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Mitrotti A, Giliberti M, Di Leo V, di Bari I, Pontrelli P, Gesualdo L. Hidden genetics behind glomerular scars: an opportunity to understand the heterogeneity of focal segmental glomerulosclerosis? Pediatr Nephrol 2024; 39:1685-1707. [PMID: 37728640 PMCID: PMC11026212 DOI: 10.1007/s00467-023-06046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 09/21/2023]
Abstract
Focal segmental glomerulosclerosis (FSGS) is a complex disease which describes different kinds of kidney defects, not exclusively linked with podocyte defects. Since nephrin mutation was first described in association with early-onset nephrotic syndrome (NS), many advancements have been made in understanding genetic patterns associated with FSGS. New genetic causes of FSGS have been discovered, displaying unexpected genotypes, and recognizing possible site of damage. Many recent large-scale sequencing analyses on patients affected by idiopathic chronic kidney disease (CKD), kidney failure (KF) of unknown origin, or classified as FSGS, have revealed collagen alpha IV genes, as one of the most frequent sites of pathogenic mutations. Also, recent interest in complex and systemic lysosomal storage diseases, such as Fabry disease, has highlighted GLA mutations as possible causes of FSGS. Tubulointerstitial disease, recently classified by KDIGO based on genetic subtypes, when associated with UMOD variants, may phenotypically gain FSGS features, as well as ciliopathy genes or others, otherwise leading to completely different phenotypes, but found carrying pathogenic variants with associated FSGS phenotype. Thus, glomerulosclerosis may conceal different heterogeneous conditions. When a kidney biopsy is performed, the principal objective is to provide an accurate diagnosis. The broad spectrum of phenotypic expression and genetic complexity is demonstrating that a combined path of management needs to be applied. Genetic investigation should not be reserved only to selected cases, but rather part of medical management, integrating with clinical and renal pathology records. FSGS heterogeneity should be interpreted as an interesting opportunity to discover new pathways of CKD, requiring prompt genotype-phenotype correlation. In this review, we aim to highlight how FSGS represents a peculiar kidney condition, demanding multidisciplinary management, and in which genetic analysis may solve some otherwise unrevealed idiopathic cases. Unfortunately there is not a uniform correlation between specific mutations and FSGS morphological classes, as the same variants may be identified in familial cases or sporadic FSGS/NS or manifest a variable spectrum of the same disease. These non-specific features make diagnosis challenging. The complexity of FSGS genotypes requires new directions. Old morphological classification does not provide much information about the responsible cause of disease and misdiagnoses may expose patients to immunosuppressive therapy side effects, mistaken genetic counseling, and misguided kidney transplant programs.
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Affiliation(s)
- Adele Mitrotti
- Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
| | - Marica Giliberti
- Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Di Leo
- Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Ighli di Bari
- Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Paola Pontrelli
- Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
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Han Q, Xu H, Li L, Lei S, Yang M. Demographic distribution analysis of different glomerular diseases in Southwest China from 2008 to 2022. Int Urol Nephrol 2024; 56:2011-2020. [PMID: 38172368 DOI: 10.1007/s11255-023-03902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Environmental and lifestyle factors play an etiological role in the pathogenesis of different glomerular diseases. Thus, exploring the epidemic characteristics of renal disease in different nationalities and regions is important. MATERIALS AND METHODS Patients who underwent renal biopsy from October 2008 to October 2022 were included. The proportion and change tendency of glomerular diseases and the differences between the sexes and different ages and races were analyzed. RESULTS There were 15,146 cases of glomerular diseases (98.5%), involving 7538 males (49.8%) and 7608 females (50.2%). The mean age was 37.0 years (range 0-80 years). The proportion of membranous nephropathy (MN) and diabetic nephropathy (DN) showed an increased trend. The most common primary glomerulonephritis (PGN) was IgA nephropathy (IgAN, 44.6%), followed by minimal-change disease (MCD, 24.3%) and MN (15.4%). Lupus nephritis (LN, 30%) accounted for the largest proportion of SGNs, followed by Henoch-Schonlein purpura nephritis (HSPN, 20.9%) and DN (19.8%). Compared with adults aged 18-60 years old, MCD and HSPN were more common in children and MN and DN in elderly individuals, statistically significant differences. Additionally, the sex and age distribution of PGN and SGN between the Tibetan and Han populations differed significantly, whereby LN was higher in the Han population and HSPN in the Tibetan population. CONCLUSION The distribution of glomerular diseases showed age, sex and race differences. This research will be beneficial for providing epidemiological evidence for clinical diagnosis, disease prevention and public health decision-making.
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Affiliation(s)
- Qianqian Han
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
| | - Huan Xu
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
| | - Lin Li
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Song Lei
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Mei Yang
- Department of Pathology, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
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Goto K, Imaizumi T, Hamada R, Ishikura K, Kosugi T, Narita I, Sugiyama H, Shimizu A, Yokoyama H, Sato H, Mauryama S. Renal pathology in adult and paediatric population of Japan: review of the Japan renal biopsy registry database from 2007 to 2017. J Nephrol 2023; 36:2257-2267. [PMID: 37597092 PMCID: PMC10638177 DOI: 10.1007/s40620-023-01687-9] [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: 12/21/2022] [Accepted: 05/17/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND The Japan Renal Biopsy Registry (J-RBR), a nationwide, web-based, registry system, started in 2007. This study aimed to summarise the epidemiology of biopsy-diagnosed kidney disease in Japan over 10 years. METHODS We analysed the J-RBR database, from 2007 to 2017. Patients' clinical data collected at the time of biopsy and histopathological diagnoses were used for epidemiological and clinicopathologic analyses. RESULTS The predominant renal biopsy diagnoses were immunoglobulin A nephropathy (39.2%), lupus nephritis (6.5%) and minimal change disease (6.0%) in younger adults (19-64 years), and membranous nephropathy (17.4%), antineutrophil cytoplasmic antibody-associated vasculitis or anti-glomerular basement membrane glomerulonephritis (13.0%), and immunoglobulin A nephropathy (12.5%) in older adults (≥ 65 years). The percentages of patients diagnosed with membranoproliferative glomerulonephritis and immunoglobulin A nephropathy decreased, whereas those with immunoglobulin A vasculitis and diabetic nephropathy increased over the decade. In paediatric patients (< 19 years), immunoglobulin A nephropathy (36.1%), minimal change disease (17.6%), and immunoglobulin A vasculitis (8.6%) were the predominant diagnoses. The percentage of patients diagnosed with immunoglobulin A vasculitis increased over the decade. Based on the sex distribution, minimal change disease and membranous nephropathy were predominant in men aged < 20 and > 40 years, respectively, whereas immunoglobulin A vasculitis and antineutrophil cytoplasmic antibody-associated vasculitis or anti-glomerular basement membrane glomerulonephritis were predominant in women in their 20s and 30s and aged < 50 years, respectively. Immunoglobulin A nephropathy was predominant in men at most ages and in women in their 20s to 40s. CONCLUSIONS This study describes the distribution and changes in kidney biopsy diagnoses over 10 years in Japan and paves the way for future research on kidney diseases in adults and children.
