1
|
Sanathkumar HT, Fernando EM, Kurien AA, Srinivasaprasad ND, Suren S, Thirumalvalavan K. Clinical Profile, Histopathology, and Outcomes in Infection-Related Glomerulonephritis - Single-Center Experience. Indian J Nephrol 2022; 32:546-554. [PMID: 36704600 PMCID: PMC9872921 DOI: 10.4103/ijn.ijn_470_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 09/12/2021] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Infection-related glomerulonephritis (IRGN) is an important source of renal morbidity with adverse outcomes in adults. Data from large centers in India is lacking on this common, yet poorly understood entity. Materials and Methods We performed a prospective observational study of all patients diagnosed with IRGN at our center over a 3-year period between 2017 and 2019. "Typical IRGN" patients were diagnosed based on clinical and laboratory assessment; others underwent renal biopsy. Renal and patient survival outcomes were assessed in addition to factors that help predict outcomes. Results One hundred and twenty-five patients with a diagnosis of IRGN were included in the study, including 86 patients who underwent renal biopsy. This represented 24% of all biopsies during this time period, and IRGN was the most common nondiabetic kidney disease identified in diabetic biopsies at our center. Female preponderance and a seasonal variation were striking. Atypical sources of infection like otomycosis, tooth abscess, and dengue virus infection were noted. Male gender and diabetes were important risk factors for severe disease. Rapidly progressive glomerulonephritis (RPGN), atypical serum complement profiles, and comorbid illnesses were common in adults. Though children had more benign disease and outcomes, life-threatening complications were also noted. C3 dominance was the most striking immunofluorescence (IF) finding and was associated with poorer outcomes. Crescentic IRGN was rare, and four cases of IgA-dominant IRGN were noted. Also, 24% of the cohort required renal replacement therapy. RPGN presentation of IRGN portended worst prognosis with end-stage renal disease (ESRD) in 31% and death in 22% of patients. Conclusion IRGN is a common clinical entity in adults with the potential for adverse renal and survival outcomes. We have identified clinical and biopsy characteristics that are associated with ESRD and death.
Collapse
Affiliation(s)
| | - Edwin M. Fernando
- Department of Nephrology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Anila Abraham Kurien
- Renopath, Center for Renal and Urological Pathology Private Limited, VMT Nagar, Kolathur, Chennai, Tamil Nadu, India
| | - ND Srinivasaprasad
- Department of Nephrology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sujith Suren
- Department of Nephrology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - K Thirumalvalavan
- Department of Nephrology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
2
|
Arivazhagan S, Lamech TM, Myvizhiselvi M, Arumugam V, Alavudeen SS, Dakshinamoorthy S, Dineshkumar T, Sakthirajan R, Dhanapriya J, Shankar P, Padmaraj R, Kurien AA, Gopalakrishnan N. Efficacy of Corticosteroids in Infection-Related Glomerulonephritis–A Randomized Controlled Trial. Kidney Int Rep 2022; 7:2160-2165. [PMID: 36217524 PMCID: PMC9546739 DOI: 10.1016/j.ekir.2022.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Infection-related glomerulonephritis (IRGN) is associated with glomerular immune complex deposition along with complement activation. Steroids may attenuate glomerular injury and thereby improve renal outcomes. Methods We randomly assigned patients who had biopsy-proven IRGN and serum creatinine greater than 1.5 mg/dl to receive corticosteroids plus supportive care (intervention arm), or supportive care alone (control arm). Patients were followed up for 6 months. The primary outcome was complete renal recovery at 6 months. Safety of steroid therapy was also assessed. Results A total of 52 patients underwent randomization. At 6 months, 17 of 26 patients (65.4%) in the intervention arm and 14 of 26 patients (53.8%) in the control arm had complete renal recovery (odds ratio 1.6; 95% confidence interval, 0.5–4.9; P = 0.397). There was no statistically significant difference in any of the secondary outcomes. Adverse events occurred in 12 patients (46.2%) in the intervention arm and 2 patients (7.7%) in the control arm (P = 0.002). Conclusion In this single-center trial, corticosteroids did not result in a statistically significant increase in rates of complete renal recovery at 6 months. There was a significantly increased risk of adverse events associated with the use of corticosteroids.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Natarajan Gopalakrishnan
- Institute of Nephrology, Madras Medical College, Chennai, India
- Correspondence: Natarajan Gopalakrishnan, Institute of Nephrology, Rajiv Gandhi Government General Hospital, Park Town, Chennai 600003, India.
