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Wenderfer SE, Cooper JC. Do we really need cyclophosphamide for lupus nephritis? Pediatr Nephrol 2024:10.1007/s00467-024-06367-9. [PMID: 38607424 DOI: 10.1007/s00467-024-06367-9] [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] [Received: 12/06/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
A 14-year-old patient presents with hematuria and proteinuria. Clinical evaluation reveals a positive anti-nuclear antibody titer, positive anti-double stranded DNA antibody and hypocomplementemia. Systemic lupus erythematosus (SLE) is diagnosed based on the 2019 EULAR/ACR (European League Against Rheumatism/American College of Rheumatology) classification criteria (Aringer et al. Arthritis Rheumatol 71:1400-1412, 2019). A kidney biopsy is performed that confirms the presence of immune complex glomerulonephritis, ISN-RPS (International Society of Nephrology/Renal Pathology Society) class IV (Bajema et al. Kidney Int 93:789-796, 2018). According to the latest clinical practice guidelines (Rovin et al. Kidney Int 100:753-779, 2021; Fanouriakis et al. Ann Rheum Dis 83:15-29, 2023), there are alternatives to treating this patient with cyclophosphamide. But what if this patient also presented with oliguria and volume overload requiring intensive care and dialysis? What if this patient also presented with altered mental status and seizures, and was diagnosed with neuropsychiatric lupus? What if this patient was also diagnosed with a pulmonary hemorrhage and respiratory failure? The clinical practice guidelines do not address these scenarios that are not uncommon in patients with SLE. Moreover, in some countries worldwide, patients do not have the privilege of access to biologics or more expensive alternatives. The purpose of this review is to evaluate the contemporary options for initial treatment of nephritis in patients with SLE.
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Affiliation(s)
- Scott E Wenderfer
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.
- Pediatric Nephrology, BC Children's Hospital, Vancouver, BC, Canada.
| | - Jennifer C Cooper
- Department of Pediatrics, University of Colorado, Denver, CO, USA
- Pediatric Rheumatology, Children's Hospital Colorado, Aurora, CO, USA
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2
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Wang CS, Sadun RE, Zhou W, Miller KR, Pyle L, Ardoin SP, Bacha C, Hause E, Hui-Yuen J, Ling N, Pereira M, Riebschleger M, Rouster-Stevens K, Sarkissian A, Shalen J, Soulsby W, Twilt M, Wu EY, Lewandowski LB, Wenderfer SE, Cooper JC. Renal Response Outcomes of the EuroLupus and National Institutes of Health Cyclophosphamide Dosing Regimens in Childhood-Onset Proliferative Lupus Nephritis. Arthritis Rheumatol 2024; 76:469-478. [PMID: 37800549 DOI: 10.1002/art.42725] [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: 10/03/2022] [Revised: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE We compared clinical characteristics and renal response in patients with childhood-onset proliferative lupus nephritis (LN) treated with the EuroLupus versus National Institutes of Health (NIH) cyclophosphamide (CYC) regimen. METHODS A retrospective cohort study was conducted at 11 pediatric centers in North America that reported using both CYC regimens. Data were extracted from the electronic medical record at baseline and 3, 6, and 12 months after treatment initiation with CYC. To evaluate the adjusted association between CYC regimen (EuroLupus vs NIH) and renal response over time, generalized estimating equations with a logit link were used. An interaction between time and CYC regimen was included, and a contrast between CYC regimens at 12 months was used to evaluate the primary outcome. RESULTS One hundred forty-five patients (58 EuroLupus, 87 NIH) were included. EuroLupus patients were on average older at the start of current CYC therapy, had longer disease duration, and more commonly had relapsed or refractory LN compared with the NIH group. After multivariable adjustment, there was no significant association between CYC regimen and achieving complete renal response at 12 months (odds ratio [OR] of response for the EuroLupus regimen, reference NIH regimen: 0.76; 95% confidence interval [CI] 0.29-1.98). There was also no significant association between CYC regimen and achieving at least a partial renal response at 12 months (OR 1.35, 95% CI 0.57-3.19). CONCLUSION Our study failed to demonstrate a benefit of the NIH regimen over the EuroLupus CYC regimen in childhood-onset proliferative LN. However, future prospective outcome studies are needed.
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Affiliation(s)
| | | | - Wenru Zhou
- University of Colorado Anschutz Medical Campus, Aurora
| | | | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Aurora
| | | | | | - Emily Hause
- University of Minnesota Masonic Children's Hospital, Minneapolis
| | - Joyce Hui-Yuen
- Cohen Children's Medical Center, New Hyde Park, New York
| | | | - Maria Pereira
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Kelly Rouster-Stevens
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | - Julia Shalen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Marinka Twilt
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Laura B Lewandowski
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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De Mutiis C, Wenderfer SE, Basu B, Bagga A, Orjuela A, Sar T, Aggarwal A, Jain A, Yap HK, Teo S, Ito S, Ohnishi A, Iwata N, Kasapcopur O, Yildiz M, Laurent A, Mastrangelo A, Ogura M, Shima Y, Rianthavorn P, Silva CA, Trindade V, Gianviti A, Akinori M, Hamada R, Fujimura J, Minamikawa S, Kamiyoshi N, Kaito H, Ishimori S, Iannuzzella F, Tullus K. International cohort of 382 children with lupus nephritis - presentation, treatment and outcome at 24 months. Pediatr Nephrol 2023; 38:3699-3709. [PMID: 37221349 DOI: 10.1007/s00467-023-06018-5] [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: 01/20/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Children with lupus have a higher chance of nephritis and worse kidney outcome than adult patients. METHODS We retrospectively analyzed clinical presentation, treatment and 24-month kidney outcome in a cohort of 382 patients (≤ 18 years old) with lupus nephritis (LN) class ≥ III diagnosed and treated in the last 10 years in 23 international centers. RESULTS The mean age at onset was 11 years 9 months and 72.8% were females. Fifty-seven percent and 34% achieved complete and partial remission at 24-month follow-up, respectively. Patients with LN class III achieved complete remission more often than those with classes IV or V (mixed and pure). Only 89 of 351 patients maintained stable complete kidney remission from the 6th to 24th months of follow-up. eGFR ≥ 90 ml/min/1.73 m2 at diagnosis and biopsy class III were predictive of stable kidney remission. The youngest and the oldest age quartiles (2y-9y, 5m) (14y, 2m-18y,2m) showed lower rates of stable remission (17% and 20.7%, respectively) compared to the two other age groups (29.9% and 33.7%), while there was no difference in gender. No difference in achieving stable remission was found between children who received mycophenolate or cyclophosphamide as induction treatment. CONCLUSION Our data show that the rate of complete remission in patients with LN is still not high enough. Severe kidney involvement at diagnosis was the most important risk factor for not achieving stable remission while different induction treatments did not impact outcome. Randomized treatment trials involving children and adolescents with LN are needed to improve outcome for these children. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Chiara De Mutiis
- Paediatric Unit, Maggiore Hospital, Azienda USL, Bologna, Italy.