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Affiliation(s)
- Kazunori Goto
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Riku Hamada
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tomoki Kosugi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Sugiyama
- Department of Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Medical Care Work, Kawasaki College of Allied Health Professions, Okayama, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Shoichi Mauryama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
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Shakeel S, Rashid R, Mubarak M. Biopsy-Proven Renal Diseases in the Elderly: A Developing Country Perspective. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:313-322. [PMID: 37417184 DOI: 10.4103/1319-2442.379030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Renal diseases are one of the common causes of morbidity and mortality in elderly population. Currently, the spectrum of renal diseases in elderly population in our country is unknown. The aim of this study was to determine the pattern of renal diseases in elderly patients in Pakistan. In this retrospective, observational study, we included all consecutive patients aged ≥60 years, on whom native renal biopsies were performed during a period of 25 years from January 1994 to December 2018. The final histologic diagnosis was categorized into four groups, primary glomerular diseases (PGDs), secondary glomerular diseases (SGDs), tubulointerstitial disease (TID), and vascular diseases (VDs). A total of 324 renal biopsies are performed in the study period. The mean age was 64.6 ± 5.1 years, range of 60-80 years with a male-to-female ratio of 3.26:1. The mean serum creatinine at biopsy was 4.1 ± 2.86 mg/dL. Indications for biopsy were acute kidney injury (AKI) in 141 (43.5%), followed by nephrotic syndrome (NS) in 128 (39.5%). Renal disease category was PGD in 204 (63%), SGD in 42 (13%), TID in 58 (17.9%), and VD in 20 (6.1%). Focal segmental glomerulosclerosis (FSGS) is the leading cause of PGD in 55 (27%). Among SGD, amyloidosis was the most common cause in 27 (64.3%). In patients who were biopsied for AKI, majority were crescentic glomerulonephritis accounting for 28 (19.8%). In conclusion, AKI and NS are the common biopsy indications in our population. Overall FSGS is the most common histologic diagnosis in this cohort.
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Affiliation(s)
- Shaheera Shakeel
- Javed I. Kazi Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Rahma Rashid
- Javed I. Kazi Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammed Mubarak
- Javed I. Kazi Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Native kidney biopsies in older adults: disease spectrum, long-term kidney and patient survival and safety. Int Urol Nephrol 2022; 54:2365-2373. [DOI: 10.1007/s11255-022-03143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
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S J, G B, M S, Balasubramanian S. A Spectrum of Biopsy - Proven Renal Disorders and Their Clinicopathological Correlation in Elderly Population From a Tertiary Care Center in South India. Cureus 2021; 13:e17031. [PMID: 34381661 PMCID: PMC8351875 DOI: 10.7759/cureus.17031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) has become a health concern with an extensive burden on incidence and prognosis. While the increasing lifespan contributes to a higher incidence of CKD among the elderly, the diagnostic picture in this age group is complicated by senescence-related changes. A better understanding of the etiology and progression of the disease warrants renal biopsy in such patients. This study aims to explore the histopathological spectrum of native renal biopsies leading to CKD in elderly patients in a tertiary care hospital. Methods Among the list of patients who had undergone renal biopsy at our institute from January 2015 to March 2020, elderly patients aged ≥ 60years were chosen for this study. Their demographic details, lab investigations and histopathological reports were collected. The sex distribution and prevalence of different renal diseases was calculated. The subjects were classified into four broad diagnostic groups - primary glomerular disease, diabetic nephropathy, hypertensive nephropathy, and tubulointerstitial disease. The estimated glomerular filtration rate (eGFR) values were calculated and used to stage chronic kidney disease in these patients. Statistical analysis was carried out to find a correlation between diagnostic groups and CKD presence and between serum C3 values and immunofluorescence for the same on biopsy. Results One hundred thirty-two patients formed the study sample with a male to female ratio of 1.28:1, showing a slight male predominance. The most common diagnostic group was primary glomerular disease (46%), among which focal segmental glomerulosclerosis (FSGS) was the most common entity (12%). 47.7% and 66.6% of patients in the study sample showed elevated serum blood urea nitrogen (BUN) and creatinine values, respectively. 86% of our study sample had low eGFR values, and the majority (35%) of the patients were classified under CKD stage 3. CKD incidence was high among patients with primary glomerular diseases, but no significant statistical correlation was found. 43.5% of all IF positive cases showed low serum C3 values and established a positive correlation between IF and serum C3 values. Conclusion There is no statistically significant correlation of the four diagnostic groups to the CKD. CKD in the elderly may be multifactorial, and a collaborative study across the nations may be needed to further evaluate the etiology.
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Affiliation(s)
- Josephine S
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Barathi G
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Susruthan M
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Chen T, Zhou Y, Chen X, Chen B, Pan J. Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome. Ren Fail 2021; 43:1004-1011. [PMID: 34157952 PMCID: PMC8231360 DOI: 10.1080/0886022x.2021.1942913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The impact of acute kidney injury (AKI) on the progression of renal function in idiopathic membranous nephropathy (iMN) with nephrotic syndrome (NS) patients have not yet been reported, we sought to investigate the incidence, clinical features and prognosis of AKI in iMN with NS patients and determine clinical predictors for progression from AKI to advanced chronic kidney disease (CKD) stage. METHODS We analyzed clinical and pathological data of iMN with NS patients retrospectively collected from Jan 2012 to Dec 2018. The primary renal endpoint was defined as persistent eGFR <45ml/min per 1.73 m2 more than 3 months. Comparisons of survival without primary renal endpoint were performed by Kaplan-Meier curves and log-rank test. Univariate and multivariate Cox proportional hazard models were constructed to determine independent variables associated with primary renal endpoint . RESULTS 434 iMN with NS patients were enrolled. The incidence of AKI 1 stage, AKI 2 stage and AKI 3 stage was 23.1, 4.8 and 0.7% respectively. 66 (53.2%) patients with AKI had complete renal function recovery and 42 (33.9%) patients with AKI reached primary renal endpoint. Survival without primary renal endpoint was worse in AKI patients than No AKI patients (67.1 ± 5.3 and 43.7 ± 7.3% vs 99.5 ± 0.5 and 92.5 ± 4.2% at 2 and 4 years,p < 0.001). AKI was independently associated with primary renal endpoint, with an adjusted hazard ratio(HR) of 25.1 (95%CI 7.7-82.1, p < 0.001). CONCLUSIONS AKI was usually mild and overlooked in iMN patients with NS, but it had a strong association with poor clinical outcomes and was an independent risk factor for CKD progression.