| |
Collapse
|
3
|
Ahmad N, Natarajan V, Rathaur VK, Chacham S. A Rare Association of Post-Streptococcal Uveitis and Post-Streptococcal Glomerulonephritis in a Child. Indian J Nephrol 2022; 32:516-518. [PMID: 36568608 PMCID: PMC9775605 DOI: 10.4103/ijn.ijn_426_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/16/2020] [Accepted: 12/25/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Najeeb Ahmad
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vivekanand Natarajan
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vyas Kumar Rathaur
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Swathi Chacham
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence: Dr. Swathi Chacham, Department of Pediatrics, 6th Level (floor), A block, Medical College Building, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India. E-mail:
| |
Collapse
|
4
|
John EE, Thomas A, Eapen JJ, Yusuf S, Roy S, Valson AT, David VG, Varughese S, Alexander S. Latency, Anti-Bacterial Resistance Pattern, and Bacterial Infection-Related Glomerulonephritis. Clin J Am Soc Nephrol 2021; 16:1210-1220. [PMID: 34099500 PMCID: PMC8455032 DOI: 10.2215/cjn.18631120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Bacterial infection-related GN occurs concurrent to or after known or unknown infections. It is important to understand the clinical implications of the bacterial isolates, antimicrobial resistance patterns, and effect of latency-based classification on kidney and patient outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In total, 501 consecutive adults diagnosed with bacterial infection-related GN between 2005 and 2017 were included from a biopsy registry of 15,545 patients at a single center in South India, and follow-up data were collected from electronic medical records until December 2019. Latency was defined as time between resolution of infection and onset of GN, which was classified as parainfectious, peri-infectious, or postinfectious GN. Longitudinal kidney and patient outcomes were studied. RESULTS The mean age of the cohort was 40 (± 15) years, 6% were above 65 years, and 330 (66%) were men. Diabetes was present in 93 (19%) patients. Seventy percent (353 of 501) of patients had known infections, with the median latent period for parainfectious (115 of 353, 33%), peri-infectious (97 of 353, 27%), and postinfectious (141 of 353, 40%) GN being 0, 5 (4-7), and 15 (10-31) days, respectively. The most common predisposing organism was Streptococcus pyogenes (137 of 353, 39%). Drug-resistant nonstreptococcal bacteria were methicillin-resistant Staphylococcus aureus (25%, four of 16), extended-spectrum β-lactamases (20%, 12 of 59), and carbapenem-resistant organisms (10%, six of 59). Twenty of 22 (91%) of the drug-resistant organisms were isolated from the parainfectious group. The most common site of infection was skin in peri- (23 of 97, 24%) and postinfectious GN (61 of 141, 43%), and urinary tract in parainfectious GN (35 of 115, 30%). Of 321 patients with >3 months of follow-up, 48 (15%) developed kidney failure over a median period of 10 (2-37) months and 14 (4%) died. Parainfectious GN, eGFR<30 ml/min per 1.73 m2, moderate-to-severe interstitial fibrosis and tubular atrophy, and nontreatment with renin-angiotensin system blockers were significant risk factors for progression to kidney failure by a Cox proportional-hazards model. CONCLUSIONS Along with clinical and histologic predictors, parainfectious GN caused predominantly by nonstreptococcal and drug-resistant bacterial infections was associated with poor kidney prognosis.
Collapse
Affiliation(s)
| | - Athul Thomas
- Department of Nephrology, Christian Medical College, Vellore, India
| | | | - Sabina Yusuf
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Sanjeet Roy
- Department of General Pathology, Christian Medical College, Vellore, India
| | - Anna T. Valson
- Department of Nephrology, Christian Medical College, Vellore, India
| | | | | | | |
Collapse
|
5
|
Yu W, Yang W, Zhao MY, Meng XL. Functional Metabolomics Analysis Elucidating the Metabolic Biomarker and Key Pathway Change Associated With the Chronic Glomerulonephritis and Revealing Action Mechanism of Rhein. Front Pharmacol 2020; 11:554783. [PMID: 33101021 PMCID: PMC7544993 DOI: 10.3389/fphar.2020.554783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022] Open
Abstract
Chronic glomerulonephritis (CGN) as the culprit of kidney failure can increase the mortality of critically ill patients and seriously threatens people’s health all over the world. This study using metabolomics strategy is to reveal the potential therapeutic mechanism-related targets to evaluate the effects of rhein (RH) on CGN rats. Changes of serum metabolites and pathways were analyzed by non-targeted metabolomic method based on liquid chromatography-mass spectrometry (LC-MS) combined with ingenuity pathway analysis. In addition, the levels of biochemical indicators were also detected. A total of 25 potential biomarkers were identified to express serum metabolic turbulence in CGN animal model, and then 16 biomarkers were regulated by RH trending to the normal states. From metabolite enrichment and pathway analysis, pharmacological activity of RH on CGN were mainly involved in six vital metabolic pathways including phenylalanine, tyrosine and tryptophan biosynthesis, phenylalanine metabolism, arachidonic acid metabolism, tricarboxylic acid cycle (TCA cycle), alanine, aspartate, and glutamate metabolism, arginine and proline metabolism. It suggested CGN treatment with RH, which may be mediated via interference with metabolic pathway such as amino acid metabolism, arachidonic acid metabolism, and TCA cycle to regulating inflammation, oxidation response and immune regulation against CGN. It showed that metabolomics method offer deeply insight into the therapeutic mechanisms of natural product.
