunction, is associated with disorders of many organ systems. The evaluation of kidney function in the context of K-W syndrome is challenging. CASE REPORT A 45-year-old man with K-W syndrome first diagnosed at 5 years of age developed peripheral edema and was found to have proteinuria under 1 g/24 h. His past history was significant for hypertension for 7 years. He was managed conservatively initially, but over the next year the serum creatinine concentration increased from 18 to 32 µmol/L (0.2 to 0.36 mg/dL). A percutaneous kidney biopsy was performed in the fetal position due to an inability of the patient to lay prone or supine. Minimal change disease (MCD) was diagnosed. Treatment consisted of dietary salt restriction, ramipril, amiloride, and hydrochlorothiazide, while avoiding corticosteroids. The serum creatinine concentration initially returned to the 18-20 µmol/L (0.2-0.22 mg/dL) range with increased fluid intake, but then slowly declined to 6 µmol/L (0.07 mg/dL) over the next 14 years. Muscle strength remained poor. CONCLUSIONS K-W syndrome, when associated with proteinuria, presents novel diagnostic and therapeutic challenges to the latter. The serum creatinine concentration may be unhelpful in assessing kidney function in K-W syndrome. A conservative management approach to MCD is reasonable to minimize comorbidity.
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Affiliation(s)
- Michael West
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
| | - Michelle M. Nash
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
| | - Lindita Rapi
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
| | - Adriana Krizova
- Department of Anatomical Pathology, St. Michael’s Hospital, Toronto, Canada
| | - G.V. Ramesh Prasad
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, St. Michael’s Hospital, Toronto, Canada
- Corresponding Author: G.V. Ramesh Prasad, e-mail:
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17
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Rankin AJ, Kipgen D, Geddes CC, Fox JG, Milne G, Mackinnon B, McQuarrie EP. Assessment of active tubulointerstitial nephritis in non-scarred renal cortex improves prediction of renal outcomes in patients with IgA nephropathy. Clin Kidney J 2018; 12:348-354. [PMID: 31198533 PMCID: PMC6543968 DOI: 10.1093/ckj/sfy093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background The addition of tubulointerstitial inflammation to the existing pathological classification of IgA nephropathy (IgAN) is appealing but was previously precluded due to reportedly wide inter-observer variability. We report a novel method to score percentage of non-atrophic renal cortex containing active tubulointerstitial inflammation (ATIN) in patients with IgAN and assess its utility to predict clinical outcomes. Methods All adult patients with a native renal biopsy diagnosis of IgAN between 2010 and 2015 in a unit serving 1.5 million people were identified. Baseline characteristics, biopsy reports and outcome data were collected. ATIN was calculated by subtracting the percentage of atrophic cortex from the percentage of total cortex with tubulointerstitial inflammation, with ≥10% representing significant ATIN. The primary outcome was a composite of requiring renal replacement therapy or doubling of serum creatinine. Results In total 153 new cases of IgAN were identified, of which 111 were eligible for inclusion. Of these, 76 (68%) were male and 54 (49%) had ATIN on biopsy. During a median follow-up of 2.3 years, 34 (31%) reached the primary outcome. On univariable Cox regression analysis, ATIN was associated with a five-fold increase in the primary outcome [hazard ratio (HR) (95% confidence interval) 4.9 (95% confidence interval (CI) 2.1–11.3)]. On multivariable analysis, mesangial hypercellularity, tubular atrophy and interstitial fibrosis and ATIN independently associated with renal outcome (P = 0.02 for ATIN). Inter-observer reproducibility revealed fair agreement in the diagnosis of ATIN (κ=0.43, P = 0.05). Conclusions Within our centre, ATIN was significantly associated with renal outcome in patients with IgAN, independently of established histological features and baseline clinical characteristics.
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Affiliation(s)
- Alastair J Rankin
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - David Kipgen
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin C Geddes
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jonathan G Fox
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Gordon Milne
- Department of Pathology, University Hospital Monklands, Airdrie, UK
| | - Bruce Mackinnon
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Emily P McQuarrie
- Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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18
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Kamata Y, Sato H, Joh K, Tsuchiya Y, Kunugi S, Shimizu A, Konta T, Baughman RP, Azuma A. Clinical characteristics of biopsy-proven renal sarcoidosis in Japan. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:252-260. [PMID: 32476910 DOI: 10.36141/svdld.v35i3.6655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/09/2018] [Indexed: 11/02/2022]
Abstract
Background: Although some articles have described renal sarcoidosis, the incidence among biopsy cases remains unclear. Here, we defined the incidence of renal sarcoidosis among renal biopsy cases and analyzed the clinical course. Methods: We performed an epidemiological study examining renal biopsy cases treated at 5 centers between January 2000 and September 2015 and identified 16 cases (7 men, 9 women; mean (±SD) age, 59.4±18.6 years) out of a total of 14191 renal biopsy cases. Renal involvement of sarcoidosis was defined as granulomatous tubulointerstitial nephritis, tubulointerstitial nephritis without granulomatous lesions, and renal calcinosis. Fifteen of the cases were treated with steroid therapy. One case initially received steroid pulse therapy. The outcome was evaluated based on the estimated glomerular filtration rate (eGFR), CKD stage, and the change in eGFR (ΔeGFR) after treatment. A favorable response was defined as ΔeGFR ≥25%. Results: The incidence of renal sarcoidosis was 0.11%. The mean eGFR was 28.2±16.1 mL/min/1.73 m2. At the last observation, the mean eGFR was 43.7±19.7 mL/min/1.73 m2. Although a favorable response to steroid therapy was found in the majority of cases (10/15, 67%), 12 of the 15 cases (80%) had residual renal dysfunction at the last observation and 8 cases (53%) had moderate to severe renal dysfunction. Conclusion: Renal sarcoidosis is extremely rare among renal biopsy cases. Among cases with an unfavorable response to steroid therapy, pathogenetic mechanisms other than sarcoidosis and severe nephron damage were observed. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 252-260).
