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Eadon MT. Prognostic implications of unbiased molecular categorization in kidney disease. Kidney Int 2024; 105:1162-1164. [PMID: 38777400 DOI: 10.1016/j.kint.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 05/25/2024]
Abstract
In this commentary, a novel approach to the reclassification of chronic kidney disease is reviewed. In the revisited study, the investigators identify 4 distinct subtypes of kidney disease derived from an unbiased self-organizing map of transcriptomic data from kidney biopsy samples. These molecular subtypes then are characterized by biologic cell processes, clinical and histopathologic features, urinary proteomics, and disease progression. The strengths and limitations of the self-organizing map approach are assessed; the prognostic, diagnostic, and therapeutic implications are considered briefly.
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Affiliation(s)
- Michael T Eadon
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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2
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Møller M, Borg R, Bressendorff I, Fink LN, Gravesen E, Jensen KH, Hansen T, Krustrup D, Persson F, Rossing P, Sembach FE, Thuesen ACB, Hansen D. Rationale and design of a prospective, clinical study of kidney biopsies in people with type 2 diabetes and severely increased albuminuria (the PRIMETIME 2 study). BMJ Open 2023; 13:e072216. [PMID: 37280026 PMCID: PMC10254618 DOI: 10.1136/bmjopen-2023-072216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Diabetic kidney disease is a severe complication of diabetes. The diagnosis is based on clinical characteristics such as persistently elevated albuminuria, hypertension and decline in kidney function, although this definition is not specific to kidney disease caused by diabetes. The only way to establish an accurate diagnosis-diabetic nephropathy-is by performing a kidney biopsy. The histological presentation of diabetic nephropathy can be associated with a heterogeneous range of histological features with many pathophysiological factors involved demonstrating the complexity of the condition. Current treatment strategies aim to slow disease progression and are not specific to the underlying pathological processes.This study will investigate the prevalence of diabetic nephropathy in individuals with type 2 diabetes (T2D) and severely elevated albuminuria. The deep molecular characterisation of the kidney biopsy and biological specimens may pave the way for improved diagnostic accuracy and a better understanding of the pathological processes involved and may also reveal new targets for individualised treatment. METHODS AND ANALYSIS In the PRecIsion MEdicine based on kidney TIssue Molecular interrogation in diabetic nEphropathy 2 study, research kidney biopsies will be performed in 300 participants with T2D, urine albumin/creatinine ratio ≥700 mg/g and estimated glomerular filtration ratio >30 mL/min/1.73 m2. Cutting-edge molecular technologies will be applied to the kidney, blood, urine, faeces and saliva samples for comprehensive multi-omics profiling. The associated disease course and clinical outcomes will be assessed by annual follow-up for 20 years. ETHICS AND DISSEMINATION The Danish Regional Committee on Health Research Ethics and the Knowledge Center on Data Protection (in the Capital Region of Denmark) have granted approval for the study. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04916132.
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Affiliation(s)
- Marie Møller
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Rikke Borg
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Iain Bressendorff
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Eva Gravesen
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Karina Haar Jensen
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorrit Krustrup
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | | | - Peter Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Anne C B Thuesen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gui Y, Palanza Z, Fu H, Zhou D. Acute kidney injury in diabetes mellitus: Epidemiology, diagnostic, and therapeutic concepts. FASEB J 2023; 37:e22884. [PMID: 36943403 PMCID: PMC10602403 DOI: 10.1096/fj.202201340rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Acute kidney injury (AKI) and diabetes mellitus (DM) are public health problems that cause a high socioeconomic burden worldwide. In recent years, the landscape of AKI etiology has shifted: Emerging evidence has demonstrated that DM is an independent risk factor for the onset of AKI, while an alternative perspective considers AKI as a bona fide complication of DM. Therefore, it is necessary to systematically characterize the features of AKI in DM. In this review, we summarized the epidemiology of AKI in DM. While focusing on circulation- and tissue-specific microenvironment changes after DM, we described the active cellular and molecular mechanisms of increased kidney susceptibility to AKI under DM stress. We also reviewed the current diagnostic and therapeutic strategies for AKI in DM recommended in the clinic. Updated recognition of the epidemiology, pathophysiology, diagnosis, and medications of AKI in DM is believed to reveal a path to mitigate the frequency of AKI and DM comorbidity that will ultimately improve the quality of life in DM patients.