Collapse
Affiliation(s)
- Wei Yu
- Department of Intensive Care Unit, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Yang
- Department of Intensive Care Unit, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming-Yan Zhao
- Department of Intensive Care Unit, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiang-Lin Meng
- Department of Intensive Care Unit, First Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
6
|
Hickey NA, Shalamanova L, Whitehead KA, Dempsey-Hibbert N, van der Gast C, Taylor RL. Exploring the putative interactions between chronic kidney disease and chronic periodontitis. Crit Rev Microbiol 2020; 46:61-77. [PMID: 32046541 DOI: 10.1080/1040841x.2020.1724872] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) and chronic periodontitis (CP) are both common diseases, which are found disproportionately comorbid with each other and have been reported to have a detrimental effect on the progression of each respective disease. They have an overlap in risk factors and both are a source of systemic inflammation along with a wide selection of immunological and non-specific effects that can affect the body over the lifespan of the conditions. Previous studies have investigated the directionality of the relationship between these two diseases; however, there is a lack of literature that has examined how these diseases may be interacting at the localized and systemic level. This review discusses how oral microorganisms have the ability to translocate and have distal effects and provides evidence for microbial involvement in a systemic disease. Furthermore, it summarizes the reported local and systemic effects of CKD and CP and discusses how the interaction of these effects may be responsible for directionality associations reported.
Collapse
Affiliation(s)
- Niall A Hickey
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Liliana Shalamanova
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Kathryn A Whitehead
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Nina Dempsey-Hibbert
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Christopher van der Gast
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Rebecca L Taylor
- Centre for Bioscience, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
7
|
Bhalla K, Gupta A, Nanda S, Mehra S. Epidemiology and clinical outcomes of acute glomerulonephritis in a teaching hospital in North India. J Family Med Prim Care 2019; 8:934-937. [PMID: 31041228 PMCID: PMC6482747 DOI: 10.4103/jfmpc.jfmpc_57_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Context: Acute glomerulonephritis (AGN) is a major cause of morbidity in developing countries like India. AGN includes both infectious and non infectious causes leading to immunological insult to the kidney. Aims: This study is an attempt to evaluate the clinical characteristics, complications and outcome of acute glomerulonephritis. Settings and Design: This hospital based descriptive study was conducted at a tertiary care hospital in North India. Materials and Methods: 50 children with AGN were recruited and analyzed over a period of one year. Detailed clinical examination and relevant laboratory investigations were done. Children were followed up for 6 months. Statistical Analysis Used: Data analysis was done using SPSS software and the results obtained are shown in the form of frequencies along with percentages. Results: 50 patients were enrolled in the study with male to female ratio of 1.72:1. Pharyngitis was the most common predisposing condition (70.2%). 22(40.4%) of patients had developed complications. Of this acute kidney injury with significant pulmonary edema was seen in 16 patients and 6 patients had encephalopathy with seizures. Two patients had to be managed with hemodialysis. 42 patients had positive CRP (>10) and ASO titres were >200 Todd units in all patients. At 6 months’ majority of patients had complete clinical recovery with microscopic hematuria present only in 8 patients, persistent hypertension in 2 patients, 8 patients had proteinuria. These patients are being still followed up. Conclusions: Complications and morbidity is significantly high during the acute phase in AGN. Non infectious causes should also be kept in mind. This study highlights the complications requiring intensive care and need for long term follow up.
Collapse
Affiliation(s)
- Kapil Bhalla
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashish Gupta
- Department of Trauma Centre, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Department of Paediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| |
Collapse
|