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Canas JJ, Arregui SW, Zhang S, Knox T, Calvert C, Saxena V, Schwaderer AL, Hains DS. DEFA1A3 DNA gene-dosage regulates the kidney innate immune response during upper urinary tract infection. Life Sci Alliance 2024; 7:e202302462. [PMID: 38580392 PMCID: PMC10997819 DOI: 10.26508/lsa.202302462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
Antimicrobial peptides (AMPs) are host defense effectors with potent neutralizing and immunomodulatory functions against invasive pathogens. The AMPs α-Defensin 1-3/DEFA1A3 participate in innate immune responses and influence patient outcomes in various diseases. DNA copy-number variations in DEFA1A3 have been associated with severity and outcomes in infectious diseases including urinary tract infections (UTIs). Specifically, children with lower DNA copy numbers were more susceptible to UTIs. The mechanism of action by which α-Defensin 1-3/DEFA1A3 copy-number variations lead to UTI susceptibility remains to be explored. In this study, we use a previously characterized transgenic knock-in of the human DEFA1A3 gene mouse to dissect α-Defensin 1-3 gene dose-dependent antimicrobial and immunomodulatory roles during uropathogenic Escherichia coli (UPEC) UTI. We elucidate the relationship between kidney neutrophil- and collecting duct intercalated cell-derived α-Defensin 1-3/DEFA1A3 expression and UTI. We further describe cooperative effects between α-Defensin 1-3 and other AMPs that potentiate the neutralizing activity against UPEC. Cumulatively, we demonstrate that DEFA1A3 directly protects against UPEC meanwhile impacting pro-inflammatory innate immune responses in a gene dosage-dependent manner.
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Affiliation(s)
- Jorge J Canas
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samuel W Arregui
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Kidney and Urology Translational Research Center, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shaobo Zhang
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Kidney and Urology Translational Research Center, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Taylor Knox
- Kidney and Urology Translational Research Center, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christi Calvert
- Kidney and Urology Translational Research Center, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vijay Saxena
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Kidney and Urology Translational Research Center, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew L Schwaderer
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA
- Kidney and Urology Translational Research Center, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA
- Kidney and Urology Translational Research Center, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
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Schwaderer AL, Rajadhyaksha E, Canas J, Saxena V, Hains DS. Intercalated cell function, kidney innate immunity, and urinary tract infections. Pflugers Arch 2024; 476:565-578. [PMID: 38227050 DOI: 10.1007/s00424-024-02905-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
Intercalated cells (ICs) in the kidney collecting duct have a versatile role in acid-base and electrolyte regulation along with the host immune defense. Located in the terminal kidney tubule segment, ICs are among the first kidney cells to encounter bacteria when bacteria ascend from the bladder into the kidney. ICs have developed several mechanisms to combat bacterial infections of the kidneys. For example, ICs produce antimicrobial peptides (AMPs), which have direct bactericidal activity, and in many cases are upregulated in response to infections. Some AMP genes with IC-specific kidney expression are multiallelic, and having more copies of the gene confers increased resistance to bacterial infections of the kidney and urinary tract. Similarly, studies in human children demonstrate that those with history of UTIs are more likely to have single-nucleotide polymorphisms in IC-expressed AMP genes that impair the AMP's bactericidal activity. In murine models, depleted or impaired ICs result in decreased clearance of bacterial load following transurethral challenge with uropathogenic E. coli. A 2021 study demonstrated that ICs even act as phagocytes and acidify bacteria within phagolysosomes. Several immune signaling pathways have been identified in ICs which may represent future therapeutic targets in managing kidney infections or inflammation. This review's objective is to highlight IC structure and function with an emphasis on current knowledge of IC's diverse innate immune capabilities.
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Affiliation(s)
- Andrew L Schwaderer
- Division of Nephrology, Department of Pediatrics, Indiana University, 699 Riley Hospital Drive, STE 230, Indianapolis, IN, 46202, USA.
| | - Evan Rajadhyaksha
- Division of Nephrology, Department of Pediatrics, Indiana University, 699 Riley Hospital Drive, STE 230, Indianapolis, IN, 46202, USA
| | - Jorge Canas
- Division of Nephrology, Department of Pediatrics, Indiana University, 699 Riley Hospital Drive, STE 230, Indianapolis, IN, 46202, USA
| | - Vijay Saxena
- Division of Nephrology, Department of Pediatrics, Indiana University, 699 Riley Hospital Drive, STE 230, Indianapolis, IN, 46202, USA
| | - David S Hains
- Division of Nephrology, Department of Pediatrics, Indiana University, 699 Riley Hospital Drive, STE 230, Indianapolis, IN, 46202, USA
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Starr MC, Voivodas M, Hains DS. Using aquapheresis with continuous hematocrit monitoring to guide ultrafiltration. Pediatr Nephrol 2024; 39:597-601. [PMID: 37661234 DOI: 10.1007/s00467-023-06143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Management of edema and volume overload in patients with hypoalbuminemia, either due to nephrotic syndrome or other disease processes, can be extremely challenging. METHODS We describe the management of five patients with hypoalbuminemia and severe fluid overload using the Aquadex FlexFlow device with continuous hematocrit monitoring to guide ultrafiltration. RESULTS We report five pediatric patients ranging in age from 7 days to 11 years and in size from 2.7 to 65 kg with hypoalbuminemia due to a variety of etiologies treated with slow continuous ultrafiltration with continuous hematocrit monitoring to guide ultrafiltration using the Aquadex device. Treatment allowed successful fluid removal in all cases, without hypotension or other hemodynamic complications. CONCLUSIONS In a variety of clinical circumstances and in patients from infants to adolescence, we report that patients with diuretic-resistant fluid overload can be treated with Aquadex using continuous hematocrit monitoring to guide management to allow fluid removal without hemodynamic instability or other complications. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, 410 W 10Th Street, Suite 2000A, Indianapolis, IN, 46202, USA.
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Michelle Voivodas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, 410 W 10Th Street, Suite 2000A, Indianapolis, IN, 46202, USA
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Starr MC, Altemose K, Parsley J, Cater DT, Hains DS, Soranno DE. Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy. Pediatr Nephrol 2024; 39:325-329. [PMID: 37310496 DOI: 10.1007/s00467-023-06036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, some continuous kidney replacement therapy (CKRT) initiations were transitioned to telemedicine to improve the timeliness of initiation, and minimize COVID-19 transmission. While telemedicine would appear acceptable for many clinical settings, safety and timeliness of telemedicine CKRT initiation is undescribed. METHODS We conducted a single-center retrospective cohort study of pediatric patients on CKRT from January 2021-September 2022. Information on patient characteristics and CKRT therapy was extracted from the electronic health record. Multidisciplinary team provider attitudes and perspectives were assessed using survey. RESULTS During the study period, there were 101 CKRT circuit initiations in patients not previously receiving CKRT, with 33% (33/101) initiated by telemedicine. There were no differences in patient characteristics, including age, weight at initiation, severity of illness, nor degree of fluid overload between the in-person and telemedicine initiation cohorts. CKRT telemedicine initiations were timelier, occurring on average 3.0 h after decision to initiate therapy compared to 5.8 h for all in-person CKRT starts (p < 0.001) and 5.5 h for night and weekend in-person starts (p < 0.001). Complications did not differ between telemedicine and in-person starts (15% vs. 15%, p = 0.99) and initial circuit life was similar. There were no differences in likelihood of death or duration of CKRT therapy. Telemedicine initiations were widely acceptable to multidisciplinary providers. CONCLUSION In appropriately selected patients, telemedicine initiation of CKRT is a timely and safe option. Further standardization of telemedicine initiation of CKRT should be considered to improve the timely delivery of CKRT and may improve nephrology workforce wellness. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Michelle C Starr
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA.
| | - Kathleen Altemose
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessalynn Parsley
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel T Cater
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David S Hains
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle E Soranno
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Bioengineering, Purdue University, West Lafayette, IN, USA
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Saxena V, Arregui S, Zhang S, Canas J, Qin X, Hains DS, Schwaderer AL. Generation of Atp6v1g3-Cre mice for investigation of intercalated cells and the collecting duct. Am J Physiol Renal Physiol 2023; 325:F770-F778. [PMID: 37823193 PMCID: PMC10881235 DOI: 10.1152/ajprenal.00137.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
Kidney intercalated cells (ICs) maintain acid-base homeostasis and recent studies have demonstrated that they function in the kidney's innate defense. To study kidney innate immune function, ICs have been enriched using vacuolar ATPase (V-ATPase) B1 subunit (Atp6v1b1)-Cre (B1-Cre) mice. Although Atp6v1b1 is considered kidney specific, it is expressed in multiple organ systems, both in mice and humans, raising the possibility of off-target effects when using the Cre-lox system. We have recently shown using single-cell RNA sequencing that the gene that codes for the V-ATPase G3 subunit (mouse gene: Atp6v1g3; human gene: ATP6V1G3; protein abbreviation: G3) mRNA is selectively enriched in human kidney ICs. In this study, we generated Atp6v1g3-Cre (G3-Cre) reporter mice using CRISPR/CAS technology and crossed them with Tdtomatoflox/flox mice. The resultant G3-Cre+Tdt+ progeny was evaluated for kidney specificity in multiple tissues and found to be highly specific to kidney cells with minimal or no expression in other organs evaluated compared with B1-Cre mice. Tdt+ cells were flow sorted and were enriched for IC marker genes on RT-PCR analysis. Next, we crossed these mice to ihCD59 mice to generate an IC depletion mouse model (G3-Cre+ihCD59+/+). ICs were depleted in these mice using intermedilysin, which resulted in lower blood pH, suggestive of a distal renal tubular acidosis phenotype. The G3-Cre mice were healthy, bred normally, and produce regular-sized litter. Thus, this new "IC reporter" mice can be a useful tool to study ICs.NEW & NOTEWORTHY This study details the development, validation, and experimental use of a new mouse model to study the collecting duct and intercalated cells. Kidney intercalated cells are a cell type increasingly recognized to be important in several human diseases including kidney infections, acid-base disorders, and acute kidney injury.
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Affiliation(s)
- Vijay Saxena
- Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Samuel Arregui
- Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Shaobo Zhang
- Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Jorge Canas
- Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Xuebin Qin
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana, United States
| | - David S Hains
- Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Andrew L Schwaderer
- Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
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Lipp SN, Jacobson KR, Schwaderer AL, Hains DS, Calve S. Cover Image. Dev Dyn 2023. [DOI: 10.1002/dvdy.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Lipp SN, Jacobson KR, Schwaderer AL, Hains DS, Calve S. FOXD1 is required for 3D patterning of the kidney interstitial matrix. Dev Dyn 2023; 252:463-482. [PMID: 36335435 DOI: 10.1002/dvdy.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The interstitial extracellular matrix (ECM) is comprised of proteins and glycosaminoglycans and provides structural and biochemical information during development. Our previous work revealed the presence of transient ECM-based structures in the interstitial matrix of developing kidneys. Stromal cells are the main contributors to interstitial ECM synthesis, and the transcription factor Forkhead Box D1 (Foxd1) is critical for stromal cell function. To investigate the role of Foxd1 in interstitial ECM patterning, we combined 3D imaging and proteomics to explore how the matrix changes in the murine developing kidney when Foxd1 is knocked out. RESULTS We found that COL26A1, FBN2, EMILIN1, and TNC, interstitial ECM proteins that are transiently upregulated during development, had a similar distribution perinatally but then diverged in patterning in the adult. Abnormally clustered cortical vertical fibers and fused glomeruli were observed when Foxd1 was knocked out. The changes in the interstitial ECM of Foxd1 knockout kidneys corresponded to disrupted Foxd1+ cell patterning but did not precede branching dysmorphogenesis. CONCLUSIONS The transient ECM networks affected by Foxd1 knockout may provide support for later-stage nephrogenic structures.
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Affiliation(s)
- Sarah N Lipp
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
- The Indiana University Medical Scientist/Engineer Training Program, Indianapolis, Indiana, USA
| | - Kathryn R Jacobson
- Purdue University Interdisciplinary Life Science Program, Purdue University, West Lafayette, Indiana, USA
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, USA
| | - David S Hains
- Department of Pediatrics, Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, USA
| | - Sarah Calve
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
- Purdue University Interdisciplinary Life Science Program, Purdue University, West Lafayette, Indiana, USA
- Department of Mechanical Engineering, University of Colorado--Boulder, Boulder, Colorado, USA
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Saxena V, Arregui S, Kamocka MM, Hains DS, Schwaderer A. MAP3K7 is an innate immune regulatory gene with increased expression in human and murine kidney intercalated cells following uropathogenic Escherichia coli exposure. J Cell Biochem 2022; 123:1817-1826. [PMID: 35959632 PMCID: PMC9671826 DOI: 10.1002/jcb.30318] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/28/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023]
Abstract
Understanding the mechanisms responsible for the kidney's defense against ascending uropathogen is critical to devise novel treatment strategies against increasingly antibiotic resistant uropathogen. Growing body of evidence indicate Intercalated cells of the kidney as the key innate immune epithelial cells against uropathogen. The aim of this study was to find orthologous and differentially expressed bacterial defense genes in human versus murine intercalated cells. We simultaneously analyzed 84 antibacterial genes in intercalated cells enriched from mouse and human kidney samples. Intercalated cell "reporter mice" were exposed to saline versus uropathogenic Escherichia coli (UPEC) transurethrally for 1 h in vivo, and intercalated cells were flow sorted. Human kidney intercalated cells were enriched from kidney biopsy using magnetic-activated cell sorting and exposed to UPEC in vitro for 1 h. RT2 antibacterial PCR array was performed. Mitogen-activated protein kinase kinase kinase 7 (MAP3K7) messenger RNA (mRNA) expression increased in intercalated cells of both humans and mice following UPEC exposure. Intercalated cell MAP3K7 protein expression was defined by immunofluorescence and confocal imaging analysis, was consistent with the increased MAP3K7 mRNA expression profiles defined by PCR. The presence of the orthologous innate immune gene MAP3K7/TAK1 suggests that it may be a key regulator of the intercalated cell antibacterial response and demands further investigation of its role in urinary tract infection pathogenesis.