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Affiliation(s)
- Yuan Gui
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Zachary Palanza
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Haiyan Fu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Dong Zhou
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
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4
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Andrulli S, Rossini M, Gigliotti G, La Manna G, Feriozzi S, Aucella F, Granata A, Moggia E, Santoro D, Manenti L, Infante B, Ferrantelli A, Cianci R, Giordano M, Giannese D, Seminara G, Di Luca M, Bonomini M, Spatola L, Bruno F, Baraldi O, Micarelli D, Piemontese M, Distefano G, Mattozzi F, De Giovanni P, Penna D, Garozzo M, Vernaglione L, Abaterusso C, Zanchelli F, Brugnano R, Gintoli E, Sottini L, Quaglia M, Cavoli GL, De Fabritiis M, Conte MM, Manes M, Battaglia Y, Fontana F, Gesualdo L. The risks associated with percutaneous native kidney biopsies: a prospective study. Nephrol Dial Transplant 2022; 38:655-663. [PMID: 35587882 PMCID: PMC9976765 DOI: 10.1093/ndt/gfac177] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The known risks and benefits of native kidney biopsies are mainly based on the findings of retrospective studies. The aim of this multicentre prospective study was to evaluate the safety of percutaneous renal biopsies and quantify biopsy-related complication rates in Italy. METHODS The study examined the results of native kidney biopsies performed in 54 Italian nephrology centres between 2012 and 2020. The primary outcome was the rate of major complications 1 day after the procedure, or for longer if it was necessary to evaluate the evolution of a complication. Centre and patient risk predictors were analysed using multivariate logistic regression. RESULTS Analysis of 5304 biopsies of patients with a median age of 53.2 years revealed 400 major complication events in 273 patients (5.1%): the most frequent was a ≥2 g/dL decrease in haemoglobin levels (2.2%), followed by macrohaematuria (1.2%), blood transfusion (1.1%), gross haematoma (0.9%), artero-venous fistula (0.7%), invasive intervention (0.5%), pain (0.5%), symptomatic hypotension (0.3%), a rapid increase in serum creatinine levels (0.1%) and death (0.02%). The risk factors for major complications were higher plasma creatinine levels [odds ratio (OR) 1.12 for each mg/dL increase, 95% confidence interval (95% CI) 1.08-1.17], liver disease (OR 2.27, 95% CI 1.21-4.25) and a higher number of needle passes (OR for each pass 1.22, 95% CI 1.07-1.39), whereas higher proteinuria levels (OR for each g/day increase 0.95, 95% CI 0.92-0.99) were protective. CONCLUSIONS This is the first multicentre prospective study showing that percutaneous native kidney biopsies are associated with a 5% risk of a major post-biopsy complication. Predictors of increased risk include higher plasma creatinine levels, liver disease and a higher number of needle passes.
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Affiliation(s)
| | - Michele Rossini
- Nephrology, Dialysis and Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Gigliotti
- Nephrology and Dialysis Unit, Maria Santissima Addolorata Hospital, Eboli, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplantation Unit, University of Bologna, Bologna, Italy
| | - Sandro Feriozzi
- Nephrology and Dialysis Unit, Belcolle Hospital, Viterbo, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Granata
- Nephrology and Dialysis Unit, ‘San Giovanni di Dio’ Hospital, Agrigento, Italy
- Nephrology and Dialysis Unit, Cannizzaro Hospital, Catania, Italy
| | | | - Domenico Santoro
- Nephrology and Dialysis Unit, Università degli Studi di Messina Facoltà di Medicina e Chirurgia, Messina, Italy
| | - Lucio Manenti
- Dipartimento di Medicina e Chirurgia, UO di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Barbara Infante
- Nephrology, Dialysis and Transplantation Unit, Department of Biomedical Sciences, University of Foggia, Foggia, Italy
| | - Angelo Ferrantelli
- Nephrology and Dialysis Unit, Villa Sofia Cervello United Hospitals, Palermo, Italy
| | - Rosario Cianci
- Nephrology Unit, Umberto I Policlinico di Roma, Roma, Italy
| | - Mario Giordano
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Domenico Giannese
- Nephrology, Dialysis, Transplantation, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Marina Di Luca
- Unit of Nephrology and Dialysis, San Salvatore Hospital, Pesaro, Italy
| | - Mario Bonomini
- Department of Medicine, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Leonardo Spatola
- Renal and Hemodialysis Unit, Istituto Clinico Humanitas, Rozzano, Italy
| | - Francesca Bruno
- Nephrology and Dialysis Unit, Maria Santissima Addolorata Hospital, Eboli, Italy
| | - Olga Baraldi
- Nephrology Dialysis and Renal Transplantation Unit, University of Bologna, Bologna, Italy
| | - David Micarelli
- Nephrology and Dialysis Unit, Belcolle Hospital, Viterbo, Italy