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Affiliation(s)
- Tianxin Chen
- Department of nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Zhou
- Department of nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinxin Chen
- Department of nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Chen
- Department of nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingye Pan
- Department of ICU, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejian province, P.R.China; Key Laboratory of Intelligent Critical Care and Life Support Research of Zhejiang Province
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Nie S, Wang M, Wan Q, Kong Y, Ou J, Jia N, Zhang X, Luo F, Liu X, Wang L, Cao Y, Chen R, Zhao M, Chan DYL, Wang G. Kidney Biopsy in Patients With Monoclonal Gammopathy: A Multicenter Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:687149. [PMID: 34109201 PMCID: PMC8180861 DOI: 10.3389/fmed.2021.687149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: To analyze the clinical characteristics and renal pathological manifestations of patients with monoclonal gammopathy (MG) and kidney injury. Methods: This was a multicenter retrospective cohort study conducted at four tertiary hospitals in China. The study population comprised patients with MG admitted from January 1 2013 to December 31 2020. Hospitalization records, laboratory data, and kidney biopsy reports of all patients were collected from the electronic hospital information systems. The study outcomes included kidney disease progression and major hemorrhagic complications after kidney biopsy. Results: We identified 1,164 patients with MG, 782 (67.2%) of whom had underlying kidney injury. Of 101 patients who underwent kidney biopsy, 16 had malignant neoplasms. Amyloid nephropathy was the most common finding (n = 34, 33.7%), followed by membranous nephropathy (n = 18, 17.8%) and membranoproliferative nephritis (n = 8, 7.9%). Among 85 patients with non-malignant hematologic conditions who underwent kidney biopsy, 43 had MG of renal significance (MGRS) related lesions and 42 had MG-unrelated lesions. The risk of kidney disease progression was higher in patients with kidney injury than in patients without kidney injury. Conclusion: Among patients with MG and kidney injury, only 12.9% underwent kidney biopsy and more than 40% of these patients had MG-unrelated lesions. A kidney biopsy is safe and essential to maximize the possibility of correct diagnosis for patients with clinically suspected MG of renal significance (MGRS).
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Affiliation(s)
- Sheng Nie
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengyi Wang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qijun Wan
- Center for Nephrology and Urology Shenzhen University, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China.,Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yaozhong Kong
- The First People's Hospital of Foshan, Foshan, China
| | - Jun Ou
- Division of Nephrology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Nan Jia
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaodong Zhang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Luo
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoting Liu
- Kingmed Diagnostic Laboratory Ltd, Guangzhou, China
| | - Lin Wang
- Kingmed Diagnostic Laboratory Ltd, Guangzhou, China
| | - Yue Cao
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruixuan Chen
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingpeng Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - David Yiu Leung Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Guobao Wang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangdong Provincial Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Nie P, Lou Y, Wang Y, Bai X, Zhang L, Jiang S, Li B, Luo P. Clinical and pathological analysis of renal biopsies of elderly patients in Northeast China: a single-center study. Ren Fail 2021; 43:851-859. [PMID: 33970769 PMCID: PMC8118502 DOI: 10.1080/0886022x.2021.1923527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To identify the clinical characteristics, histopathological features, and prognosis of kidney disease in a large cohort of elderly patients from Northeast China. Methods We retrospectively analyzed the renal disease spectrum in 7,122 patients who underwent renal biopsies at the Second Hospital of Jilin University from 2006 to 2020. Patients were grouped according to age: below 60 years (non-elderly group, n = 5923) and at least 60 years (elderly group, n = 1199). The clinical and pathological characteristics of renal biopsy patients in the groups were analyzed using the t-test and chi-square test. Results Compared with the non-elderly group, the elderly group had significantly fewer patients with primary glomerulonephritis, but more patients with tubulointerstitial disorders (p < .05). The incidence of IgA nephropathy, mesangial proliferative glomerulonephritis, and lupus nephritis was significantly lower in elderly patients than in non-elderly patients. The incidence of membranous nephropathy, membranoproliferative glomerulonephritis, diabetic nephropathy, hypertensive nephropathy, systemic vasculitis-associated renal damage, and amyloid nephropathy was significantly higher in elderly patients than in non-elderly patients (p < .05). The incidence of perinephric hematoma (≥4 cm2) in elderly patients with renal biopsy was lower than that in non-elderly patients. We noted that 79.9% of primary glomerulonephritis patients who received immunosuppressive therapy showed a remission rate of 83.5%. Conclusion The spectrum of kidney disease in the elderly is different from that in the younger population.
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Affiliation(s)
- Ping Nie
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
| | - Yan Lou
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
| | - Yali Wang
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
| | - Xue Bai
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
| | - Li Zhang
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
| | - Shan Jiang
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
| | - Bing Li
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
| | - Ping Luo
- The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, China
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Clinicopathologic features and prognostic factors in older patients with biopsy-proven diabetic nephropathy. Int Urol Nephrol 2021; 53:1161-1170. [PMID: 33389518 DOI: 10.1007/s11255-020-02710-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/04/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The older population has increased sharply in China. However, renal clinical and histopathological data in this population are lacking. This study investigated the clinicopathologic features and the related risk factors for long-term renal survival in older patients with diabetic nephropathy (DN). METHODS In this retrospective observational study, 74 older patients (≥ 60 years old) with type 2 diabetes mellitus and biopsy-proven DN from 2007 to 2019 were included. Clinical data were extracted from electronic records. Renal biopsy specimens were semiquantitatively evaluated using the Renal Pathology Society (RPS) classification system. Cox proportional hazard analysis was used to estimate hazard ratios (HRs) for progression to end-stage renal disease (ESRD). RESULTS During the median follow-up period of 22 months, 24 (32%) older patients progressed to ESRD. Older patients who progressed to ESRD had poorer renal function, lower hemoglobin and albumin concentrations, more severe glomerular lesions, and higher percentages of Kimmelstiel-Wilson lesions than those who did not progress to ESRD. After adjusting for age, sex, baseline renal function, and pathological parameters, multivariate Cox proportional hazard analysis showed that RPS glomerular classification (HR 2.49, 95% confidence interval [CI] 1.03-6.04), estimated glomerular filtration rate (eGFR) (HR 0.76, 95% CI 0.58-0.99), and proteinuria (HR 3.85, 95% CI 1.44-10.27) were independent risk factors for progression to ESRD. CONCLUSION Lower eGFR, heavier proteinuria, and more severe RPS glomerular lesions were associated with ESRD in older patients with type 2 diabetes mellitus and DN.