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Affiliation(s)
- Vijay Saxena
- Department of Pediatric NephrologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Samuel Arregui
- Department of Pediatric NephrologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Malgorzata Maria Kamocka
- Department of Medicine, Division of NephrologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - David S. Hains
- Department of Pediatric NephrologyIndiana University School of MedicineIndianapolisIndianaUSA,Department of Pediatrics, Division of NephrologyRiley Hospital for ChildrenIndianapolisIndianaUSA
| | - Andrew Schwaderer
- Department of Pediatric NephrologyIndiana University School of MedicineIndianapolisIndianaUSA,Department of Pediatrics, Division of NephrologyRiley Hospital for ChildrenIndianapolisIndianaUSA
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Starr MC, Cater DT, Wilson AC, Wallace S, Bennett WE, Hains DS. Association Between Continuous Kidney Replacement Therapy Clearance and Outcome in Pediatric Patients With Hyperammonemia Not Due to Inborn Error of Metabolism. Pediatr Crit Care Med 2022; 23:e356-e360. [PMID: 35383692 DOI: 10.1097/pcc.0000000000002949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe a single-center experience of pediatric patients with hyperammonemia not due to inborn errors of metabolism and determine the association between use of continuous kidney replacement therapy (CKRT) treatment and outcomes. DESIGN Retrospective cohort study. SETTING Tertiary-care children's hospital. PATIENTS All children less than 21 years old admitted to the hospital with hyperammonemia defined as an elevated ammonia levels (>100 µmol/L) not due to inborn error of metabolism. INTERVENTIONS None. MEASURES AND MAIN RESULTS Of 135 children with hyperammonemia, the most common reason for admission was infection in 57 of 135 (42%), congenital heart disease in 20 of 135 (14%), and bone marrow transplantation in 10 of 135 (7%). The overall mortality was 61% (82 of 135), which increased with degree of hyperammonemia (17 of 23 [74%] in those with ammonia >250 µmol/L). After multivariable regression, hyperammonemia severity was not associated with mortality (aOR, 1.4; 95% CI, 0.92-2.1; p = 0.11). Of the 43 patients (32%) receiving CKRT, 21 were prescribed standard clearance and 22 high clearance. The most common indications for CKRT were fluid overload in 17 of 43 (42%) and acute kidney injury or uremia in 16 of 43 (37%). Mean CKRT duration was 13 days. There was no difference between standard and high clearance groups in risk of death (76% vs 86%; p = 0.39), cerebral edema on CT scan (19% vs 27%; p = 0.52), nor decrease in ammonia levels after 24 or 48 hours of CKRT ( p = 0.20, p = 0.94). Among those receiving CKRT, we failed to find an association between high clearance and decreased risk of death in multivariable analysis (aOR, 1.2; 95% CI, 0.64-2.3; p = 0.55). CONCLUSIONS In our single-center retrospective study, we failed to find an association between clearance on CKRT and improved survival nor decreased cerebral edema on head imaging. In fact, we failed to find an association between ammonia level and mortality, after controlling for illness severity.
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Affiliation(s)
- Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University, Indianapolis, IN
| | - Daniel T Cater
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Amy C Wilson
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Samantha Wallace
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University, Indianapolis, IN
| | - William E Bennett
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University, Indianapolis, IN
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Marasco Júnior CA, Edwards ME, Lamarca RS, Sobreira TJP, Caterino JM, Hains DS, Schwaderer AL, Lima Gomes PCFD, Ferreira CR. Suspect screening of exogenous compounds using multiple reaction screening (MRM) profiling in human urine samples. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1201-1202:123290. [PMID: 35588643 PMCID: PMC10566365 DOI: 10.1016/j.jchromb.2022.123290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/14/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022]
Abstract
Thousands of chemical compounds produced by industry are dispersed in the human environment widely enough to reach the world population, and the introduction of new chemicals constantly occurs. As new synthetic molecules emerge, rapid analytical workflows for screening possible presence of exogenous compounds in biofluids can be useful as a first pass analysis to detect chemical exposure and guide the development and application of more elaborate LC-MS/MS methods for quantification. In this study, a suspect screening workflow using the multiple reaction monitoring (MRM) profiling method is proposed as a first pass exploratory technique to survey selected exogenous molecules in human urine samples. The workflow was applied to investigate 12 human urine samples using 310 MRMs related to the chemical functionalities of 87 exogenous compounds present in the METLIN database and reported in the literature. A total of 11 MRMs associated with five different compounds were detected in the samples. Product ion scans for the precursor ions of the selected MRMs were acquired as a further identification step for these chemicals. The suspect screening results suggested the presence of five exogenous compounds in the human urine samples analyzed, namely metformin, metoprolol, acetaminophen, paraxanthine and acrylamide. LC-MS/MS was applied as a last step to confirm these results, and the presence of four out of the five targets selected by MRM profiling were corroborated, indicating that this workflow can support the selection of suspect compounds to screen complex samples and guide more time-consuming and specific quantification analyses.
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Affiliation(s)
- César A Marasco Júnior
- National Institute for Alternative Technologies of Detection, Toxicological Evaluation and Removal of Micropollutants and Radioactives (INCT-DATREM), Institute of Chemistry, São Paulo State University (UNESP), P.O. Box 355, 14800-060 Araraquara, São Paulo, Brazil; Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Madison E Edwards
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Rafaela S Lamarca
- National Institute for Alternative Technologies of Detection, Toxicological Evaluation and Removal of Micropollutants and Radioactives (INCT-DATREM), Institute of Chemistry, São Paulo State University (UNESP), P.O. Box 355, 14800-060 Araraquara, São Paulo, Brazil
| | - Tiago J P Sobreira
- Bindley Bioscience Center, Purdue University, West Lafayette, IN 47907, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - David S Hains
- Department of Pediatrics, Indiana University, Indianapolis, IN 43202, USA
| | | | - Paulo Clairmont F de Lima Gomes
- National Institute for Alternative Technologies of Detection, Toxicological Evaluation and Removal of Micropollutants and Radioactives (INCT-DATREM), Institute of Chemistry, São Paulo State University (UNESP), P.O. Box 355, 14800-060 Araraquara, São Paulo, Brazil.
| | - Christina R Ferreira
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA; Bindley Bioscience Center, Purdue University, West Lafayette, IN 47907, USA.
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Rawson A, Saxena V, Gao H, Hooks J, Xuei X, McGuire P, Hato T, Hains DS, Anderson RM, Schwaderer AL. A Pilot Single Cell Analysis of the Zebrafish Embryo Cellular Responses to Uropathogenic Escherichia coli Infection. Pathog Immun 2022; 7:1-18. [PMID: 35178490 PMCID: PMC8843076 DOI: 10.20411/pai.v7i1.479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Uropathogenic Escherichia coli (UPEC) infections are common and when they disseminate can be of high morbidity.
Methods: We studied the effects of UPEC infection using single cell RNA sequencing (scRNAseq) in zebrafish. Bulk RNA sequencing has historically been used to evaluate gene expression patterns, but scRNAseq allows gene expression to be evaluated at the single cell level and is optimal for evaluating heterogeneity within cell types and rare cell types. Zebrafish cohorts were injected with either saline or UPEC,and scRNAseq and canonical pathway analyses were performed.
Results: Canonical pathway analysis of scRNAseq data provided key information regarding innate immune pathways in the cells determined to be thymus cells, ionocytes, macrophages/monocytes, and pronephros cells. Pathways activated in thymus cells included interleukin 6 (IL-6) signaling and production of reactive oxygen species. Fc receptor-mediated phagocytosis was a leading canonical pathway in the pronephros and macrophages. Genes that were downregulated in UPEC vs saline exposed embryos involved the cellular response to the Gram-negative endotoxin lipopolysaccharide (LPS) and included Forkhead Box O1a (Foxo1a), Tribbles Pseudokinase 3 (Trib3), Arginase 2 (Arg2) and Polo Like Kinase 3 (Plk3).
Conclusions: Because 4-day post fertilization zebrafish embryos only have innate immune systems, the scRNAseq provides insights into pathways and genes that cell types utilize in the bacterial response. Based on our analysis, we have identified genes and pathways that might serve as genetic targets for treatment and further investigation in UPEC infections at the single cell level.
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Affiliation(s)
- Ashley Rawson
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology
| | - Vijay Saxena
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology
| | - Hongyu Gao
- Indiana University School of Medicine, Department of Medical & Molecular Genetics
| | - Jenaya Hooks
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology
| | - Xiaoling Xuei
- Indiana University School of Medicine, Department of Medical & Molecular Genetics
| | - Patrick McGuire
- Indiana University School of Medicine, Department of Medical & Molecular Genetics
| | - Takashi Hato
- Indiana University School of Medicine, Department of Medicine, Division of Nephrology
| | - David S. Hains
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology
| | - Ryan M. Anderson
- University of Chicago, Section of Endocrinology, Diabetes and Metabolism
- CORRESPONDING AUTHOR Andrew Schwaderer, Indiana University School of Medicine, Riley Hospital for Children, 699 Riley Hospital Dr., RR230, Indianapolis, IN 46202; Phone: 317-274-2527;
| | - Andrew L. Schwaderer
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology
- CORRESPONDING AUTHOR Ryan M Anderson, University of Chicago, Medicine-Endocrinology, Chicago, IL 60637;
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12
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Pierce KR, Eichler T, Mosquera Vasquez C, Schwaderer AL, Simoni A, Creacy S, Hains DS, Spencer JD. Ribonuclease 7 polymorphism rs1263872 reduces antimicrobial activity and associates with pediatric urinary tract infections. J Clin Invest 2021; 131:149807. [PMID: 34779412 DOI: 10.1172/jci149807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/28/2021] [Indexed: 01/18/2023] Open
Abstract
Ribonuclease 7 (RNase 7) is an antimicrobial peptide that prevents urinary tract infections (UTI); however, it is yet unknown how RNASE7 genetic variations affect its antimicrobial activity and its mitigation of UTI risk. This study determined whether the RNASE7 SNP rs1263872 is more prevalent in children with UTI and defined how rs1263872 affects RNase 7's antimicrobial activity against uropathogenic E. coli (UPEC). We performed genotyping for rs1263872 in 2 national UTI cohorts, including children enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux trial or the Careful Urinary Tract Infection Evaluation study. Genotypes from these cohorts were compared with those of female controls with no UTI. To assess whether rs1263872 affects RNase 7's antimicrobial activity, we generated RNase 7 peptides and genetically modified urothelial cultures encoding wild-type RNase 7 and its variant. Compared with controls, girls in both UTI cohorts had an increased prevalence of the RNASE7 variant. Compared with the missense variant, wild-type RNase 7 peptide showed greater bactericidal activity against UPEC. Wild-type RNase 7 overexpression in human urothelial cultures reduced UPEC invasive infection compared with mutant overexpression. These results show that children with UTI have an increased prevalence of RNASE7 rs1263872, which may increase UTI susceptibility by suppressing RNase 7's antibacterial activity.