| | - Matteo Piemontese
- Nephrology and Dialysis Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giulio Distefano
- Nephrology and Dialysis Unit, ‘San Giovanni di Dio’ Hospital, Agrigento, Italy
| | - Francesca Mattozzi
- Paediatric Nephrology Unit, Regina Margherita Children's Hospital, Torino, Italy
| | - Paola De Giovanni
- Nephrology and Dialysis Unit, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Davide Penna
- Nephrology and Dialysis Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maurizio Garozzo
- Nephrology and Dialysis Unit, Santa Marta and Santa Venera Hospital District, Acireale, Italy
| | - Luigi Vernaglione
- Nephrology and Dialysis, ‘M. Giannuzzi’ Hospital of Manduria, Brindisi, Italy
| | - Cataldo Abaterusso
- Nephrology and Dialysis Unit, Civil Hospital of Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Fulvia Zanchelli
- Nephrology and Dialysis Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | | | - Enrica Gintoli
- Nephrology and Dialysis Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Sottini
- Nephrology and Dialysis Unit, Presidio Ospedaliero Santa Chiara, Trento, Italy
| | - Marco Quaglia
- AOU Maggiore Della Carità, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | | | - Marco De Fabritiis
- Nephrology and Dialysis Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Maria Maddalena Conte
- Nephrology and Dialysis Unit, University Hospital Maggiore della Carità, Novara, Italy
| | - Massimo Manes
- Nephrology and Dialysis Unit, Umberto Parini Hospital, Aosta, Italy
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, Hospital-University St Anna, Ferrara, Italy
| | - Francesco Fontana
- Nephrology and Dialysis Unit, Azienda Ospedaliero Universitaria, Modena, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Bermejo S, García-Carro C, Mast R, Vergara A, Agraz I, León JC, Bolufer M, Gabaldon MA, Serón D, Bestard O, Soler MJ. Safety of Obtaining an Extra Biobank Kidney Biopsy Core. J Clin Med 2022; 11:jcm11051459. [PMID: 35268550 PMCID: PMC8911133 DOI: 10.3390/jcm11051459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background and objectives: Kidney biopsy (KB) is the “gold standard” for the diagnosis of nephropathies and it is a diagnostic tool that presents a low rate of complications. Nowadays, biobank collections of renal tissue of patients with proven renal pathology are essential for research in nephrology. To provide enough tissue for the biobank collection, it is usually needed to obtain an extra kidney core at the time of kidney biopsy. The objective of our study is to evaluate the complications after KB and to analyze whether obtaining an extra core increases the risk of complications. Material and methods: Prospective observational study of KBs performed at Vall d’Hebron Hospital between 2019 and 2020. All patients who accepted to participate to our research biobank of native kidney biopsies were included to the study. Clinical and laboratory data were reviewed and we studied risk factors associated with complications. Results: A total of 221 patients were included, mean age 56.6 (±16.8) years, 130 (58.8%) were men, creatinine was 2.24 (±1.94) mg/dL, proteinuria 1.56 (0.506–3.590) g/24 h, hemoglobin 12.03 (±2.3) g/dL, INR 0.99 (±0.1), and prothrombin time (PT) 11.86 (±1.2) s. A total of 38 patients (17.2%) presented complications associated with the procedure: 13.1% were minor complications, 11.3% (n = 25) required blood transfusion, 1.4% (n = 3) had severe hematomas, 2.3% (n = 5) required embolization, and 0.5% (n = 1) presented arterio-venous fistula. An increased risk for complication was independently associated with obtaining a single kidney core (vs. 2 and 3 cores) (p = 0.021). Conclusions: KB is an invasive and safe procedure with a low percentage of complications. Obtaining an extra kidney core for research does not increase the risk of complications during the intervention, which remains low in concordance with previously published reports.
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Affiliation(s)
- Sheila Bermejo
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
- Correspondence: (S.B.); (M.J.S.)
| | - Clara García-Carro
- Nephrology Department, Hospital Clínico San Carlos, 28940 Madrid, Spain;
| | - Richard Mast
- Radiology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ander Vergara
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
| | - Irene Agraz
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
| | - Juan Carlos León
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
| | - Monica Bolufer
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
| | | | - Daniel Serón
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
| | - Oriol Bestard
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
| | - Maria Jose Soler
- Nephrology Department, Hospital de Vall d’Hebron, 08035 Barcelona, Spain; (A.V.); (I.A.); (J.C.L.); (M.B.); (D.S.); (O.B.)
- Correspondence: (S.B.); (M.J.S.)