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Nazareth TA, Kariburyo F, Kirkemo A, Xie L, Pavlova-Wolf A, Bartels-Peculis L, Vaidya N, Sim JJ. Patients with Idiopathic Membranous Nephropathy: A Real-World Clinical and Economic Analysis of U.S. Claims Data. J Manag Care Spec Pharm 2019; 25:1011-1020. [PMID: 31283419 PMCID: PMC10397828 DOI: 10.18553/jmcp.2019.18456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Membranous nephropathy (MN) is a common cause of nephrotic syndrome in nondiabetic adults. Approximately one third of patients with MN progress to end-stage renal disease (ESRD), while others may be successfully treated to remission. Patients with MN represent a high-risk population for whom management strategies can alter and improve outcomes. Currently, there is little real-world evidence regarding the burden of MN on health plans. OBJECTIVES To (a) characterize clinical and economic outcomes during a 1-year time frame among a prevalent cohort of patients with MN and (b) compare the 5% of patients incurring the highest cost with the remaining 95%. METHODS A retrospective analysis of commercially insured patients was conducted using MarketScan administrative health care claims data from January 1, 2012, to December 31, 2015. Patients were aged ≥ 18 years, enrolled In a fee-for-service plan, and had ≥ 2 medical claims for an MN diagnosis (ICD-9-CM codes 581.1, 582.1, and 583.1). Diagnoses indicating clear secondary causes were excluded wherever possible. Demographics were determined as of the first diagnosis date; clinical characteristics (e.g., MN-specific therapy, complications, and procedures), health care resource utilization (HCRU; inpatient, outpatient including other outpatient and emergency department [ED], and prescriptions), and costs were evaluated for 1 year following MN diagnosis. Total costs and cost distribution (2017 U.S. dollars) were examined using plan-paid and patient-paid amounts. The 95th percentile was used to categorize and compare the subcohorts: high-cost cohort (HCC) patients (top 5%) and non-high-cost cohort (NHCC) patients (the remaining 95%). Descriptive analyses, chi-square tests, and Wilcoxon rank-sum tests were conducted. RESULTS 2,689 patients were identified (60.0% male, mean age = 46.4 years). Severity and advanced disease were observed In a higher proportion of HCC patients (n = 134) versus NHC patients (n = 2,555) via adverse health outcomes, procedures, and immunosuppressant use. HCC patients used significantly more resources on average than NHCC patients (additional use): 1.7 inpatient, 1.2 ED, and 4.8 outpatient office visits; 15 prescriptions; and 64.8 other outpatient visits (i.e., outpatient, hospital, and ESRD facilities). Total MN-related cost and mean (SD) cost per patient were $123.2 million and $45,814 ($101,353); HCC patients accounted for 43.7% of total costs for a mean cost per patient of $401,608 versus NHCC patients at 56.3% and mean cost per patient of $27,154. The greatest costs for both groups were related to outpatient visits (HCC = 46.7%; NHCC = 52.8%), inpatient visits (HCC = 27.7%; NHCC = 28.6%), and prescriptions (HCC = 25.7%; NHCC = 18.6%). CONCLUSIONS Patients with MN are significantly burdened with high disease severity and adverse health outcomes, resulting In substantial HCRU and costs. Health plan cost drivers for MN (HCC and NHCC patients) occurred primarily In the outpatient setting, followed by the inpatient setting and prescriptions. Modifiable aspects preceding progression to advanced renal disease and worse outcomes should be explored to Identify effective interventions and improve resource allocation earlier In the disease pathway, before ESRD. DISCLOSURES This study was funded by Mallinckrodt Pharmaceuticals. Kirkemo, Pavlova-Wolf, and Bartels-Peculis are employees and stockholders of Mallinckrodt Pharmaceuticals. Nazareth was an employee of Mallinckrodt Pharmaceuticals at the time of this study. Kariburyo, Xie, and Vaidya are employees of STATinMED Research, a paid consultant to Mallinckrodt Pharmaceuticals. Sim received an investigator-initiated research grant from Mallinkcrodt Pharmaceuticals. A portion of the study results were previously presented at the American Society of Nephrology (ASN) Kidney Week 2017; November 2, 2017; New Orleans, LA.
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Affiliation(s)
| | | | - Aaron Kirkemo
- Mallinckrodt Pharmaceuticals, Bedminster, New Jersey
| | - Lin Xie
- STATinMED Research, Ann Arbor, Michigan
| | | | | | | | - John J. Sim
- Division of Nephrology and Hypertension, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California
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12
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Liu D, Zhang J, Shi Y, Liu Z. Gene polymorphism and risk of idiopathic membranous nephropathy. Life Sci 2019; 229:124-131. [DOI: 10.1016/j.lfs.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/09/2023]
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13
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Clinical and Pathological Analysis of 4910 Patients Who Received Renal Biopsies at a Single Center in Northeast China. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6869179. [PMID: 31032355 PMCID: PMC6457280 DOI: 10.1155/2019/6869179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/09/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
Purpose To identify the epidemiology and pathological types of kidney diseases and their changes during the past decade, in a population from Northeast China. Methods We retrospectively analysed clinical and renal pathological data from 4910 patients who received renal biopsies in the Second Hospital of Jilin University from 2008 to 2017. Results Males received more renal biopsies than females (p < 0.001). The average age (p < 0.001) and percentage of elderly patients (p < 0.001) increased over time. The pathological types were primary glomerulonephritis (PGN, 73.2%), secondary glomerulonephritis (SGN, 23.7%), tubular-interstitial nephropathy (TIN, 2.8%), and hereditary nephropathy (HN, 0.3%). The most common forms of PGN were membranous nephropathy (MN, 37.2%) and IgA nephropathy (IgAN, 29.9%). Over time, the prevalence of IgAN decreased, but the prevalence of MN increased. MN was more common in middle-aged and elderly patients, but IgAN was most common in young adults. Analysis of SGN data indicated that lupus nephritis (LN, 34.0%), Henoch-Schönlein purpura glomerulonephritis (HSPN, 17.9%), and diabetic nephropathy (DN, 11.7%) were the most common forms. Over time, the prevalence of DN (p = 0.003), hypertension-associated renal damage (p = 0.005), and systemic vasculitis-associated nephritis (SVARD, p < 0.001) increased, but the prevalence of HSPN (p < 0.001) and hepatitis B virus-associated glomerulonephritis (HBV-GN, p = 0.001) decreased. Nephrotic syndrome was the main clinical manifestation of PGN. Conclusion From 2008 to 2017, renal biopsies were increasingly performed in the elderly. There were notable changes in the epidemiology and pathological types of kidney disease among renal biopsy patients at our centre.
