1
|
Cowell W, Limaye M, Brukbaker SG, Silverstein JS, Mehta-Lee SS, Kahn LG, Malaga-Dieguez L, Reiser J, Trasande L. Changes in plasma soluble urokinase plasminogen activator receptor levels across pregnancy and in relation to hypertensive disorders. Am J Obstet Gynecol MFM 2023; 5:100825. [PMID: 36775198 PMCID: PMC10655249 DOI: 10.1016/j.ajogmf.2022.100825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 02/12/2023]
Affiliation(s)
- Whitney Cowell
- Department of Pediatrics, NYU Grossman School of Medicine, Translational Research Bldg Room 809, 225 E 30th St., New York, NY 10016.
| | - Meghana Limaye
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY
| | - Sara G Brukbaker
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY
| | - Jenna S Silverstein
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY
| | - Shilpi S Mehta-Lee
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY
| | - Linda G Kahn
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | | | - Jochen Reiser
- Department of Internal Medicine, Rush Medical College, Chicago, IL
| | - Leonardo Trasande
- Division of Environmental Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| |
Collapse
|
2
|
Ramírez M, Chakravarti S, Busovsky-McNeal M, McKinstry J, Al-qaqaa Y, Sahulee R, Kumar TS, Li X, Goldberg JD, Gefen AM, Malaga-Dieguez L. Elevated Levels of Urinary Biomarkers TIMP-2 and IGFBP-7 Predict Acute Kidney Injury in Neonates after Congenital Heart Surgery. J Pediatr Intensive Care 2021; 11:153-158. [PMID: 35734207 PMCID: PMC9208843 DOI: 10.1055/s-0041-1740359] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives This article investigated the utility of urine biomarkers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in identifying acute kidney injury (AKI) in neonates after congenital heart surgery (CHS). TIMP-2 and IGFBP-7 are cell cycle arrest proteins detected in urine during periods of kidney stress/injury. Methods We conducted a single-center, prospective study between September 2017 and May 2019 with neonates undergoing CHS requiring cardiopulmonary bypass (CPB). Urine samples were analyzed using NephroCheck prior to surgery and 6, 12, 24, and 96 hours post-CPB. All patients were evaluated using the Acute Kidney Injury Network (AKIN) criteria. Wilcoxon rank sum tests were used to compare the medians of the [TIMP-2*IGFBP-7] values in the AKIN negative and positive groups at each time point. Receiver operating characteristic curves were used to measure how well the [TIMP-2*IGFBP-7] values predict AKIN status. Results Thirty-six patients were included. No patients met the AKIN criteria for AKI preoperatively. Postoperatively, 19 patients (53%) met the AKIN criteria for AKI diagnosis: 13 (36%) stage 1, 5 (14%) stage 2, and 1 (3%) stage 3. None required renal replacement therapy. At the 24-hour time points, patients who met the AKIN criteria for AKI had a statistically significantly higher [TIMP-2*IGFBP7] values than the patients without AKI (1.1 vs. 0.27 [ng/mL] 2 /1,000) at 24 hours (adj- p = 0.0019). Conclusion AKI is a serious complication associated with adverse outcomes in patients undergoing cardiac surgery. [TIMP-2*IGFBP-7] urinary level 24 hours after CPB is a good predictor of AKI in this population.