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Affiliation(s)
| | - Hiroshi Sato
- Clinical Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Kensuke Joh
- Department of Pathology Tohoku, University Graduate School of Medicine, Sendai, Japan
| | | | - Shinobu Kunugi
- Analytic Human Pathology, Nihon Medical University, Tokyo, Japan
| | - Akira Shimizu
- Analytic Human Pathology, Nihon Medical University, Tokyo, Japan
| | - Tsuneo Konta
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University, Yamagata, Japan
| | - Robert P Baughman
- Interstitial Lung Disease/Sarcoidosis Clinic, University of Cincinnati, Cincinnati, USA
| | - Arata Azuma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nihon Medical University, Tokyo, Japan
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19
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Shin HS, Cho DH, Kang SK, Kim HJ, Kim SY, Yang JW, Kang GH, Kim YN, Jung Y, Cheon BK, Rim H. Patterns of renal disease in South Korea: a 20-year review of a single-center renal biopsy database. Ren Fail 2018; 39:540-546. [PMID: 28722531 PMCID: PMC6014498 DOI: 10.1080/0886022x.2017.1348955] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Several registries and centers have reported the results of renal biopsies from different parts of the world. As there are few data regarding the epidemiology of glomerulonephritis (GN) in South Korea, we conducted this study on renal biopsy findings during the last 20 years from a single center. Methods: Data for 818 patients who underwent renal biopsy at our center between 1992 and 2011 were collected retrospectively. All kidney specimens were examined with light microscopy (LM) and immunofluorescent microscopy (IF). Results: There were 818 cases of native kidney biopsies. In cases of primary GN, the most frequent type of renal pathology in adults (18–59 years) was mesangial proliferative GN (MsPGN, 34.5%) followed by IgA nephropathy (IgAN, 33.3%) and membranous GN (MGN, 8.8%). Indications in adults (18–59 years) were asymptomatic urinary abnormalities (75.3%) followed by nephrotic syndrome (19.8%) and acute kidney injury (AKI, 3.4%). Conclusions: Among 818 renal biopsy specimens, MsPGN and IgAN were the most frequent biopsy-proven renal diseases. MGN was the third most common cause of primary GN and lupus nephritis (LN) was the most common secondary glomerular disease. Our data contribute to the epidemiology of renal disease in South Korea.
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Affiliation(s)
- Ho Sik Shin
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Dae Hyeon Cho
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Soo Kyoung Kang
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Hyun Jeong Kim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Soo Young Kim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Joung Wook Yang
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Gyong Hoon Kang
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Ye Na Kim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Yeonsoon Jung
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
| | - Bong-Kwon Cheon
- b Department of Pathology , Kosin University College of Medicine , Busan , Korea
| | - Hark Rim
- a Department of Internal Medicine , Kosin University College of Medicine , Busan , Korea
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Coppo R. IgA Nephropathy: A European Perspective in the Corticosteroid Treatment. KIDNEY DISEASES 2018; 4:58-64. [PMID: 29998120 DOI: 10.1159/000487265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/26/2018] [Indexed: 12/27/2022]
Abstract
Background IgA nephropathy (IgAN) is detected in Europe in 22% of glomerular diseases diagnosed by biopsy. The frequency of IgAN as cause of ESRD in Europe has increased in the last decades, accounting for 35% of young and adult transplanted patients. These data justify the interest for risk factors and a possible therapeutic approach. Summary Insight into a European perspective of IgAN was allowed by the multicenter study VALIGA, on 1,147 patients, almost all Caucasians, with follow-up of 4.7 years. The predictive value of mesangial hypercellularity (M), segmental sclerosis (S), tubular atrophy interstitial fibrosis (T) as independent biomarkers of progression was validated. Endocapillary hypercellularity was predictive of increased follow-up proteinuria. Two groups of patients selected by a propensity score to perfectly match for histologic features (MEST) and clinical data treated with renin-angiotensin system blockers (RASBs) and corticosteroids, or RASBs alone were compared and a beneficial effect of corticosteroids in addition to RASB was found in patients with proteinuria > 1 g/day, with an initial eGFR < 50 mL/min/1.73 m2. On the contrary, the STOP-IgAN RCT found that immunosuppressive therapy in addition to optimal supportive care did not provide substantial kidney-related benefits in European patients with IgAN, because there was no difference in the rate of decrease in eGFR, although corticosteroid/immunosuppressive therapy induced complete remission of proteinuria more frequently than supportive care alone. The NEFIGAN trial evaluated a targeted release formulation of budesonide (TRF budesonide) delivering the drug in the distal ileum. TRF budesonide, additionally to optimized RAS blockade, reduced proteinuria and maintained eGFR in IgAN patients, suggesting a reduced risk of future progression to ESRD. Key Messages In Europe, there is a reasoned search of a balanced approach to corticosteroid therapy for patients with IgAN, with particular attention to selecting the patients at risk of progression while limiting the unwanted systemic adverse events.
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Affiliation(s)
- Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
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21
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Perkowska-Ptasinska A, Bartczak A, Wagrowska-Danilewicz M, Halon A, Okon K, Wozniak A, Danilewicz M, Karkoszka H, Marszalek A, Kowalewska J, Mroz A, Korolczuk A, Oko A, Debska-Slizien A, Naumnik B, Hruby Z, Klinger M, Ciechanowski K, Myslak M, Sulowicz W, Rydzewski A, Wiecek A, Manitius J, Gregorczyk T, Niemczyk S, Nowicki M, Gellert R, Stompor T, Wieliczko M, Marczewski K, Paczek L, Rostkowska O, Deborska-Materkowska D, Bogdanowicz G, Milkowski A, Durlik M. Clinicopathologic correlations of renal pathology in the adult population of Poland. Nephrol Dial Transplant 2017; 32:ii209-ii218. [PMID: 28339709 DOI: 10.1093/ndt/gfw365] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/13/2016] [Indexed: 01/28/2023] Open
Abstract
Background This is the first report on the epidemiology of biopsy-proven kidney diseases in Poland. Methods The Polish Registry of Renal Biopsies has collected information on all (n = 9394) native renal biopsies performed in Poland from 2009 to 2014. Patients' clinical data collected at the time of biopsy, and histopathological diagnoses were used for epidemiological and clinicopathologic analysis. Results There was a gradual increase in the number of native renal biopsies performed per million people (PMP) per year in Poland in 2009-14, starting from 36 PMP in 2009 to 44 PMP in 2014. A considerable variability between provinces in the mean number of biopsies performed in the period covered was found, ranging from 5 to 77 PMP/year. The most common renal biopsy diagnoses in adults were immunoglobulin A nephropathy (IgAN) (20%), focal segmental glomerulosclerosis (FSGS) (15%) and membranous glomerulonephritis (MGN) (11%), whereas in children, minimal change disease (22%), IgAN (20%) and FSGS (10%) were dominant. Due to insufficient data on the paediatric population, the clinicopathologic analysis was limited to patients ≥18 years of age. At the time of renal biopsy, the majority of adult patients presented nephrotic-range proteinuria (45.2%), followed by urinary abnormalities (38.3%), nephritic syndrome (13.8%) and isolated haematuria (1.7%). Among nephrotic patients, primary glomerulopathies dominated (67.6% in those 18-64 years of age and 62.4% in elderly patients) with leading diagnoses being MGN (17.1%), FSGS (16.2%) and IgAN (13.0%) in the younger cohort and MGN (23.5%), amyloidosis (18.8%) and FSGS (16.8%) in the elderly cohort. Among nephritic patients 18-64 years of age, the majority (55.9%) suffered from primary glomerulopathies, with a predominance of IgAN (31.3%), FSGS (12.7%) and crescentic GN (CGN) (11.1%). Among elderly nephritic patients, primary and secondary glomerulopathies were equally common (41.9% each) and pauci-immune GN (24.7%), CGN (20.4%) and IgAN (14.0%) were predominant. In both adult cohorts, urinary abnormalities were mostly related to primary glomerulopathies (66.8% in younger and 50% in elderly patients) and the leading diagnoses were IgAN (31.4%), FSGS (15.9%), lupus nephritis (10.7%) and FSGS (19.2%), MGN (15.1%) and pauci-immune GN (12.3%), respectively. There were significant differences in clinical characteristics and renal biopsy findings between male and female adult patients. Conclusions The registry data focused new light on the epidemiology of kidney diseases in Poland. These data should be used in future follow-up and prospective studies.