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Dinesh KP, Raniele D, Michels K, Avasare RS, Larsen CP, Kayton R, Khalighi MA, Andeen NK. Anti-LRP2 Nephropathy With Abundant IgG4-Positive Plasma Cells: A Case Report. Am J Kidney Dis 2019; 74:132-137. [PMID: 30876746 DOI: 10.1053/j.ajkd.2018.12.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/17/2018] [Indexed: 12/24/2022]
Abstract
In older adults, the most common kidney biopsy diagnoses include pauci-immune crescentic glomerulonephritis, membranous nephropathy, and focal segmental glomerulosclerosis. Recently, investigators described a small series of older patients (aged 66-80 years) with acute kidney injury and a kidney biopsy demonstrating tubular basement membrane (TBM) immune deposits of polytypic immunoglobulin G (IgG) and C3, acute tubular injury, and tubulointerstitial inflammation. They identified a circulating antibody against kidney tubular low-density lipoprotein (LDL) receptor-related protein 2 (LRP2; also known as megalin) in patients' sera and colocalization of LRP2 with IgG in TBM deposits. We present a rare case of anti-LRP2 nephropathy/anti-brush border antibody disease and describe the novel feature of abundant IgG4-positive interstitial plasma cells. Along with the combination of TBM deposits, tubulointerstitial nephritis (TIN), and segmental glomerular subepithelial immune deposits seen in both entities, this newly described feature adds to the morphologic overlap with IgG4-related TIN. Identification of large TBM deposits using light microscopy and IgG staining of apical aspects of proximal tubules using immunofluorescence microscopy can point to the correct diagnosis of anti-LRP2 nephropathy and prompt confirmatory studies. Particularly in older patients with immune complex-mediated TIN who lack clinical, laboratory, radiographic, and/or characteristic histologic features of IgG4-TIN or other autoimmune, infectious, or drug-related injury, a diagnosis of anti-LRP2 nephropathy should be considered.
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Affiliation(s)
| | | | | | - Rupali S Avasare
- Division of Nephrology, Department of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Robert Kayton
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Mazdak A Khalighi
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Nicole K Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR.
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15
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Tuğcu M, Kasapoğlu U, Şahin G, Apaydın S, Gümrükçü G. Evaluation of kidney biopsies in elderly patients. Int Urol Nephrol 2019; 51:869-874. [PMID: 30830658 DOI: 10.1007/s11255-019-02109-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The renal parenchymal disease spectrum in geriatric patients is similar to that in younger patients and can be controlled by appropriate treatment. We evaluated the clinicopathological features of kidney biopsies from geriatric patients. MATERIALS AND METHODS One hundred nine native kidney biopsies from older patients (> 65 years old) obtained from 2005 to 2014 were evaluated retrospectively. The specimens were inspected by the same pathologist in the same laboratory by light microscopy and immunofluorescence. RESULTS The mean age of the patients was 72.4 ± 7.8 years (range 65-90 years), and 51.3% were female. The most frequent indication for kidney biopsy was proteinuria at the nephrotic level (56.8%). The most frequent histopathological diagnoses were focal segmental glomerulosclerosis in primary glomerulonephritis and secondary amyloidosis in secondary glomerulonephritis. The rate of major complications due to kidney biopsy was < 1%. RESULT Kidney biopsy is an effective and safe method of evaluating renal parenchymal diseases in older patients.
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Affiliation(s)
- Murat Tuğcu
- Department of Nephrology, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak Mahallesi, Muhsin Yazıcıoğlu Cd No: 10, 34899, Istanbul, Turkey.
| | - Umut Kasapoğlu
- Department of Nephrology, Agrı Public Hospital, Agrı, Turkey
| | - Gülizar Şahin
- Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Süheyla Apaydın
- Department of Nephrology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gülistan Gümrükçü
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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16
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Zhou Q, Yang X, Wang M, Wang H, Zhao J, Bi Y, Wang X, Yao J, Chen Y, Lin C, Xie X, Jiang H, Chen J. Changes in the diagnosis of glomerular diseases in east China: a 15-year renal biopsy study. Ren Fail 2018; 40:657-664. [PMID: 30484732 PMCID: PMC6282433 DOI: 10.1080/0886022x.2018.1537930] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: There have been some gradual changes in the distribution of renal biopsy pathological diagnoses during recent years. This study aimed to show changes in renal disease prevalence in China by investigating 10 patients diagnosed at our Kidney Disease Centre during the last 15 years. Methods and results: All patients aged 15-year-old or older who underwent renal biopsy at the First Affiliated Hospital, Zhejiang University, from 2001 to 2015 were enrolled. There were 5 common types of primary glomerulonephritis: IgA nephropathy (IgA N), membranous nephropathy (MN), mesangial progressive glomerulonephritis (MsPGN), minimal change disease (MCD), and focal segmental glomerulosclerosis (FSGS), which represented 50%, 16.8%, 15.9%, 8.1% and 2.5% of total cases, respectively. IgA nephropathy was the most common type of primary glomerulonephritis (PGN). Conclusions: Our results mostly showed a new trend that the diagnosis of IgA nephropathy was not increasing and the prevalence of membranous nephropathy had increased, becoming the second most common type of primary glomerulonephritis.Key POINTS Distinguished with other domestic studies, IgA nephropathy did not show a trend of continuous growth although it still had about the half proportion of PGN, whereas membranous nephropathy kept rising and became the second common PGN. Concerning SGN, LN peaked in the younger-age and middle-age groups with a significant female prevalence, DN, BANS and SV had a male predominance peaking in the middle-age and old-age groups.
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Affiliation(s)
- Qin Zhou
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Xin Yang
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Meifang Wang
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China
| | - Huiping Wang
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Jie Zhao
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Yan Bi
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Xiayue Wang
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Jihong Yao
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Ying Chen
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Chuan Lin
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Xishao Xie
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Hong Jiang
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
| | - Jianghua Chen
- a Kidney Disease Centre, The First Affiliated Hospital , Zhejiang University School of Medicine , Hangzhou , China.,b Kidney Disease Immunology Laboratory, The Third Grade Laboratory , State Administration of Traditional Chinese Medicine of China , Hangzhou , China
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17
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Ng JKC, Ma TKW, Lai FMM, Chow KM, Kwan BCH, Leung CB, Li PKT, Szeto CC. Causes of nephrotic syndrome and nephrotic-range proteinuria are different in adult Chinese patients: A single centre study over 33 years. Nephrology (Carlton) 2018; 23:565-572. [PMID: 28425160 DOI: 10.1111/nep.13061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/01/2017] [Accepted: 04/15/2017] [Indexed: 12/28/2022]
Abstract
AIM The reported causes of nephrotic syndrome (NS) varies between different countries. Less is known about the causes of nephrotic-range proteinuria (NPU). We aimed to evaluate the underlying causes of NS and NPU. METHODS This was a single-centre, retrospective study of adult patients who underwent renal biopsy between 1983 and 2015 in a tertiary referral hospital in Hong Kong. We determined the distribution of histopathological diagnoses with regard to the age subgroups and time periods. RESULTS Among 7456 patients who underwent renal biopsy, 982 and 838 patients had NS and NPU, respectively. The most common diagnosis in NS was minimal change disease (MCD) (33.3%), followed by membranous nephropathy (MN) (23.6%) and lupus nephritis (LN) (12.8%); whereas the most common diagnosis in NPU was LN (27.4%), followed by immunoglobulin A nephropathy (IgAN) (21.4%) and diabetic nephropathy (DN) (9.3%). In the NS group, MCD was the most common diagnosis in young adults while MN was the leading cause in the elderly. On the other hand, LN was the most common pathology in the NPU group until the age of 60. Over the past three decades, there was a trend of decrease in the proportion of IgAN in both NS and NPU group, while a combined pathology of hypertensive nephrosclerosis and diabetic nephropathy (HTNS and DN) increased significantly. CONCLUSIONS The causes of NS and NPU in Chinese adults were different and may represent two distinct pathological identities. The spectrum of renal histopathology among these two groups changed significantly over time.