Collapse
Affiliation(s)
- Michelle Ramírez
- Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States,Address for correspondence Michelle Ramírez, MD 550 First Avenue New York, NY 10016United States
| | - Sujata Chakravarti
- Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
| | - Melissa Busovsky-McNeal
- Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
| | - Jaclyn McKinstry
- Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
| | - Yasir Al-qaqaa
- Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
| | - Raj Sahulee
- Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
| | - T.K. Susheel Kumar
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, United States
| | - Xiaochun Li
- Division of Biostatistics and NYU + HHC CTSI BERD, NYU Grossman School of Medicine, New York, United States
| | - Judith D. Goldberg
- Division of Biostatistics and NYU + HHC CTSI BERD, NYU Grossman School of Medicine, New York, United States
| | - Ashley M. Gefen
- Department of Nephrology, Cohen Children's Medical Center, New York, United States
| | - Laura Malaga-Dieguez
- Department of Nephrology, NYU Hassenfeld Children's Hospital, New York, United States
| |
Collapse
|
3
|
Malaga-Dieguez L, Trachtman H, Giusti R. Pulmonary Manifestations of Renal Disorders in Children. Pediatr Clin North Am 2021; 68:209-222. [PMID: 33228933 DOI: 10.1016/j.pcl.2020.09.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The causes of kidney disease in pediatric patients are evenly divided between congenital abnormalities of the kidney and urinary tract and acquired disorders. Nearly 10% to 15% of adults in the United States have chronic kidney disease (CKD); there are no comparable data in children. Regardless of patient age, CKD is a systemic problem that affects every organ system, including the lung. We review the tests used to diagnose and evaluate kidney disease and the main clinical syndromes that are likely to be encountered to aid the pulmonology consultant who is asked to evaluate patients with kidney disease.
Collapse
Affiliation(s)
- Laura Malaga-Dieguez
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA.
| | - Howard Trachtman
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
| | - Robert Giusti
- Division of Pediatric Pulmonology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
| |
Collapse
|
4
|
Delbarba E, Marasa M, Canetta PA, Piva SE, Chatterjee D, Kil BH, Mu X, Gibson KL, Hladunewich MA, Hogan JJ, Julian BA, Kidd JM, Laurin LP, Nachman PH, Rheault MN, Rizk DV, Sanghani NS, Trachtman H, Wenderfer SE, Gharavi AG, Bomback AS, Ahn W, Appel GB, Babayev R, Batal I, Bomback AS, Brown E, Campenot ES, Canetta P, Chan B, Chatterjee D, D’Agati VD, Delbarba E, Fernandez H, Foroncewicz B, Gharavi AG, Ghiggeri GM, Hines WH, Jain NG, Kil BH, Kiryluk K, Lau WL, Lin F, Lugani F, Marasa M, Markowitz G, Mohan S, Mu X, Mucha K, Nickolas TL, Piva S, Radhakrishnan J, Rao MK, Sanna-Cherchi S, Santoriello D, Stokes MB, Yu N, Valeri AM, Zviti R, Greenbaum LA, Smoyer WE, Al-Uzri A, Ashoor I, Aviles D, Baracco R, Barcia J, Bartosh S, Belsha C, Bowers C, Braun MC, Chishti A, Claes D, Cramer C, Davis K, Erkan E, Feig D, Freundlich M, Gbadegesin R, Hanna M, Hidalgo G, Hunley TE, Jain A, Kallash M, Khalid M, Klein JB, Lane JC, Mahan J, Mathews N, Nester C, Pan C, Patterson L, Patel H, Revell A, Rheault MN, Silva C, Sreedharan R, Srivastava T, Steinke J, Twombley K, Wenderfer SE, Vasylyeva TL, Weaver DJ, Wong CS, Almaani S, Ayoub I, Budisavljevic M, Derebail V, Fatima H, Falk R, Fogo A, Gehr T, Gibson K, Glenn D, Harris R, Hogan S, Jain K, Jennette JC, Julian B, Kidd J, Laurin LP, Massey