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Eadon MT, Dagher PC, El-Achkar TM. Cellular and molecular interrogation of kidney biopsy specimens. Curr Opin Nephrol Hypertens 2022; 31:160-167. [PMID: 34982521 PMCID: PMC8799512 DOI: 10.1097/mnh.0000000000000770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Traditional histopathology of the kidney biopsy specimen has been an essential and successful tool for the diagnosis and staging of kidney diseases. However, it is likely that the full potential of the kidney biopsy has not been tapped so far. Indeed, there is now a concerted worldwide effort to interrogate kidney biopsy samples at the cellular and molecular levels with unprecedented rigor and depth. This review examines these novel approaches to study kidney biopsy specimens and highlights their potential to refine our understanding of the pathophysiology of kidney disease and lead to precision-based diagnosis and therapy. RECENT FINDINGS Several consortia are now active at studying kidney biopsy samples from various patient cohorts with state-of-the art cellular and molecular techniques. These include advanced imaging approaches as well as deep molecular interrogation with tools such as epigenetics, transcriptomics, proteomics and metabolomics. The emphasis throughout is on rigor, reproducibility and quality control. SUMMARY Although these techniques to study kidney biopsies are complementary, each on its own can yield novel ways to define and classify kidney disease. Therefore, great efforts are needed in order to generate an integrated output that can propel the diagnosis and treatment of kidney disease into the realm of precision medicine.
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Affiliation(s)
- Michael T Eadon
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Murea M, Flythe JE, Anjay R, Emaad ARM, Gupta N, Kovach C, Vachharajani TJ, Kalantar-Zadeh K, Casino FG, Basile C. Kidney dysfunction requiring dialysis is a heterogeneous syndrome: we should treat it like one. Curr Opin Nephrol Hypertens 2022; 31:92-99. [PMID: 34846314 DOI: 10.1097/mnh.0000000000000754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Advanced kidney failure requiring dialysis, commonly labeled end-stage kidney disease or chronic kidney disease stage 5D, is a heterogeneous syndrome -a key reason that may explain why: treating advanced kidney dysfunction is challenging and many clinical trials involving patients on dialysis have failed, thus far. Treatment with dialytic techniques - of which maintenance thrice-weekly hemodialysis is most commonly used - is broadly named kidney 'replacement' therapy, a term that casts the perception of a priori abandonment of intrinsic kidney function and subsumes patients into a single, homogeneous group. RECENT FINDINGS Patients with advanced kidney failure necessitating dialytic therapy may have ongoing endogenous kidney function, and differ in their clinical manifestations and needs. Different terminology, for example, kidney dysfunction requiring dialysis (KDRD) with stages of progressive severity could better capture the range of phenotypes of patients who require kidney 'assistance' therapy. SUMMARY Classifying patients with KDRD based on objective, quantitative levels of endogenous kidney function, as well as patient-reported symptoms and quality of life, would facilitate hemodialysis prescriptions tailored to level of kidney dysfunction, clinical needs, and personal priorities. Such classification would encourage clinicians to move toward personalized, physiological, and adaptive approach to hemodialysis therapy.
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem
| | - Jennifer E Flythe
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Rastogi Anjay
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Abdel-Rahman M Emaad
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia
| | - Nupur Gupta
- Indiana University Health, Indianapolis, Indiana
| | - Cassandra Kovach
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Tushar J Vachharajani
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Francesco G Casino
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti
- Dialysis Centre SM2, Policoro, Italy
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8
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Deonaraine KK, Carlucci PM, Fava A, Li J, Wofsy D, James JA, Putterman C, Diamond B, Davidson A, Fine DM, Monroy-Trujillo J, Atta MG, Haag K, Rao DA, Apruzzese W, Belmont HM, Izmirly PM, Wu M, Connery S, Payan-Schober F, Furie RA, Berthier CC, Dall'Era M, Cho K, Kamen DL, Kalunian K, Anolik J, Ishimori M, Weisman MH, Petri MA, Buyon JP. Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network. Lupus Sci Med 2021; 8:8/1/e000522. [PMID: 34389634 PMCID: PMC8354250 DOI: 10.1136/lupus-2021-000522] [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: 05/19/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022]
Abstract
Objectives In lupus nephritis the pathological diagnosis from tissue retrieved during kidney biopsy drives treatment and management. Despite recent approval of new drugs, complete remission rates remain well under aspirational levels, necessitating identification of new therapeutic targets by greater dissection of the pathways to tissue inflammation and injury. This study assessed the safety of kidney biopsies in patients with SLE enrolled in the Accelerating Medicines Partnership, a consortium formed to molecularly deconstruct nephritis. Methods 475 patients with SLE across 15 clinical sites in the USA consented to obtain tissue for research purposes during a clinically indicated kidney biopsy. Adverse events (AEs) were documented for 30 days following the procedure and were determined to be related or unrelated by all site investigators. Serious AEs were defined according to the National Institutes of Health reporting guidelines. Results 34 patients (7.2%) experienced a procedure-related AE: 30 with haematoma, 2 with jets, 1 with pain and 1 with an arteriovenous fistula. Eighteen (3.8%) experienced a serious AE requiring hospitalisation; four patients (0.8%) required a blood transfusion related to the kidney biopsy. At one site where the number of cores retrieved during the biopsy was recorded, the mean was 3.4 for those who experienced a related AE (n=9) and 3.07 for those who did not experience any AE (n=140). All related AEs resolved. Conclusions Procurement of research tissue should be considered feasible, accompanied by a complication risk likely no greater than that incurred for standard clinical purposes. In the quest for targeted treatments personalised based on molecular findings, enhanced diagnostics beyond histology will likely be required.
