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Tang Z, Wang JM, Qin JM, Wen LM. Analysis of risk factors and development of a nomogram prediction model for lupus nephritis in systemic lupus erythematosus patients. Lupus 2023:9612033231189904. [PMID: 37480363 DOI: 10.1177/09612033231189904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
BACKGROUND This study aimed to explore risk factors for lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients and establish a Nomogram prediction model based on LASSO-logistic regression. METHODS The clinical and laboratory data of SLE patients in Meishan People's Hospital from July 2012 to December 2021 were analyzed retrospectively. All SLE patients were divided into two groups with or without LN. Risk factors were screened based on LASSO-logistic regression analysis, and a Nomogram prediction model was established. The receiver operating characteristic curve, calibration curves, and decision curve analysis were adopted to evaluate the performance of the Nomogram model. RESULTS A total of 555 SLE patients were enrolled, including 303 SLE patients with LN and 252 SLE patients without LN. LASSO regression and multivariate logistic regression analyses showed that ESR, mucosal ulcer, proteinuria, and hematuria were independent risk factors for LN in SLE patients. The four clinical features were incorporated into the Nomogram prediction model. Results showed that calibration curve was basically close to the diagonal dotted line with slope 1 (ideal prediction case), which proved that the prediction ability of the model was acceptable. In addition, the decision curve analysis showed that the Nomogram prediction model could bring net clinical benefits to patients when the threshold probability was 0.12-0.54. CONCLUSION Four clinical indicators of ESR, mucosal ulcer, proteinuria, and hematuria were independent risk factors for LN in SLE patients. The predictive power of the Nomogram model based on LASSO-logistic regression was acceptable and could be used to guide clinical work.
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Affiliation(s)
- Zhen Tang
- Department of Gastroenterology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Jia-Min Wang
- Department of Science and Technology, Sichuan Mianyang 404 Hospital, Mianyang, China
- Department of Hospital Infection Management, Meishan People's Hospital, Meishan, China
| | - Jia-Min Qin
- Department of Gastroenterology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Li-Ming Wen
- Department of Gastroenterology, Sichuan Mianyang 404 Hospital, Mianyang, China
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Lee J. Delineating the Risk of Lupus Nephritis: How Far Have We Come? JOURNAL OF RHEUMATIC DISEASES 2021; 28:173-175. [PMID: 37476364 PMCID: PMC10324905 DOI: 10.4078/jrd.2021.28.4.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/27/2021] [Indexed: 07/22/2023]
Affiliation(s)
- Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Ah Guerra A, Garro R, McCracken C, Rouster-Stevens K, Prahalad S. Predictors for early readmission in patients hospitalized with new onset pediatric lupus nephritis. Lupus 2021; 30:1991-1997. [PMID: 34530647 DOI: 10.1177/09612033211044648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective is to determine the 30-day hospital readmission rate following a hospitalization due to pediatric lupus nephritis of recent onset and characterize the risk factors associated with these early readmissions. METHODS The study included 76 children hospitalized from 01/01/2008 to 4/30/2017 due to a new diagnosis of lupus nephritis. We calculated the 30-day hospital readmission rate and compared the characteristics of the patients that were readmitted to patients that were not readmitted using univariable and multivariable analysis. RESULTS The 30-day readmission rate was 17.1%. Factors that predicted hospital readmission in unavailable analysis were male gender (38.5 vs 14.3%, p = 0.04), not receiving pulse steroids (30.8 vs 3.2%, p = < .001), receiving diuretic treatment (69.2 vs 34.9%, p = .02), receiving albumin infusions (46.2 vs 12.7%, p = .004), stage 2 hypertension on day one of admission (76.9 vs 41.3%, p = .02), a higher white blood cell count on discharge (13.7 × 103/mm3 vs 8.8 × 103/mm3, p = .023), need for non-angiotensin converting enzyme (ACE) antihypertensive drugs (76.9 vs 46%, p = .042), and being discharged on nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1 vs 4.8%, p = .025). Multivariable analysis demonstrated an increased risk of readmission for patients not treated with intravenous pulse methylprednisolone (IVMP) (OR = 17.5 (1.81-168.32) p = .013), and for those who required intravenous albumin assisted diuresis for hypervolemia (OR=6.25 (1.29-30.30) p = .022). CONCLUSION In all, 17% of children hospitalized due to new onset lupus nephritis were readmitted within 30 days of discharge. Absence of IVMP and receiving intravenous albumin assisted diuresis during initial hospitalization increase the risk of early readmission in new onset pediatric lupus nephritis.