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Affiliation(s)
| | - Artur Bartczak
- Department of Pathology, Medical Center of Postgraduate Education, Warsaw, Poland
| | | | - Agnieszka Halon
- Department of Pathomorphology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Okon
- Department of Clinical and Experimental Pathology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Aldona Wozniak
- Biopsy Diagnostics Laboratory, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Henryk Karkoszka
- Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Katowice, Poland
| | - Andrzej Marszalek
- Department of Pathomorphology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jolanta Kowalewska
- Department of Pathology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Andrzej Mroz
- Department of Pathology, Medical Center of Postgraduate Education, Warsaw, Poland
| | | | - Andrzej Oko
- Department of Nephrology, Transplantology, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Alicja Debska-Slizien
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Beata Naumnik
- Department of Nephrology and Transplantology with Dialysis Unit, Medical University Bialystok, Bialystok, Poland
| | - Zbigniew Hruby
- Department of Nephrology, with subdivision of Diabetology and Transplantology, District Specialist Hospital in Wroclaw, Wroclaw, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Kazimierz Ciechanowski
- Clinic of Nephrology, Transplantology and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Marek Myslak
- Department of Nephrology and Kidney Transplantation, District Hospital in Szczecin, Szczecin, Poland
| | | | - Andrzej Rydzewski
- Department of Internal Diseases, Nephrology and Transplantology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Andrzej Wiecek
- Department of Nephrology, Silesian School of Medicine, Katowice, Poland
| | - Jacek Manitius
- Department of Nephrology, Hypertension and Internal Medicine, Collegium Medicum UMK, Bydgoszcz, Poland
| | | | - Stanislaw Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Michal Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland.,Nephrology and Dialysis, Polish Mother's Memorial Hospital, Lodz, Poland
| | - Ryszard Gellert
- Department of Nephrology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Tomasz Stompor
- PD Unit, Chair and Department of Nephrology, Jagiellonian University, Cracow, Poland
| | - Monika Wieliczko
- Department of Nephrology, Dialysis, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Marczewski
- Zaklad Etyki i Filozofii Czlowieka, Uniwersytet Medyczny w Lublinie, Lublinie, Poland
| | - Leszek Paczek
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Olga Rostkowska
- Department of Transplantology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Magdalena Durlik
- Department of Transplantology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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22
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Affiliation(s)
- Robert J Wyatt
- University of Tennessee Health Sciences Center, Children's Foundation Research Institute at the Le Bonheur Children's Hospital, Memphis, TN, USA.
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23
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Möhner M, Pohrt A, Gellissen J. Occupational exposure to respirable crystalline silica and chronic non-malignant renal disease: systematic review and meta-analysis. Int Arch Occup Environ Health 2017; 90:555-574. [PMID: 28409224 PMCID: PMC5583269 DOI: 10.1007/s00420-017-1219-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 04/05/2017] [Indexed: 12/12/2022]
Abstract
Background While occupational exposure to respirable silica is known to lead to lung disease, most notably silicosis, its association with chronic kidney disease is unclear. Objectives This review explores the association between occupational exposure to respirable silica and chronic non-malignant renal disease such as glomerulonephritis. The evidence has been collected and compiled. Possible sources of bias are thoroughly discussed. Methods Cohort studies with silica exposure and case–control studies of renal disease were searched in PubMed until January 2015. Two authors independently abstracted data; any disagreement was resolved by consulting a third reviewer. A meta-analysis was performed to evaluate the association to silica exposure. Results A total of 23 cohort and four case–control studies were included in the analysis. The meta-analysis of cohort studies yielded elevated overall SMRs for renal disease. Some studies, however, included dose–response analyses, most of which did not show a positive trend. The approaches and results of the case–control studies were very heterogeneous. Conclusions While the studies of cohorts exposed to silica found elevated SMRs for renal disease, no clear evidence of a dose–response relationship emerged. The elevated risk may be attributed to diagnostic and methodological issues. In order to permit a reliable estimation of a possible causal link, exposed cohorts should be monitored for renal disease, as the information from mortality studies is hardly reliable in this field. Electronic supplementary material The online version of this article (doi:10.1007/s00420-017-1219-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Möhner
- Division of Work and Health, Federal Institute for Occupational Safety and Health, Nöldnerstr. 40/42, 10317, Berlin, Germany.
| | - Anne Pohrt
- Division of Work and Health, Federal Institute for Occupational Safety and Health, Nöldnerstr. 40/42, 10317, Berlin, Germany
| | - Johannes Gellissen
- Division of Work and Health, Federal Institute for Occupational Safety and Health, Nöldnerstr. 40/42, 10317, Berlin, Germany
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Cattran DC, Brenchley PE. Membranous nephropathy: integrating basic science into improved clinical management. Kidney Int 2017; 91:566-574. [PMID: 28065518 DOI: 10.1016/j.kint.2016.09.048] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/26/2016] [Accepted: 09/08/2016] [Indexed: 02/08/2023]
Abstract
Idiopathic membranous nephropathy (INM) remains a common cause of the nephrotic syndrome in adults. The autoimmune nature of IMN was clearly delineated in 2009 with the identification of the glomerular-deposited IgG to be a podocyte receptor, phospholipase A2 receptor (PLA2R) in 70% to 75% of cases. This anti-PLA2R autoantibody, predominantly the IgG4 subclass, has been quantitated in serum using an enzyme-linked immunosorbent assay and has been used to aid diagnosis and monitor response to immunosuppressive therapy. In 2014, a second autoantigen, thrombospondin type 1 domain-containing 7A (THSD7A), was identified. Immunostaining of biopsy specimens has further detected either PLA2R or THSD7A antigen in the deposited immune complexes in 5% to 10% of cases autoantibody seronegative at the time of biopsy. Therefore, the term IMN should now be superseded by the term primary or autoimmune MN (AMN) (anti-PLA2R or anti-THSD7A positive) classifying ∼80% to 90% of cases previously designated IMN. Cases of secondary MN associated with other diseases show much lower association with these autoantibodies, but their true incidence in secondary cases still needs to be defined. How knowledge of the autoimmune mechanism and the sequential measurement of these autoantibodies is likely to change the clinical management and trajectory of AMN by more precisely defining its diagnosis, prognosis, and treatment is discussed. Their application early in the disease course to new and old therapies will provide additional precision to AMN management. We also review innovative therapeutic approaches on the horizon that are expected to lead to our ultimate goal of improved patient care in A(I)MN.