| | - Scott E Wenderfer
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Alvaro Orjuela
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Tanmoy Sar
- Division of Pediatric Nephrology, Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Avinash Jain
- Department of Clinical Immunology and Rheumatology, Sawai Mansingh Medical College, Jaipur, India
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sharon Teo
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, Japan
| | - Ai Ohnishi
- Department of Pediatrics, Yokohama City University, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Audrey Laurent
- Department of Pediatric Nephrology, Rheumatology and Dermatology, Hospices Civils de Lyon, Lyon, France
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Pornpimol Rianthavorn
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Trindade
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra Gianviti
- Division of Nephrology and Dialysis, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Miyazono Akinori
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Riku Hamada
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Junya Fujimura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shogo Minamikawa
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naohiro Kamiyoshi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kaito
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Ishimori
- Department of Pediatrics, Aijinkai Takatsuki General Hospital, Osaka, Japan
| | | | - Kjell Tullus
- Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Cody EM, Wenderfer SE, Sullivan KE, Kim AHJ, Figg W, Ghumman H, Qiu T, Huang B, Devarajan P, Brunner HI. Urine biomarker score captures response to induction therapy with lupus nephritis. Pediatr Nephrol 2023; 38:2679-2688. [PMID: 36715772 PMCID: PMC10393841 DOI: 10.1007/s00467-023-05888-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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Renal Activity Index for Lupus (RAIL) consists of urine protein assessment of neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, monocyte chemotactic protein 1, adiponectin, hemopexin, and ceruloplasmin, which non-invasively identifies lupus nephritis (LN). We aimed to delineate RAIL scores with inactive versus active LN and changes over time with response to LN induction therapy. METHODS There were 128 pediatric patients with systemic lupus erythematosus (SLE) and age-matched healthy controls recruited in a prospective case control study, with kidney biopsy confirmation of LN. Laboratory and clinical information was recorded and urine collected at diagnosis and end of induction and during maintenance therapy. Response to therapy was assessed by repeat kidney biopsy or laboratory parameters. Urine was assayed for RAIL biomarkers and the RAIL score calculated. RESULTS Pediatric RAIL (pRAIL) scores from 128 children and young adults with SLE (with/without LN: 70/38) including 25 during LN induction therapy, differentiated clinically active LN from inactive LN or without LN, and controls (all p < 0.0017). pRAIL scores significantly decreased with complete LN remission by 1.07 ± 1.7 (p = 0.03). CONCLUSIONS The RAIL biomarkers differentiate LN patients based on activity of kidney disease, with decreases of ≥ 1 in pRAIL scores indicating complete response to induction therapy. Significantly lower RAIL scores in healthy controls and in SLE patients without known LN raise the possibility of subclinical kidney disease. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ellen M Cody
- Division of Nephrology, Hypertension and Pheresis, Department of Pediatrics, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus, Box 8116, St. Louis, MO, 63110, USA.
| | - Scott E Wenderfer
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Nephrology, B.C. Children's Hospital, Vancouver, BC, Canada
| | - Kathleen E Sullivan
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Wesley Figg
- Medical School, Baylor College of Medicine, Houston, TX, USA
| | - Harneet Ghumman
- Department of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tingting Qiu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Hermine I Brunner
- Department of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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5
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Roberts JE, Burn C, Sadun RE, Smitherman EA, Wenderfer SE, Son MBF. Real-world use and outcomes of belimumab in childhood-onset lupus: A single-center retrospective study. Lupus 2023:9612033231187752. [PMID: 37410059 DOI: 10.1177/09612033231187752] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Studies of real-world effectiveness of belimumab in adults with systemic lupus erythematosus have shown improved disease control and decreased oral glucocorticoid use. However, belimumab use outside of clinical trial settings has not been well studied in childhood-onset systemic lupus erythematosus (cSLE). We aimed to characterize indications for belimumab use and evaluate oral glucocorticoid doses and disease activity scores in the year following belimumab initiation at a single, large pediatric rheumatology center. METHODS We included children and young adults with cSLE who received ≥ 1 dose of belimumab. Repeated measures one-way ANOVA was used to compare SLEDAI-2K scores and prednisone-equivalent daily oral glucocorticoid doses at baseline, 6 months, and 12 months after belimumab initiation for those who continued therapy for a year. RESULTS We identified 21 patients with cSLE who received ≥ 1 dose of belimumab. The median disease duration at belimumab initiation was 30.8 months [IQR 21.0-79.1]. At the time of belimumab initiation, 100% of patients were taking an antimalarial, 81% were on oral glucocorticoids, and 91% were on at least one conventional DMARD. Thirteen patients (62%) continued belimumab for ≥6 months and 11 (52%) for ≥12 months. Among those continuing belimumab for ≥12 months, median [IQR] oral prednisone daily doses in milligrams at baseline, 6 months, and 12 months were 12.5 [7.5-17.5], 9 [6.25-10], and 5 [5-9.5], p = 0.037, and median [IQR] SLEDAI-2K scores at baseline, 6 months, and 12 months were 8 [5.5-10.5], 6 [3.5-10], and 6 [6-8.5], p = 0.548, respectively. CONCLUSIONS In our cohort of pediatric patients with lupus and moderate disease activity treated with belimumab for ≥12 months, daily oral glucocorticoid doses were significantly lower 6 and 12 months after belimumab initiation than baseline. Use in patients with active nephritis was uncommon. Further research is needed in a large, multicenter cohort to determine the real-world effectiveness of belimumab in children and develop guidelines for use.
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Affiliation(s)
- Jordan E Roberts
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Cordelia Burn
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Mary Beth F Son
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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6
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Kiryluk K, Sanchez-Rodriguez E, Zhou XJ, Zanoni F, Liu L, Mladkova N, Khan A, Marasa M, Zhang JY, Balderes O, Sanna-Cherchi S, Bomback AS, Canetta PA, Appel GB, Radhakrishnan J, Trimarchi H, Sprangers B, Cattran DC, Reich H, Pei Y, Ravani P, Galesic K, Maixnerova D, Tesar V, Stengel B, Metzger M, Canaud G, Maillard N, Berthoux F, Berthelot L, Pillebout E, Monteiro R, Nelson R, Wyatt RJ, Smoyer W, Mahan J, Samhar AA, Hidalgo G, Quiroga A, Weng P, Sreedharan R, Selewski D, Davis K, Kallash M, Vasylyeva TL, Rheault M, Chishti A, Ranch D, Wenderfer SE, Samsonov D, Claes DJ, Akchurin O, Goumenos D, Stangou M, Nagy J, Kovacs T, Fiaccadori E, Amoroso A, Barlassina C, Cusi D, Del Vecchio L, Battaglia GG, Bodria M, Boer E, Bono L, Boscutti G, Caridi G, Lugani F, Ghiggeri G, Coppo R, Peruzzi L, Esposito V, Esposito C, Feriozzi S, Polci R, Frasca G, Galliani M, Garozzo M, Mitrotti A, Gesualdo L, Granata S, Zaza G, Londrino F, Magistroni R, Pisani I, Magnano A, Marcantoni C, Messa P, Mignani R, Pani A, Ponticelli C, Roccatello D, Salvadori M, Salvi E, Santoro D, Gembillo G, Savoldi S, Spotti D, Zamboli P, Izzi C, Alberici F, Delbarba E, Florczak M, Krata N, Mucha K, Pączek L, Niemczyk S, Moszczuk B, Pańczyk-Tomaszewska M, Mizerska-Wasiak M, Perkowska-Ptasińska A, Bączkowska T, Durlik M, Pawlaczyk K, Sikora P, Zaniew M, Kaminska D, Krajewska M, Kuzmiuk-Glembin I, Heleniak Z, Bullo-Piontecka B, Liberek T, Dębska-Slizien A, Hryszko T, Materna-Kiryluk A, Miklaszewska M, Szczepańska M, Dyga K, Machura E, Siniewicz-Luzeńczyk K, Pawlak-Bratkowska M, Tkaczyk M, Runowski D, Kwella N, Drożdż D, Habura I, Kronenberg F, Prikhodina L, van Heel D, Fontaine B, Cotsapas C, Wijmenga C, Franke A, Annese V, Gregersen PK, Parameswaran S, Weirauch M, Kottyan L, Harley JB, Suzuki H, Narita I, Goto S, Lee H, Kim DK, Kim YS, Park JH, Cho B, Choi M, Van Wijk A, Huerta A, Ars E, Ballarin J, Lundberg S, Vogt B, Mani LY, Caliskan Y, Barratt J, Abeygunaratne T, Kalra PA, Gale DP, Panzer U, Rauen T, Floege J, Schlosser P, Ekici AB, Eckardt KU, Chen N, Xie J, Lifton RP, Loos RJF, Kenny EE, Ionita-Laza I, Köttgen A, Julian BA, Novak J, Scolari F, Zhang H, Gharavi AG. Genome-wide association analyses define pathogenic signaling pathways and prioritize drug targets for IgA nephropathy. Nat Genet 2023; 55:1091-1105. [PMID: 37337107 DOI: 10.1038/s41588-023-01422-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 12/06/2021] [Accepted: 05/05/2023] [Indexed: 06/21/2023]
Abstract
IgA nephropathy (IgAN) is a progressive form of kidney disease defined by glomerular deposition of IgA. Here we performed a genome-wide association study of 10,146 kidney-biopsy-diagnosed IgAN cases and 28,751 controls across 17 international cohorts. We defined 30 genome-wide significant risk loci explaining 11% of disease risk. A total of 16 loci were new, including TNFSF4/TNFSF18, REL, CD28, PF4V1, LY86, LYN, ANXA3, TNFSF8/TNFSF15, REEP3, ZMIZ1, OVOL1/RELA, ETS1, IGH, IRF8, TNFRSF13B and FCAR. The risk loci were enriched in gene orthologs causing abnormal IgA levels when genetically manipulated in mice. We also observed a positive genetic correlation between IgAN and serum IgA levels. High polygenic score for IgAN was associated with earlier onset of kidney failure. In a comprehensive functional annotation analysis of candidate causal genes, we observed convergence of biological candidates on a common set of inflammatory signaling pathways and cytokine ligand-receptor pairs, prioritizing potential new drug targets.