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Affiliation(s)
- Keith R Pierce
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tad Eichler
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Claudia Mosquera Vasquez
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Andrew L Schwaderer
- Division of Nephrology, Department of Pediatrics, and.,Kidney and Urology Translational Research Group, Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aaron Simoni
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | | | - David S Hains
- Division of Nephrology, Department of Pediatrics, and.,Kidney and Urology Translational Research Group, Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John D Spencer
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's, Columbus, Ohio, USA.,Division of Nephrology and Hypertension, Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's, Columbus, Ohio, USA
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13
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Hains DS, Polley S, Liang D, Saxena V, Arregui S, Ketz J, Barr-Beare E, Rawson A, Spencer JD, Cohen A, Hansen PL, Tuttolomondo M, Casella C, Ditzel HJ, Cohen D, Hollox EJ, Schwaderer AL. Deleted in malignant brain tumor 1 genetic variation confers urinary tract infection risk in children and mice. Clin Transl Med 2021; 11:e477. [PMID: 34323417 PMCID: PMC8255058 DOI: 10.1002/ctm2.477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- David S Hains
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Shamik Polley
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Dong Liang
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Vijay Saxena
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Samuel Arregui
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - John Ketz
- The Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Ashley Rawson
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - John D Spencer
- The Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ariel Cohen
- The Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Pernille L Hansen
- Lundbeckfonden Center of Excellence NanoCAN, University of Southern Denmark, Odense, Denmark.,Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Martina Tuttolomondo
- Lundbeckfonden Center of Excellence NanoCAN, University of Southern Denmark, Odense, Denmark.,Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Cinzia Casella
- Lundbeckfonden Center of Excellence NanoCAN, University of Southern Denmark, Odense, Denmark.,Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Henrik J Ditzel
- Lundbeckfonden Center of Excellence NanoCAN, University of Southern Denmark, Odense, Denmark.,Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Daniel Cohen
- Emergency Department, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Edward J Hollox
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
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14
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Lipp SN, Jacobson KR, Hains DS, Schwarderer AL, Calve S. 3D Mapping Reveals a Complex and Transient Interstitial Matrix During Murine Kidney Development. J Am Soc Nephrol 2021; 32:1649-1665. [PMID: 33875569 PMCID: PMC8425666 DOI: 10.1681/asn.2020081204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The extracellular matrix (ECM) is a network of proteins and glycosaminoglycans that provides structural and biochemical cues to cells. In the kidney, the ECM is critical for nephrogenesis; however, the dynamics of ECM composition and how it relates to 3D structure during development is unknown. METHODS Using embryonic day 14.5 (E14.5), E18.5, postnatal day 3 (P3), and adult kidneys, we fractionated proteins based on differential solubilities, performed liquid chromatography-tandem mass spectrometry, and identified changes in ECM protein content (matrisome). Decellularized kidneys were stained for ECM proteins and imaged in 3D using confocal microscopy. RESULTS We observed an increase in interstitial ECM that connects the stromal mesenchyme to the basement membrane (TNXB, COL6A1, COL6A2, COL6A3) between the embryo and adult, and a transient elevation of interstitial matrix proteins (COL5A2, COL12A1, COL26A1, ELN, EMID1, FBN1, LTBP4, THSD4) at perinatal time points. Basement membrane proteins critical for metanephric induction (FRAS1, FREM2) were highest in abundance in the embryo, whereas proteins necessary for integrity of the glomerular basement membrane (COL4A3, COL4A4, COL4A5, LAMB2) were more abundant in the adult. 3D visualization revealed a complex interstitial matrix that dramatically changed over development, including the perinatal formation of fibrillar structures that appear to support the medullary rays. CONCLUSION By correlating 3D ECM spatiotemporal organization with global protein abundance, we revealed novel changes in the interstitial matrix during kidney development. This new information regarding the ECM in developing kidneys offers the potential to inform the design of regenerative scaffolds that can guide nephrogenesis in vitro.
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Affiliation(s)
- Sarah N. Lipp
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Medical Scientist/Engineer Training Program, Indiana University, Indianapolis, Indiana
| | - Kathryn R. Jacobson
- Interdisciplinary Life Science Program, Purdue University, West Lafayette, Indiana
| | - David S. Hains
- Department of Pediatrics, School of Medicine, Indiana University, Riley Children’s Hospital, Indianapolis, Indiana
| | - Andrew L. Schwarderer
- Department of Pediatrics, School of Medicine, Indiana University, Riley Children’s Hospital, Indianapolis, Indiana
| | - Sarah Calve
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Interdisciplinary Life Science Program, Purdue University, West Lafayette, Indiana
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado
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15
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Saxena V, Gao H, Arregui S, Zollman A, Kamocka MM, Xuei X, McGuire P, Hutchens M, Hato T, Hains DS, Schwaderer AL. Kidney intercalated cells are phagocytic and acidify internalized uropathogenic Escherichia coli. Nat Commun 2021; 12:2405. [PMID: 33893305 PMCID: PMC8065053 DOI: 10.1038/s41467-021-22672-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 03/18/2021] [Indexed: 02/02/2023] Open
Abstract
Kidney intercalated cells are involved in acid-base homeostasis via vacuolar ATPase expression. Here we report six human intercalated cell subtypes, including hybrid principal-intercalated cells identified from single cell transcriptomics. Phagosome maturation is a biological process that increases in biological pathway analysis rank following exposure to uropathogenic Escherichia coli in two of the intercalated cell subtypes. Real time confocal microscopy visualization of murine renal tubules perfused with green fluorescent protein expressing Escherichia coli or pHrodo Green E. coli BioParticles demonstrates that intercalated cells actively phagocytose bacteria then acidify phagolysosomes. Additionally, intercalated cells have increased vacuolar ATPase expression following in vivo experimental UTI. Taken together, intercalated cells exhibit a transcriptional response conducive to the kidney's defense, engulf bacteria and acidify the internalized bacteria. Intercalated cells represent an epithelial cell with characteristics of professional phagocytes like macrophages.
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Affiliation(s)
- Vijay Saxena
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology, Indianapolis, IN, USA.
| | - Hongyu Gao
- Indiana University School of Medicine, Department of Medical & Molecular Genetics, Indianapolis, IN, USA
| | - Samuel Arregui
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology, Indianapolis, IN, USA
| | - Amy Zollman
- Indiana University School of Medicine, Department of Medicine, Division of Nephrology, Indianapolis, IN, USA
| | - Malgorzata Maria Kamocka
- Indiana University School of Medicine, Department of Medicine, Division of Nephrology, Indianapolis, IN, USA
| | - Xiaoling Xuei
- Indiana University School of Medicine, Department of Medical & Molecular Genetics, Indianapolis, IN, USA
| | - Patrick McGuire
- Indiana University School of Medicine, Department of Medical & Molecular Genetics, Indianapolis, IN, USA
| | - Michael Hutchens
- Oregon Health and Science University, Department of Anesthesiology & Perioperative Medicine, Portland, OR, USA
| | - Takashi Hato
- Indiana University School of Medicine, Department of Medicine, Division of Nephrology, Indianapolis, IN, USA
| | - David S Hains
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology, Indianapolis, IN, USA
| | - Andrew L Schwaderer
- Indiana University School of Medicine, Department of Pediatrics, Division of Nephrology, Indianapolis, IN, USA.
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16
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Canas JJ, Starr MC, Hooks J, Arregui S, Wilson AC, Carroll AE, Saxena V, Amanat F, Krammer F, Fill J, Schade A, Chambers A, Schneider J, Schwaderer AL, Hains DS. Longitudinal SARS-CoV-2 seroconversion and functional heterogeneity in a pediatric dialysis unit. Kidney Int 2021; 99:484-486. [PMID: 33509357 PMCID: PMC7830216 DOI: 10.1016/j.kint.2020.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Jorge J Canas
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA; Department of Microbiology and Immunology, Indiana University, Indianapolis, Indiana, USA
| | - Michelle C Starr
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Jenaya Hooks
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Samuel Arregui
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Amy C Wilson
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Aaron E Carroll
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Vijay Saxena
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey Fill
- Clinical Diagnostics Laboratory, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Andrew Schade
- Clinical Diagnostics Laboratory, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Antonio Chambers
- Clinical Diagnostics Laboratory, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Jack Schneider
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | | | - David S Hains
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA; Department of Microbiology and Immunology, Indiana University, Indianapolis, Indiana, USA.
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17
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Caterino JM, Stephens JA, Camargo CA, Wexler R, Hebert C, Southerland LT, Hunold KM, Hains DS, Bischof JJ, Wei L, Wolfe AJ, Schwaderer A. Asymptomatic Bacteriuria versus Symptom Underreporting in Older Emergency Department Patients with Suspected Urinary Tract Infection. J Am Geriatr Soc 2021; 68:2696-2699. [PMID: 33460062 DOI: 10.1111/jgs.16775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Julie A Stephens
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Randell Wexler
- Department of Family Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Courtney Hebert
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Infectious Diseases, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - David S Hains
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lai Wei
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Loyola University Chicago, Chicago, Illinois, USA
| | - Andrew Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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Crisci T, Arregui S, Canas J, Hooks J, Chan M, Powers C, Schwaderer AL, Hains DS, Starr MC. Placement on COVID-19 Units Does Not Increase Seroconversion Rate of Pediatric Graduate Medical Residents. Front Pediatr 2021; 9:633082. [PMID: 33996685 PMCID: PMC8116566 DOI: 10.3389/fped.2021.633082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease COVID-19 (coronavirus disease 2019) has presented graduate medical education (GME) training programs with a unique set of challenges. One of the most pressing is how should hospital systems that rely on graduate medical residents provide appropriate care for patients while protecting trainees. This question is of particular concern as healthcare workers are at high risk of SARS-CoV-2 exposure. Objective: This cross-sectional study sought to assess the impact of hospital COVID-19 patient placement on pediatric graduate medical residents by comparing rates of SARS-CoV-2 seroconversion rates of residents who worked on designated COVID-19 teams and those who did not. Methods: Forty-four pediatric and medicine-pediatric residents at Riley Children's Hospital (Indianapolis, IN) were tested for SARS-CoV-2 immunoglobulin M (IgM) and IgG seroconversion in May 2020 using enzyme-linked immunosorbent assays (Abnova catalog no. KA5826), 2 months after the first known COVID-19 case in Indiana. These residents were divided into two groups: those residents who worked on designated COVID-19 teams, and those who did not. Groups were compared using χ2 or Fisher exact test for categorical variables, and continuous variables were compared using Student t testing. Results: Forty-four of 104 eligible residents participated in this study. Despite high rates of seroconversion, there was no difference in the risk of SARS-CoV-2 seroconversion between residents who worked on designated COVID-19 teams (26% or 8/31) and those who did not (31% or 4/13). Eleven of 44 residents (25%) tested positive for SARS-CoV-2 IgG, whereas only 5/44 (11.4%) tested positive for SARS-CoV-2 IgM, without a detectable difference between exposure groups. Conclusion: We did not observe a difference in SARS-CoV-2 seroconversion between different exposure groups. These data are consistent with growing evidence supporting the efficacy of personal protective equipment. Further population-based research on the role of children in transmitting the SARS-CoV-2 virus is needed to allow for a more evidence-based approach toward managing the COVID-19 pandemic.
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Affiliation(s)
- Timothy Crisci
- Medicine-Pediatric Residency, Indiana University, Indianapolis, IN, United States
| | - Samuel Arregui
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jorge Canas
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jenaya Hooks
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Melvin Chan
- Medicine-Pediatric Residency, Indiana University, Indianapolis, IN, United States
| | - Cory Powers
- Medicine-Pediatric Residency, Indiana University, Indianapolis, IN, United States
| | - Andrew L Schwaderer
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - David S Hains
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Michelle C Starr
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, United States
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19
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Hanson AE, Hains DS, Schwaderer AL, Starr MC. Variation in COVID-19 Diagnosis by Zip Code and Race and Ethnicity in Indiana. Front Public Health 2020; 8:593861. [PMID: 33363087 PMCID: PMC7759524 DOI: 10.3389/fpubh.2020.593861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To describe variations in coronavirus disease 2019 (COVID-19) diagnosis by zip code race and ethnicity in Indiana. Methods: Cross-sectional evaluation of subjects with SARS-CoV-2 at Indiana University Health. We performed two separate analyses, first evaluating likelihood of COVID-19 diagnosis by race (Caucasian, African American, Asian, or other) and ethnicity (Hispanic vs. non-Hispanic) in the cohort encompassing the entire state of Indiana. Subsequently, patient data was geolocated with zip codes in Marion County and the immediate surrounding counties, and descriptive statistical analyses were used to calculate the number of COVID-19 cases per 10,000 persons for each of these zip codes. Results: Indiana had a total of 3,892 positive COVID-19 cases from January 1 to April 30, 2020. The odds of testing positive for COVID-19 were four-fold higher in African Americans than non-African Americans (OR 4.58, 95% CI 4.25-4.94, P < 0.0001). Increased COVID-19 cases per 10,000 persons were seen in zip codes with higher percentage of African American (median infection rate of 17.4 per 10,000 population in zip codes above median % African American compared to 6.7 per 10,000 population in zip codes below median % African American, with an overall median infection rate 9.9 per 10,000 population, P < 0.0001) or Hispanic residents (median infection rate of 15.9 per 10,000 population in zip codes above median % Hispanic compared to 7.0 per 10,000 population in zip codes below median % Hispanic, overall median infection rate 9.6 per 10,000 population, P < 0.0001). Conclusions: Individuals from zip codes with higher percentages of African American, Hispanic, foreign-born, and/or residents living in poverty are disproportionately affected by COVID-19. Urgent work is needed to understand and address the disproportionate burden of COVID-19 in minority communities and when economic disparities are present.
