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Obrișcă B, Mocanu V, Jurubiță R, Vrabie A, Berechet A, Lujinschi Ș, Sorohan B, Andronesi A, Achim C, Lupușoru G, Micu G, Caceaune N, Gherghiceanu M, Ismail G. Histological reappraisal of IgA nephropathy: the role of glomerular pattern of injury and mesangial complement deposition. BMC Nephrol 2024; 25:145. [PMID: 38658875 PMCID: PMC11040743 DOI: 10.1186/s12882-024-03577-z] [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] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a clear need to refine the histological assessment in IgA Nephropathy (IgAN). We sought to investigate the clinical significance of the light microscopy (LM) pattern of glomerular injury and of the intensity of mesangial C3 staining in IgAN. METHODS We conducted a retrospective, observational study that included all patients with biopsy-proven primary IgAN that had at least 12 months of follow-up. The LM pattern of glomerular injury was reevaluated based on a modified HAAS classification. Mesangial C3 deposition by immunofluorescence (IF) staining was scored semi-quantitatively. The study primary composite endpoint was defined as doubling of serum creatinine or ESRD (dialysis, renal transplant or eGFR < 15 ml/min). The secondary study endpoint was eGFR decline per year. RESULTS This cohort included 214 patients with IgAN (mean age, 41.4 ± 12.6 years), with a mean eGFR and median 24-h proteinuria of 55.2 ± 31.5 ml/min/1.73m2 and 1.5 g/day (IQR:0.8-3.25), respectively. The most frequent LM pattern was the mesangioproliferative (37.4%), followed by the sclerotic (22.5%) and proliferative/necrotizing patterns (21.4%). Regarding the IF findings, mild-moderate and intense mesangial C3 staining was present in 30.6% and 61.1% of patients, respectively. Those with sclerosing and crescentic patterns had the worst renal survival (5-year renal survival of 48.8% and 42.9%) and the highest rate of eGFR change/year (-2.32 ml/min/y and - 2.16 ml/min/y, respectively) compared to those with other glomerular patterns of injury. In addition, those with intense C3 staining reached the composite endpoint more frequently compared to those without intense C3 staining (35.5% vs. 21.4%, p = 0.04). After multivariate adjustment, patients with crescentic and sclerosing patterns had a 3.6-fold and 2.1-fold higher risk for the composite endpoint compared to those with mesangioproliferative pattern, while an intense mesangial C3 deposition being also associated with a worse renal outcome (HR, 3.33; 95%CI, 1.21-9.2). CONCLUSIONS We have shown that the LM pattern of glomerular injury and the intensity of mesangial C3 deposition might stratify more accurately the renal outcome in patients with IgAN.
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Affiliation(s)
- Bogdan Obrișcă
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
| | - Valentin Mocanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Roxana Jurubiță
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Alexandra Vrabie
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andreea Berechet
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Ștefan Lujinschi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Bogdan Sorohan
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andreea Andronesi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Camelia Achim
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriela Lupușoru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Nicu Caceaune
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihaela Gherghiceanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Victor Babes" National Institute of Pathology, Bucharest, Romania
| | - Gener Ismail
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
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Sorohan BM, Obrișcă B, Jurubiță R, Lupușoru G, Achim C, Andronesi A, Frățilă G, Berechet A, Micu G, Ismail G. Sodium citrate versus sodium bicarbonate for metabolic acidosis in patients with chronic kidney disease: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37475. [PMID: 38457574 PMCID: PMC10919529 DOI: 10.1097/md.0000000000037475] [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: 01/09/2024] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Metabolic acidosis (MA) is frequently associated with chronic kidney disease (CKD) progression. Our aim was to compare the effect of oral sodium citrate (SC) with that of oral sodium bicarbonate (SB) on renal function and serum bicarbonate correction, as well as to evaluate their safety profile in patients with MA of CKD. METHODS We conducted a prospective, single-center, randomized 1:1, parallel, controlled, unblinded clinical trial of 124 patients with MA and CKD stages 3b and 4. The primary outcome was the mean change in estimated glomerular filtration rate (eGFR). The secondary outcomes were mean change in serum bicarbonate level, eGFR decrease by 30%, eGFR decrease by 50%, dialysis, death