HD, Mottl A, Nachman P, Nadasdy T, Novak J, Parikh S, Pichette V, Poulton C, Powell TB, Renfrow M, Rizk D, Rovin B, Royal V, Saha M, Sanghani N, Self S, Adler S, Alpers C, Matar RB, Brown E, Cattran D, Choi M, Dell KM, Dukkipati R, Fervenza FC, Fornoni A, Gadegbeku C, Gipson P, Hasely L, Hingorani S, Hladunewich M, Hogan J, Holzman LB, Jefferson JA, Jhaveri K, Johnstone DB, Kaskel F, Kogan A, Kopp J, Lafayette R, Lemley KV, Malaga-Dieguez L, Meyers K, Neu A, O’Shaughnessy MM, O’Toole JF, Parekh R, Reich H, Reidy K, Rondon H, Sambandam KK, Sedor JR, Selewski DT, Sethna CB, Schelling J, Sperati JC, Swiatecka-Urban A, Trachtman H, Tuttle KR, Weisstuch J, Vento S, Zhdanova O, Gillespie B, Gipson DS, Hill-Callahan P, Helmuth M, Herreshoff E, Kretzler M, Lienczewski C, Mansfield S, Mariani L, Nast CC, Robinson BM, Troost J, Wladkowski M, Zee J, Zinsser D, Guay-Woodford LM. Persistent Disease Activity in Patients With Long-Standing Glomerular Disease. Kidney Int Rep 2020; 5:860-871. [PMID: 32518868 PMCID: PMC7270998 DOI: 10.1016/j.ekir.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 03/09/2020] [Indexed: 11/03/2022] Open
Abstract
Introduction Methods Results Conclusion
Collapse
|
5
|
Contento MN, Vercillo RN, Malaga-Dieguez L, Pehrson LJ, Wang Y, Liu M, Stewart Z, Montgomery R, Trachtman H. Center Volume and Kidney Transplant Outcomes in Pediatric Patients. Kidney Med 2020; 2:297-306. [PMID: 32734249 PMCID: PMC7380383 DOI: 10.1016/j.xkme.2020.01.008] [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: 12/31/2022] Open
Abstract
Rationale & Objectives Recent data demonstrate that center volume is not a factor in the outcomes of adult kidney transplant recipients. This study assessed whether center volume affects graft survival in pediatric patients who received a kidney transplant. Study Design Case-cohort study. Setting & Participants Kidney transplantation centers, recipients younger than 18 years. Results Data were retrieved from the Scientific Registry of Transplant Recipients for transplantations performed July 1, 2010, to June 30, 2015, and the Organ Procurement and Transplantation Network for transplantations performed January 1, 2010, to December 30, 2015. Center volume was divided into 3 groups: low (<4 per year), intermediate (4-8 per year), and high (>8 per year). The primary outcome was 3-year graft survival rate. Outcomes were reviewed in 115 centers that performed 3,762 transplantations. There were no substantive differences in sex, age, ethnicity, diagnosis, and kidney donor profile index score in the 3 transplantation center volume categories. During the 5-year period (July 1, 2010, to June 30, 2015), 3-year graft survival in centers with low, intermediate, and high volumes were 88.4%, 90.3%, and 92.1%, respectively; P = 0.02. Although outcomes for deceased donor kidney recipients were similar in the 3 volume categories, outcomes in patients who received a living kidney donation were better in the high-volume centers. Low household income was associated with poorer outcomes. However, 3-year graft survival was similar in the 3 center volume categories in high and low mean household income states. Limitations Lack of information for complications and individual family household income of recipients. Conclusions Transplantation outcomes are worse in pediatric patients treated at lower-volume centers. The difference was more pronounced for patients receiving living versus deceased donor kidneys. The distribution of household income in pediatric transplant recipients may also be a factor that contributes to lower 3-year graft survival in low-volume centers.