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Affiliation(s)
| | | | | | - Michelle C. Starr
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
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20
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Rawson A, Wilson AC, Schwaderer AL, Spiwak E, Johnston B, Anderson S, Nailescu C, Gupta S, Christenson JC, Hains DS, Starr MC. Coronavirus disease 2019 (COVID-19) in two pediatric patients with kidney disease on chronic immunosuppression: A case series. Hemodial Int 2020; 25:E1-E5. [PMID: 33015942 PMCID: PMC7675317 DOI: 10.1111/hdi.12876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/31/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) is a highly infectious disease caused by the severe acute respiratory syndrome coronavirus 2 virus (SARS‐CoV‐2). While children appear to experience less severe disease than adults, those with underlying conditions such as kidney disease may be more susceptible to infection. Limited data are present for children with kidney disease, and there are limited prior reports of pediatric hemodialysis patients with COVID‐19. This report describes the mild clinical disease course of COVID‐19 in two pediatric patients with chronic kidney disease, one on hemodialysis and both on chronic immunosuppression. We review treatment in these patients, as well as our measures to reduce transmission among our hemodialysis patients and staff.
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Affiliation(s)
- Ashley Rawson
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Amy C Wilson
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Andrew L Schwaderer
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Elizabeth Spiwak
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Bethanne Johnston
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Shannon Anderson
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Corina Nailescu
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Sushil Gupta
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - John C Christenson
- Division of Infectious Diseases, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - David S Hains
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Michelle C Starr
- Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
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21
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Hains DS, Schwaderer AL, Carroll AE, Starr MC, Wilson AC, Amanat F, Krammer F. Asymptomatic Seroconversion of Immunoglobulins to SARS-CoV-2 in a Pediatric Dialysis Unit. JAMA 2020; 323:2424-2425. [PMID: 32407440 PMCID: PMC7226282 DOI: 10.1001/jama.2020.8438] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This case series describes subclinical development of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in some patients and health care workers in a pediatric dialysis unit after contact with a seropositive patient.
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Affiliation(s)
- David S. Hains
- Department of Pediatrics, Indiana University, Indianapolis
| | | | | | | | - Amy C. Wilson
- Department of Pediatrics, Indiana University, Indianapolis
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
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Ketz J, Saxena V, Arregui S, Jackson A, Schwartz GJ, Yagisawa T, Fairchild RL, Hains DS, Schwaderer AL. Developmental loss, but not pharmacological suppression, of renal carbonic anhydrase 2 results in pyelonephritis susceptibility. Am J Physiol Renal Physiol 2020; 318:F1441-F1453. [PMID: 32390512 DOI: 10.1152/ajprenal.00583.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Carbonic anhydrase II knockout (Car2-/-) mice have depleted numbers of renal intercalated cells, which are increasingly recognized to be innate immune effectors. We compared pyelonephritis susceptibility following reciprocal renal transplantations between Car2-/- and wild-type mice. We examined the effect of pharmacological CA suppression using acetazolamide in an experimental murine model of urinary tract infection. Car2-/- versus wild-type mice were compared for differences in renal innate immunity. In our transplant scheme, mice lacking CA-II in the kidney had increased pyelonephritis risk. Mice treated with acetazolamide had lower kidney bacterial burdens at 6 h postinfection, which appeared to be due to tubular flow from diuresis because comparable results were obtained when furosemide was substituted for acetazolamide. Isolated Car2-/- kidney cells enriched for intercalated cells demonstrated altered intercalated cell innate immune gene expression, notably increased calgizzarin and insulin receptor expression. Intercalated cell number and function along with renal tubular flow are determinants of pyelonephritis risk.
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Affiliation(s)
- John Ketz
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Vijay Saxena
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Samuel Arregui
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Ashley Jackson
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - George J Schwartz
- Division of Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Takafumi Yagisawa
- Department of Inflammation and Immunity, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert L Fairchild
- Department of Inflammation and Immunity, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Andrew L Schwaderer
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
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Qureshi AH, Liang D, Canas J, Hooks J, Arrregui SW, Saxena V, Rooney R, Nolan V, Schwaderer AL, Hains DS. DCHS1 DNA copy number loss associated with pediatric urinary tract infection risk. Innate Immun 2020; 26:473-481. [PMID: 32295462 PMCID: PMC7491237 DOI: 10.1177/1753425920917193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Urinary tract infections (UTI), associated with vesicoureteral reflux (VUR), can lead to chronic kidney disease. Genetic alterations in the innate immune defenses contribute to UTI risk. We investigated a novel gene, Dachsous Cadherin-Related 1 (DCHS1), in children with UTI. We determined absolute DNA copy number (CN) of DCHS1 in children with UTI. In this case-control study, we utilized multiple complementary methods to determine the genomic CN of DCHS1. Children with (n = 370) and without (n = 71) VUR from two well-phenotyped clinical trials of UTI were copy-typed and compared to 491 healthy controls with no known history of VUR or UTI. Less than 1% of controls had a single copy of DCHS1, while 31% of children with UTI and no VUR and 7% of children with UTI and VUR had a single copy of the DCHS1 gene. Using immunostaining, we localized expression postnatally to the bladder and renal epithelia. Mice were also challenged with two uropathogenic Escherichia coli strains, and Dchs1 mRNA was quantified. This study represents the first report of DCHS1 in association with pediatric UTI. We hypothesize that its role in innate immunity is critical to lower urinary tract defense. Further investigation is required to determine the role of DCHS1 in innate immunity.
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Affiliation(s)
- Aslam H Qureshi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Tennessee Health Science Center, USA.,Department of Pediatrics, Children's Hospital at Erlanger, University of Tennessee College of Medicine, USA
| | - Dong Liang
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Jorge Canas
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Jenaya Hooks
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Samuel W Arrregui
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Vijay Saxena
- Department of Pediatrics, Indiana University School of Medicine, USA
| | - Robert Rooney
- Integrative Genomics Biorepository, Department of Pediatrics, University of Tennessee Health Science Center, USA
| | - Vikki Nolan
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, USA
| | - Andrew L Schwaderer
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, USA
| | - David S Hains
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, USA
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24
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Szymanski KM, Szymanski AJ, Salama AK, Hains DS, Cain MP, Misseri R. Estimating and tracking renal function in children and adults with spina bifida. J Pediatr Urol 2020; 16:169-177. [PMID: 31956092 DOI: 10.1016/j.jpurol.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Estimated glomerular filtration rate (eGFR) in the general population is stable in children after 2 years of age until adulthood. In the first three decades after age 18, eGFR decreases by 0.3-0.8 ml/min/1.73 m2/year. Little data exists regarding eGFR changes in the spina bifida (SB) population given variability in muscle mass. In the absence of a validated SB-specific eGFR formula, the performance of different eGFR formulas may vary. We performed a cross-sectional study (1) to determine trends in eGFR with increasing age in children and adults with SB and (2) to compare eGFRs calculated using different formulas. METHODS We retrospectively reviewed records of patients 2-50 years old with SB followed at our institution (2014-2019). We determined eGFR using four pediatric formulas (2-17 years: CKiDSCr, CKiDCys, CKiDSCr-Cys, ZappitelliSCr-Cys) and four adult formulas (18 + years: MDRDSCr, CKD-EPISCr, CKD-EPICys, CKD-EPISCr-Cys). One eGFR per patient was included (most recent eGFR for those with serial measurements). Patients were categorized as chronic kidney disease (CKD) stage 2 (eGFR 60-89) and Stage 3+ (<60). Non-parametric tests, linear regression, and Spearman's correlation were used for analysis. RESULTS Among 209 children with SB (median age 10.3 years), depending on the formula used, eGFR decreased by -0.7 to -1.8 ml/min/1.73 m2/year (CKiDCys, CKiDScr, p ≤ 0.001), remained stable (CKiDSCr-Cys, p = 0.41), or increased by +2.7/year (ZappitelliSCr-Cys, p < 0.001) (Figure). The proportion of children with CKD 2 or higher varied between formulas (11.5-58.9%, p < 0.001). Correlations between pediatric formulas were negligible to moderate. Comparing any two formulas, 12.0-65.6% of children were assigned a different CKD stage. Among 164 adults (median age 26.3), eGFR decreased for each formula (range: -1.3 to -2.2/year, p ≤ 0.01) (Figure). The proportion of adults with CKD 2 or higher varied between formulas (9.2-30.5%, p < 0.001). Correlations between adult formulas were moderate to very high. Comparing any two formulas, 8.5-26.8% of adults were assigned a different CKD stage. COMMENT We cannot reliably determine whether eGFR changed during childhood. Among adults, eGFR decreased with age for every formula evaluated at greater than twice the general population rate. Without a validated SB-specific eGFR formula, we are left with formulas providing different results. CONCLUSIONS Estimated GFR among adults with SB appears to deteriorate at a higher rate than in the general population. Due to lack of precision of accepted eGFR formulas in the SB population, this may be a real phenomenon, an artifact of inaccurate eGFR formulas, or both. A validated SB-specific eGFR formula is needed.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA.
| | - Arthur J Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Amr K Salama
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - David S Hains
- Department of Pediatrics, Division of Nephrology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indiana, USA
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Abstract
BACKGROUND The 2011 American Academy of Pediatrics clinical practice guideline recommends when to obtain renal and bladder ultrasound (RBUS) and voiding cystourethrography (VCUG) following febrile urinary tract infection (UTI) for children age 2-24 months. However, there is not consensus about when to obtain imaging in neonates. The objective of this study is to evaluate UTI diagnostic criteria along with RBUS and VCUG in neonates admitted to the NICU in the first 3 months of life. METHODS A retrospective electronic medical record review was performed of neonates admitted to Nationwide Children's Hospital system NICUs between January 2010 and December 2014 with UTI as a primary or secondary diagnosis. Urine culture results were evaluated versus established UTI criteria and renal US and VCUG results were compared. RESULTS Of 81 patients with a straight catheterized urine culture obtained, 28 patients met laboratory criteria for diagnosis of UTI and all but 4 had a RBUS. Urine cultures had an equal distribution of Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Coagulase negative staphylococcus. RBUS showed dilation of the collecting system in 37.5% of patients with UTI compared to 41.3% without UTI. VCUG showed vesicourteral reflux (VUR) on 41.7% of those with UTI compared to 34.8% without UTI. For patients with UTI, the sensitivity of RBUS for VUR on VCUG was 60% with CI [0.17, 0.93] and specificity was 43% with CI [0.12, 0.80]. In patients without UTI, sensitivity of RBUS for VUR on VCUG was 63% with CI [0.26, 0.90] and specificity was 71% with CI [0.42, 0.90]. CONCLUSIONS Fewer than half of neonates that were diagnosed clinically with UTI met laboratory criteria for a UTI. Positive urine cultures grew a wide variety of organisms. The sensitivity of renal ultrasound for VUR is only about 60%.
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Affiliation(s)
- Laura Walawender
- Nationwide Children's Hospital, Department of Pediatrics, United States
| | - David S Hains
- Indiana University, Department of Pediatrics, Division of Nephrology, United States
| | - Andrew L Schwaderer
- Indiana University, Department of Pediatrics, Division of Nephrology, United States.
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Spiech KM, Tripathy PR, Woodcock AM, Sheth NA, Collins KS, Kannegolla K, Sinha AD, Sharfuddin AA, Pratt VM, Khalid M, Hains DS, Moe SM, Skaar TC, Moorthi RN, Eadon MT. Implementation of a Renal Precision Medicine Program: Clinician Attitudes and Acceptance. Life (Basel) 2020; 10:life10040032. [PMID: 32224869 PMCID: PMC7235993 DOI: 10.3390/life10040032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
A precision health initiative was implemented across a multi-hospital health system, wherein a panel of genetic variants was tested and utilized in the clinical care of chronic kidney disease (CKD) patients. Pharmacogenomic predictors of antihypertensive response and genomic predictors of CKD were provided to clinicians caring for nephrology patients. To assess clinician knowledge, attitudes, and willingness to act on genetic testing results, a Likert-scale survey was sent to and self-administered by these nephrology providers (N = 76). Most respondents agreed that utilizing pharmacogenomic-guided antihypertensive prescribing is valuable (4.0 ± 0.7 on a scale of 1 to 5, where 5 indicates strong agreement). However, the respondents also expressed reluctance to use genetic testing for CKD risk stratification due to a perceived lack of supporting evidence (3.2 ± 0.9). Exploratory sub-group analyses associated this reluctance with negative responses to both knowledge and attitude discipline questions, thus suggesting reduced exposure to and comfort with genetic information. Given the evolving nature of genomic implementation in clinical care, further education is warranted to help overcome these perception barriers.
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Affiliation(s)
- Katherine M. Spiech
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Purnima R. Tripathy
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Alex M. Woodcock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Nehal A. Sheth
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Kimberly S. Collins
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Karthik Kannegolla
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Arjun D. Sinha
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Asif A. Sharfuddin
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Victoria M. Pratt
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Myda Khalid
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.K.); (D.S.H.)
| | - David S. Hains
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (M.K.); (D.S.H.)
| | - Sharon M. Moe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Todd C. Skaar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Ranjani N. Moorthi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
| | - Michael T. Eadon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (K.M.S.); (P.R.T.); (A.M.W.); (N.A.S.); (K.S.C.); (K.K.); (A.D.S.); (A.A.S.); (S.M.M.); (T.C.S.); (R.N.M.)