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Affiliation(s)
- Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Terry King-Wing Ma
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fernand Mac-Moune Lai
- Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Ming Chow
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bonnie Ching-Ha Kwan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Bon Leung
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Philip Kam-To Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Lin J, Cheng Z, Qian Q. Elderly patients with glomerular diseases and IgA nephropathy. Nephrology (Carlton) 2018; 22 Suppl 4:20-26. [PMID: 29155502 DOI: 10.1111/nep.13144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
As the population ages, greater numbers of elderly patients will present with kidney diseases. Many kidney diseases, such as IgA nephropathy, will require kidney biopsy for diagnostic confirmation, treatment guidance and prognostication. In this paper, we review the current and expected future healthcare landscape with a focus on the ageing population, pros and cons of kidney biopsy in elderly patients, as well as treatment strategies and precautions. We also review the available data on IgA nephropathy in the elderly, including its occurrence rate based on the kidney biopsy, clinicohistopathological features, differentiation with IgA-dominant postinfectious glomerulonephritis, treatment options and outcome prediction. Overall, information on kidney diseases in patients with advanced age, including IgA nephropathy, is limited. Clinical evaluation and management strategies are extrapolated largely from studies in younger adults. Age-specific clinical and translational investigations of kidney diseases are eminently needed.
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Affiliation(s)
- Jing Lin
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Zhen Cheng
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Qi Qian
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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19
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Bae E, Lee SW, Park S, Kim DK, Lee H, Huh H, Chin HJ, Lee S, Ryu DR, Park JI, Kim S, Park DJ, Kang SW, Kim YS, Oh YK, Kim YC, Lim CS, Park JT, Lee JP. Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea. Arch Gerontol Geriatr 2018. [DOI: 10.1016/j.archger.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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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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21
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Hou JH, Zhu HX, Zhou ML, Le WB, Zeng CH, Liang SS, Xu F, Liang DD, Shao SJ, Liu Y, Liu ZH. Changes in the Spectrum of Kidney Diseases: An Analysis of 40,759 Biopsy-Proven Cases from 2003 to 2014 in China. KIDNEY DISEASES 2017; 4:10-19. [PMID: 29594138 DOI: 10.1159/000484717] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022]
Abstract
Objectives To evaluate the changing spectrum of kidney diseases over time in China using renal biopsy-proven cases. Methods All patients over the age of 14 years who were diagnosed with a kidney disease by renal biopsy in the Renal Biopsy Registry of the National Clinical Research Center of Kidney Diseases in Jinling Hospital, Nanjing, from 2003 to 2014 were included. Results In total, 40,759 cases of renal biopsy were analyzed. The mean age of the patients was 36.59 ± 14.12 years. 52.0$ of the patients were male. Primary glomerulonephritis (PGN), secondary glomerulonephritis, tubulointerstitial disease, and hereditary renal diseases accounted for 67.1, 26.4, 2.9, and 2.5$, respectively. IgA nephropathy (IgAN), membranous nephropathy (MN), minimal change disease, and focal segmental glomerulosclerosis were the leading PGN diagnoses. The frequency of MN increased significantly (p < 0.001) by doubling from 2003 to 2014. An analysis by age category indicated that the frequency of MN increased significantly over time (p < 0.001) in all age categories and increased by more than 2 times in the 14-24 age category. Lupus nephritis (LN) and Henoch-Schönlein purpura nephritis (HSPN) decreased significantly (p < 0.001), diabetic nephropathy (DN) increased nearly twice (p < 0.001), monoclonal immunoglobulin deposition disease (MIDD) tripled (p < 0.001), and hypertensive nephropathy (HT) (p < 0.001) and renal amyloidosis (AMY) (p < 0.05) showed an upward trend. An analysis by age category showed that hepatitis B-related nephritis has significantly decreased in the 14-24 age category (p < 0.001). Conclusion PGN continued to be the predominant kidney disease in China with IgAN being the most common PGN. The frequency of MN increased significantly, with a maximum increase in young adults. LN and HSPN decreased significantly, DN and MIDD increased significantly, and HT and AMY also showed an increasing trend. The kidney disease trends presented in this study serve as a reference point for patient care, disease prevention, and public health interventions.
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Affiliation(s)
- Jin-Hua Hou
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Hui-Xian Zhu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Min-Lin Zhou
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wei-Bo Le
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Cai-Hong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Shao-Shan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Dan-Dan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Si-Jia Shao
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ye Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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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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Tang L, Yao J, Kong X, Sun Q, Wang Z, Zhang Y, Wang P, Liu Y, Li W, Cui M, Zhen J, Xu D. Increasing prevalence of membranous nephropathy in patients with primary glomerular diseases: A cross-sectional study in China. Nephrology (Carlton) 2017; 22:168-173. [PMID: 26854278 DOI: 10.1111/nep.12739] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 12/11/2022]
Abstract
AIM Primary glomerular disease (PGD) remains the most common renal disease in China. A limited number of single centre studies show that the frequency of membranous nephropathy (MN) has increased; however, IgA nephropathy (IgAN) is still the most common PGD. To the best of our knowledge, there has been no multi-centre study in China that has explored the changes in PGD spectrum. To further investigate the changes in renal histopathological spectrum, we performed the cross-sectional study. METHOD From June 2010 to May 2015, 5935 patients from 37 hospitals in Shandong Province were involved in this retrospective study. The study was divided into five periods according to 1-year intervals. The patients were divided into four age groups (≤18 years, 19-44 years, 45-59 years and ≥60 years). RESULT Among the 5935 qualified specimens, 4855 (81.8%) were diagnosed with PGD. MN (43.3%) became the most common PGD instead of IgA (34.1%) (P < 0.001). The frequency of MN was increased from 30.7% in period 1 to 53.5% in period 5 (P < 0.001). The prevalence of MN tended to increase in every age section. IgA was the main cause of PGD in periods 1 and 2; however, its proportion decreased significantly from 41.8% in period 2 to 25.2% in period 5 (P < 0.001). CONCLUSION Primary glomerular disease remains the most common renal disease in our study. For the first time, this cross-sectional study suggests that MN, in place of IgAN, has grown to be the first leading pathological type of PGD.