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Affiliation(s)
- Angel Ah Guerra
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, 426490University of California Davis, Sacramento, CA, USA
| | - Rouba Garro
- Department of Pediatrics, Division of Pediatric Nephrology, 12239Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Courtney McCracken
- Department of Pediatrics, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Division of Pediatric Rheumatology, 12239Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sampath Prahalad
- Department of Pediatrics, Division of Pediatric Rheumatology, 12239Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
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Shin JM, Kim D, Kwon YC, Ahn GY, Lee J, Park Y, Lee YK, Lee TH, Park DJ, Song YJ, Ha E, Kim K, Bang SY, Choi CB, Lee HS, Bae SC. Clinical and Genetic Risk Factors Associated With the Presence of Lupus Nephritis. JOURNAL OF RHEUMATIC DISEASES 2021; 28:150-158. [PMID: 37475996 PMCID: PMC10324894 DOI: 10.4078/jrd.2021.28.3.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 07/22/2023]
Abstract
Objective To elucidate whether clinical features and the weighted genetic risk score (wGRS) were associated with the presence of lupus nephritis (LN). Methods We retrospectively divided patients with systemic lupus erythematosus (SLE, n=1,078) into biopsy-proven LN (n=507) and non-LN groups (non-LN, n=571) Baseline clinical features, serologic markers, and the wGRS were collected The wGRS was calculated from 112 non-human leukocyte antigen (non-HLA) loci and HLA-DRβ1 amino acid haplotypes for SLE Associations among clinical features, wGRS, and the presence of LN were identified. Results In the multivariate analysis, patients with LN were younger at diagnosis (odds ratio [OR]=0.97, p<0.001), had more pleuritis (OR=2.44, p<0.001) and pericarditis (OR=1.62, p=0.029), had a higher detection rate of anti-double stranded deoxyribonucleic acid (anti-dsDNA antibodies, OR=2.22, p<0.001), anti-Smith antibodies (anti-Sm antibodies, OR=1.70, p=0.002), low level of complement (OR=1.37, p=0.043) and absence of antiphospholipid antibodies (aPL antibodies, OR=1.60, p=0.002), and had higher wGRS (OR=1.16, p=0.012) Mediation analysis suggested that anti-Sm antibodies and low complement could be mediators in the relationship between high wGRS and the presence of LN. Conclusion Onset age, pleuritis, pericarditis, several serologic markers, and wGRS were associated with the presence of LN Anti-Sm antibodies and low complement appeared to mediate the indirect relationship between wGRS and the presence of LN.
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Affiliation(s)
- Jung-Min Shin
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dam Kim
- Department of Rheumatology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Young-Chang Kwon
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Ga-Young Ahn
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jiyoung Lee
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Youngho Park
- Department of Big Data Application, College of Social Economic & Interdisciplinary Studies, Hannam University, Daejeon, Korea
| | - Yeon-Kyung Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae-Han Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dae Jin Park
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yeo-Jin Song
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Eunji Ha
- Departments of Life and Nanopharmaceutical Sciences, Kyung Hee University, Seoul, Korea
- Departments of Biology, Kyung Hee University, Seoul, Korea
| | - Kwangwoo Kim
- Departments of Life and Nanopharmaceutical Sciences, Kyung Hee University, Seoul, Korea
- Departments of Biology, Kyung Hee University, Seoul, Korea
| | - So-Young Bang
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Hye-Soon Lee
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
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Huo AX, Chen WH, Liu YH, Gao P, Li J. Efficacy of sifalimumab for treatment of skin injury caused by systemic lupus erythematosus. Medicine (Baltimore) 2019; 98:e17607. [PMID: 31651869 PMCID: PMC6824784 DOI: 10.1097/md.0000000000017607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This study aims to provide the best possible evidence-based information on the efficacy and safety of sifalimumab for treatment of skin injury (SI) caused by systemic lupus erythematosus (SLE). METHODS In this study, electronic databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Social Care Online, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched comprehensively from inceptions to June 30, 2019 without language restrictions. We will include randomized controlled trials (RCTs) on evaluating the efficacy and safety of sifalimumab for SI caused by SLE. Two investigators will conduct study selection, data extraction, and risk of bias assessment independently. We will use RevMan 5.3 Software to perform statistical analysis. RESULTS This study will lie in the exhaustive and systematic nature of the literature search and its methods for evaluating quality and analyzing RCTs data. Considering the controversial efficacy of the treatment for sifalimumab, this study is responsible for improving the existing evidence on the efficacy and safety of sifalimumab for SI caused by SLE. CONCLUSION The results of this study will provide latest evidence for judging whether sifalimumab is an effective intervention for patients with SI caused by SLE or not. STUDY REGISTRATION CRD42019148225.