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Affiliation(s)
- Daniel C Cattran
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Paul E Brenchley
- Renal Research Labs, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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25
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Cattran DC, Kim ED, Reich H, Hladunewich M, Kim SJ. Membranous Nephropathy: Quantifying Remission Duration on Outcome. J Am Soc Nephrol 2016; 28:995-1003. [PMID: 27756808 DOI: 10.1681/asn.2015111262] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 09/04/2016] [Indexed: 11/03/2022] Open
Abstract
Although change in proteinuria has been proposed as a surrogate for long-term prognosis in membranous nephropathy (MGN), variability in proteinuria levels and lag between these changes and acceptable end points, such as ESRD, has limited its utility. This cohort study examined the prognostic significance of remission duration in 376 patients with biopsy-proven idiopathic/primary MGN who achieved a remission after a period of nephrotic-range proteinuria. We defined complete remission (CR), partial remission (PR), and relapse as proteinuria ≤0.3, 0.4-3.4, and ≥3.5 g/d after CR or PR, respectively. The exposure variable was the remission status of patients at fixed landmarks (3, 6, 12, 24, and 36 months) after the date of first remission. The primary outcome was ESRD or 50% reduction in eGFR. We fitted Cox proportional hazards models to examine the association of remission status at each landmark and the primary end point. Persistent remission associated with unadjusted hazard ratios for the primary outcome that ranged by landmark from 0.35 (95% confidence interval, 0.20 to 0.61) to 0.56 (95% confidence interval, 0.31 to 1.04). Separate analyses for PR and CR yielded similar results. After adjustment, maintaining remission associated with significantly reduced risk of the primary outcome at all landmarks. Durable remissions associated with improved renal survival. Although the longer the remission, the greater the improvement, patients with remission durations as short as 3 months had improved renal prognosis compared with patients who relapsed. This study validates and quantifies PR and CR as surrogates for long-term outcome in MGN.
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Affiliation(s)
- Daniel C Cattran
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; and
| | - Esther D Kim
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; and
| | - Heather Reich
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; and
| | - Michelle Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; and
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26
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Jegatheesan D, Nath K, Reyaldeen R, Sivasuthan G, John GT, Francis L, Rajmokan M, Ranganathan D. Epidemiology of biopsy-proven glomerulonephritis in Queensland adults. Nephrology (Carlton) 2016; 21:28-34. [PMID: 26154936 DOI: 10.1111/nep.12559] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2015] [Indexed: 12/17/2022]
Abstract
AIM There is a paucity of data pertaining to the incidence of biopsy-proven glomerulonephritis (GN) in Australia. This retrospective study aims to review the data from all adult native renal biopsies performed in the state of Queensland from 2002 to 2011--comparing results with centres from across the world. METHODS Pathology reports of 3697 adult native kidney biopsies were reviewed, of which 2048 had GN diagnoses. Age, gender, clinical indication and histopathology findings were compared. RESULTS The average age at biopsy was 48 ± 17 years. Male preponderance was noted overall (∼60%), with lupus nephritis being the only individual GN with female predilection. The average rate of biopsy was 12.04 per hundred thousand people per year (php/yr). Nephrotic and nephritic syndromes comprised approximately 75% of all clinical indications that lead to GN diagnoses. IgA nephropathy (1.41 php/yr) was the most common primary GN followed by focal segmental glomerulosclerosis (1.02 php/yr) and crescentic GN (0.73 php/yr). Diabetic nephropathy (0.84 php/yr), lupus nephritis (0.69 php/yr) and amyloidosis (0.19 php/yr) were the most commonly identified secondary GN. CONCLUSION IgA nephropathy is the predominant primary GN in Queensland, and nephrotic syndrome the most common indication for a renal biopsy. While crescentic GN incidence has significantly increased with time, focal segmental glomerulosclerosis incidence has not shown any trend. Incidence of GN overall appears to increase with age. The annual rate of biopsy in this study appears lower than previously published in an Australian population.
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Affiliation(s)
- Dev Jegatheesan
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Karthik Nath
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Reza Reyaldeen
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Goutham Sivasuthan
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - George T John
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Leo Francis
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mohana Rajmokan
- Communicable Diseases Unit, Department of Health, Queensland Government, Brisbane, Queensland, Australia
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27
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O'Shaughnessy MM, Hogan SL. Distinguishing the Signals From the Noise: Can Epidemiologic Studies Inform Our Understanding of Glomerular Disease? Am J Kidney Dis 2016; 68:503-507. [PMID: 27664473 DOI: 10.1053/j.ajkd.2016.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 05/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | - Susan L Hogan
- University of North Carolina, Chapel Hill, North Carolina
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28
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Gupta A, Campion-Smith J, Hayes W, Deal JE, Gilbert RD, Inward C, Judd BA, Krishnan RG, Marks SD, O'Brien C, Shenoy M, Sinha MD, Tse Y, Tyerman K, Mallik M, Hussain F. Positive trends in paediatric renal biopsy service provision in the UK: a national survey and re-audit of paediatric renal biopsy practice. Pediatr Nephrol 2016; 31:613-21. [PMID: 26525201 DOI: 10.1007/s00467-015-3247-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/15/2015] [Accepted: 10/04/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Paediatric renal biopsy standards introduced in the UK in 2010 were intended to reduce variation and improve practice. A concurrent national drive was aimed at building robust paediatric nephrology networks to ensure services cater for the needs of the family and minimise time away from home. We aimed to identify current national practice since these changes on behalf of the British Association for Paediatric Nephrology. METHODS All UK paediatric nephrology centres were invited to complete a survey of their biopsy practice, including advance preparation. From 1 January to 30 June 2012, a national prospective audit of renal biopsies was undertaken at participating centres comparing practice with the British Association for Paediatric Nephrology (BAPN) standards and audit results from 2005. RESULTS Survey results from 11 centres demonstrated increased use of pre-procedure information leaflets (63.6 % vs 45.5 %, P = 0.39) and play preparation (90.9 % vs 9.1 %, P = 0.0001). Audit of 331 biopsies showed a move towards day-case procedures (49.5 % vs 32.9 %, P = 0.17) and reduced major complications (4.5 % vs 10.4 %, P = 0.002). Biopsies with 18-gauge needles had significantly higher mean pass rates (3.2 vs 2.3, P = 0.0008) and major complications (15.3 % vs 3.3 %, P = 0.0015) compared with 16-gauge needles. CONCLUSIONS Percutaneous renal biopsy remains a safe procedure in children, thus improving family-centered service provision in the UK.