Collapse
Affiliation(s)
- Marissa N Contento
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Rachel N Vercillo
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Laura Malaga-Dieguez
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Laura Jane Pehrson
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | - Yuyan Wang
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY
| | - Zoe Stewart
- Division of Transplantation, Department of Surgery, NYU Langone Health, New York, NY
| | - Robert Montgomery
- Division of Transplantation, Department of Surgery, NYU Langone Health, New York, NY
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| |
Collapse
|
6
|
Meyers N, Nelson-Williams C, Malaga-Dieguez L, Kaufmann H, Loring E, Knight J, Lifton RP, Trachtman H. Hypokalemia Associated With a Claudin 10 Mutation: A Case Report. Am J Kidney Dis 2018; 73:425-428. [PMID: 30482581 DOI: 10.1053/j.ajkd.2018.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/04/2018] [Accepted: 08/14/2018] [Indexed: 12/19/2022]
Abstract
Hypokalemia of renal origin can arise from genetic abnormalities in a variety of transporters or channel proteins that mediate tubular handling of potassium. Recently, mutations in claudin 10 have been documented in patients with hypokalemia in association with a range of other electrolyte abnormalities and skin and sweat gland manifestations. We report a 12-year-old Hispanic boy who presented with anhydrosis, aptyalism, alacrima, hypokalemia, and hypocalciuria, in whom we detected a homozygous mutation in the claudin 10 gene. During the 4-year follow-up period, he developed hypermagnesemia and a decline in estimated glomerular filtration rate to 59mL/min/1.73m2. His unaffected parents and siblings were heterozygous for the mutation. We summarize the clinical phenotype encountered in patients with claudin 10 mutations. It is characterized by significant heterogeneity in electrolyte and extrarenal abnormalities and is associated with a risk for progressive loss of kidney function in up to 33% of cases. Awareness of this association between claudin 10 mutations and electrolyte abnormalities, namely hypokalemia and hypermagnesemia, sheds new light on the physiology of potassium and magnesium handling along the nephron and increases the likelihood of identifying the underlying tubular mechanism in patients with newly diagnosed hypokalemia with or without concomitant hypermagnesemia.
Collapse
Affiliation(s)
- Nicole Meyers
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | | | - Laura Malaga-Dieguez
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY
| | | | - Erin Loring
- Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - James Knight
- Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, CT
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY.
| |
Collapse
|
7
|
Malaga-Dieguez L, Spencer R, Pehrson LJ, Vento S, Menzer K, Devinsky O, Trachtman H. Early manifestations of renal disease in patients with tuberous sclerosis complex. Int J Nephrol Renovasc Dis 2017; 10:91-95. [PMID: 28496353 PMCID: PMC5422499 DOI: 10.2147/ijnrd.s123638] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Renal manifestations are the second most significant cause of morbidity and mortality in patients with tuberous sclerosis complex (TSC), and include renal cysts, angiomyolipomas, fat-poor lesions, and malignant tumors. These lesions begin in childhood and often lead to chronic kidney disease (CKD). Little is known on the incidence of early modifiable risk factors of CKD, such as proteinuria and hypertension, or subtle decreases in glomerular filtration rate that correspond to the early stages of CKD in children with TSC. The impact of genotype on these early manifestations of CKD has not been investigated. Design Retrospective chart review of 84 children and young adults with TSC. Measurements This study assessed the prevalence of hypertension, renal impairment, and proteinuria, as well as the genotype–phenotype correlations. Results Children and young adults with TSC2 mutations had a significantly higher rate of renal lesions, hypertension (36% vs 14%), and decreased renal function than those with TSC1 mutations. Conclusion On the basis of estimated glomerular filtration rate and blood pressure, our findings are consistent with the hypothesis that TSC2 mutations are associated with more severe early renal involvement in children. There is a compelling need for close collaboration of nephrologists and neurologists to provide care to pediatric patients with TSC to improve screening and management of early manifestations of renal disease.
Collapse
Affiliation(s)
| | | | | | | | - Kimberly Menzer
- Department of Neurology, Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
| | - Orrin Devinsky
- Department of Neurology, Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
| | | |
Collapse
|
8
|
Kataria A, Trachtman H, Malaga-Dieguez L, Trasande L. Association between perfluoroalkyl acids and kidney function in a cross-sectional study of adolescents. Environ Health 2015; 14:89. [PMID: 26590127 PMCID: PMC4654837 DOI: 10.1186/s12940-015-0077-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [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: 08/13/2015] [Accepted: 11/18/2015] [Indexed: 05/19/2023]
Abstract
BACKGROUND Perfluoroalkyl acids are synthetic compounds widely used in industrial and commercial applications. Laboratory studies suggest that these persistent and bioaccumulative chemicals produce oxidant stress and damage glomerular endothelial cells, raising concern regarding the impact of these compounds on renal function. METHODS We performed cross-sectional analyses of data 1960 participants aged 12-19 years of the 2003-2010 National Health and Nutrition Examination Surveys. PFAA exposure was assessed using levels of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid, and perfluorohexane sulfonic acid. Primary study outcomes were estimated glomerular filtration rate (eGFR) and serum uric acid. RESULTS While adjusting for demographics, cotinine, prehypertension, insulin resistance, body mass index, and hypercholesterolemia, adolescents in the highest PFOA and PFOS quartile had a lower eGFR, 6.84 mL/min/1.73 m(2) (95% CI: 2.19 to 11.48) and 9.69 mL/min/1.73 m(2) (95 % CI: -4.59 to 14.78), respectively, compared to the lowest quartile. Highest PFOA and PFOS quartiles were also associated with 0.21 mg/dL (95% CI: 0.056 to 0.37) and 0.19 mg/dL (95% CI: 0.032 to 0.34) increases in uric acid, respectively. CONCLUSIONS PFAAs are associated with a reduction in kidney function and increased uric acid levels in otherwise healthy adolescents. Reverse causation and residual confounding could explain the results. Our study results confirm and amplify previous findings, though longitudinal studies examining prenatal and childhood biomarkers in relationship with robust measures of childhood renal function are needed.