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Affiliation(s)
- Krzysztof Kiryluk
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.
- Institute for Genomic Medicine, Columbia University, New York City, NY, USA.
| | - Elena Sanchez-Rodriguez
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Xu-Jie Zhou
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Francesca Zanoni
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Lili Liu
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Nikol Mladkova
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Atlas Khan
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Maddalena Marasa
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Jun Y Zhang
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Olivia Balderes
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Simone Sanna-Cherchi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
- Institute for Genomic Medicine, Columbia University, New York City, NY, USA
| | - Andrew S Bomback
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Pietro A Canetta
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Gerald B Appel
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Jai Radhakrishnan
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Hernan Trimarchi
- Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Ben Sprangers
- Department of Microbiology and Immunology, Laboratory of Molecular Immunology, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Daniel C Cattran
- Department of Nephrology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Heather Reich
- Department of Nephrology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - York Pei
- Department of Nephrology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Pietro Ravani
- Division of Nephrology, Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Dita Maixnerova
- 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Vladimir Tesar
- 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Benedicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM Clinical Epidemiology Team, Villejuif, France
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint Quentin University, INSERM Clinical Epidemiology Team, Villejuif, France
| | - Guillaume Canaud
- Université de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Maillard
- Nephrology, Dialysis, and Renal Transplantation Department, University North Hospital, Saint Etienne, France
| | - Francois Berthoux
- Nephrology, Dialysis, and Renal Transplantation Department, University North Hospital, Saint Etienne, France
| | | | - Evangeline Pillebout
- Center for Research on Inflammation, University of Paris, INSERM and CNRS, Paris, France
| | - Renato Monteiro
- Center for Research on Inflammation, University of Paris, INSERM and CNRS, Paris, France
| | - Raoul Nelson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Robert J Wyatt
- Division of Pediatric Nephrology, University of Tennessee Health Sciences Center, Memphis, TN, USA
- Children's Foundation Research Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - William Smoyer
- Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - John Mahan
- Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Al-Akash Samhar
- Division of Pediatric Nephrology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Guillermo Hidalgo
- Division of Pediatric Nephrology, Department of Pediatrics, HMH Hackensack University Medical Center, Hackensack, NJ, USA
| | - Alejandro Quiroga
- Division of Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Patricia Weng
- Division of Pediatric Nephrology, Mattel Children's Hospital, Los Angeles, CA, USA
| | - Raji Sreedharan
- Division of Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David Selewski
- Division of Pediatric Nephrology, Mott Children's Hospital, Ann Arbor, MI, USA
| | - Keefe Davis
- Division of Pediatric Nephrology, Department of Pediatrics, The Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Mahmoud Kallash
- Division of Pediatric Nephrology, SUNY Buffalo, Buffalo, NY, USA
| | - Tetyana L Vasylyeva
- Division of Pediatric Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Michelle Rheault
- Division of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - Aftab Chishti
- Division of Pediatric Nephrology, University of Kentucky, Lexington, KY, USA
| | - Daniel Ranch
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Scott E Wenderfer
- Division of Pediatric Nephrology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Dmitry Samsonov
- Division of Pediatric Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Donna J Claes
- Division of Pediatric Nephrology, Department of Pediatrics, New York Medical College, New York City, NY, USA
| | - Oleh Akchurin
- Division of Pediatric Nephrology, Department of Pediatrics, Weill Cornell Medical College, New York City, NY, USA
| | | | - Maria Stangou
- The Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Judit Nagy
- 2nd Department of Internal Medicine, Nephrological and Diabetological Center, University of Pécs, Pécs, Hungary
| | - Tibor Kovacs
- 2nd Department of Internal Medicine, Nephrological and Diabetological Center, University of Pécs, Pécs, Hungary
| | - Enrico Fiaccadori
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Amoroso
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristina Barlassina
- Renal Division, Dipartimento di Medicina, Chirurgia e Odontoiatria, San Paolo Hospital, School of Medicine, University of Milan, Milan, Italy
| | - Daniele Cusi
- Renal Division, Dipartimento di Medicina, Chirurgia e Odontoiatria, San Paolo Hospital, School of Medicine, University of Milan, Milan, Italy
| | | | | | | | - Emanuela Boer
- Division of Nephrology and Dialysis, Gorizia Hospital, Gorizia, Italy
| | - Luisa Bono
- Nephrology and Dialysis, A.R.N.A.S. Civico and Benfratelli, Palermo, Italy
| | - Giuliano Boscutti
- Nephrology, Dialysis and Renal Transplant Unit, S. Maria della Misericordia Hospital, ASUFC, Udine, Italy
| | - Gianluca Caridi
- Division of Nephrology, Dialysis and Transplantation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - Francesca Lugani
- Division of Nephrology, Dialysis and Transplantation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - GianMarco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - Rosanna Coppo
- Regina Margherita Children's Hospital, Torino, Italy
| | - Licia Peruzzi
- Regina Margherita Children's Hospital, Torino, Italy
| | | | | | | | | | - Giovanni Frasca
- Division of Nephrology, Dialysis and Renal Transplantation, Riuniti Hospital, Ancona, Italy
| | | | - Maurizio Garozzo
- Unità Operativa di Nefrologia e Dialisi, Ospedale di Acireale, Acireale, Italy
| | - Adele Mitrotti
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Simona Granata
- Renal Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University of Verona, Verona, Italy
| | | | - Riccardo Magistroni
- Department of Surgical, Medical, Dental, Oncologic and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Pisani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Magnano
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Piergiorgio Messa
- Nephrology Dialysis and Kidney Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Renzo Mignani
- Azienda Unità Sanitaria Locale Rimini, Rimini, Italy
| | - Antonello Pani
- Department of Nephrology and Dialysis, G. Brotzu Hospital, Cagliari, Italy
| | | | - Dario Roccatello
- Nephrology and Dialysis Unit, G. Bosco Hub Hospital (ERK-net Member) and University of Torino, Torino, Italy
| | - Maurizio Salvadori
- Division of Nephrology and Renal Transplantation, Carreggi Hospital, Florence, Italy
| | - Erica Salvi
- Renal Division, DMCO (Dipartimento di Medicina, Chirurgia e Odontoiatria), San Paolo Hospital, School of Medicine, University of Milan, Milan, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, AOU G Martino, University of Messina, Messina, Italy
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, AOU G Martino, University of Messina, Messina, Italy
| | - Silvana Savoldi
- Unit of Nephrology and Dialysis, ASL TO4-Consultorio Cirié, Turin, Italy
| | | | | | - Claudia Izzi
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Federico Alberici
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Elisa Delbarba
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Michał Florczak
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Krata
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Disease, Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Barbara Moszczuk
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Teresa Bączkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan Medical University, Poznan, Poland
| | - Przemyslaw Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | - Dorota Kaminska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Clinical Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Kuzmiuk-Glembin
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Zbigniew Heleniak
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Barbara Bullo-Piontecka
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Liberek
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Dębska-Slizien
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | | | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Szczepańska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Dyga
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Edyta Machura
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Katarzyna Siniewicz-Luzeńczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Monika Pawlak-Bratkowska
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Dariusz Runowski
- Department of Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Norbert Kwella
- Department of Nephrology, Hypertension and Internal Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Ireneusz Habura
- Department of Nephrology, Karol Marcinkowski Hospital, Zielona Góra, Poland
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Larisa Prikhodina
- Division of Inherited and Acquired Kidney Diseases, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russia
| | - David van Heel
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bertrand Fontaine
- Sorbonne University, INSERM, Center of Research in Myology, Institute of Myology, University Hospital Pitie-Salpetriere, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service of Neuro-Myology, University Hospital Pitie-Salpetriere, Paris, France
| | - Chris Cotsapas
- Departments of Neurology and Genetics, Yale University, New Haven, CT, USA
| | | | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Vito Annese
- CBP American Hospital, Dubai, United Arab Emirates
| | - Peter K Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institutes for Medical Research, North Shore LIJ Health System, New York City, NY, USA
| | | | - Matthew Weirauch
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leah Kottyan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John B Harley
- US Department of Veterans Affairs Medical Center and Cincinnati Education and Research for Veterans Foundation, Cincinnati, OH, USA
| | - Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hajeong Lee
- Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - BeLong Cho
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Murim Choi
- Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ans Van Wijk
- Amsterdam University Medical Centre, VU University Medical Center (VUMC), Amsterdam, the Netherlands
| | - Ana Huerta
- Hospital Universitario Puerta del Hierro Majadahonda, REDINREN, IISCIII, Madrid, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory and Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, REDINREN, IISCIII, Barcelona, Spain
| | - Jose Ballarin
- Molecular Biology Laboratory and Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau, Universitat Autònoma de Barcelona, REDINREN, IISCIII, Barcelona, Spain
| | - Sigrid Lundberg
- Department of Nephrology, Danderyd University Hospital, and Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laila-Yasmin Mani
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasar Caliskan
- Division of Nephrology, Saint Louis University, Saint Louis, MO, USA
| | - Jonathan Barratt
- John Walls Renal Unit, University Hospitals of Leicester, Leicester, UK
| | | | | | - Daniel P Gale
- Department of Renal Medicine, University College London, London, UK
| | | | - Thomas Rauen
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Pascal Schlosser
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Richard P Lifton
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Laboratory of Human Genetics and Genomics, The Rockefeller University, New York City, NY, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research, Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eimear E Kenny
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York City, NY, USA
- Center for Population Genomic Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Iuliana Ionita-Laza
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Bruce A Julian
- Departments of Microbiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jan Novak
- Departments of Microbiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Francesco Scolari
- Department of Medical and Surgical Specialties and Nephrology Unit, University of Brescia-ASST Spedali Civili, Brescia, Italy
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Ali G Gharavi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.