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Affiliation(s)
- Asheeta Gupta
- Birmingham Childrens Hospital, Steelhouse Lane, Birmingham, UK, B4 6NH.
| | | | - Wesley Hayes
- Bristol Royal Hospital for Children, Bristol, UK
| | | | | | | | - Brian A Judd
- Alder Hey Children's Hospital in Liverpool, Liverpool, UK
| | | | | | - Catherine O'Brien
- Birmingham Childrens Hospital, Steelhouse Lane, Birmingham, UK, B4 6NH
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Yincent Tse
- Great North Children's Hospital, Newcastle Upon Tyne, UK
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29
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Gipson DS, Troost JP, Lafayette RA, Hladunewich MA, Trachtman H, Gadegbeku CA, Sedor JR, Holzman LB, Moxey-Mims MM, Perumal K, Kaskel FJ, Nelson PJ, Tuttle KR, Bagnasco SM, Hogan MC, Dell KM, Appel GB, Lieske JC, Ilori TO, Sethna CB, Fervenza FC, Hogan SL, Nachman PH, Rosenberg AZ, Greenbaum LA, Meyers KEC, Hewitt SM, Choi MJ, Kopp JB, Zhdanova O, Hodgin JB, Johnstone DB, Adler SG, Avila-Casado C, Neu AM, Hingorani SR, Lemley KV, Nast CC, Brady TM, Barisoni-Thomas L, Fornoni A, Jennette JC, Cattran DC, Palmer MB, Gibson KL, Reich HN, Mokrzycki MH, Sambandam KK, Zilleruelo GE, Licht C, Sampson MG, Song P, Mariani LH, Kretzler M. Complete Remission in the Nephrotic Syndrome Study Network. Clin J Am Soc Nephrol 2015; 11:81-9. [PMID: 26656320 DOI: 10.2215/cjn.02560315] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/24/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES This analysis from the Nephrotic Syndrome Study Network (NEPTUNE) assessed the phenotypic and pathology characteristics of proteinuric patients undergoing kidney biopsy and defined the frequency and factors associated with complete proteinuria remission (CRever). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We enrolled adults and children with proteinuria ≥0.5 g/d at the time of first clinically indicated renal biopsy at 21 sites in North America from April 2010 to June 2014 into a prospective cohort study. NEPTUNE central pathologists assigned participants to minimal-change disease (MCD), FSGS, membranous nephropathy, or other glomerulopathy cohorts. Outcome measures for this analysis were (1) CRever with urine protein-to-creatinine ratio (UPC) <0.3 g/g with preserved native kidney function and (2) ESRD. Continuous variables are reported as median and interquartile range (IQR; 25th, 75th percentile). Cox proportional hazards modeling was used to assess factors associated with CRever. RESULTS We enrolled 441 patients: 116 (27%) had MCD, 142 (32%) had FSGS, 66 (15%) had membranous nephropathy, and 117 (27%) had other glomerulopathy. The baseline UPC was 4.1 g/g (IQR, 1.9, 7.7) and the eGFR was 81 ml/min per 1.73 m(2) (IQR, 50, 105). Median duration of observation was 19 months (IQR, 11, 30). CRever occurred in 46% of patients, and 4.6% progressed to ESRD. Multivariate analysis demonstrated that higher prebiopsy proteinuria (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.5) and pathology diagnosis (FSGS versus MCD; hazard ratio, 0.2; 95% confidence interval, 0.1 to 0.5) were inversely associated with CRever. The effect of immunosuppressive therapy on remission varied by pathology diagnosis. CONCLUSIONS In NEPTUNE, the high frequency of other pathology in proteinuric patients affirms the value of the diagnostic kidney biopsy. Clinical factors, including level of proteinuria before biopsy, pathology diagnosis, and immunosuppression, are associated with complete remission.
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Affiliation(s)
- Debbie S Gipson
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Jonathan P Troost
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Richard A Lafayette
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michelle A Hladunewich
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Howard Trachtman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Crystal A Gadegbeku
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - John R Sedor
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Lawrence B Holzman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marva M Moxey-Mims
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Kalyani Perumal
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Frederick J Kaskel
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Peter J Nelson
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Katherine R Tuttle
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Serena M Bagnasco
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marie C Hogan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Katherine M Dell
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Gerald B Appel
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - John C Lieske
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Titilayo O Ilori
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Christine B Sethna
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Fernando C Fervenza
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Susan L Hogan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Patrick H Nachman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Avi Z Rosenberg
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Larry A Greenbaum
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Kevin E C Meyers
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Stephen M Hewitt
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michael J Choi
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jeffrey B Kopp
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Olga Zhdanova
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jeffrey B Hodgin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Duncan B Johnstone
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sharon G Adler
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Carmen Avila-Casado
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alicia M Neu
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sangeeta R Hingorani
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Kevin V Lemley
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Cynthia C Nast
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Tammy M Brady
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Laura Barisoni-Thomas
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alessia Fornoni
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - J Charles Jennette
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Daniel C Cattran
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Matthew B Palmer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Keisha L Gibson
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Heather N Reich
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michele H Mokrzycki
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Kamalanathan K Sambandam
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Gaston E Zilleruelo
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Christoph Licht
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Matthew G Sampson
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Peter Song
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Laura H Mariani
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Matthias Kretzler
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Magistroni R, D’Agati VD, Appel GB, Kiryluk K. New developments in the genetics, pathogenesis, and therapy of IgA nephropathy. Kidney Int 2015; 88:974-89. [PMID: 26376134 PMCID: PMC4653078 DOI: 10.1038/ki.2015.252] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023]
Abstract
Recent years have brought notable progress in the field of IgA nephropathy. Here, we highlight important new directions and latest developments, including successful discovery of several genetic susceptibility loci, formulation of the multihit pathogenesis model, introduction of the Oxford pathology scoring system, and formalization of the Kidney Disease Improving Global Outcomes (KDIGO) consensus treatment guidelines. We focus on the latest genetic findings that confirm a strong contribution of inherited factors and explain some of the geoethnic disparities in disease susceptibility. Most IgA nephropathy susceptibility loci discovered to date encode genes involved in the maintenance of the intestinal epithelial barrier and response to mucosal pathogens. The concerted pattern of interpopulation allelic differentiation across all genetic loci parallels the disease prevalence and correlates with variation in local pathogens, suggesting that multilocus adaptation might have shaped the present-day landscape of IgA nephropathy. Importantly, the 'Intestinal Immune Network for IgA Production' emerged as one of the new targets for potential therapeutic intervention. We place these findings in the context of the multihit pathogenesis model and existing knowledge of IgA immunobiology. Lastly, we provide our perspective on the existing treatment options, discuss areas of clinical uncertainty, and outline ongoing clinical trials and translational studies.