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Affiliation(s)
- Ai-xin Huo
- Department of Immunology and Rheumatology, Yanan University Affiliated Hospital, Yan’an
| | - Wen-hui Chen
- Department of Dermatology, Shaanxi Provincial Institute of Dermatology and Venereology, Xi’an, China
| | - Yu-hong Liu
- Department of Immunology and Rheumatology, Yanan University Affiliated Hospital, Yan’an
| | - Peng Gao
- Department of Immunology and Rheumatology, Yanan University Affiliated Hospital, Yan’an
| | - Jing Li
- Department of Immunology and Rheumatology, Yanan University Affiliated Hospital, Yan’an
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Ntatsaki E, Vassiliou VS, Velo-Garcia A, Salama AD, Isenberg DA. Renal transplantation for lupus nephritis: non-adherence and graft survival. Lupus 2019; 28:651-657. [PMID: 30982400 DOI: 10.1177/0961203319842641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Poor adherence to immunosuppressive treatment is common in patients with systemic lupus erythematosus and may identify those with lupus nephritis (LN) who have a poorer prognosis. Non-adherence has also been reported to be a potential adverse outcome predictor in renal transplantation (rTp). We investigated whether non-adherence is associated with increased rTp graft rejection and/or failure in patients with LN. METHODS Patients with LN undergoing rTp in two major London hospitals were retrospectively included. Medical and electronic records were reviewed for documented concerns of non-adherence as well as laboratory biochemical drug levels. The role of non-adherence and other potential predictors of graft rejection/failure including demographics, comorbidities, age at systemic lupus erythematosus and LN diagnosis, type of LN, time on dialysis prior to rTp and medication use were investigated using logistic regression. RESULTS Out of 361 patients with LN, 40 had rTp. During a median follow-up of 8.7 years, 17/40 (42.5%) of these patients had evidence of non-adherence. A total of 12 (30.0%) patients experienced graft rejection or failure or both. In the adherent group 2/23 (8.7%) had graft rejection, whilst in the non-adherent this rose to 5/17 (29.4%, p = 0.11). Graft failure was seen in 5/23 (21.7%) patients from the adherent group and 4/17 (23.5%) in the non-adherent group ( p = 0.89). Non-adherent patients had a trend towards increased graft rejection, hazard ratio 4.38, 95% confidence interval = 0.73-26.12, p = 0.11. Patients who spent more time on dialysis prior to rTp were more likely to be adherent to medication, p = 0.01. CONCLUSION Poor adherence to immunosuppressive therapy is common and has been shown to associate with a trend towards increased graft failure in patients with LN requiring rTp. This is the first paper to report that shorter periods on dialysis prior to transplantation might lead to increased non-adherence in lupus patients.
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Affiliation(s)
- E Ntatsaki
- 1 Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom.,2 Rheumatology Department, Ipswich Hospital, Ipswich, United Kingdom
| | - V S Vassiliou
- 3 Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,4 Department of Medicine, Imperial College London, London, United Kingdom
| | - A Velo-Garcia
- 1 Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom.,5 Internal Medicine Department, University Hospital Complex of Pontevedra, Pontevedra, Spain
| | - A D Salama
- 6 Centre for Nephrology, University College London, London, United Kingdom
| | - D A Isenberg
- 1 Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom
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Ntatsaki E, Velo-Garcia A, Vassiliou VS, Salama AD, Isenberg DA. Impact of pre-transplant time on dialysis on survival in patients with lupus nephritis. Clin Rheumatol 2018; 37:2399-2404. [PMID: 29748727 PMCID: PMC6097102 DOI: 10.1007/s10067-018-4115-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/02/2018] [Accepted: 04/17/2018] [Indexed: 11/25/2022]
Abstract
Lupus nephritis (LN) is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) often leading to end-stage renal failure (ESRF) and necessitating renal transplantation (rTp). Optimal timing of rTp in SLE patients with ESRF is uncertain and could potentially affect survival. We investigated the time spent on dialysis before rTp and survival following rTp in a cohort of SLE patients. Retrospective analysis of all adult SLE patients receiving rTp over a 40-year period (1975–2015) in two tertiary UK centres. Cox proportional hazard regression and receiver operator curves (ROC) were used to determine the risk associated with time on dialysis before rTp and other potential predictors. Forty patients (age 35 ± 11 years, 34 female, 15 Caucasian, 15 Afro–Caribbean and 10 South Asian) underwent rTp. During a median follow-up of 104 months (IQR 80,145), eight (20%) patients died and the 5-year survival was 95%. Univariate analysis identified time on dialysis prior to rTp as the only potentially modifiable risk predictor of survival with a hazard ratio of 1.013 for each additional month spent on dialysis (95% CI = 1.001–1.026, p = 0.03). ROC curves demonstrated that > 24 months on dialysis had an adverse effect with sensitivity of 0.875 and specificity 0.500 for death. No other modifiable predictors were significantly associated with mortality, indicating that time on dialysis had an independent effect. Increased time on dialysis pre-transplantation is an independent modifiable risk factor of mortality in this cohort of patients with lupus nephritis.