Collapse
Affiliation(s)
- Anglina Kataria
- Department of Pediatrics, New York University School of Medicine, 227 East 30th St, Room 735, New York, NY, 10016, USA
| | - Howard Trachtman
- Department of Pediatrics, New York University School of Medicine, 227 East 30th St, Room 735, New York, NY, 10016, USA
| | - Laura Malaga-Dieguez
- Department of Pediatrics, New York University School of Medicine, 227 East 30th St, Room 735, New York, NY, 10016, USA
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, 227 East 30th St, Room 735, New York, NY, 10016, USA.
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
- Department of Population Health, New York University School of Medicine, New York, NY, USA.
- New York University Wagner School of Public Service, New York, NY, USA.
- Department of Nutrition, Food Studies, and Public Health, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA.
- New York University Global Institute of Public Health, New York, NY, USA.
| |
Collapse
|
9
|
Han SH, Malaga-Dieguez L, Chinga F, Kang HM, Tao J, Reidy K, Susztak K. Deletion of Lkb1 in Renal Tubular Epithelial Cells Leads to CKD by Altering Metabolism. J Am Soc Nephrol 2015; 27:439-53. [PMID: 26054542 DOI: 10.1681/asn.2014121181] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/12/2015] [Indexed: 12/30/2022] Open
Abstract
Renal tubule epithelial cells are high-energy demanding polarized epithelial cells. Liver kinase B1 (LKB1) is a key regulator of polarity, proliferation, and cell metabolism in epithelial cells, but the function of LKB1 in the kidney is unclear. Our unbiased gene expression studies of human control and CKD kidney samples identified lower expression of LKB1 and regulatory proteins in CKD. Mice with distal tubule epithelial-specific Lkb1 deletion (Ksp-Cre/Lkb1(flox/flox)) exhibited progressive kidney disease characterized by flattened dedifferentiated tubule epithelial cells, interstitial matrix accumulation, and dilated cystic-appearing tubules. Expression of epithelial polarity markers β-catenin and E-cadherin was not altered even at later stages. However, expression levels of key regulators of metabolism, AMP-activated protein kinase (Ampk), peroxisome proliferative activated receptor gamma coactivator 1-α (Ppargc1a), and Ppara, were significantly lower than those in controls and correlated with fibrosis development. Loss of Lkb1 in cultured epithelial cells resulted in energy depletion, apoptosis, less fatty acid oxidation and glycolysis, and a profibrotic phenotype. Treatment of Lkb1-deficient cells with an AMP-activated protein kinase (AMPK) agonist (A769662) or a peroxisome proliferative activated receptor alpha agonist (fenofibrate) restored the fatty oxidation defect and reduced apoptosis. In conclusion, we show that loss of LKB1 in renal tubular epithelial cells has an important role in kidney disease development by influencing intracellular metabolism.