- Correspondence: ; Tel.: 317-274-2502; Fax: 317-274-8575
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Saxena V, Fitch J, Ketz J, White P, Wetzel A, Chanley MA, Spencer JD, Becknell B, Pierce KR, Arregui SW, Nelson RD, Schwartz GJ, Velazquez V, Walker LA, Chen X, Yan P, Hains DS, Schwaderer AL. Publisher Correction: Whole Transcriptome Analysis of Renal Intercalated Cells Predicts Lipopolysaccharide Mediated Inhibition of Retinoid X Receptor alpha Function. Sci Rep 2020; 10:5090. [PMID: 32184403 PMCID: PMC7078295 DOI: 10.1038/s41598-020-60599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vijay Saxena
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States.
| | - James Fitch
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - John Ketz
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States
| | - Peter White
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Amy Wetzel
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Melinda A Chanley
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States
| | - John D Spencer
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Brian Becknell
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Keith R Pierce
- Innate Immunity Translational Research Center, Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee, United States
| | - Sam W Arregui
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States
| | - Raoul D Nelson
- Division of Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - George J Schwartz
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, United States
| | - Victoria Velazquez
- Research Institute at Nationwide Children's Hospital Flow Cytometry Core Laboratory, Columbus, Ohio, United States
| | - Logan A Walker
- Department of Physics, College of Arts and Sciences, The Ohio State University, Columbus, Ohio, United States
| | - Xi Chen
- Genomics Shared Resource, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Pearlly Yan
- Genomics Shared Resource, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States.,Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - David S Hains
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States.
| | - Andrew L Schwaderer
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States.
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28
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Nailescu C, Khalid M, Wilson AC, Amanat F, Arregui S, Canas J, Hooks J, Krammer F, Schwaderer AL, Hains DS. Assessment of Seroconversion to SARS-CoV-2 in a Cohort of Pediatric Kidney Transplant Recipients. Front Pediatr 2020; 8:601327. [PMID: 33194930 PMCID: PMC7661782 DOI: 10.3389/fped.2020.601327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The occurrence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated coronavirus disease 2019 (COVID-19) have profoundly affected adult kidney disease patients. In contrast, pediatric solid organ transplant recipients, including pediatric kidney transplant (KT) recipients, do not seem to be at particularly higher risk for SARS-CoV-2 infection or for severe COVID-19 disease. This patient population might be protected by certain mechanisms, such as the immunosuppressive medications with their anti-inflammatory properties or simply being well-versed in self-protection techniques. Assessing SARS-CoV-2 antibody serologies could potentially help understand why this patient population is apparently spared from severe SARS-CoV-2 clinical courses. Objective: To examine SARS-CoV-2 serologic status in a cohort of pediatric KT recipients. Methods: SARS-CoV-2 anti-spike IgG and IgM antibodies were measured by three different methods in pediatric KT recipients coming for routine clinic visits immediately post-confinement in May-June of 2020. The patients were considered seroconverted if SARS-CoV-2 antibodies were positive by 2/3 methods and weak positive/indeterminate if positive by 1/3. Results: Thirty-one patients were evaluated (about 1/3 of our institution's pediatric KT population). One patient seroconverted, while three were considered weak positive/indeterminate. None were symptomatic and none had nasopharyngeal PCR confirmed SARS-CoV-2 disease. Conclusions: Seroconversion to SARS-CoV-2 was rare in this population and likely reflects the social distancing practiced by these patients. The results will serve as a foundation for a future longitudinal study to evaluate the long-term emergence and persistence of antibodies in this population and may inform studies of response to a future vaccine.
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Affiliation(s)
- Corina Nailescu
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Myda Khalid
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Amy C Wilson
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, United States
| | - Samuel Arregui
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jorge Canas
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Jenaya Hooks
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, United States
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
| | - David S Hains
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States
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29
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Liang D, McHugh KM, Brophy PD, Shaikh N, Manak JR, Andrews P, Hakker I, Wang Z, Schwaderer AL, Hains DS. DNA copy number variations in children with vesicoureteral reflux and urinary tract infections. PLoS One 2019; 14:e0220617. [PMID: 31404082 PMCID: PMC6690579 DOI: 10.1371/journal.pone.0220617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 07/19/2019] [Indexed: 11/18/2022] Open
Abstract
Vesicoureteral reflux (VUR) is a complex, heritable disorder. Genome-wide linkage analyses of families affected by VUR have revealed multiple genomic loci linked to VUR. These loci normally harbor a number of genes whose biologically functional variant is yet to be identified. DNA copy number variations (CNVs) have not been extensively studied at high resolution in VUR patients. In this study, we performed array comparative genomic hybridization (aCGH) on a cohort of patients with a history of both VUR and urinary tract infection (UTI) with the objective of identifying genetic variations responsible for VUR and/or UTI susceptibility. UTI/VUR-associated CNVs were identified by aCGH results from the 192 Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) patients compared to 683 controls. Rare, large CNVs that are likely pathogenic and lead to VUR development were identified using stringent analysis criteria. Because UTI is a common affliction with multiple risk factors, we utilized standard analysis to identify potential disease-modifying CNVs that can contribute to UTI risk. Gene ontology analysis identified that CNVs in innate immunity and development genes were enriched in RIVUR patients. CNVs affecting innate immune genes may contribute to UTI susceptibility in VUR patients and may provide the first step in assisting clinical medicine in determining adverse outcome risk in children with VUR.
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Affiliation(s)
- Dong Liang
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States of America
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Kirk M. McHugh
- Division of Anatomy, The Ohio State University, Columbus, OH, United States of America
| | - Pat D. Brophy
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Nader Shaikh
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - J. Robert Manak
- Departments of Biology and Pediatrics, University of Iowa, Iowa City, IA, United States of America
| | - Peter Andrews
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, United States of America
| | - Inessa Hakker
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, United States of America
| | - Zihua Wang
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, United States of America
| | - Andrew L. Schwaderer
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States of America
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States of America
| | - David S. Hains
- Department of Pediatrics, Indiana University, Indianapolis, IN, United States of America
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States of America
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30
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Saxena V, Fitch J, Ketz J, White P, Wetzel A, Chanley MA, Spencer JD, Becknell B, Pierce KR, Arregui SW, Nelson RD, Schwartz GJ, Velazquez V, Walker LA, Chen X, Yan P, Hains DS, Schwaderer AL. Whole Transcriptome Analysis of Renal Intercalated Cells Predicts Lipopolysaccharide Mediated Inhibition of Retinoid X Receptor alpha Function. Sci Rep 2019; 9:545. [PMID: 30679625 PMCID: PMC6345901 DOI: 10.1038/s41598-018-36921-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/23/2018] [Indexed: 01/14/2023] Open
Abstract
The renal collecting duct consists of intercalated cells (ICs) and principal cells (PCs). We have previously demonstrated that collecting ducts have a role in the innate immune defense of the kidney. Transcriptomics is an important tool used to enhance systems-level understanding of cell biology. However, transcriptomics performed on whole kidneys provides limited insight of collecting duct cell gene expression, because these cells comprise a small fraction of total kidney cells. Recently we generated reporter mouse models to enrich collecting duct specific PC and ICs and reported targeted gene expression of anti-microbial peptide genes. Here we report transcriptomics on enriched ICs and PCs and performed a pilot study sequencing four single ICs. We identified 3,645 genes with increased relative expression in ICs compared to non-ICs. In comparison to non-PCs, 2,088 genes had higher relative expression in PCs. IC associated genes included the innate interleukin 1 receptor, type 1 and the antimicrobial peptide(AMP) adrenomedullin. The top predicted canonical pathway for enriched ICs was lipopolysaccharide/Interleukin 1 mediated inhibition of Retinoid X Receptor alpha function and decreased Retinoid X Receptor expression was confirmed to occur 1-hour post experimental murine UTI in ICs but not in non-ICs.
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Affiliation(s)
- Vijay Saxena
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States.
| | - James Fitch
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - John Ketz
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States
| | - Peter White
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Amy Wetzel
- The Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Melinda A Chanley
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States
| | - John D Spencer
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Brian Becknell
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University, Columbus, Ohio, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Keith R Pierce
- Innate Immunity Translational Research Center, Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee, United States
| | - Sam W Arregui
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States
| | - Raoul D Nelson
- Division of Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - George J Schwartz
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York, United States
| | - Victoria Velazquez
- Research Institute at Nationwide Children's Hospital Flow Cytometry Core Laboratory, Columbus, Ohio, United States
| | - Logan A Walker
- Department of Physics, College of Arts and Sciences, The Ohio State University, Columbus, Ohio, United States
| | - Xi Chen
- Genomics Shared Resource, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Pearlly Yan
- Genomics Shared Resource, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States.,Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - David S Hains
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States.
| | - Andrew L Schwaderer
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, United States.
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Vasylyeva TL, Díaz-González de Ferris ME, Hains DS, Ho J, Harshman LA, Reidy KJ, Brady TM, Okamura DM, Samsonov DV, Wenderfer SE, Hartung EA. Developing a Research Mentorship Program: The American Society of Pediatric Nephrology's Experience. Front Pediatr 2019; 7:155. [PMID: 31069203 PMCID: PMC6491803 DOI: 10.3389/fped.2019.00155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Most pediatric nephrologists work in academia. Mentor-mentee relationships provide support and guidance for successful research career. Mentorship program implementation is valuable in medical fields for providing research opportunities to young faculty. Methods: The American Society of Pediatric Nephrology (ASPN) established a research mentorship program to (a) assist with matching of appropriate mentor-mentee dyads and (b) establish metrics for desirable mentor-mentee outcomes with two independent components: (1) the grants review workshop, a short-term program providing mentor feedback on grant proposals, and (2) the longitudinal program, establishing long-term mentor-mentee relationships. Regular surveys of both mentors and mentees were reviewed to evaluate and refine the program. Results: Twelve mentees and 17 mentors participated in the grant review workshop and 19 mentees were matched to mentors in the longitudinal program. A review of NIH RePORTER data indicated that since 2014, 13 NIH grants have been awarded. Mentees in the longitudinal program reported that the program helped most with identifying an outside mentor, improving grant research content, and with general career development. Mentors perceived themselves to be most helpful in assisting with overall career plans. Email communications were preferred over phone or face-to-face communications. Mentees endorsed strong interest in staying in touch with their mentors and 100% of mentors expressed their willingness to serve in the future. Conclusion: This mentorship program was initiated and supported by a relatively small medical society and has shown early success in cultivating mentoring relationships for a future generation of clinician-scientists.
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Affiliation(s)
- Tetyana L Vasylyeva
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - María E Díaz-González de Ferris
- UNC Transition Program, Manning Drive N.C. Children's Hospital, The University of North Carolina, Chapel Hill, NC, United States
| | - David S Hains
- Division of Pediatric Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jacqueline Ho
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lyndsay A Harshman
- Division of Pediatric Nephrology, Department of Pediatrics, University of Iowa Stead Family, Iowa City, IA, United States
| | - Kimberly J Reidy
- Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, United States
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daryl M Okamura
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | | | - Scott E Wenderfer
- Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States
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Atherton JG, Hains DS, Bissler J, Pendley BD, Lindner E. Generation, clearance, toxicity, and monitoring possibilities of unaccounted uremic toxins for improved dialysis prescriptions. Am J Physiol Renal Physiol 2018. [PMID: 29537310 DOI: 10.1152/ajprenal.00106.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Current dialysis-dosing calculations provide an incomplete assessment of blood purification. They exclude clearances of protein-bound uremic toxins (PB-UTs), such as polyamines, p-cresol sulfate, and indoxyl sulfate, relying solely on the clearance of urea as a surrogate for all molecules accumulating in patients with end-stage renal disease (ESRD). PB-UTs clear differently in dialysis but also during normal renal function. The kidney clears PB toxins via the process of secretion, whereas it clears urea through filtration. Herein, we review the clearance, accumulation, and toxicity of various UTs. We also suggest possible methods for their monitoring toward the ultimate goal of a more comprehensive dialysis prescription. A more inclusive dialysis prescription would retain the kidney-filtration surrogate, urea, and consider at least one PB toxin as a surrogate for UTs cleared through cellular secretion. A more comprehensive assessment of UTs that includes both secretion and filtration is expected to result in a better understanding of ESRD toxicity and consequently, to reduce ESRD mortality.
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Affiliation(s)
- James G Atherton
- Department of Biomedical Engineering, University of Memphis , Memphis, Tennessee.,Le Bonheur Children's Hospital , Memphis, Tennessee
| | | | - John Bissler
- Le Bonheur Children's Hospital , Memphis, Tennessee
| | - Bradford D Pendley
- Department of Biomedical Engineering, University of Memphis , Memphis, Tennessee
| | - Ernő Lindner
- Department of Biomedical Engineering, University of Memphis , Memphis, Tennessee
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Carpenter CP, Rawson A, Hains DS, Giel DW. Resolution of Diabetes Insipidus After Pyeloplasty: A Case Report and Review of the Literature. Urology 2018; 115:168-170. [PMID: 29499256 DOI: 10.1016/j.urology.2018.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/10/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022]
Abstract
Nephrogenic diabetes insipidus (NDI), a rare cause of polyuria and polydipsia in children, is usually managed with medications and careful monitoring of water intake. We present a child who was incidentally found to have right hydronephrosis secondary to ureteropelvic junction obstruction, and was subsequently also diagnosed with NDI. After being medically managed, he underwent open right pyeloplasty. His polydipsia abated within 1 month of surgery, and he has done well off of medications since that time. NDI resolution after correction of obstructive uropathy in adults has been reported, but this represents a novel case in pediatrics.