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Affiliation(s)
- Riccardo Magistroni
- Division of Nephrology, Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, NY, USA
- Division of Nephrology Dialysis and Transplantation, Department of Surgery, Medicine, Dentistry, Morphologic Science, Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Vivette D. D’Agati
- Division of Renal Pathology, Department of Pathology, College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Gerald B. Appel
- Division of Nephrology, Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Feehally J, Barratt J. The Genetics of IgA Nephropathy: An Overview from Western Countries. KIDNEY DISEASES 2015; 1:33-41. [PMID: 27536663 DOI: 10.1159/000381738] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 03/16/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND IgA nephropathy (IgAN) is the commonest primary glomerulonephritis worldwide and a significant cause of chronic kidney disease and end-stage renal disease. It is widely accepted that genetic factors play a role in the pathogenesis of IgAN. However, the identity of these genetic factors remains uncertain. SUMMARY Critical to all genetic studies is a precise phenotypic definition of the disease. It is well recognised that IgAN displays striking phenotypic variation, raising the possibility that it may not be a single disease and it may not be the same disease in different parts of the world. In this review, we discuss the challenges that this phenotypic variation poses to interpreting genetic data and the current evidence for specific gene involvement in IgAN, focusing particularly on data from European IgAN cohorts. KEY MESSAGE With advances in genetic techniques, in particular next-generation sequencing, and an increased understanding of the importance of copy number variations, epigenetics and transcriptomics, it is likely that we will gain a greater understanding of the genetic basis for IgAN. However, due to the lack of consistency in epidemiological clinicopathological studies both within and between continents, this will only be achieved if we are able to more precisely phenotype IgAN populations. FACTS FROM EAST AND WEST The reported prevalence of IgAN is higher in Asia than in Europe and North America. However, differences in use of biopsy for the diagnosis of IgAN should be taken into account in analysing data from both East and West. In Europe, IgAN affects men more frequently than women; this is not the case in Asia. Familial IgAN has been more frequently reported in Europe than in Asia. Within Europe, familial IgAN is more evident in southern than in northern populations. Changes in the pattern of serum IgA1 O-glycosylation is a common finding in IgAN patients in the East and West. SNPs within the gene coding for the enzyme C1GALT1 have been reported in Chinese and European patients. However, there is no evidence for a role of gene polymorphism of the C1GALT1 chaperone cosmc in Europeans. Genetic variants in the HLA gene family have been observed in populations from the East and West. Associations between IgAN and variants of the TAP1/PSMB and DEFA genes were observed in Asian but not in Western patients. Association with the angiotensin-converting enzyme gene was seen only in Asian patients.
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Affiliation(s)
- John Feehally
- The John Walls Renal Unit, University Hospitals of Leicester, and Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Jonathan Barratt
- The John Walls Renal Unit, University Hospitals of Leicester, and Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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Maixnerova D, Neprasova M, Skibova J, Mokrisova J, Rysava R, Reiterova J, Jancova E, Merta M, Zadrazil J, Honsova E, Tesar V. IgA nephropathy in Czech patients--are we able reliably predict the outcome? Kidney Blood Press Res 2014; 39:555-62. [PMID: 25531750 DOI: 10.1159/000368467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of our study was to retrospectively analyse data of 520 Czech patients with IgA nephropathy (IgAN) and to specify the risk factors affecting renal survival of IgAN patients. METHODS Cox proportional hazards regression model was used to evaluate the effects of different variables on renal survival during a median follow up of six years. McNemar´s test was used to analyse the progression of renal function according to Bartosik´s formula. RESULTS In our retrospective analysis of 520 Czech IgAN patients Cox proportional hazards regression model with five variables [hypertension, sex, GFR, proteinuria, age] was used. Significant regression coefficient was found for GFR, hypertension and proteinuria. Using stepwise algorithm GFR (OR = 3.09), hypertension (OR = 2.09) and proteinuria (OR = 1.97) were found as the most important factors for renal survival in our group of IgAN patients. Among patients with CKD 3 we found significantly better renal survival in patients with proteinuria < 1g/day compared to patients with higher proteinuria. We did not find the significant difference between predicted progression of renal function due to Bartosik´s formula and real progression of renal parametres assessed by GFR at the end of the follow up in our group of IgAN patients. CONCLUSION Our retrospective study of 520 Czech IgAN patients confirmed GFR, hypertension and proteinuria as the most important factors affecting the prognosis of IgAN patients. We validated Toronto Bartosik´s formula to predict prognosis of IgAN patients.
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Affiliation(s)
- Dita Maixnerova
- Department of Nephrology, General Teaching Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Maixnerova D, Jancova E, Skibova J, Rysava R, Rychlik I, Viklicky O, Merta M, Kolsky A, Reiterova J, Neprasova M, Kidorova J, Honsova E, Tesar V. Nationwide biopsy survey of renal diseases in the Czech Republic during the years 1994-2011. J Nephrol 2014; 28:39-49. [PMID: 24756969 DOI: 10.1007/s40620-014-0090-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/02/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND We describe data on 10,472 renal biopsies gathered by the Czech Registry of Renal Biopsies over a period of 18 years. METHODS We assessed the main demographic, clinical and histological data of individuals who underwent renal biopsies of native kidneys in 31 centers in the Czech Republic (population 10.3 million) during the period 1994-2011. RESULTS We evaluated 10,472 renal biopsies: males 57.8%, children (≤15 years) 13.6%, elderly (>60 years) 19.1%. The most frequent biopsy-proven diseases were primary (55.7%) and secondary (29.1%) glomerulonephritides (GN). Tubulointerstitial nephritis (TIN) was observed in 3.4 % and vascular diseases in 4.1%. The samples were non-diagnostic in 4.2%. Among primary GN the most frequent diagnoses were IgA nephropathy (IgAN) (37.4%), membranous GN (MGN) (13%) and focal segmental glomerulosclerosis (FSGS) (12.6%). Among secondary GN, systemic lupus erythematosus (SLE) represented 23.2%, hereditary diseases 19.8% and necrotizing vasculitis (NV) 19.4%. Among adults, mild renal insufficiency [serum creatinine (SCr) 111-200 μmol/l] was present in 24.7%, advanced renal insufficiency (SCr 201-400 μmol/l) in 15.3, and 12.3% of patients had SCr > 400 μmol/l. The most common diseases in patients with nephrotic proteinuria were minimal change disease (MCD) (39.7%) among children, IgAN (26.2%) in adults aged 16-60 years and amyloidosis (42.7%) among the elderly. The mean annual incidence (per million population) was: primary GN 30.9, secondary GN 18.1, IgAN 11.6, MGN 4.0, SLE 4.0, FSGS 3.9, MCD 3.4, NV 3.2, diabetic nephropathy 2.3, thin basement membrane glomerulopathy 2.0, mesangioproliferative GN 1.9, and TIN 1.9. Ultrasound needle guidance was used in 66.8%. The frequency of serious complications (symptomatic hematoma, gross hematuria, blood transfusion) was approximately 3.2%. CONCLUSIONS This report provides representative population-based data on native biopsy-proven renal diseases in the Czech Republic. Over the 18 years of nationwide biopsy survey, we noted an increase of the mean age of renal biopsy cases, an increasing proportion of elderly, and a cardinal change in biopsy technique towards ultrasonography needle guidance.