Collapse
Affiliation(s)
- Seung Hyeok Han
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Laura Malaga-Dieguez
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frank Chinga
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hyun Mi Kang
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jianling Tao
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Kimberly Reidy
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; and
| | - Katalin Susztak
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| |
Collapse
|
10
|
Abstract
Hemophagocytic lymphohistiocytosis is a hyperinflammatory disorder resulting from primary or secondary immune dysfunction. AKI is frequent in severe hemophagocytic lymphohistiocytosis and has been attributed to multiorgan failure or the use of nephrotoxic drugs, but AKI is rarely considered a direct consequence of the disease process. We describe a child with familial hemophagocytic lymphohistiocytosis type 3 who developed AKI requiring prolonged renal replacement therapy because of severe renal inflammation. There was massive infiltration of the renal parenchyma by activated macrophages and cytotoxic T cells, and acute tubular injury. The patient responded to high-dose intravenous methylprednisolone, which resulted in improvement of renal function and discontinuation of renal replacement therapy. This case confirms the occurrence of reversible AKI due to hemophagocytic lymphohistiocytosis-induced activated macrophage infiltration of the renal parenchyma and inflammation.
Collapse
Affiliation(s)
| | - Wu Ming
- Pathology, New York University School of Medicine, New York, New York
| | | |
Collapse
|
11
|
Abstract
Focal segmental glomerulosclerosis (FSGS) is a rare but important cause of end-stage kidney disease in children and adults. Current therapy, consisting of corticosteroids and calcineurin inhibitors, fails to achieve a sustained remission in most patients. Therefore, there is a pressing need to develop new treatments for this glomerulopathy. Traditional approaches have focused on agents that modulate the immune system. In this review, we summarize preclinical and clinical data with newer agents that may ameliorate FSGS. We focus on drugs that inhibit immune injury or inflammation, such as abatacept, rituximab, adalimumab, and stem cells. The potential of agents that block the glomerular action of circulating permeability factors such as soluble urokinase receptor is reviewed. Finally, because fibrosis represents the final common pathway of glomerular damage in FSGS, the experience with a wide range of antifibrotic agents is presented. Despite extensive research on the podocyte dysfunction in the pathogenesis of FSGS, there are few agents that directly target podocyte structure or viability. We conclude that FSGS is a heterogeneous disorder and that intensified translational research is vital to improve our understanding of distinct subtypes that have a defined prognosis and predictable response to targeted therapeutic interventions.
Collapse
|
12
|
Lo T, Malaga-Dieguez L, Trachtman H. U.S. Preventive Services Task Force Recommendation and Pediatric Hypertension Screening: Dereliction of Duty or Call to Arms? J Clin Hypertens (Greenwich) 2014; 16:342-3. [DOI: 10.1111/jch.12301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tiffany Lo
- Division of Nephrology; Department of Pediatrics; NYU Langone Medical Center; New York NY
| | - Laura Malaga-Dieguez
- Division of Nephrology; Department of Pediatrics; NYU Langone Medical Center; New York NY
| | - Howard Trachtman
- Division of Nephrology; Department of Pediatrics; NYU Langone Medical Center; New York NY
| |
Collapse
|
13
|
Abstract
Steroid-resistant nephrotic syndrome has a poor prognosis and often leads to end-stage renal disease development. In this issue of the JCI, Ashraf and colleagues used exome sequencing to identify mutations in the aarF domain containing kinase 4 (ADCK4) gene that cause steroid-resistant nephrotic syndrome. Patients with ADCK4 mutations had lower coenzyme Q10 levels, and coenzyme Q10 supplementation ameliorated renal disease in a patient with this particular mutation, suggesting a potential therapy for patients with steroid-resistant nephrotic syndrome with ADCK4 mutations.