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Affiliation(s)
- Kristina K Deonaraine
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Philip M Carlucci
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrea Fava
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Li
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - David Wofsy
- Rheumatology Division and Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Chaim Putterman
- Division of Rheumatology and Department of Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Betty Diamond
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Anne Davidson
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Derek M Fine
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Mohamed G Atta
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin Haag
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William Apruzzese
- Division of Rheumatology, Inflammation, Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - H Michael Belmont
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Peter M Izmirly
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ming Wu
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sean Connery
- Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Fernanda Payan-Schober
- Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard A Furie
- Division of Rheumatology, Northwell Health, Great Neck, NY, USA
| | - Celine C Berthier
- Internal Medicine, Department of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Maria Dall'Era
- Rheumatology Division and Russell/Engleman Rheumatology Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Kerry Cho
- Nephrology Division, University of California San Francisco, San Francisco, CA, USA
| | - Diane L Kamen
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth Kalunian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jennifer Anolik
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mariko Ishimori
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
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9
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Oliva-Damaso N, Mora-Gutiérrez JM, Bomback AS. Glomerular Diseases in Diabetic Patients: Implications for Diagnosis and Management. J Clin Med 2021; 10:1855. [PMID: 33923227 PMCID: PMC8123132 DOI: 10.3390/jcm10091855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022] Open
Abstract
The prevalence of diabetes continues to rise worldwide. In addition to rising rates of diabetic kidney disease, we are also seeing a parallel rise in nondiabetic kidney disease among patients with diabetes. These nondiabetic lesions include focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy, and other glomerular diseases. The management of diabetic kidney disease is rapidly evolving to include, beyond glycemic control and renin angiotensin inhibition, the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and mineralocorticoid receptor antagonists. These and other new treatment strategies should be applicable to managing glomerular disease in diabetic patients to reduce toxicities associated with immunosuppression and, in particular, corticosteroids. The prevalence of glomerular disease in diabetic patients is underappreciated. Diagnosis and appropriately treating these diseases remain an important avenue to modify kidney outcomes in diabetic patients.
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Affiliation(s)
- Nestor Oliva-Damaso
- Department of Medicine, Division of Nephrology, Hospital Costa del Sol, 29603 Marbella, Malaga, Spain;
| | - José María Mora-Gutiérrez
- Department of Medicine, Division of Nephrology, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain;
| | - Andrew S. Bomback
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY 10032, USA
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10
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Poggio ED, McClelland RL, Blank KN, Hansen S, Bansal S, Bomback AS, Canetta PA, Khairallah P, Kiryluk K, Lecker SH, McMahon GM, Palevsky PM, Parikh S, Rosas SE, Tuttle K, Vazquez MA, Vijayan A, Rovin BH. Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications. Clin J Am Soc Nephrol 2020; 15:1595-1602. [PMID: 33060160 PMCID: PMC7646247 DOI: 10.2215/cjn.04710420] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. RESULTS A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. CONCLUSIONS Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
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Affiliation(s)
- Emilio D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kristina N Blank
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Spencer Hansen
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Shweta Bansal
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Pietro A Canetta
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Pascale Khairallah
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Stewart H Lecker
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gearoid M McMahon
- Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul M Palevsky
- Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samir Parikh
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, Massachusetts.,Nephrology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katherine Tuttle
- Division of Nephrology, Providence Medical Research Center, Sacred Heart Medical Center, Spokane, Washington
| | - Miguel A Vazquez
- Division of Nephrology, UT Southwestern Medical Center, Dallas, Texas
| | - Anitha Vijayan
- Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri
| | - Brad H Rovin
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
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