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Affiliation(s)
- Dita Maixnerova
- Department of Nephrology, 1st Faculty of Medicine, Charles University, U Nemocnice 2, 128 08, Prague 2, Czech Republic,
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McQuarrie EP, Mackinnon B, McNeice V, Fox JG, Geddes CC. The incidence of biopsy-proven IgA nephropathy is associated with multiple socioeconomic deprivation. Kidney Int 2013; 85:198-203. [PMID: 24025641 DOI: 10.1038/ki.2013.329] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 05/22/2013] [Accepted: 05/29/2013] [Indexed: 11/09/2022]
Abstract
Chronic kidney disease is more common in areas of socioeconomic deprivation, but the relationship with the incidence and diagnosis of biopsy-proven renal disease is unknown. In order to study this, all consecutive adult patients undergoing renal biopsy in West and Central Scotland over an 11-year period were prospectively analyzed for demographics, indication, and histologic diagnosis. Using the Scottish Index of Multiple Deprivation, 1555 eligible patients were separated into quintiles of socioeconomic deprivation according to postcode. Patients in the most deprived quintile were significantly more likely to undergo biopsy compared with patients from less deprived areas (109.5 compared to 95.9 per million population/year). Biopsy indications were significantly more likely to be nephrotic syndrome, or significant proteinuria without renal impairment. Patients in the most deprived quintile were significantly more likely to have glomerulonephritis. There was a significant twofold increase in the diagnosis of IgA nephropathy in the patients residing in the most compared with the least deprived postcodes not explained by the demographics of the underlying population. Thus, patients from areas of socioeconomic deprivation in West and Central Scotland are significantly more likely to undergo native renal biopsy and have a higher prevalence of IgA nephropathy.
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Affiliation(s)
- Emily P McQuarrie
- Glasgow Renal and Transplant Unit, Western Infirmaryon behalf of the Scottish Renal Biopsy Registry, Glasgow, UK
| | - Bruce Mackinnon
- Glasgow Renal and Transplant Unit, Western Infirmaryon behalf of the Scottish Renal Biopsy Registry, Glasgow, UK
| | | | - Jonathan G Fox
- Glasgow Renal and Transplant Unit, Western Infirmaryon behalf of the Scottish Renal Biopsy Registry, Glasgow, UK
| | - Colin C Geddes
- Glasgow Renal and Transplant Unit, Western Infirmaryon behalf of the Scottish Renal Biopsy Registry, Glasgow, UK
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Volovăt C, Cãruntu I, Costin C, Stefan A, Popa R, Volovăt S, Siriopol D, Voroneanu L, Nistor I, Segall L, Covic A. Changes in the histological spectrum of glomerular diseases in the past 16 years in the North-Eastern region of Romania. BMC Nephrol 2013; 14:148. [PMID: 23855530 PMCID: PMC3716947 DOI: 10.1186/1471-2369-14-148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/09/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to describe the findings of renal biopsies from a large nephrology center in Iasi, Romania, performed between 2005 and 2010. We compared these findings with our previous ones, from 1995 to 2004, as well as with similar reports. METHODS We studied retrospectively 239 renal biopsies. The indications for renal biopsy were categorized into: nephrotic syndrome, acute nephritic syndrome, asymptomatic urinary abnormalities, acute kidney injury, and chronic kidney disease of unknown etiology. RESULTS During the past 16 years, a gradual increase in the annual number of renal biopsies/per million population (p.m.p.)/year was observed, although this incidence remained lower than in other European countries. Nephrotic syndrome was the indication for renal biopsy in over 50% of cases. Glomerulonephritis (GN) was the main histological diagnosis in 91% of cases, of which 56% were primary GN and 35% were secondary GN. The frequency of various types of primary GN was: membranoproliferative GN (MPGN) - 29.3%, membranous nephropathy (MN) -27.5%, focal segmental glomerulosclerosis (FSGS) - 17.2%, mesangial GN (including IgAN) -13.7%, crescentic GN - 9.4%, and minimal change disease (MCD) - 2.5%. Compared to the previously reported period (1994-2004), we observed a significant decrease in the frequency of MPGN and significant increases in the frequency of FSGS and, particularly MN - which more than doubled. CONCLUSION We report significant changes in the histological spectrum of GN in North-Eastern Romania in 2005-2010, compared to the previously reported 10-yrs. These changes seem to be following a trend that has also been observed in Western countries a few decades ago, and which may have a socioeconomic explanation.