- Institute for Genomic Medicine, Columbia University, New York City, NY, USA.
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8
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Inthavong H, Vanarsa K, Castillo J, Hicks MJ, Mohan C, Wenderfer SE. Urinary CD163 is a marker of active kidney disease in childhood-onset lupus nephritis. Rheumatology (Oxford) 2023; 62:1335-1342. [PMID: 35961024 PMCID: PMC9977135 DOI: 10.1093/rheumatology/keac465] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 03/14/2022] [Revised: 07/22/2022] [Accepted: 08/06/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the utility of urine CD163 for detecting disease activity in childhood-onset SLE (cSLE) patients. METHODS Sixty consecutive pediatric patients fulfilling four or more ACR criteria for SLE and 20 healthy controls were recruited for testing of urinary CD163 using ELISA. SLE disease activity was assessed using the SLEDAI-2K. RESULTS Urine CD163 was significantly higher in patients with active LN than inactive SLE patients and healthy controls, with receiver operating characteristics area under the curve values ranging from 0.93 to 0.96. LN was ascertained by kidney biopsy. Levels of CD163 significantly correlated with the SLEDAI, renal SLEDAI, urinary protein excretion and C3 complement levels. Urine CD163 was also associated with high renal pathology activity index and chronicity index, correlating strongly with interstitial inflammation and interstitial fibrosis based on the examination of concurrent kidney biopsies. CONCLUSION Urine CD163 emerges as a promising marker for identifying cSLE patients with active kidney disease. Longitudinal studies are warranted to validate the clinical utility of urine CD163 in tracking kidney disease activity in children with lupus.
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Affiliation(s)
| | - Kamala Vanarsa
- Department of Biomedical Engineering, University of Houston
| | | | - M John Hicks
- Department of Pathology, Texas Children’s Hospital
- Department of Immunology and Pathology, Baylor College of Medicine
| | - Chandra Mohan
- Department of Biomedical Engineering, University of Houston
| | - Scott E Wenderfer
- Renal Section, Texas Children’s Hospital
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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9
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Krissberg JR, O'Shaughnessy MM, Smith AR, Helmuth ME, Almaani S, Aviles DH, Brathwaite KE, Cai Y, Cattran D, Gbadegesin R, Glenn DA, Greenbaum LA, Iragorri S, Jain K, Khalid M, Kidd J, Kopp J, Lafayette R, Lane JC, Lugani F, Nestor JG, Parekh RS, Reidy K, Selewski DT, Sethna CB, Sperati CJ, Tuttle K, Twombley K, Vasylyeva TL, Weaver DJ, Wenderfer SE, Gibson K. Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease. Am J Kidney Dis 2023; 81:318-328.e1. [PMID: 36191724 PMCID: PMC9974571 DOI: 10.1053/j.ajkd.2022.08.010] [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: 01/28/2022] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE The effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort. EXPOSURE Race and ethnicity as a participant-reported social factor. OUTCOME Acute care utilization defined as hospitalizations or emergency department visits. ANALYTICAL APPROACH Multivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and acute care utilization. RESULTS Black or Hispanic participants had lower SES and more severe glomerular disease than White or Asian participants. Acute care utilization rates were 45.6, 29.5, 25.8, and 19.2 per 100 person-years in Black, Hispanic, White, and Asian adults, respectively, and 55.8, 42.5, 40.8, and 13.0, respectively, for children. Compared with the White race (reference group), Black race was significantly associated with acute care utilization in adults (rate ratio [RR], 1.76 [95% CI, 1.37-2.27]), although this finding was attenuated after multivariable adjustment (RR, 1.31 [95% CI, 1.03-1.68]). Black race was not significantly associated with acute care utilization in children; Asian race was significantly associated with lower acute care utilization in children (RR, 0.32 [95% CI 0.14-0.70]); no significant associations between Hispanic ethnicity and acute care utilization were identified. LIMITATIONS We used proxies for SES and lacked direct information on income, household unemployment, or disability. CONCLUSIONS Significant differences in acute care utilization rates were observed across racial and ethnic groups in persons with prevalent glomerular disease, although many of these difference were explained by differences in SES and disease severity. Measures to combat socioeconomic disadvantage in Black patients and to more effectively prevent and treat glomerular disease are needed to reduce disparities in acute care utilization, improve patient wellbeing, and reduce health care costs.