or prolonged hospitalization, and a combined endpoint. RESULTS No significant difference was found between the groups in terms of mean eGFR change [adjusted mean difference = -0.99 mL/min/1.73 m2 (95% CI: -2.51 to 0.93, P = .20)]. We observed a mean serum bicarbonate change of 6.15 mmol/L [(95% CI: 5.55-6.74), P < .001] in the SC group and of 6.19 mmol/L [(95% CI: 5.54-6.83), P < .001] in the SB group, but no significant difference between the 2 groups [adjusted mean difference = 0.31 mmol/L (-0.22 to 0.85), P = .25]. Cox proportional hazard analysis showed similar risks regarding eGFR decrease by 30% (P = .77), eGFR decrease by 50% (P = .50), dialysis (P = .85), death or prolonged hospitalization (P = .29), and combined endpoint (P = .57). Study drug discontinuation due to adverse events was significantly more common in the SB group (17.7% vs 4.8%, P = .02). CONCLUSIONS SC and SB have a similar effect on kidney function decline, both improve serum bicarbonate level, but SB is associated with higher rates of medication discontinuation due to adverse events.
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Affiliation(s)
- Bogdan Marian Sorohan
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
- Fundeni Clinical Institute, Department of Kidney Transplantation, Bucharest, Romania
| | - Bogdan Obrișcă
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
| | - Roxana Jurubiță
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
| | - Gabriela Lupușoru
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
| | - Camelia Achim
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
| | - Andreea Andronesi
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
| | - Georgiana Frățilă
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
| | - Andreea Berechet
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
| | - Georgia Micu
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
| | - Gener Ismail
- “Carol Davila” University of Medicine and Pharmacy, Department of Nephrology, Bucharest, Romania
- Fundeni Clinical Institute, Department of Nephrology, Bucharest, Romania
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Frățilă G, Sorohan BM, Achim C, Andronesi A, Obrișcă B, Lupușoru G, Zilișteanu D, Jurubiță R, Bobeică R, Bălănică S, Micu G, Mocanu V, Ismail G. Oral Furosemide and Hydrochlorothiazide/Amiloride versus Intravenous Furosemide for the Treatment of Resistant Nephrotic Syndrome. J Clin Med 2023; 12:6895. [PMID: 37959360 PMCID: PMC10648037 DOI: 10.3390/jcm12216895] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Data on diuretic treatment in nephrotic syndrome (NS) are scarce. Our goal was to assess the non-inferiority of the combined oral diuretics (furosemide/hydrochlorothiazide/amiloride) compared to intravenous (i.v.) furosemide in patients with NS and resistant edema. METHODS We conducted a prospective randomized trial on 22 patients with resistant nephrotic edema (RNE), defined as hypervolemia and a FENa < 0.2%. Based on a computer-generated 1:1 randomization, we assigned patients to receive either intravenous furosemide (40 mg bolus and then continuous administration of 5 mg/h) or oral furosemide (40 mg/day) and hydrochlorothiazide/amiloride (50/5 mg/day) for a period of 5 days. Clinical and laboratory measurements were performed daily. Hydration status was assessed by bioimpedance on day 1 and at the end of day 5 after treatment initiation. The primary endpoint was weight change from baseline to day 5. Secondary endpoints were hydration status change measured by bioimpedance and safety outcomes (low blood pressure, severe electrolyte disturbances, acute kidney injury and worsening hypervolemia). RESULTS Primary endpoint analysis showed that after 5 days of treatment, there was a significant difference in weight change from baseline between groups [adjusted mean difference: -3.33 kg (95% CI: -6.34 to -0.31), p = 0.03], with a higher mean weight change in the oral diuretic treatment group [-7.10 kg (95% CI: -18.30 to -4.30) vs. -4.55 kg (95%CI: -6.73 to -2.36)]. Secondary endpoint analysis showed that there was no significant difference between groups regarding hydration status change [adjusted mean difference: -0.05 L (95% CI: -2.6 to 2.6), p = 0.96], with a mean hydration status change in the oral diuretic treatment group of -4.71 L (95% CI: -6.87 to -2.54) and -3.91 L (95% CI: -5.69 to -2.13) in the i.v. diuretic treatment group. We observed a significant decrease in adjusted mean serum sodium of -2.15 mmol/L [(95% CI: -4.25 to -0.05), p = 0.04]), favored by the combined oral diuretic treatment [-2.70 mmol/L (95% CI: -4.89 to -0.50) vs. -0.10 mmol/L (95%CI: -1.30 to 1.10)]. No statistically significant difference was observed between the two groups in terms of adverse events. CONCLUSIONS A combination of oral diuretics based on furosemide, amiloride and hydrochlorothiazide is non-inferior to i.v. furosemide in weight control of patients with RNE and a similar safety profile.