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Affiliation(s)
- Christina P Carpenter
- Division of Pediatric Urology, Le Bonheur Children's Hospital, Memphis, TN; Department of Urology, The University of Tennessee Health Science Center, Memphis, TN.
| | - Ashley Rawson
- Division of Nephrology, Riley Hospital for Children, Indianapolis, IN; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - David S Hains
- Division of Nephrology, Riley Hospital for Children, Indianapolis, IN; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Dana W Giel
- Division of Pediatric Urology, Le Bonheur Children's Hospital, Memphis, TN; Department of Urology, The University of Tennessee Health Science Center, Memphis, TN
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Mink R, Schwartz A, Carraccio C, High P, Dammann C, McGann KA, Kesselheim J, Herman B, Baffa G, Herman B, Turner DA, Fussell J, High P, Hsu D, Stafford D, Aye T, Sauer C, Kesselheim J, Myers A, McGann K, Dammann C, Chess P, Mahan J, Weiss P, Curran M, Schwartz A, Carraccio C, Herman B, Mink R, Havalad V, Pinheiro J, Alderman E, Fuloria M, McCabe ME, Mehta J, Rivas Y, Rosenberg M, Doughty C, Hergenroeder A, Kale A, Lee-Kim Y, Rama JA, Steuber P, Voigt B, Hardy K, Johnston S, Boyer D, Mauras C, Schonwald A, Sharma T, Barron C, Dennehy P, Jacobs ES, Welch J, Kumar D, Mason K, Roizen N, Rose JA, Bokor B, Chapman JI, Frank L, Sami I, Schuette J, Lutes RE, Savelli S, Amirnovin R, Harb R, Kato R, Marzan K, Monzavi R, Vanderbilt D, Doughty L, McAneney C, Rice W, Widdice L, Erenberg F, Gonzalez BE, Adkins D, Green D, Narayan A, Rehder K, Clingenpeel J, Starling S, Karpen HE, Rouster-Stevens K, Bhatia J, Fuqua J, Anders J, Trent M, Ramanathan R, Nicolau Y, Dozor AJ, Kinane TB, Stanley T, Rao AN, Bone M, Camarda L, Heffner V, Kim O, Nocton J, Rabbitt AL, Tower R, Amaya M, Jaroscak J, Kiger J, Macias M, Titus O, Awonuga M, Vogt K, Warwick A, Coury D, Hall M, Letson M, Rose M, Glickstein J, Lusman S, Roskind C, Soren K, Katz J, Siqueira L, Atlas M, Blaufox A, Gottleib B, Meryash D, Vuguin P, Weinstein T, Armsby L, Madison L, Scottoline B, Shereck E, Henry M, Teaford PA, Long S, Varlotta L, Zubrow A, Barlow C, Feldman H, Ganz H, Grimm P, Lee T, Weiner LB, Molle-Rios Z, Slamon N, Guillen U, Miller K, Federman M, Cron R, Hoover W, Simpson T, Winkler M, Harik N, Ross A, Al-Ibrahim O, Carnevale FP, Waz W, Bany-Mohammed F, Kim JH, Printz B, Brook M, Hermiston M, Lawson E, van Schaik S, McQueen A, Booth KVP, Tesher M, Barker J, Friedman S, Mohon R, Sirotnak A, Brancato J, Sayej WN, Maraqa N, Haller M, Stryjewski B, Brophy P, Rahhal R, Reinking B, Volk P, Bryant K, Currie M, Potter K, Falck A, Weiner J, Carney MM, Felt B, Barnes A, Bendel CM, Binstadt B, Carlson K, Garrison C, Moffatt M, Rosen J, Sharma J, Tieves KS, Hsu H, Kugler J, Simonsen K, Fastle RK, Dannaway D, Krishnan S, McGuinn L, Lowe M, Witchel SF, Matheo L, Abell R, Caserta M, Nazarian E, Yussman S, Thomas AD, Hains DS, Talati AJ, Adderson E, Kellogg N, Vasquez M, Allen C, Brion LP, Green M, Journeycake J, Yen K, Quigley R, Blaschke A, Bratton SL, Yost CC, Etheridge SP, Laskey T, Pohl J, Soprano J, Fairchild K, Norwood V, Johnston TA, Klein E, Kronman M, Nanda K, Smith L, Allen D, Frohna JG, Patel N, Estrada C, Fleming GM, Gillam-Krakauer M, Moore P, El Khoury JC, Helderman J, Barretto G, Levasseur K, Johnston L. Creating the Subspecialty Pediatrics Investigator Network. J Pediatr 2018; 192:3-4.e2. [PMID: 29246355 DOI: 10.1016/j.jpeds.2017.09.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Mink
- Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance, CA
| | | | | | - Pamela High
- W Alpert Medical School of Brown University, Providence, RI
| | | | | | | | - Bruce Herman
- University of Utah/Primary Children's Hospital, Salt Lake City, UT
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Saxena V, Hains DS, Ketz J, Chanley M, Spencer JD, Becknell B, Pierce KR, Nelson RD, Purkerson JM, Schwartz GJ, Schwaderer AL. Cell-specific qRT-PCR of renal epithelial cells reveals a novel innate immune signature in murine collecting duct. Am J Physiol Renal Physiol 2017; 315:F812-F823. [PMID: 28468965 DOI: 10.1152/ajprenal.00512.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The urinary tract is usually culture negative despite its close proximity to microbial flora. The precise mechanism by which the kidneys and urinary tract defends against infection is not well understood. The initial kidney cells to encounter ascending pathogens are the collecting tubule cells that consist of principal cells (PCs) that express aquaporin 2 (AQP2) and intercalated cells (ICs) that express vacuolar H+-ATPase (V-ATPase, B1 subunit). We have previously shown that ICs are involved with the human renal innate immune defense. Here we generated two reporter mice, VATPase B1-cre+tdT+ mice to fluorescently label ICs and AQP2-cre+tdT+ mice to fluorescently label PCs, and then performed flow sorting to enrich PCs and ICs for analysis. Isolated ICs and PCs along with proximal tubular cells were used to measure antimicrobial peptide (AMP) mRNA expression. ICs and PCs were significantly enriched for AMPs. Isolated ICs responded to uropathogenic Escherichia coli (UPEC) challenge in vitro and had higher RNase4 gene expression than control while both ICs and PCs responded to UPEC challenge in vivo by upregulating Defb1 mRNA expression. To our knowledge, this is the first report of isolating murine collecting tubule cells and performing targeted analysis for multiple classes of AMPs.
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Affiliation(s)
- Vijay Saxena
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University , Columbus, Ohio
| | - David S Hains
- Innate Immunity Translational Research Center, Children's Foundation Research Institute at Le Bonheur Children's Hospital , Memphis, Tennessee
| | - John Ketz
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University , Columbus, Ohio
| | - Melinda Chanley
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University , Columbus, Ohio
| | - John D Spencer
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University , Columbus, Ohio
| | - Brian Becknell
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University , Columbus, Ohio
| | - Keith R Pierce
- Innate Immunity Translational Research Center, Children's Foundation Research Institute at Le Bonheur Children's Hospital , Memphis, Tennessee
| | - Raoul D Nelson
- Division of Nephrology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Jeffrey M Purkerson
- University of Rochester Medical Center, School of Medicine and Dentistry , Rochester, New York
| | - George J Schwartz
- University of Rochester Medical Center, School of Medicine and Dentistry , Rochester, New York
| | - Andrew L Schwaderer
- The Research Institute at Nationwide Children's, Center for Clinical and Translational Research, Columbus, Ohio, and College of Medicine, Ohio State University , Columbus, Ohio
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Hains DS, Cohen HL, McCarville MB, Ellison EE, Huffman A, Glass S, Qureshi AH, Pierce KR, Cahill AL, Dixon A, Santos ND. Elucidation of Renal Scars in Children With Vesicoureteral Reflux Using Contrast-Enhanced Ultrasound: A Pilot Study. Kidney Int Rep 2017; 2:420-424. [PMID: 29142969 PMCID: PMC5678645 DOI: 10.1016/j.ekir.2017.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/19/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Vesicoureteral reflux is a common disorder in children but can result in kidney scarring following acute pyelonephritis. The gold standard diagnostic to detect renal scars in children is 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. DMSA has a number of limitations including radiation exposure, need for sedation, and radiotracer supply shortages. Contrast-enhanced ultrasound (CEUS) is a technique whereby biocompatible microspheres of inert gas are administered i.v. that reflect ultrasonography sound waves and do not involve radiation. Because the contrast agent is rapidly cleared, contrast images must be obtained within minutes of administration. CEUS has been used in a variety of organ systems, but its use in pediatric kidney diseases is limited. Methods In this study, we performed CEUS in 7 children with documented renal scars by radiographic imaging consistent with reflux nephropathy. Results In all subjects, CEUS detected all previously known radiologic abnormalities as well as detecting new areas of hypoenhancing renal parenchyma. None of the patients experienced any serious adverse events. Discussion This study represents the first report of using CEUS to characterize renal scars in children with reflux nephropathy. We conclude that CEUS is a highly sensitive, rapid, and cost-effective diagnostic imaging modality for detecting and monitoring renal scars in children with vesicoureteral reflux.
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Affiliation(s)
- David S. Hains
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Correspondence: David S. Hains, Department of Pediatrics, University of Tennessee Health Science Center, Center for Innate Immunity Translational Research, Children’s Foundation Research, 50 N. Dunlap, 369R, Memphis, Tennessee, USA 38103.Department of PediatricsUniversity of Tennessee Health Science CenterCenter for Innate Immunity Translational ResearchChildren’s Foundation Research50 N. Dunlap, 369RMemphisTennesseeUSA 38103
| | - Harris L. Cohen
- Department of Radiology, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - M. Beth McCarville
- Department of Diagnostic Imaging (MS 220), St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ellen E. Ellison
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amy Huffman
- Department of Radiology, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Stacey Glass
- Department of Radiology, Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
| | - Aslam H. Qureshi
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Keith R. Pierce
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ashlyn L. Cahill
- Center for Innate Immunity Translational Research, Children’s Foundation Research Institute at Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ashley Dixon
- Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Noel Delos Santos
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Abstract
AIM To find the trend in patient's visits to our centers for vesicoureteral reflux (VUR). We hypothesize that VUR diagnosis and hence possible nephropathy recognition may be diminishing because of changing practice patterns. METHODS Data were extracted from electronic medical records for new and follow-up patients aged 0-18 years with ICD-9/10 codes to correspond with VUR, VUR unilateral, VUR bilateral, and VUR with reflux nephropathy, as well as new patients with diagnoses of urinary tract infections (UTI) and pyelonephritis at two major pediatric centers from 2012 to 2015. Figures and statistics to reflect absolute clinic visits and annual trends were created with SPSS 2010. Linear regression was applied. RESULTS Annually, Le Bonheur Children's Hospital and Nationwide Children's Hospital experienced an average decrease of 13 and 17% in total VUR visits, and an average decrease of 22 and 27% in VUR nephropathy visits, respectively, for each institution. Patient visits for UTIs were reduced an average of 16% annually in both centers. Linear regression demonstrated that number of patients (patients/year ± SE) decreased annually 69 ± 19 (P = 0.02), 7 ± 2 (P = 0.02), and 67 ± 25 (P = 0.04) for VUR, VUR nephropathy, and UTI, respectively. CONCLUSION We conclude that the decreased number of VUR and VUR nephropathy cases identified in subspecialty clinics (Nephrology/Urology) at two major children's hospitals reflect a possible decreased identification of VUR. This trend may also be due to decreased referral of low grade cases of VUR. We cannot conclude that "undifferentiated UTI" referrals increased concomitantly to account for the decreased VUR as our data reflects a decreased trend in those visits as well. We suggest that clinicians following the American Academy of Pediatrics guidelines ensure that all UTI are accounted for and surveillance is appropriately escalated for recurrent UTI or abnormal imaging results.