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Affiliation(s)
- Jill R Krissberg
- Division of Pediatric Nephrology, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Michelle M O'Shaughnessy
- Department of Renal Medicine, Cork University Hospital, Ireland; and School of Medicine, University College Cork, Ireland
| | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Salem Almaani
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Diego H Aviles
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Kaye E Brathwaite
- Division of Pediatric/Nephrology, Children's Hospital at Montefiore/Einstein, Bronx, New York
| | - Yi Cai
- Pediatric Nephrology, Dialysis and Transplantation, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Daniel Cattran
- Division of Nephrology, University Health Network, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Rasheed Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, North Carolina
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Larry A Greenbaum
- Division of Pediatric Nephrology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Koyal Jain
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Myda Khalid
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jason Kidd
- Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Richard Lafayette
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Jerome C Lane
- Division of Pediatric Nephrology, Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Francesca Lugani
- L'Unità Operativa Complessa Nefrology, Dialysis and Transplant, Laboratorio di Nefrologia Molecolare, Istituto Giannina Gaslini Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Jordan G Nestor
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Rulan S Parekh
- Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Kimberly Reidy
- Division of Pediatric/Nephrology, Children's Hospital at Montefiore/Einstein, Bronx, New York
| | - David T Selewski
- Department of Pediatrics, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Christine B Sethna
- Division of Pediatric Nephrology, Cohen Children's Medical Center, New Hyde Park, New York
| | - C John Sperati
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Tuttle
- Providence Health Care, Department of Medicine, Division of Nephrology, University of Washington, Spokane and Seattle, Washington
| | - Katherine Twombley
- Department of Pediatrics, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Tetyana L Vasylyeva
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Donald J Weaver
- Division of Pediatric Nephrology and Hypertension, Atrium Health Levine Children's, Charlotte, North Carolina
| | - Scott E Wenderfer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Keisha Gibson
- Department of Medicine and Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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10
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Patel P, de Guzman M, Hicks MJ, Maliakkal JG, Rheault MN, Selewski DT, Twombley K, Misurac JM, Tran CL, Constantinescu AR, Onder AM, Seamon M, Seeherunvong W, Singh V, Pan C, Okamura DM, Omoloja A, Kallash M, Smoyer WE, Hidalgo G, Wenderfer SE. Utility of the 2018 revised ISN/RPS thresholds for glomerular crescents in childhood-onset lupus nephritis: a Pediatric Nephrology Research Consortium study. Pediatr Nephrol 2022; 37:3139-3145. [PMID: 35347402 DOI: 10.1007/s00467-022-05524-2] [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] [Received: 11/13/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The revised 2018 ISN/RPS Classification System for lupus nephritis (LN) includes calculations for both activity index (A.I.) and chronicity index (C.I.). Unchanged were the thresholds of < 25%, 25-50%, and > 50% crescents to distinguish between mild, moderate, and severe activity/chronicity. We aimed to evaluate these thresholds for percent crescents in childhood-onset LN. METHODS Eighty-six subjects < 21 years of age were enrolled from the Pediatric Glomerulonephritis with Crescents Registry, a retrospective multi-center cohort sponsored by the Pediatric Nephrology Research Consortium. Thresholds of 10%, 25%, and 50% for both cellular/fibrocellular and fibrous crescents were interrogated for primary outcomes of kidney failure, eGFR, and eGFR slope. RESULTS Median age at time of initial biopsy was 14 years (range 1-21). Median follow-up time was 3 years (range 1-11). Cumulative incidence of kidney failure was 6% at 1 year and 10% at latest follow-up. Median eGFR slope was - 18 mL/1.73 m2/min (IQR - 51 to + 8) at 1 year and - 3 mL/min/1.73 m2/year (IQR - 19 to + 6) at latest follow-up. We found no difference in kidney failure at the proposed < 25% and 25-50% cellular crescents thresholds, and thus added a new provisional threshold of 10% that better predicted outcomes in children. Moreover, use of 10% and 25% thresholds for fibrous crescents showed a fourfold and sevenfold increase in risk of kidney failure. CONCLUSIONS In children with crescentic LN, use of 10% and 25% thresholds for cellular crescents better reflects disease activity, while these thresholds for fibrous crescents better discriminates kidney disease outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Pooja Patel
- Pediatric Rheumatology, Texas Children's Hospital, TX, Houston, USA.,Baylor College of Medicine, Houston, TX, USA.,Pediatric Rheumatology, Northwestern University, Chicago, IL, USA
| | - Marietta de Guzman
- Pediatric Rheumatology, Texas Children's Hospital, TX, Houston, USA.,Baylor College of Medicine, Houston, TX, USA
| | - M John Hicks
- Baylor College of Medicine, Houston, TX, USA.,Pathology, Texas Children's Hospital, Houston, TX, USA
| | | | | | - David T Selewski
- Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Twombley
- Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Jason M Misurac
- Pediatric Nephrology, University of Iowa, Iowa City, IA, USA
| | - Cheryl L Tran
- Pediatric Nephrology, Mayo Clinic, Rochester, MN, USA
| | | | - Ali M Onder
- Pediatric Nephrology, University of Mississippi, Jackson, MS, USA
| | - Meredith Seamon
- Pediatric Nephrology, University of Utah, Salt Lake City, UT, USA
| | | | - Vaishali Singh
- Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cynthia Pan
- Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daryl M Okamura
- Pediatric Nephrology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Abiodun Omoloja
- Pediatric Nephrology, Wright State University, Dayton, OH, USA
| | - Mahmoud Kallash
- Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - William E Smoyer
- Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Scott E Wenderfer
- Baylor College of Medicine, Houston, TX, USA. .,Pediatric Nephrology, Texas Children's Hospital, Houston, TX, USA.
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11
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Ames EG, Powell C, Engen RM, Weaver DJ, Mansuri A, Rheault MN, Sanderson K, Lichter-Konecki U, Daga A, Burrage LC, Ahmad A, Wenderfer SE, Luckritz KE. Multisite Retrospective Review of Outcomes in Renal Replacement Therapy for Neonates with Inborn Errors of Metabolism. J Pediatr 2022; 246:116-122.e1. [PMID: 35358588 PMCID: PMC9233075 DOI: 10.1016/j.jpeds.2022.03.043] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/24/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the outcomes of neonates in a contemporary multi-institutional cohort who receive renal replacement therapy (RRT) for hyperammonemia. STUDY DESIGN We performed a retrospective analysis of 51 neonatal patients with confirmed inborn errors of metabolism that were treated at 9 different children's hospitals in the US between 2000 and 2015. RESULTS Twenty-nine patients received hemodialysis (57%), 21 patients received continuous renal replacement therapy (41%), and 1 patient received peritoneal dialysis (2%). The median age at admission of both survivors (n = 33 [65%]) and nonsurvivors (n = 18) was 3 days. Peak ammonia and ammonia at admission were not significantly different between survivors and nonsurvivors. Hemodialysis, having more than 1 indication for RRT in addition to hyperammonemia, and complications during RRT were all risk factors for mortality. After accounting for multiple patient factors by multivariable analyses, hemodialysis was associated with a higher risk of death compared with continuous renal replacement therapy. When clinical factors including evidence of renal dysfunction, number of complications, concurrent extracorporeal membrane oxygenation, vasopressor requirement, and degree of hyperammonemia were held constant in a single Cox regression model, the hazard ratio for death with hemodialysis was 4.07 (95% CI 0.908-18.2, P value = .067). To help providers caring for neonates with hyperammonemia understand their patient's likelihood of survival, we created a predictive model with input variables known at the start of RRT. CONCLUSIONS Our large, multicenter retrospective review supports the use of continuous renal replacement therapy for neonatal hyperammonemia.
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Affiliation(s)
- Elizabeth G. Ames
- Division of Pediatric Genetics, Metabolism, and Genomic Medicine, Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI
| | - Corey Powell
- Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI
| | - Rachel M. Engen
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald J. Weaver
- Division of Nephrology and Hypertension, Department of Pediatrics, Atrium Health Levine Children’s, Charlotte, NC
| | - Asif Mansuri
- Children’s Hospital of Georgia, Augusta University, Augusta, GA
| | | | - Keia Sanderson
- University of North Carolina Department of Medicine-Nephrology, Chapel Hill, NC
| | - Uta Lichter-Konecki
- Division of Genetic and Genomic Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Ankana Daga
- Division of Nephrology, Boston Children’s Hospital, Boston, MA
| | - Lindsay C. Burrage
- Department of Pediatrics, Baylor College of Medicine, Houston, TX;,Texas Children’s Hospital, Houston, TX
| | - Ayesha Ahmad
- Division of Pediatric Genetics, Metabolism, and Genomic Medicine, Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI
| | - Scott E. Wenderfer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX;,Texas Children’s Hospital, Houston, TX
| | - Kera E. Luckritz
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI
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12
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Soliman SA, Haque A, Vanarsa K, Zhang T, Ismail F, Lee KH, Pedroza C, Greenbaum LA, Mason S, Hicks MJ, Wenderfer SE, Mohan C. Urine ALCAM, PF4 and VCAM-1 Surpass Conventional Metrics in Identifying Nephritis Disease Activity in Childhood-Onset Systemic Lupus Erythematosus. Front Immunol 2022; 13:885307. [PMID: 35720325 PMCID: PMC9204340 DOI: 10.3389/fimmu.2022.885307] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 02/27/2022] [Accepted: 04/28/2022] [Indexed: 12/20/2022] Open
Abstract
Objectives Serial kidney biopsy for repeat evaluation and monitoring of lupus nephritis (LN) in childhood-onset Systemic Lupus Erythematosus (cSLE) remains challenging, thus non-invasive biomarkers are needed. Here, we evaluate the performance of ten urine protein markers of diverse nature including cytokines, chemokines, and adhesion molecules in distinguishing disease activity in cSLE. Methods Eighty-four pediatric patients meeting ≥4 ACR criteria for SLE were prospectively enrolled for urine assay of 10 protein markers normalized to urine creatinine, namely ALCAM, cystatin-C, hemopexin, KIM-1, MCP-1, NGAL, PF-4, Timp-1, TWEAK, and VCAM-1 by ELISA. Samples from active renal (LN) and active non-renal SLE patients were obtained prior to onset/escalation of immunosuppression. SLE disease activity was evaluated using SLEDAI-2000. 59 patients had clinically-active SLE (SLEDAI score ≥4 or having a flare), of whom 29 patients (34.5%) were classified as active renal, and 30 patients (35.7%) were active non-renal. Twenty-five healthy subjects were recruited as controls. Results Urine concentrations of ALCAM, KIM-1, PF4 and VCAM-1 were significantly increased in active LN patients versus active non-renal SLE, inactive SLE and healthy controls. Five urine proteins differed significantly between 2 (hemopexin, NGAL, MCP1) or 3 (Cystatin-C, TWEAK) groups only, with the highest levels detected in active LN patients. Urine ALCAM, VCAM-1, PF4 and hemopexin correlated best with total SLEDAI as well as renal-SLEDAI scores (p < 0.05). Urine ALCAM, VCAM-1 and hemopexin outperformed conventional laboratory measures (anti-dsDNA, complement C3 and C4) in identifying concurrent SLE disease activity among patients (AUCs 0.75, 0.81, 0.81 respectively), while urine ALCAM, VCAM-1 and PF4 were the best discriminators of renal disease activity in cSLE (AUCs 0.83, 0.88, 0.78 respectively), surpassing conventional biomarkers, including proteinuria. Unsupervised Bayesian network analysis based on conditional probabilities re-affirmed urine ALCAM as being most predictive of active LN in cSLE patients. Conclusion Urinary ALCAM, PF4, and VCAM-1 are potential biomarkers for predicting kidney disease activity in cSLE and hold potential as surrogate markers of nephritis flares in these patients.