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Affiliation(s)
- Eleana Ntatsaki
- Centre for Rheumatology, Division of Medicine, University College London, 250 Euston Road, London, NW1 2PG, UK. .,Rheumatology Department, Ipswich Hospital, Heath Road, Ipswich, IP4 5PD, UK.
| | - Alba Velo-Garcia
- Centre for Rheumatology, Division of Medicine, University College London, 250 Euston Road, London, NW1 2PG, UK.,Internal Medicine Department, University Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.,Imperial College London, London, UK
| | - Alan D Salama
- Centre for Nephrology, University College London, London, UK
| | - David A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, 250 Euston Road, London, NW1 2PG, UK
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Clinicopathological study of male and female patients with lupus nephritis: a retrospective study. Int Urol Nephrol 2018; 50:313-320. [DOI: 10.1007/s11255-017-1780-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
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Jourde-Chiche N, Whalen E, Gondouin B, Speake C, Gersuk V, Dussol B, Burtey S, Pascual V, Chaussabel D, Chiche L. Modular transcriptional repertoire analyses identify a blood neutrophil signature as a candidate biomarker for lupus nephritis. Rheumatology (Oxford) 2017; 56:477-487. [PMID: 28031441 DOI: 10.1093/rheumatology/kew439] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Indexed: 01/09/2023] Open
Abstract
Objective LN is a severe complication of SLE. Non-invasive biomarkers are needed for identifying patients at risk of a renal flare, for differentiating proliferative from non-proliferative forms and for assessing prognoses for LN. Methods We assessed the link between blood transcriptional signatures and LN using blood samples from patients with biopsy-proven LN, extra-renal SLE flares or quiescent SLE. Healthy controls, and control patients with glomerular diseases or bacterial sepsis were included. Modular repertoire analyses from microarray data were confirmed by PCR. Results A modular neutrophil signature (upregulation of module M5.15) was present in 65% of SLE patients and was strongly associated with LN. M5.15 activity was stronger in LN than in extra-renal flares (88 vs 17%). M5.15 was neither correlated to IFN modules, nor to SLEDAI or anti-dsDNA antibodies, but moderately to CS dose. M5.15 activity was associated with severity of LN, was stronger when proliferative, and decreased in patients responding to treatment. M5.15 activation was not caused by higher CS dose because it correlated only moderately to neutrophil count and was also observed among quiescent patients. Among quiescent patients, those with a past history of LN had higher M5.15 activity (50 vs 8%). M5.15 activation was present in patients with bacterial sepsis or ANCA-associated vasculitis, but not in patients with other glomerular diseases. Overall, M5.15 activation was associated with past, present or future flares of LN. Conclusion Modular neutrophil signature could be a biomarker for stratifying LN risk and for monitoring its response to treatment. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov , NCT00920114.
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Affiliation(s)
- Noémie Jourde-Chiche
- Department of Nephrology, Aix-Marseille University, AP-HM, Hôpital Conception, UMR_S 1076, Vascular Research Center of Marseille, Marseille, France
| | - Elizabeth Whalen
- Systems Immunology Department, Benaroya Research Institute, Seattle
| | - Bertrand Gondouin
- Department of Nephrology, Aix-Marseille University, AP-HM, Hôpital Conception, UMR_S 1076, Vascular Research Center of Marseille, Marseille, France
| | - Cate Speake
- Systems Immunology Department, Benaroya Research Institute, Seattle
| | - Vivian Gersuk
- Systems Immunology Department, Benaroya Research Institute, Seattle
| | - Bertrand Dussol
- Department of Nephrology, Aix-Marseille University, AP-HM, Hôpital Conception, UMR_S 1076, Vascular Research Center of Marseille, Marseille, France
| | - Stephane Burtey
- Department of Nephrology, Aix-Marseille University, AP-HM, Hôpital Conception, UMR_S 1076, Vascular Research Center of Marseille, Marseille, France
| | - Virginia Pascual
- Immunology, Baylor Institute for Immunology Research, Dallas, TX, USA
| | - Damien Chaussabel
- Systems Biology Department, Sidra Medical and Research Center, Doha, Qatar
| | - Laurent Chiche
- Department of Internal Medicine, Hôpital Européen, Marseille, France
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