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Affiliation(s)
- Aslam Hyder Qureshi
- Innate Immunity Translational Research Center, Children Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, United States.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Oluwaseun Ajayi
- Biomedical Informatics Core, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, United States
| | | | - David S Hains
- Innate Immunity Translational Research Center, Children Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, United States.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
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38
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Li B, Haridas B, Jackson AR, Cortado H, Mayne N, Kohnken R, Bolon B, McHugh KM, Schwaderer AL, Spencer JD, Ching CB, Hains DS, Justice SS, Partida-Sanchez S, Becknell B. Inflammation drives renal scarring in experimental pyelonephritis. Am J Physiol Renal Physiol 2017; 312:F43-F53. [PMID: 27760770 PMCID: PMC5283888 DOI: 10.1152/ajprenal.00471.2016] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/13/2016] [Indexed: 12/30/2022] Open
Abstract
Acquired renal scarring occurs in a subset of patients following febrile urinary tract infections and is associated with hypertension, proteinuria, and chronic kidney disease. Limited knowledge of histopathology, immune cell recruitment, and gene expression changes during pyelonephritis restricts the development of therapies to limit renal scarring. Here, we address this knowledge gap using immunocompetent mice with vesicoureteral reflux. Transurethral inoculation of uropathogenic Escherichia coli in C3H/HeOuJ mice leads to renal mucosal injury, tubulointerstitial nephritis, and cortical fibrosis. The extent of fibrosis correlates most significantly with inflammation at 7 and 28 days postinfection. The recruitment of neutrophils and inflammatory macrophages to infected kidneys is proportional to renal bacterial burden. Transcriptome analysis reveals molecular signatures associated with renal ischemia-reperfusion injury, immune cell chemotaxis, and leukocyte activation. This murine model recapitulates the cardinal histopathological features observed in humans with acquired renal scarring following pyelonephritis. The integration of histopathology, quantification of cellular immune influx, and unbiased transcriptional profiling begins to define potential mechanisms of tissue injury during pyelonephritis in the context of an intact immune response. The clear relationship between inflammatory cell recruitment and fibrosis supports the hypothesis that acquired renal scarring arises as a consequence of excessive host inflammation and suggests that immunomodulatory therapies should be investigated to reduce renal scarring in patients with pyelonephritis.
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Affiliation(s)
- Birong Li
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Babitha Haridas
- Department of Neurology, State University of New York at Buffalo, Buffalo, New York
| | - Ashley R Jackson
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Hanna Cortado
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas Mayne
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Rebecca Kohnken
- College of Veterinary Medicine and Comparative Pathology and Mouse Phenotyping Shared Resource, The Ohio State University, Columbus, Ohio
| | | | - Kirk M McHugh
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Anatomy, The Ohio State University College of Allied Health Sciences, Columbus, Ohio
| | - Andrew L Schwaderer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Division of Nephrology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - John David Spencer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Division of Nephrology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Christina B Ching
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Division of Urology, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - David S Hains
- Children's Research Foundation Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; and
| | - Sheryl S Justice
- Division of Urology, Department of Surgery, The Ohio State University, Columbus, Ohio
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Santiago Partida-Sanchez
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Brian Becknell
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio;
- Division of Nephrology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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Ambite I, Rydstrom G, Schwaderer AL, Hains DS. The Genetics of Urinary Tract Infections and the Innate Defense of the Kidney and Urinary tract. J Pediatr Genet 2016; 5:25-32. [PMID: 27617139 DOI: 10.1055/s-0035-1557110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 04/02/2015] [Indexed: 12/31/2022]
Abstract
The urinary tract is a sterile organ system. Urinary tract infections (UTIs) are common and often serious infections. Research has focused on uropathogen, environment, and host factors leading to UTI pathogenesis. A growing body of evidence exists implicating genetic factors that can contribute to UTI risks. In this review, we highlight genetic variations in aspects of the innate immune system critical to the host response to uropathogens. This overview includes genetic variations in pattern recognition receptor molecules, chemokines/cytokines, and neutrophil activation. We also comprehensively cover murine knockout models of UTI, genetic variations involved in renal scarring as a result of ascending UTIs, and asymptomatic bacteriuria.
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Affiliation(s)
- Ines Ambite
- Section of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Gustav Rydstrom
- Section of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Andrew L Schwaderer
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, United States
| | - David S Hains
- Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee, United States; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States
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Eichler TE, Becknell B, Easterling RS, Ingraham SE, Cohen DM, Schwaderer AL, Hains DS, Li B, Cohen A, Metheny J, Tridandapani S, Spencer JD. Insulin and the phosphatidylinositol 3-kinase signaling pathway regulate Ribonuclease 7 expression in the human urinary tract. Kidney Int 2016; 90:568-79. [PMID: 27401534 DOI: 10.1016/j.kint.2016.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/12/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
Diabetes mellitus is a systemic disease associated with a deficiency of insulin production or action. Diabetic patients have an increased susceptibility to infection with the urinary tract being the most common site. Recent studies suggest that Ribonuclease 7 (RNase 7) is a potent antimicrobial peptide that plays an important role in protecting the urinary tract from bacterial insult. Because the impact of diabetes on RNase 7 expression and function are unknown, we investigated the effects of insulin on RNase 7 using human urine specimens. The urinary RNase 7 concentrations were measured in healthy control patients and insulin-deficient type 1 diabetics before and after starting insulin therapy. Compared with controls, diabetic patients had suppressed urinary RNase 7 concentrations, which increased with insulin. Using primary human urothelial cells, the mechanisms by which insulin stimulates RNase 7 synthesis were next explored. Insulin induced RNase 7 production via the phosphatidylinositide 3-kinase signaling pathway (PI3K/AKT) to shield urothelial cells from uropathogenic E. coli. In contrast, uropathogenic E. coli suppressed PI3K/AKT activity and RNase 7 production. Thus, insulin and PI3K/AKT signaling are essential for RNase 7 expression and increased infection risks in diabetic patients may be secondary to suppressed RNase 7 production. Our data may provide unique insight into novel urinary tract infection therapeutic strategies in at-risk populations.
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Affiliation(s)
- Tad E Eichler
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Brian Becknell
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - Robert S Easterling
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Susan E Ingraham
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - Daniel M Cohen
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - Andrew L Schwaderer
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA
| | - David S Hains
- Innate Immunity Translational Research Center, Department of Pediatrics, Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Birong Li
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Ariel Cohen
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Jackie Metheny
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA
| | - Susheela Tridandapani
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA; Department of Molecular Virology, Immunology, and Medical Genetics, Comprehensive Cancer Center, The Ohio State University James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
| | - John David Spencer
- Center for Clinical and Translational Research, Department of Pediatrics, The Research Institute at Nationwide Children's, Columbus, Ohio, USA; Division of Nephrology, Department of Pediatrics, Nationwide Children's, Columbus, Ohio, USA.
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Abstract
The past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). Recently, a clinical debate has generated an open discussion in academic circles. New evidence has shifted treatment patterns away from widespread surgical management and recently brought into question some pharmacologic treatments. VUR is usually not hazardous by itself but is a significant risk factor for urinary tract infection (UTI) and less commonly, renal scarring and insufficiency. Given the costs and morbidity of UTI as well as the potential for significant renal injury, our approach remains conservative. Careful follow-up, parental education about pathophysiology and management of VUR and UTI, and management of bowel and bladder dysfunction (BBD) when present, are the foundation of treatment. Additionally, though we recognize the limitation of continuous antibiotic prophylaxis (CAP), we believe the benefits outweigh the risks and costs for many patients. Careful observation can be considered in patients with a single medical home, parental understanding of what UTI signs and symptoms are, low grade VUR, no history of complicated UTIs and close follow-up. Surgical management remains a relevant option for select patients who fail conservative measures with breakthrough UTIs or failure to resolve. Minimally invasive surgical options are available with acceptable outcomes though open ureteroneocystostomy still carries the highest success rate.
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Affiliation(s)
- Derrick L Johnston
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - Aslam H Qureshi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Tennessee Health Science Center
| | - Rhys W Irvine
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - Dana W Giel
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, University of Tennessee Health Science Center
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Schwaderer AL, Wang H, Kim S, Kline JM, Liang D, Brophy PD, McHugh KM, Tseng GC, Saxena V, Barr-Beare E, Pierce KR, Shaikh N, Manak JR, Cohen DM, Becknell B, Spencer JD, Baker PB, Yu CY, Hains DS. Polymorphisms in α-Defensin-Encoding DEFA1A3 Associate with Urinary Tract Infection Risk in Children with Vesicoureteral Reflux. J Am Soc Nephrol 2016; 27:3175-3186. [PMID: 26940096 DOI: 10.1681/asn.2015060700] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/13/2016] [Indexed: 12/12/2022] Open
Abstract
The contribution of genetic variation to urinary tract infection (UTI) risk in children with vesicoureteral reflux is largely unknown. The innate immune system, which includes antimicrobial peptides, such as the α-defensins, encoded by DEFA1A3, is important in preventing UTIs but has not been investigated in the vesicoureteral reflux population. We used quantitative real-time PCR to determine DEFA1A3 DNA copy numbers in 298 individuals with confirmed UTIs and vesicoureteral reflux from the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Study and 295 controls, and we correlated copy numbers with outcomes. Outcomes studied included reflux grade, UTIs during the study on placebo or antibiotics, bowel and bladder dysfunction, and renal scarring. Overall, 29% of patients and 16% of controls had less than or equal to five copies of DEFA1A3 (odds ratio, 2.09; 95% confidence interval, 1.40 to 3.11; P<0.001). For each additional copy of DEFA1A3, the odds of recurrent UTI in patients receiving antibiotic prophylaxis decreased by 47% when adjusting for vesicoureteral reflux grade and bowel and bladder dysfunction. In patients receiving placebo, DEFA1A3 copy number did not associate with risk of recurrent UTI. Notably, we found that DEFA1A3 is expressed in renal epithelium and not restricted to myeloid-derived cells, such as neutrophils. In conclusion, low DEFA1A3 copy number associated with recurrent UTIs in subjects in the RIVUR Study randomized to prophylactic antibiotics, providing evidence that copy number polymorphisms in an antimicrobial peptide associate with UTI risk.
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Affiliation(s)
| | - Huanyu Wang
- The Centers for Clinical and Translational Medicine and
| | | | | | - Dong Liang
- Innate Immunity Translational Research Center, Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Pat D Brophy
- Division of Nephrology, Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
| | - Kirk M McHugh
- Division of Anatomy, The Ohio State University, Columbus, Ohio
| | | | - Vijay Saxena
- The Centers for Clinical and Translational Medicine and
| | | | - Keith R Pierce
- Innate Immunity Translational Research Center, Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Nader Shaikh
- Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Robert Manak
- Departments of Biology and Pediatrics, University of Iowa, Iowa; and
| | | | | | | | - Peter B Baker
- Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Chack-Yung Yu
- Molecular and Human Genetics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - David S Hains
- Innate Immunity Translational Research Center, Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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Carpenter AR, Becknell MB, Ching CB, Cuaresma EJ, Chen X, Hains DS, McHugh KM. Uroplakin 1b is critical in urinary tract development and urothelial differentiation and homeostasis. Kidney Int 2015; 89:612-24. [PMID: 26880456 DOI: 10.1016/j.kint.2015.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/12/2015] [Accepted: 09/24/2015] [Indexed: 11/15/2022]
Abstract
Proper development and maintenance of urothelium is critical to its function. Uroplakins are expressed in developing and mature urothelium where they establish plaques associated with the permeability barrier. Their precise functional role in development and disease is unknown. Here, we disrupted Upk1b in vivo where its loss resulted in urothelial plaque disruption in the bladder and kidney. Upk1b(RFP/RFP) bladder urothelium appeared dysplastic with expansion of the progenitor cell markers, Krt14 and Krt5, increased Shh expression, and loss of terminal differentiation markers Krt20 and uroplakins. Upk1b(RFP/RFP) renal urothelium became stratified with altered cellular composition. Upk1b(RFP/RFP) mice developed age-dependent progressive hydronephrosis. Interestingly, 16% of Upk1b(RFP/RFP) mice possessed unilateral duplex kidneys. Our study expands the role of uroplakins, mechanistically links plaque formation to urinary tract development and function, and provides a tantalizing connection between congenital anomalies of the kidney and urinary tract along with functional deficits observed in a variety of urinary tract diseases. Thus, kidney and bladder urothelium are regionally distinct and remain highly plastic, capable of expansion through tissue-specific progenitor populations. Furthermore, Upk1b plays a previously unknown role in early kidney development representing a novel genetic target for congenital anomalies of the kidney and urinary tract.