Collapse
|
14
|
Endemann M, Bergmeister H, Bidmon B, Boehm M, Csaicsich D, Malaga-Dieguez L, Arbeiter K, Regele H, Herkner K, Aufricht C. Evidence for HSP-mediated cytoskeletal stabilization in mesothelial cells during acute experimental peritoneal dialysis. Am J Physiol Renal Physiol 2007; 292:F47-56. [PMID: 17210795 DOI: 10.1152/ajprenal.00503.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Low biocompatibility of peritoneal dialysis fluid (PDF) injures mesothelial cells and activates their stress response. In this study, we investigated the role of heat shock proteins (HSP), the main cytoprotective effectors of the stress response, in cytoskeletal stabilization of mesothelial cells in experimental peritoneal dialysis. In cultured human mesothelial cells, cytoskeletal integrity was assessed by detergent extractability of marker proteins following in vitro PDF exposure. Effects of HSP on stabilization of ezrin were evaluated by a conditioning protocol (PDF pretreatment) and repair assay, based on coincubation of cytoskeletal protein fractions with recombinant HSP-72 or HSP-72 antibodies. In the rat model, detachment of mesothelial cells from their peritoneal monolayer during in vivo PDF exposure was assessed with and without overexpression of HSP-72 (by heat conditioning). In vitro, cytoskeletal disruption on sublethal PDF exposure was demonstrated by significantly altered detergent extractability of ezrin and ZO-1. Restoration was associated with significant induction and cytoskeletal redistribution of HSP during recovery. Both the conditioning protocol and in vitro repair assay provided evidence for HSP-72-mediated cytoskeletal stabilization. In the rat model, overexpression of HSP-72 following heat conditioning resulted in significantly reduced detachment of mesothelial cells on in vivo exposure to PDF. Our results establish an essential role of HSP in repair and cytoprotection of cytoskeletal integrity in mesothelial cells following acute in vitro and in vivo exposure to PDF. Repeated exposure to PDF, as is the rule in the clinical setting, may not only cause repeat injury to mesothelial cells but rather represents a kind of inadvertent conditioning treatment.
Collapse
|
15
|
Vargha R, Endemann M, Kratochwill K, Riesenhuber A, Wick N, Krachler AM, Malaga-Dieguez L, Aufricht C. Ex vivo reversal of in vivo transdifferentiation in mesothelial cells grown from peritoneal dialysate effluents. Nephrol Dial Transplant 2006; 21:2943-7. [PMID: 16861732 DOI: 10.1093/ndt/gfl355] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND During peritoneal dialysis (PD), epithelial-mesenchymal transition (EMT) is likely involved in aberrant healing and progressive peritoneal fibrosis. Recently, EMT of the kidney was actively reversed into the opposite direction, into mesenchymal-epithelial transition (MET), by treatment with bone morphogenic protein-7 (BMP-7). In this study, the potential for ex vivo interconversion of in vivo transdifferentiation processes was investigated in mesothelial cells. METHODS In vivo EMT was assessed in mesothelial cell cultures randomly grown from peritoneal effluents of seven patients on chronic PD. Then, ex vivo treatment with modulating factors was performed by incubating cobblestone-like cell cultures with transforming growth factor (TGF- beta1) and fibroblast-like cultures with BMP-7. Effects were assessed by morphological characterization, western analysis and reverse transcription-polymerase chain reaction of marker proteins ezrin and alpha-smooth muscle actin (alpha-SMA). RESULTS PD caused progressive in vivo EMT with loss of the epithelial phenotype in the majority of mesothelial cell cultures over a 12-month period. EMT was reproducible by ex vivo treatment of cultured cells with TGF-beta1, converting the epithelial to the fibroblast-like phenotype. Ex vivo treatment with BMP-7 reversed in vivo and ex vivo EMT. During rhBMP-7 incubation the fibroblast-like growth pattern reversed into a more epithelial morphology, the expression of ezrin increased and alpha-SMA decreased. CONCLUSION Our study shows that modulating factors of transdifferentiation, such as BMP-7, may be attractive tools in the balance between normal healing and aberrant profibrotic processes in mesothelial cells during peritoneal dialysis. Peritoneal-effluent-derived mesothelial cells are not mere biomarkers for in vivo EMT in the peritoneal cavity, but also represent an assay to test ex vivo interventions to reverse the profibrotic phenotype.
Collapse
Affiliation(s)
- Regina Vargha
- Kinderdialyse, Department of Pediatrics, AKH Wien, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|