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Affiliation(s)
- Georgiana Frățilă
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
| | - Bogdan Marian Sorohan
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Camelia Achim
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Andronesi
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Obrișcă
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gabriela Lupușoru
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Diana Zilișteanu
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Roxana Jurubiță
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
| | - Raluca Bobeică
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
| | - Sonia Bălănică
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
| | - Valentin Mocanu
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
| | - Gener Ismail
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania; (G.F.); (C.A.); (A.A.); (B.O.); (G.L.); (D.Z.); (R.J.); (R.B.); (S.B.); (G.M.); (V.M.); (G.I.)
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Lupușoru G, Ailincăi I, Sorohan BM, Andronesi A, Achim C, Micu G, Caragheorgheopol A, Manda D, Lupușoru M, Ismail G. Serum soluble urokinase plasminogen activator receptor as a potential biomarker of renal impairment severity in diabetic nephropathy. Diabetes Res Clin Pract 2021; 182:109116. [PMID: 34728182 DOI: 10.1016/j.diabres.2021.109116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/26/2021] [Revised: 10/03/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
AIMS To investigate serum soluble form of urokinase-type plasminogen activator receptor (suPAR) in patients with diabetic kidney disease (DKD) and biopsy-proven diabetic nephropathy (DN), its correlation with histological parameters and its capacity as a biomarker for renal impairment severity. METHODS We conducted a cross-sectional study on 75 patients with diabetes mellitus (DM) and DKD, among whom 28 had biopsy-proven DN. RESULTS Among the 75 patients, 9 (12%) had type 1 and 66 (88%) type 2 DM. The median value of the serum suPAR level was 2857.2 pg/mL (1916.4-3700) in the entire cohort and 2472.1 pg/mL (1782.6-3745.8) in the biopsy-proven DN subgroup, respectively. suPAR was significantly correlated with diabetes duration, diabetic retinopathy, anti-proteinuric treatment, albuminuria, kidney function, DN class, interstitial fibrosis and tubular atrophy (IFTA) score and with interstitial inflammation score. suPAR had a good accuracy for the association with chronic kidney disease (CKD) stages G3b-5, macroalbuminuria, DN class IV, IFTA score 3 and interstitial inflammation score 2. CONCLUSIONS Serum suPAR was increased in DN patients and was associated with DM duration, diabetic retinopathy, renoprotective treatment, kidney function, proteinuria, DN class, IFTA and interstitial inflammation scores. Also, suPAR had a good capacity as a biomarker for advanced renal impairment and severe histological lesions of DN.
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Affiliation(s)
- Gabriela Lupușoru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Ioana Ailincăi
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Bogdan Marian Sorohan
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
| | - Andreea Andronesi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Camelia Achim
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andra Caragheorgheopol
- Research Department, "C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Dana Manda
- Research Department, "C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Mircea Lupușoru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gener Ismail
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
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