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Affiliation(s)
- Samar A Soliman
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt.,Department of Biomedical Engineering, University of Houston, Houston TX, United States
| | - Anam Haque
- Department of Biomedical Engineering, University of Houston, Houston TX, United States
| | - Kamala Vanarsa
- Department of Biomedical Engineering, University of Houston, Houston TX, United States
| | - Ting Zhang
- Department of Biomedical Engineering, University of Houston, Houston TX, United States
| | - Faten Ismail
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Kyung Hyun Lee
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Sherene Mason
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT, United States
| | - M John Hicks
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Scott E Wenderfer
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Chandra Mohan
- Department of Biomedical Engineering, University of Houston, Houston TX, United States
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13
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Cannon LA, Wenderfer SE, Lewandowski LB, Cooper JC, Goilav B, Knight AM, Hersh AO, Ardoin SP, Sadun RE. Use of EuroLupus Cyclophosphamide Dosing for the Treatment of Lupus Nephritis in Childhood-onset Systemic Lupus Erythematosus in North America. J Rheumatol 2022; 49:607-614. [PMID: 35169053 PMCID: PMC10464387 DOI: 10.3899/jrheum.210428] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Childhood-onset systemic lupus erythematosus (cSLE) has higher rates of lupus nephritis (LN) than adult-onset SLE, often requiring intensive immunosuppression. This study examined North American practices and preferences for the low-dose EuroLupus cyclophosphamide (CYC) protocol, as compared to the high-dose National Institutes of Health (NIH) CYC protocol, to treat LN in cSLE. METHODS A 35-item Web-based survey was distributed to Childhood Arthritis and Rheumatology Research Alliance (CARRA) and Pediatric Nephrology Research Consortium (PNRC) providers. The survey assessed participant demographics, CYC prescribing practices, perceptions of EuroLupus protocol, and LN vignette treatment decisions; 1 vignette was taken from a 2009 CARRA survey and responses were compared. Multivariable logistic regression analyzed provider factors associated with use of low- vs high-dose CYC. RESULTS Responses were provided by 185/421 (44%) pediatric rheumatologists (CARRA) and 40/354 (11%) pediatric nephrologists (PNRC). Among respondents who prescribed CYC for pediatric LN over the past year (n = 135), half reported using EuroLupus. When presented with the same vignette about an adolescent with class IV LN, 32% of pediatric rheumatologists chose EuroLupus dosing in 2020, vs 6% in 2009. Provider factors associated with choosing the low-dose regimen were familiarity with the protocol (OR 4.2, P = 0.006) and greater perceived benefit (OR 1.6, P < 0.0001). Pediatric nephrologists had similar responses to the pediatric rheumatology providers. Overall, 78% of respondents perceived EuroLupus protocol efficacy to be equivalent to the high-dose protocol in cSLE LN. CONCLUSION Pediatric specialists are currently more likely to use low-dose CYC to treat cSLE LN than they were a decade ago. Nevertheless, familiarity with EuroLupus dosing remains low.
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Affiliation(s)
- Laura A Cannon
- L.A. Cannon, MD, Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, and Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
| | - Scott E Wenderfer
- S.E. Wenderfer, MD, Department of Pediatrics, Baylor College of Medicine; Renal Section, Texas Children's Hospital, Houston, Texas, USA
| | - Laura B Lewandowski
- L.B. Lewandowski, MD, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer C Cooper
- J.C. Cooper, MD, Division of Pediatric Rheumatology, Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Beatrice Goilav
- B. Goilav, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea M Knight
- A.M. Knight, MD, Division of Pediatric Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aimee O Hersh
- A.O. Hersh, MD, Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Stacy P Ardoin
- S.P. Ardoin, MD, Division of Pediatric Rheumatology, Department of Pediatrics, and Division of Rheumatology, Department of Medicine, The Ohio State University, Columbus, Ohio, USA
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14
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Chang JC, Weiss PF, Xiao R, Atkinson MA, Wenderfer SE. Use of renin angiotensin aldosterone system inhibitors in children with lupus and time to glucocorticoid discontinuation. Kidney Int 2022; 102:395-404. [PMID: 35618096 PMCID: PMC9329244 DOI: 10.1016/j.kint.2022.04.023] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/07/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023]
Abstract
There is little data to inform use of renin angiotensin aldosterone system (RAAS) inhibitors in pediatric patients with systemic lupus erythematosus (SLE). Here, we sought to characterize RAAS inhibitor use in pediatric SLE, and determine whether early RAAS inhibitor initiation among children with incident lupus nephritis is associated with decreased duration of chronic glucocorticoid exposure. A retrospective cohort study was performed of children (ages 5-18) with SLE and/or lupus nephritis in the Truven MarketScanΤΜ Medicaid and Commercial databases (2013-2018) and estimated RAAS inhibitor use. Among incident nephritis cases, we used competing risk hazard models with inverse probability of treatment weighting to estimate the association between RAAS inhibitor initiation less than 180 days after diagnosis and time to glucocorticoid discontinuation with kidney failure as a competing event. Among 592 children with nephritis and 1407 children with non-kidney SLE, 67% and 15% ever received RAAS inhibitors, respectively. Median duration of RAAS inhibitor use among 323 incident users was 14 and 9 months in children with and without nephritis, respectively. Medicaid enrollment was independently associated with greater likelihood of RAAS inhibitor use, irrespective of nephritis. Among 158 incident nephritis cases, early RAAS inhibitor initiation was significantly associated with a faster rate of glucocorticoid discontinuation (adjusted sub-distribution hazard ratio 1.81, 95% confidence interval [1.09 - 3.00]). Thus, early initiation of RAAS inhibitors may have a role in children newly diagnosed with lupus nephritis; not only those with refractory proteinuria after induction therapy. Hence, integrated health systems data could be leveraged to confirm these findings and optimize adjunctive therapies in pediatric lupus.
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Affiliation(s)
- Joyce C Chang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia Research Institute, Philadelphia PA; Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston MA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA.
| | - Pamela F Weiss
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia Research Institute, Philadelphia PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia PA; Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia PA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Scott E Wenderfer
- Pediatric Nephrology, Baylor College of Medicine, Texas Children's Hospital, Houston TX
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15
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Wenderfer SE, Orjuela A, Bekheirnia MR, Pereira M, Muscal E, Braun MC, De Guzman M. Lupus Nephritis, Autoantibody Production and Kidney Outcomes in Males with Childhood-Onset Systemic Lupus Erythematosus. Pediatr Rep 2022; 14:220-232. [PMID: 35645367 PMCID: PMC9149811 DOI: 10.3390/pediatric14020030] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023] Open
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) only represents 20% of all SLE patients, and males with SLE only represent 10%. To study this rare SLE subset, males diagnosed with cSLE over a 30-year period were identified. Organ involvement, autoantibody production, hypocomplementemia, and kidney biopsy findings were compared to cSLE females. Outcomes were assessed using SLE Disease Activity Index scores, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and Childhood Arthritis and Rheumatology Research Alliance definitions for nephritis responsiveness. Of 95 males and 545 females with cSLE, 62% and 57% developed nephritis, respectively. Median age of cSLE onset was 14 years in both genders. Among males, 80% of non-Hispanic whites, 64% of blacks, 59% of Hispanics, and 50% of Asians developed nephritis. The prevalence of pure and mixed class V membranous nephritis was 33%. Median follow-up was 3.2 years (range 0.1-18). Complete kidney responses were seen in 70% after a median 24 months; however, relapse rates were 46%. Kidney disease flares were 56% nephritic and 44% proteinuric. Males and females with cSLE present with comparable rates and nephritis class. While overall and kidney response rates are favorable, kidney disease relapses are common among males.