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Affiliation(s)
- Ashley R Carpenter
- Molecular and Human Genetics, Nationwide Children's Hospital, Columbus, Ohio, USA; College of Medicine, Ohio State University, Columbus, Ohio, USA.
| | | | | | | | - Xi Chen
- Molecular and Human Genetics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - David S Hains
- Children's Foundation Research Institute at Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kirk M McHugh
- Molecular and Human Genetics, Nationwide Children's Hospital, Columbus, Ohio, USA; Division of Anatomy, Ohio State University, Columbus, Ohio, USA
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Barr-Beare E, Saxena V, Hilt EE, Thomas-White K, Schober M, Li B, Becknell B, Hains DS, Wolfe AJ, Schwaderer AL. The Interaction between Enterobacteriaceae and Calcium Oxalate Deposits. PLoS One 2015; 10:e0139575. [PMID: 26448465 PMCID: PMC4598009 DOI: 10.1371/journal.pone.0139575] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
Background The role of calcium oxalate crystals and deposits in UTI pathogenesis has not been established. The objectives of this study were to identify bacteria present in pediatric urolithiasis and, using in vitro and in vivo models, to determine the relevance of calcium oxalate deposits during experimental pyelonephritis. Methods Pediatric kidney stones and urine were collected and both cultured and sequenced for bacteria. Bacterial adhesion to calcium oxalate was compared. Murine kidney calcium oxalate deposits were induced by intraperitoneal glyoxalate injection and kidneys were transurethrally inoculated with uropathogenic Escherichia coli to induce pyelonephritis Results E. coli of the family Enterobacteriaceae was identified in patients by calcium oxalate stone culture. Additionally Enterobacteriaceae DNA was sequenced from multiple calcium oxalate kidney stones. E. coli selectively aggregated on and around calcium oxalate monohydrate crystals. Mice inoculated with glyoxalate and uropathogenic E. coli had higher bacterial burdens, increased kidney calcium oxalate deposits and an increased kidney innate immune response compared to mice with only calcium oxalate deposits or only pyelonephritis. Conclusions In a murine model, the presence of calcium oxalate deposits increases pyelonephritis risk, likely due to preferential aggregation of bacteria on and around calcium oxalate crystals. When both calcium oxalate deposits and uropathogenic bacteria were present, calcium oxalate deposit number increased along with renal gene transcription of inner stone core matrix proteins increased. Therefore renal calcium oxalate deposits may be a modifiable risk factor for infections of the kidney and urinary tract. Furthermore, bacteria may be present in calcium oxalate deposits and potentially contribute to calcium oxalate renal disease.
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Affiliation(s)
- Evan Barr-Beare
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Vijay Saxena
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Evann E. Hilt
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Krystal Thomas-White
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Megan Schober
- Nationwide Children’s Hospital, Division of Urology, Columbus, Ohio, United States of America
| | - Birong Li
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Brian Becknell
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
| | - David S. Hains
- Lebonheur Children’s Hospital, Division of Nephrology, Memphis, Tennessee, United States of America
| | - Alan J. Wolfe
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Andrew L. Schwaderer
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
- * E-mail:
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Caterino JM, Hains DS, Camargo CA, Quraishi SA, Saxena V, Schwaderer AL. A Prospective, Observational Pilot Study of the Use of Urinary Antimicrobial Peptides in Diagnosing Emergency Department Patients With Positive Urine Cultures. Acad Emerg Med 2015; 22:1226-30. [PMID: 26375724 DOI: 10.1111/acem.12770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Urinary tract infection (UTI) often represents a diagnostic challenge in the emergency department (ED) where urine culture results are generally not available and other tests demonstrate limited sensitivity and specificity. Antimicrobial peptides (AMPs) are components of the innate immune system that have demonstrated increased urinary levels in response to infection both in children and in adults with chronic UTI. The objective of this study was to determine the relationship between urinary AMP levels and positive urine cultures in adult ED patients with suspected UTI. METHODS This was a prospective, observational study of adult ED patients with suspected UTI. Enzyme-linked immunosorbent assays were performed to measure urine levels of AMPs: human neutrophil peptides 1-3 (HNP1-3), human α-defensin 5 (HD5), human beta defensin 2 (hBD-2), and cathelicidin (LL-37). Comparisons between positive and negative cultures were performed using Wilcoxon rank sum tests and receiver operating characteristic curves, with calculation of area under the curve (AUC). Data were also analyzed for the older adult subgroup. RESULTS Of 40 patients enrolled, 23 (58%) were ≥ 65 years, 25 were female (64%), and seven (17%) were nonwhite. Cultures were positive in 13 (32%), including seven in those ≥ 65 years old. HNP1-3, HD5, and hBD-2 levels were significantly higher in those with positive than negative urine cultures. Median HNP1-3 was 5.39 ng/mg (interquartile range [IQR] = 2.74 to 11.09) in positive vs. 0.81 ng/mg (IQR = 0.06 to 3.87) in negative cultures. Median HD5 was 4.75 pg/mg (IQR = 1.6 to 22.7) in positive versus 0.00 pg/mg (IQR = 0 to 2.60) in negative cultures, and median hBD-2 was 0.13 pg/mg (IQR = 0.08 to 0.17) in positive versus 0.02 pg/mg (IQR = 0 to 0.04) in negative cultures (p < 0.05 for all). Findings were similar for adults ≥ 65 years. The AUC was ≥ 0.75 for all three AMPs, both overall and in the older adult subgroup. LL-37 was not significantly higher in patients with positive urine culture. However, LL-37 expression is vitamin D dependent, and inadequate serum levels (< 30 ng/mL) were present in 72% of those tested. CONCLUSIONS Urinary levels of HNP1-3, HD5, and hBD-2 are significantly greater in the presence of positive urine cultures in ED patients with suspected UTI. These findings are maintained in the high-risk subgroup of older adults.
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Affiliation(s)
- Jeffrey M. Caterino
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | - David S. Hains
- Department of Pediatrics; Division of Nephrology; The University of Tennessee Health Sciences Center; Memphis TN
| | - Carlos A. Camargo
- Departments of Emergency Medicine and Epidemiology; Massachusetts General; Boston MA
| | | | - Vijay Saxena
- Department of Pediatrics; Division of Nephrology; Nationwide Children's Hospital; Columbus OH
| | - Andrew L. Schwaderer
- Department of Pediatrics; Division of Nephrology; Nationwide Children's Hospital; Columbus OH
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Schnaper HW, Schubert K, Perlman SA, Clark SL, Hains DS, Roach JL, Skversky AL, Spencer JD, Springel T, Swartz SJ, Norwood VF, Satlin LM. Training the next generation of pediatric nephrology advocates: the John E. Lewy Foundation Advocacy Scholars Program. J Pediatr 2015; 166:218-9.e1. [PMID: 25620507 DOI: 10.1016/j.jpeds.2014.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- H William Schnaper
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | | | - Sharon A Perlman
- Department of Pediatrics, University of South Florida Morsani College of Medicine, St Petersburgh, FL
| | - Stephanie L Clark
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - David S Hains
- Division of Nephrology, Le Bonheur Children's Hospital, Memphis, TN
| | - Jesse L Roach
- Division of Nephrology, University of Wisconsin American Family Children's Hospital, Madison, WI
| | - Amy L Skversky
- Division of Nephrology, Children's Hospital at Montefiore, Bronx, NY
| | | | - Tamar Springel
- Division of Nephrology, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Sarah J Swartz
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Lisa M Satlin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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Hrincius ER, Liedmann S, Finkelstein D, Vogel P, Gansebom S, Ehrhardt C, Ludwig S, Hains DS, Webby R, McCullers JA. Nonstructural protein 1 (NS1)-mediated inhibition of c-Abl results in acute lung injury and priming for bacterial co-infections: insights into 1918 H1N1 pandemic? J Infect Dis 2014; 211:1418-28. [PMID: 25367299 DOI: 10.1093/infdis/jiu609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/17/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nonstructural protein 1 (NS1) proteins from avian influenza viruses like the 1918 pandemic NS1 are capable of inhibiting the key signaling integrator c-Abl (Abl1), resulting in massive cytopathic cell alterations. METHODS In the current study, we addressed the consequences of NS1-mediated alteration of c-Abl on acute lung injury and pathogenicity in an in vivo mouse model. RESULTS Comparing isogenic strains that differ only in their ability to inhibit c-Abl, we observed elevated pathogenicity for the c-Abl-inhibiting virus. NS1-mediated blockade of c-Abl resulted in severe lung pathology and massive edema formation and facilitated secondary bacterial pneumonia. This phenotype was independent of differences in replication and immune responses, defining it as an NS1 virulence mechanism distinct from its canonical functions. Microarray analysis revealed extensive downregulation of genes involved in cell integrity and vascular endothelial regulation. CONCLUSIONS NS1 protein-mediated blockade of c-Abl signaling drives acute lung injury and primes for bacterial coinfections revealing potential insights into the pathogenicity of the 1918 pandemic virus.
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Affiliation(s)
| | - Swantje Liedmann
- Institute of Molecular Virology, University of Muenster, Germany
| | | | - Peter Vogel
- Department of Veterinary Pathology, St Jude Children's Research Hospital
| | | | | | - Stephan Ludwig
- Institute of Molecular Virology, University of Muenster, Germany
| | - David S Hains
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis
| | | | - Jonathan A McCullers
- Department of Infectious Diseases Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis
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Hains DS, Chen X, Saxena V, Barr-Beare E, Flemming W, Easterling R, Becknell B, Schwartz GJ, Schwaderer AL. Carbonic anhydrase 2 deficiency leads to increased pyelonephritis susceptibility. Am J Physiol Renal Physiol 2014; 307:F869-80. [PMID: 25143453 DOI: 10.1152/ajprenal.00344.2014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Carbonic anhydrase 2 regulates acid-base homeostasis, and recent findings have indicated a correlation between cellular control of acid-base status and the innate defense of the kidney. Mice deficient in carbonic anhydrase 2 (Car2(-/-) mice) have metabolic acidosis, impaired urine acidification, and are deficient in normal intercalated cells. The objective of the present study was to evaluate the biological consequences of carbonic anhydrase 2 deficiency in a murine model of pyelonephritis. Infection susceptibility and transcription of bacterial response components in Car2(-/-) mice were compared with wild-type littermate controls. Car2(-/-) mice had increased kidney bacterial burdens along with decreased renal bacterial clearance after inoculation compared with wild-type mice. Standardization of the urine pH and serum HCO(3)(-) levels did not substantially alter kidney infection susceptibility between wild-type and Car2(-/-) mice; thus, factors other than acid-base status are responsible. Car2(-/-) mice had significantly increased neutrophil-gelatinase-associated lipocalin mRNA and protein and expression at baseline and a marked decreased ability to upregulate key bacterial response genes during pyelonephritis. Our findings provide in vivo evidence that supports a role for carbonic anhydrase 2 and intercalated cells in promoting renal bacterial clearance. Decreased carbonic anhydrase expression results in increased antimicrobial peptide production by cells other than renal intercalated cells, which is not sufficient to prevent infection after a bacterial challenge.
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Affiliation(s)
- David S Hains
- Division of Nephrology, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Xi Chen
- Division of Nephrology, Le Bonheur Children's Hospital, Memphis, Tennessee; Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Vijay Saxena
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Evan Barr-Beare
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Weisi Flemming
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Robert Easterling
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Brian Becknell
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - George J Schwartz
- Department of Pediatrics, The University of Rochester, Rochester, New York
| | - Andrew L Schwaderer
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio;
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Spencer JD, Schwaderer AL, Becknell B, Watson J, Hains DS. The innate immune response during urinary tract infection and pyelonephritis. Pediatr Nephrol 2014; 29:1139-49. [PMID: 23732397 PMCID: PMC3800267 DOI: 10.1007/s00467-013-2513-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/16/2013] [Accepted: 05/08/2013] [Indexed: 11/27/2022]
Abstract
Despite its proximity to the fecal flora, the urinary tract is considered sterile. The precise mechanisms by which the urinary tract maintains sterility are not well understood. Host immune responses are critically important in the antimicrobial defense of the urinary tract. During recent years, considerable advances have been made in our understanding of the mechanisms underlying immune homeostasis of the kidney and urinary tract. Dysfunctions in these immune mechanisms may result in acute disease, tissue destruction and overwhelming infection. The objective of this review is to provide an overview of the innate immune response in the urinary tract in response to microbial assault. In doing so, we focus on the role of antimicrobial peptides-a ubiquitous component of the innate immune response.
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Affiliation(s)
- John David Spencer
- Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA,
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Rheault MN, Wei CC, Hains DS, Wang W, Kerlin BA, Smoyer WE. Increasing frequency of acute kidney injury amongst children hospitalized with nephrotic syndrome. Pediatr Nephrol 2014; 29:139-47. [PMID: 24037143 PMCID: PMC6556228 DOI: 10.1007/s00467-013-2607-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nephrotic syndrome (NS) is among the most common kidney diseases seen in children. The major complications of NS include infection, acute kidney injury (AKI), and thromboembolism (TE). The objective of this study was to analyze long-term trends in the epidemiology of major complications of pediatric NS. METHODS We used the Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 2000-2009 to perform an analysis of U.S. hospitalizations of children diagnosed with NS with or without infection, AKI or TE. RESULTS The frequency of NS hospitalizations complicated by AKI increased by 158 % between 2000 and 2009 (p < 0.001). The frequency of NS hospitalizations with infection and TE remained stable overall. Pneumonia was the most common infectious complication while peritonitis decreased by 50 % (p < 0.001). Importantly, development of any of these major complications of NS resulted in ∼2-3-fold increases in both hospital charges and length of stay. CONCLUSIONS It is concerning that the frequency of AKI in children hospitalized with NS has more than doubled in the past decade. Strategies to prevent or initiate earlier treatments for complications of NS could have a major impact on both morbidity and health care expenses.
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Affiliation(s)
| | - Chang-Ching Wei
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - David S. Hains
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
| | - Wei Wang
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
| | - Bryce A. Kerlin
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
| | - William E. Smoyer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
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