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Affiliation(s)
- Lijun Tang
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jing Yao
- The Blood Purification Center, Shandong Veterans General Hospital, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Qing Sun
- Department of Pathology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zunsong Wang
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ying Zhang
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ping Wang
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yipeng Liu
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wenbin Li
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Meiyu Cui
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Junhui Zhen
- Department of Pathology, School of Medicine, Shandong University, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China
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24
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Kidney disease in the elderly: biopsy based data from 14 renal centers in Poland. BMC Nephrol 2016; 17:194. [PMID: 27884116 PMCID: PMC5123353 DOI: 10.1186/s12882-016-0410-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/18/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Longer life expectancy is associated with an increasing prevalence of kidney disease. Aging itself may cause renal damage, but the spectrum of kidney disorders that affect elderly patients is diverse. Few studies, mostly form US, Asia and West Europe found differences in the prevalence of some types of kidney diseases between elderly and younger patients based on renal biopsy findings, with varied proportion between glomerulopathies and arterionephrosclerosis as a dominant injury found. Here, for the first time in Eastern Europe we analyzed native kidney biopsy findings and their relationship to clinical characteristics at the time of biopsy in elderly individuals (aged ≥65) in comparison to younger adults (aged 18-64). METHODS Biopsy and clinical data from 352 patients aged ≥65 were retrospectively identified, analyzed and compared with a control group of 2214 individuals aged 18-64. All kidney biopsies studied were examined at Medical University of Warsaw in years 2009-14. RESULTS In elderly patients the leading indication for biopsy was nephrotic range proteinuria without hematuria (34.2%) and the most prevalent pathologic diagnoses were: membranous glomerulonephritis (MGN) (18.2%), focal segmental glomerulosclerosis (FSGS) (17.3%) amyloidosis (13.9%) and pauci immune glomerulonephritis (12.8%). Hypertension and age-related lesions very rarely were found an exclusive or dominant finding in a kidney biopsy (1.7%) and a cause of proteinuria (1.1%) in elderly individuals. There were 18.2% diabetics among elderly individuals, and as much as 75% of them had no morphologic signs of diabetic kidney disease in the renal biopsy. Amyloidosis, MGN, pauci immune GN, crescentic GN and light and/or heavy chain deposition disease (LCDD/HCDD) were more frequent whereas IgA nephropathy (IgAN), lupus nephritis (LN) and thin basement membrane disease (TBMD) were less common among elderly than in younger patients. CONCLUSIONS Proteinuria, a dominating manifestation in elderly patients subjected to kidney biopsy was most commonly related to glomerulopathies. The relatively high prevalence of potentially curative kidney diseases in elderly individuals implicates the importance of renal biopsy in these patients.
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25
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Wen S, Niedzwiecka K, Zhao W, Xu S, Liang S, Zhu X, Xie H, Tribouillard-Tanvier D, Giraud MF, Zeng C, Dautant A, Kucharczyk R, Liu Z, di Rago JP, Chen H. Identification of G8969>A in mitochondrial ATP6 gene that severely compromises ATP synthase function in a patient with IgA nephropathy. Sci Rep 2016; 6:36313. [PMID: 27812026 PMCID: PMC5095641 DOI: 10.1038/srep36313] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/13/2016] [Indexed: 12/04/2022] Open
Abstract
Here we elucidated the pathogenesis of a 14-year-old Chinese female who initially developed an isolated nephropathy followed by a complex clinical presentation with brain and muscle problems, which indicated that the disease process was possibly due to a mitochondrial dysfunction. Careful evaluation of renal biopsy samples revealed a decreased staining of cells induced by COX and NADH dehydrogenase activities, and a strong fragmentation of the mitochondrial network. These anomalies were due to the presence of a mutation in the mitochondrial ATP6 gene, G8969>A. This mutation leads to replacement of a highly conserved serine residue at position 148 of the a-subunit of ATP synthase. Increasing the mutation load in cybrid cell lines was paralleled by the appearance of abnormal mitochondrial morphologies, diminished respiration and enhanced production of reactive oxygen species. An equivalent of the G8969>A mutation in yeast had dramatic consequences on ATP synthase, with a block in proton translocation. The mutation was particularly abundant (89%) in the kidney compared to blood and urine, which is likely the reason why this organ was affected first. Based on these findings, we suggest that nephrologists should pay more attention to the possibility of a mitochondrial dysfunction when evaluating patients suffering from kidney problems.
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Affiliation(s)
- Shuzhen Wen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Katarzyna Niedzwiecka
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Weiwei Zhao
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Shutian Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiaodong Zhu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Honglang Xie
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Déborah Tribouillard-Tanvier
- CNRS, Institut de Biochimie et Génétique Cellulaires, UMR 5095, F-33077 Bordeaux, France.,Université de Bordeaux, IBGC, UMR 5095, F-33077 Bordeaux, France.,INSERM, Institut de Biochimie et Génétique Cellulaires, F-33077 Bordeaux, France
| | - Marie-France Giraud
- CNRS, Institut de Biochimie et Génétique Cellulaires, UMR 5095, F-33077 Bordeaux, France.,Université de Bordeaux, IBGC, UMR 5095, F-33077 Bordeaux, France
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Alain Dautant
- CNRS, Institut de Biochimie et Génétique Cellulaires, UMR 5095, F-33077 Bordeaux, France.,Université de Bordeaux, IBGC, UMR 5095, F-33077 Bordeaux, France
| | - Róża Kucharczyk
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jean-Paul di Rago
- CNRS, Institut de Biochimie et Génétique Cellulaires, UMR 5095, F-33077 Bordeaux, France.,Université de Bordeaux, IBGC, UMR 5095, F-33077 Bordeaux, France
| | - Huimei Chen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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26
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Chen Y, Li P, Cui C, Yuan A, Zhang K, Yu C. Biopsy-proven kidney diseases in the elderly: clinical characteristics, renal histopathological spectrum and prognostic factors. J Int Med Res 2016; 44:1092-1102. [PMID: 27596627 PMCID: PMC5536554 DOI: 10.1177/0300060516660247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To explore the clinical characteristics, renal histopathological spectrum and prognostic factors of biopsy-proven kidney diseases in the elderly. Methods A retrospective observational study was conducted in elderly patients who had received renal biopsies. Demographic, clinical and pathological data at the time of the biopsy were collected from the medical records. Follow-up records and prognostic factors were studied. Results The elderly (≥60 years) accounted for 74 of 434 (17.1%) native renal biopsies that were performed in a 9-year period. In the cohort of included elderly patients (n = 72), the prevalence of nephrotic syndrome and acute kidney injury was 62.5% (45 of 72) and 40.3% (29 of 72), respectively. For elderly patients with primary glomerular diseases (n = 44), membranous nephropathy was the most frequent pathological type (24 of 44; 54.5%). For elderly patients with secondary glomerular diseases (n = 25), anti-neutrophil cytoplasmic antibody-associated vasculitis was the most frequent aetiology (nine of 25; 36.0%). Requirement for renal replacement therapy (RRT) was an independent risk factor for poor prognosis. Conclusions Kidney diseases in the elderly have distinctive characteristics. Requirement for RRT was associated with poor prognosis in the elderly with biopsy-proven kidney diseases.