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Affiliation(s)
- Scott E. Wenderfer
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (A.O.); (M.R.B.); (M.C.B.)
- Texas Children’s Hospital, Houston, TX 77030, USA; (M.P.); (E.M.); (M.D.G.)
- British Columbia Children’s Hospital, Vancouver, BC V6H 3V4, Canada
| | - Alvaro Orjuela
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (A.O.); (M.R.B.); (M.C.B.)
- Texas Children’s Hospital, Houston, TX 77030, USA; (M.P.); (E.M.); (M.D.G.)
| | - Mir Reza Bekheirnia
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (A.O.); (M.R.B.); (M.C.B.)
- Texas Children’s Hospital, Houston, TX 77030, USA; (M.P.); (E.M.); (M.D.G.)
| | - Maria Pereira
- Texas Children’s Hospital, Houston, TX 77030, USA; (M.P.); (E.M.); (M.D.G.)
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eyal Muscal
- Texas Children’s Hospital, Houston, TX 77030, USA; (M.P.); (E.M.); (M.D.G.)
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michael C. Braun
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; (A.O.); (M.R.B.); (M.C.B.)
- Texas Children’s Hospital, Houston, TX 77030, USA; (M.P.); (E.M.); (M.D.G.)
| | - Marietta De Guzman
- Texas Children’s Hospital, Houston, TX 77030, USA; (M.P.); (E.M.); (M.D.G.)
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
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16
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Aljaberi N, Wenderfer SE, Mathur A, Qiu T, Jose S, Merritt A, Rose J, Devarajan P, Huang B, Brunner H. Clinical measurement of lupus nephritis activity is inferior to biomarker-based activity assessment using the renal activity index for lupus nephritis in childhood-onset systemic lupus erythematosus. Lupus Sci Med 2022; 9:e000631. [PMID: 35568436 PMCID: PMC9109101 DOI: 10.1136/lupus-2021-000631] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/24/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The renal activity index for lupus (RAIL) measures lupus nephritis (LN) activity considering urine levels of 6 biomarkers (neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, kidney injury molecule-1, adiponectin, haemopexin, ceruloplasmin). We aimed to compare the accuracy of the RAIL and the renal domain-score of the SLE disease activity index (rSLEDAI) in detecting LN activity. METHODS Random urine samples of patients with childhood-onset SLE with and without LN were assayed and scores of the RAIL, and RAIL standardised for urine creatinine (RAIL-Cr) were calculated. Clinical LN activity was measured by the rSLEDAI, and histological activity of LN was categorised as inactive/low-moderate/high for National Institute of Health-activity index scores of <2/2-10/>10, respectively. RESULTS 115 patients were included in the analysis (47 patients without and 68 with LN). RAIL, RAIL-Cr and rSLEDAI scores at the time (±3 months) of kidney biopsy were available for 32 patients. Median rSLEDAI, RAIL and RAIL-Cr values were 4, -0.04, 0.02 for inactive LN, 12, 0.7 and 0.9 for low-moderate LN activity and 12, 2 and 1.8 for high LN activity, respectively. The area under the receiver operating characteristic curve (AUC) to capture high LN activity was the lowest for the rSLEDAI (AUC=0.62), followed by the RAIL-Cr (AUC=0.73) and RAIL (AUC=0.79). Notably, when testing urine samples collected during routine clinic visits remote (>3 months) from a kidney biopsy, 50% patients with rSLEDAI scores of 0 had RAIL scores reflecting low-moderate LN activity. CONCLUSION Monitoring of renal inflammation in children and adolescents with SLE can be improved by the measurement of urine biomarkers. The RAIL may constitute important auxiliary tool for the surveillance of LN in a clinical setting and assist with the decision to obtain a kidney biopsy.
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Affiliation(s)
- Najla Aljaberi
- Department of Pediatrics, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | | | - Arjun Mathur
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tingting Qiu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Steffy Jose
- Renal Section, Texas Children's Hospital, Houston, Texas, USA
| | - Angela Merritt
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Rose
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Hermine Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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17
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Chalhoub NE, Wenderfer SE, Levy DM, Rouster-Stevens K, Aggarwal A, Savani SI, Ruth NM, Arkachaisri T, Qiu T, Merritt A, Onel K, Goilav B, Khubchandani RP, Deng J, Fonseca AR, Ardoin SP, Ciurtin C, Kasapcopur O, Jelusic M, Huber AM, Ozen S, Klein-Gitelman MS, Appenzeller S, Cavalcanti A, Fotis L, Lim SC, Silva RM, Miramontes JR, Rosenwasser NL, Saad-Magalhaes C, Schonenberg-Meinema D, Scott C, Silva CA, Enciso S, Terreri MT, Torres-Jimenez AR, Trachana M, Al-Mayouf SM, Devarajan P, Huang B, Brunner HI. International Consensus for the Dosing of Corticosteroids in Childhood-Onset Systemic Lupus Erythematosus With Proliferative Lupus Nephritis. Arthritis Rheumatol 2022; 74:263-273. [PMID: 34279063 PMCID: PMC8766607 DOI: 10.1002/art.41930] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 03/14/2021] [Accepted: 07/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To develop a standardized steroid dosing regimen (SSR) for physicians treating childhood-onset systemic lupus erythematosus (SLE) complicated by lupus nephritis (LN), using consensus formation methodology. METHODS Parameters influencing corticosteroid (CS) dosing were identified (step 1). Data from children with proliferative LN were used to generate patient profiles (step 2). Physicians rated changes in renal and extrarenal childhood-onset SLE activity between 2 consecutive visits and proposed CS dosing (step 3). The SSR was developed using patient profile ratings (step 4), with refinements achieved in a physician focus group (step 5). A second type of patient profile describing the course of childhood-onset SLE for ≥4 months since kidney biopsy was rated to validate the SSR-recommended oral and intravenous (IV) CS dosages (step 6). Patient profile adjudication was based on majority ratings for both renal and extrarenal disease courses, and consensus level was set at 80%. RESULTS Degree of proteinuria, estimated glomerular filtration rate, changes in renal and extrarenal disease activity, and time since kidney biopsy influenced CS dosing (steps 1 and 2). Considering these parameters in 5,056 patient profile ratings from 103 raters, and renal and extrarenal course definitions, CS dosing rules of the SSR were developed (steps 3-5). Validation of the SSR for up to 6 months post-kidney biopsy was achieved with 1,838 patient profile ratings from 60 raters who achieved consensus for oral and IV CS dosage in accordance with the SSR (step 6). CONCLUSION The SSR represents an international consensus on CS dosing for use in patients with childhood-onset SLE and proliferative LN. The SSR is anticipated to be used for clinical care and to standardize CS dosage during clinical trials.