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Affiliation(s)
- Carmen Volovăt
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Irina Cãruntu
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Camelia Costin
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Alina Stefan
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Raluca Popa
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Simona Volovăt
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Dimitrie Siriopol
- Department of Nephrology, University Hospital “Dr. C.I. Parhon”, Iasi, Romania
| | - Luminita Voroneanu
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Ionut Nistor
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Liviu Segall
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
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Methven S, MacGregor MS. Empiricism or rationalism: how should we measure proteinuria? Ann Clin Biochem 2013; 50:296-300. [DOI: 10.1177/0004563212473283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Proteinuria is the cardinal sign of renal disease, therefore accurate identification of clinically significant proteinuria is essential to the diagnosis and management of kidney disease. Spot samples are now widely used, namely protein: creatinine ratio (uPCR) and albumin: creatinine ratio (uACR). In this article we review the evidence comparing uPCR and uACR including clinical, laboratory and financial arguments. uPCR has a superior performance to uACR to predict 24-hour total proteinuria, the measurement on which the evidence for interventions in chronic kidney disease is based. Furthermore a retrospective study comparing uPCR and uACR as predictors of renal outcome found comparable performance to predict all-cause mortality, commencement of renal replacement therapy and doubling of serum creatinine. Only uPCR takes account of non-albumin proteinuria which has been shown to have prognostic significance. uACR was been thought to be superior at low levels (where there is less ‘noise’ from physiological urinary proteins), but uPCR has recently been shown to perform well at levels equivalent to <0.5 g/day (and even within the reference range) as a predictor of outcomes. uACR is measured using an immunoassay that may be technically superior, but is not without shortcomings (such as antigen excess) and is 2–10 times more expensive than uPCR. The theories explaining the superiority of albumin are appealing. However, the available comparative data do not seem to support the theory. We cannot explain the disparity, but in science, if the data do not fit the existing theory, then maybe it's time for a new theory.
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Affiliation(s)
- Shona Methven
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Mark S MacGregor
- John Stevenson Lynch Renal Unit, University Hospital Crosshouse, Kilmarnock, UK
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Sugiyama H, Yokoyama H, Sato H, Saito T, Kohda Y, Nishi S, Tsuruya K, Kiyomoto H, Iida H, Sasaki T, Higuchi M, Hattori M, Oka K, Kagami S, Kawamura T, Takeda T, Hataya H, Fukasawa Y, Fukatsu A, Morozumi K, Yoshikawa N, Shimizu A, Kitamura H, Yuzawa Y, Matsuo S, Kiyohara Y, Joh K, Nagata M, Taguchi T, Makino H. Japan Renal Biopsy Registry and Japan Kidney Disease Registry: Committee Report for 2009 and 2010. Clin Exp Nephrol 2013; 17:155-73. [PMID: 23385776 DOI: 10.1007/s10157-012-0746-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/18/2012] [Indexed: 12/01/2022]
Abstract
The Japan Renal Biopsy Registry (J-RBR) was started in 2007 and the Japan Kidney Disease Registry (J-KDR) was then started in 2009 by the Committee for Standardization of Renal Pathological Diagnosis and the Committee for the Kidney Disease Registry of the Japanese Society of Nephrology. The purpose of this report is to describe and summarize the registered data from 2009 and 2010. For the J-KDR, data were collected from 4,016 cases, including 3,336 (83.1 %) by the J-RBR and 680 (16.9 %) other cases from 59 centers in 2009, and from 4,681 cases including 4,106 J-RBR cases (87.7 %) and 575 other cases (12.3 %) from 94 centers in 2010, including the affiliate hospitals. In the J-RBR, 3,165 native kidneys (94.9 %) and 171 renal grafts (5.1 %) and 3,869 native kidneys (94.2 %) and 237 renal grafts (5.8 %) were registered in 2009 and 2010, respectively. Patients younger than 20 years of age comprised 12.1 % of the registered cases, and those 65 years and over comprised 24.5 % of the cases with native kidneys in 2009 and 2010. The most common clinical diagnosis was chronic nephritic syndrome (55.4 % and 50.0 % in 2009 and 2010, respectively), followed by nephrotic syndrome (22.4 % and 27.0 %); the most frequent pathological diagnosis as classified by the pathogenesis was IgA nephropathy (31.6 % and 30.4 %), followed by primary glomerular diseases (except IgA nephropathy) (27.2 % and 28.1 %). Among the primary glomerular diseases (except IgA nephropathy) in the patients with nephrotic syndrome, membranous nephropathy was the most common histopathology in 2009 (40.3 %) and minor glomerular abnormalities (50.0 %) were the most common in 2010 in native kidneys in the J-RBR. Five new secondary and longitudinal research studies by the J-KDR were started in 2009 and one was started in 2010.
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Affiliation(s)
- Hitoshi Sugiyama
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Das U, Dakshinamurty KV, Prayaga A. Pattern of biopsy-proven renal disease in a single center of south India: 19 years experience. Indian J Nephrol 2011; 21:250-7. [PMID: 22022085 PMCID: PMC3193668 DOI: 10.4103/0971-4065.85482] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The prevalence of biopsy-proven glomerulonephritis varies according to the geographic area, socioeconomic condition, race, age, demography and indication of renal biopsy. This study analyzed the distribution of biopsy-proven renal disease (BPRD) and its changing pattern over a period of 19 years from a tertiary care hospital in south India. All the renal biopsies performed from 1990 to 2008 were reviewed retrospectively. Biopsies were evaluated by light microscopy and immunofluorescence microscopy and also special stains when warranted. A total of 1849 biopsies were analyzed. The mean patient age was 32.27 ± 18.38 (range 10-80) years. The male:female ratio was 1.4:1. The most common indications of renal biopsy were nephrotic syndrome (49%), followed by chronic renal failure (13.6%) and rapidly progressive renal failure (12%). Primary glomerulonephritis (PGN) comprised 1278 (69.1%) of the total patients. Among the PGN cases, the most common one was minimal change disease (21.8%), followed by focal segmental glomerulosclerosis [FSGS (15.3%)], membranous glomerulonephritis (10%), chronic glomerulonephritis (9.7%), postinfectious glomerulonephritis (8.1%), mesengioproliferative glomerulonephritis (7.5%), diffuse proliferative glomerulonephritis (6.7%), crescentic glomerulonephritis (6.5%), IgA nephropathy [IgAN (6.3%)], membranoproliferative glomerulonephritis (5.7%), focal proliferative glomerulonephritis (1.6%) and IgM nephropathy (0.5). Secondary glomerular disease (SGN) accounted for 337 (18.2%) of the cases. The most common SGN was lupus nephritis (80.1%), followed by amyloidosis (8%) and diabetic nephropathy (6.5%). Tubulointerstitial disease [124 (6.7%)] and vascular disease [60 (3.2%)] were less common. End-stage changes and miscellaneous disease were found in 37 (2%) and 13 (0.7%) cases, respectively. The incidence of FSGS and IgAN has been increasing since 1999. This study provides descriptive biopsy data and highlights the changing incidence of renal disease which is probably contributed by an increase referral due to increased awareness together with increased manpower and infrastructure.
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Affiliation(s)
- U Das
- Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
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McQuarrie EP, Mackinnon B, Stewart GA, Geddes CC. Membranous nephropathy remains the commonest primary cause of nephrotic syndrome in a northern European Caucasian population. Nephrol Dial Transplant 2009; 25:1009-10; author reply 1010-1. [PMID: 20037184 DOI: 10.1093/ndt/gfp665] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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