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Affiliation(s)
- Yue Chen
- 1 Department of Nephrology, Tongji Hospital, Tongji University, Shanghai, China
| | - Ping Li
- 2 Department of Haematology, Tongji Hospital, Tongji University, Shanghai, China
| | - Chunli Cui
- 1 Department of Nephrology, Tongji Hospital, Tongji University, Shanghai, China
| | - Aihong Yuan
- 1 Department of Nephrology, Tongji Hospital, Tongji University, Shanghai, China
| | - Kun Zhang
- 1 Department of Nephrology, Tongji Hospital, Tongji University, Shanghai, China
| | - Chen Yu
- 1 Department of Nephrology, Tongji Hospital, Tongji University, Shanghai, China
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27
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Huang XH, Liu ZH. The Clinical Presentation and Management of Systemic Light-Chain Amyloidosis in China. KIDNEY DISEASES 2016; 2:1-9. [PMID: 27536686 DOI: 10.1159/000444287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 01/28/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Amyloidosis includes a group of diseases characterized by the extracellular deposition of various fibrillary proteins that can autoaggregate in a highly abnormal fibrillary conformation. The amyloid precursor protein of systemic light-chain (AL) amyloidosis is comprised of monoclonal light chains that are due to plasma cell dyscrasia. The clinical presentation of patients with AL amyloidosis varies from patient to patient. Current treatment strategies target the clone in order to decrease the production of the pathologic light chains. Recent advances in therapy have helped many patients with AL amyloidosis achieve hematologic and organ responses. SUMMARY AL amyloidosis is the most common type of systemic amyloidosis in China with increasing morbidity and a high mortality rate. The clinical presentation of AL amyloidosis is variable, and the median overall survival was found to be 36.3 months. The disease prognosis and risk stratification are linked to serialized measurement of cardiac biomarkers and free light chains. The treatment of AL amyloidosis is mainly based on chemotherapy and autologous hematopoietic stem cell transplantation (ASCT). The use of novel agents (thalidomide, lenalidomide, and bortezomib) alone and in combination with steroids and alkylating agents has shown efficacy and continues to be explored. KEY MESSAGES AL amyloidosis is the most common type of systemic amyloidosis in China with increasing morbidity and a high mortality rate. The lack of prospective clinical trials using the current therapies is a challenge for evidence-based decision making concerning the treatment of AL amyloidosis. FACTS FROM EAST AND WEST (1) AL amyloidosis is the most prevalent type of amyloidosis accounting for 65% of the amyloidosis-diagnosed patients in the UK and for 93% of the amyloidosis-diagnosed patients in China. The predisposition of men over women to develop AL amyloidosis might be higher in China than in Western countries (2:1 vs. 1.3:1). Both in the East and West, incidence increases with age. At the time of diagnosis, edema is twice as frequent and the proportion of renal involvement is higher in Chinese compared to Western patients. (2) Melphalan followed by ASCT is the current standard therapy but is restricted to eligible patients. The efficacy and safety of bortezomib combined with dexamethasone were proven in Western patients and recently confirmed in a Chinese cohort. Recent studies in China and the US indicate that bortezomib induction prior to ASCT increases the response rate. Thalidomide and lenalidomide have shown benefit, but toxicity and lack of clinical evidence exclude these agents from first-line therapy. The green tea extract epigallocatechin-3-gallate is under investigation as an inhibitor of AL amyloid formation and a compound that might dissolve amyloid.
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Affiliation(s)
- Xiang-Hua Huang
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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28
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Sumnu A, Gursu M, Ozturk S. Primary glomerular diseases in the elderly. World J Nephrol 2015; 4:263-270. [PMID: 25949940 PMCID: PMC4419136 DOI: 10.5527/wjn.v4.i2.263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 12/22/2014] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Primary glomerular diseases in the elderly population are a frustrating topic due to difficulties in both the diagnosis and decision making about treatment. The most frequent type of primary glomerular disease in elderly is membranous nephropathy; while its counterpart in younger population is IgA nephropathy. The most frequent cause of nephrotic syndrome in the elderly is also membranous nephropathy. Pauci-immune crescentic glomerulonephritis (GN) rate increases both in elderly and very elderly population. Pauci-immune crescentic GNs should be regarded as urgencies in elderly patients as in their younger counterparts due to potential for causing end-stage renal disease in case of delayed diagnosis and treatment, and also causing mortality due to alveolar hemorrhage in patients with pulmonary involvement. Renal biopsy is the inevitable diagnostic method in the elderly as in all other age groups. Renal biopsy prevents unnecessary treatments and provides prognostic data. So advanced age should not be the sole contraindication for renal biopsy. The course of primary glomerular diseases may differ in the elderly population. Acute kidney injury is more frequent in the course and renal functions may be worse at presentation. These patients are more prone to be hypertensive. The decision about adding immune suppressive therapies to conservative methods should be made considering many factors like co-morbidities, drug side effects and potential drug interactions, risk of infection, patient preference, life expectancy and renal functions at the time of diagnosis.
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29
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Glassock RJ. Con: Kidney biopsy: an irreplaceable tool for patient management in nephrology. Nephrol Dial Transplant 2015; 30:528-31. [DOI: 10.1093/ndt/gfv044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Clinicopathological features of renal amyloidosis: a single-center study on 47 cases. ACTA ACUST UNITED AC 2015; 35:48-53. [PMID: 25673192 DOI: 10.1007/s11596-015-1387-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/25/2014] [Indexed: 10/24/2022]
Abstract
The correlations between the clinicopathological features and the long-term outcomes of renal amyloidosis (RA) were analyzed with a view to develop strategies for improving diagnosis and prognosis of RA. We retrospectively reviewed the clinicopathological characteristics of 47 patients diagnosed with RA between 2004 and 2014 at the Wuhan Union Hospital. The data on the renal histology, clinical manifestations, and prognosis of RA patients were retrieved from the hospital records and characteristic patterns were identified. The histological changes in the kidneys were correlated with the clinical manifestations of RA. Additionally, most RA patients in this study had decreased serum levels of κ light chain and increased urine levels of κ and λ light chains as well as presence of M-protein in the urine and serum. Patients with early RA showed no specific pathognomonic symptoms. Bleeding associated with diagnostic renal biopsy was rare. We recommend that the routine work-up of patients aged over 40 years and presenting with non-diabetic nephropathy includes the non-invasive tests for the measurement of serum and urine levels of κ and λ light chains as well as protein electrophoresis tests for the presence of urinary and serum M-protein. Additionally, such patients should undergo renal biopsy screening with Cong-red staining to ensure early diagnosis of RA and improve their survival, since the risk of hemorrhage related to renal biopsy screening is low at early stages of RA.
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31
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Glassock RJ. Older adults with kidney disease-epidemiology and clinicopathologic correlations: a remarkable single-center survey. Nephrol Dial Transplant 2014; 29:2162-3. [PMID: 25355607 DOI: 10.1093/ndt/gfu337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard J Glassock
- Department of Medicine, Geffen School of Medicine at UCLA, Laguna Niguel, CA, USA
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