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Affiliation(s)
| | | | - Deborah M Levy
- The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | | | - Amita Aggarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | - Tingting Qiu
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela Merritt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Karen Onel
- Hospital for Special Surgery, New York, New York
| | | | | | - Jianghong Deng
- Capital Medical University and National Center for Children's Health, Beijing, China
| | | | | | | | - Ozgur Kasapcopur
- Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Marija Jelusic
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | - Marisa S Klein-Gitelman
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - André Cavalcanti
- Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Brazil
| | - Lampros Fotis
- National and Kapodistian University of Athens, Athens, Greece
| | | | - Rodrigo M Silva
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Christiaan Scott
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | | | - Sandra Enciso
- Hospital de la Beneficencia Española, Mexico City, Mexico
| | | | | | - Maria Trachana
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sulaiman M Al-Mayouf
- King Faisal Specialist Hospital and Research Center and Alfaisal University, Riyadh, Saudi Arabia
| | - Prasad Devarajan
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bin Huang
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hermine I Brunner
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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18
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Constantinescu AR, Mattoo TK, Smoyer WE, Greenbaum LA, Niu J, Howard N, Muff-Luett M, Benoit EB, Traum A, Annaim AA, Wenderfer SE, Plautz E, Rheault MN, Myette RL, Twombley KE, Kamigaki Y, Wandique-Rapalo B, Kallash M, Vasylyeva TL. Clinical presentation and management of nephrotic syndrome in the first year of life: A report from the Pediatric Nephrology Research Consortium. Front Pediatr 2022; 10:988945. [PMID: 36210940 PMCID: PMC9534228 DOI: 10.3389/fped.2022.988945] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nephrotic syndrome (NS) in the first year of life is called congenital (CNS) if diagnosed between 0-3 months, or infantile (INS) if diagnosed between 3-12 months of age. The aim of this study was to determine if there were clinically meaningful differences between CNS and INS patients, regarding clinical presentation, management and outcomes. DESIGN SETTING PARTICIPANTS AND MEASUREMENTS Eleven Pediatric Nephrology Research Consortium sites participated in the study, using IRB-approved retrospective chart reviews of CNS and INS patients born between 1998 and 2019. Data were collected on patient characteristics, pertinent laboratory tests, provided therapy, timing of unilateral/bilateral nephrectomy and initiation of renal replacement therapy (RRT). RESULTS The study included 69 patients, 49 with CNS and 20 with INS, with a median age at diagnosis of 1 and 6 months, respectively. Management for the two groups was similar regarding nutrition, thyroxin supplementation, immunoglobulin administration, and thrombosis prophylaxis. Within the first 2 months after diagnosis, daily albumin infusions were used more often in CNS vs. INS patients (79 vs. 30%; p = 0.006), while weekly infusions were more common in INS patients (INS vs. CNS: 50 vs. 3%; p = 0.001). During the 6 months preceding RRT, albumin infusions were more frequently prescribed in CNS vs. INS (51 vs. 15%; p = 0.007). Nephrectomy was performed more often in CNS (78%) than in INS (50%; p = 0.02). End-stage kidney disease tended to be more common in children with CNS (80%) vs. INS (60%; p = 0.09). CONCLUSION Compared to INS, patients with CNS had a more severe disease course, requiring more frequent albumin infusions, and earlier nephrectomy and RRT. Despite center-specific variations in patient care, 20-40% of these patients did not require nephrectomy or RRT.
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Affiliation(s)
- Alexandru R Constantinescu
- Integrated Medical Sciences, Charles E Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, United States.,Pediatric Nephrology, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Tej K Mattoo
- Pediatrics and Urology, Wayne State University School of Medicine, Detroit, MI, United States
| | - William E Smoyer
- Center for Clinical and Translational Research, The Ohio State University, Columbus, OH, United States
| | | | - Jianli Niu
- Department of Research and Scholarly Activity at Memorial Healthcare System, Hollywood, FL, United States
| | - Noel Howard
- Health Sciences Center School of Medicine, Texas Tech University, Amarillo, TX, United States
| | - Melissa Muff-Luett
- Pediatric Nephrology, Children's Hospital and Medical Center, Omaha, NE, United States
| | | | - Avram Traum
- Pediatric Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Ali A Annaim
- Pediatric Nephrology, Children's Hospital of Atlanta, Atlanta, GA, United States
| | - Scott E Wenderfer
- Pediatric Nephrology, Texas Children's Hospital, Houston, TX, United States
| | - Emilee Plautz
- University of Minnesota, Minneapolis, MN, United States
| | - Michelle N Rheault
- Pediatric Nephrology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States
| | - Robert L Myette
- Pediatric Nephrology, Children's Hospital of Eastern Ontario and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Katherine E Twombley
- Pediatric Nephrology, Medical University of South Carolina College of Medicine, Charleston, SC, United States
| | - Yu Kamigaki
- Center for Clinical and Translational Research, The Ohio State University, Columbus, OH, United States
| | | | - Mohammad Kallash
- Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Tetyana L Vasylyeva
- Pediatric Nephrology, Health Sciences Center School of Medicine, Texas Tech University, Amarillo, TX, United States
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19
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Wenderfer SE, Chang JC, Goodwin Davies A, Luna IY, Scobell R, Sears C, Magella B, Mitsnefes M, Stotter BR, Dharnidharka VR, Nowicki KD, Dixon BP, Kelton M, Flynn JT, Gluck C, Kallash M, Smoyer WE, Knight A, Sule S, Razzaghi H, Bailey LC, Furth SL, Forrest CB, Denburg MR, Atkinson MA. Using a Multi-Institutional Pediatric Learning Health System to Identify Systemic Lupus Erythematosus and Lupus Nephritis: Development and Validation of Computable Phenotypes. Clin J Am Soc Nephrol 2022; 17:65-74. [PMID: 34732529 PMCID: PMC8763148 DOI: 10.2215/cjn.07810621] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 06/05/2021] [Accepted: 10/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Performing adequately powered clinical trials in pediatric diseases, such as SLE, is challenging. Improved recruitment strategies are needed for identifying patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Electronic health record algorithms were developed and tested to identify children with SLE both with and without lupus nephritis. We used single-center electronic health record data to develop computable phenotypes composed of diagnosis, medication, procedure, and utilization codes. These were evaluated iteratively against a manually assembled database of patients with SLE. The highest-performing phenotypes were then evaluated across institutions in PEDSnet, a national health care systems network of >6.7 million children. Reviewers blinded to case status used standardized forms to review random samples of cases (n=350) and noncases (n=350). RESULTS Final algorithms consisted of both utilization and diagnostic criteria. For both, utilization criteria included two or more in-person visits with nephrology or rheumatology and ≥60 days follow-up. SLE diagnostic criteria included absence of neonatal lupus, one or more hydroxychloroquine exposures, and either three or more qualifying diagnosis codes separated by ≥30 days or one or more diagnosis codes and one or more kidney biopsy procedure codes. Sensitivity was 100% (95% confidence interval [95% CI], 99 to 100), specificity was 92% (95% CI, 88 to 94), positive predictive value was 91% (95% CI, 87 to 94), and negative predictive value was 100% (95% CI, 99 to 100). Lupus nephritis diagnostic criteria included either three or more qualifying lupus nephritis diagnosis codes (or SLE codes on the same day as glomerular/kidney codes) separated by ≥30 days or one or more SLE diagnosis codes and one or more kidney biopsy procedure codes. Sensitivity was 90% (95% CI, 85 to 94), specificity was 93% (95% CI, 89 to 97), positive predictive value was 94% (95% CI, 89 to 97), and negative predictive value was 90% (95% CI, 84 to 94). Algorithms identified 1508 children with SLE at PEDSnet institutions (537 with lupus nephritis), 809 of whom were seen in the past 12 months. CONCLUSIONS Electronic health record-based algorithms for SLE and lupus nephritis demonstrated excellent classification accuracy across PEDSnet institutions.
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Affiliation(s)
- Scott E. Wenderfer
- Pediatric Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Joyce C. Chang
- Pediatric Rheumatology, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy Goodwin Davies
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ingrid Y. Luna
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca Scobell
- Pediatric Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas,Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cora Sears
- Pediatric Rheumatology, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bliss Magella
- Pediatric Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mitsnefes
- Pediatric Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Brian R. Stotter
- Pediatric Nephrology, Hypertension and Pheresis, St. Louis Children’s Hospital, Washington University in St. Louis, St. Louis, Missouri
| | - Vikas R. Dharnidharka
- Pediatric Nephrology, Hypertension and Pheresis, St. Louis Children’s Hospital, Washington University in St. Louis, St. Louis, Missouri
| | - Katherine D. Nowicki
- Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bradley P. Dixon
- Pediatric Nephrology, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan Kelton
- Pediatrics, University of Washington, Seattle, Washington,Nephrology, Seattle Children’s Hospital, Seattle, Washington
| | - Joseph T. Flynn
- Pediatrics, University of Washington, Seattle, Washington,Nephrology, Seattle Children’s Hospital, Seattle, Washington
| | - Caroline Gluck
- Pediatric Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Mahmoud Kallash
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - William E. Smoyer
- Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Andrea Knight
- Pediatric Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sangeeta Sule
- Pediatric Rheumatology, George Washington University, Children’s National Medical Center, Washington, DC
| | - Hanieh Razzaghi
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L. Charles Bailey
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan L. Furth
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher B. Forrest
- Applied Clinical Research Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R. Denburg
- Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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20
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Krissberg JR, Helmuth ME, Almaani S, Cai Y, Cattran D, Chatterjee D, Gbadegesin RA, Gibson KL, Glenn DA, Greenbaum LA, Iragorri S, Jain K, Khalid M, Kidd JM, Kopp JB, Lafayette R, Nestor JG, Parekh RS, Reidy KJ, David T Selewski, John Sperati C, Tuttle KR, Twombley K, Vasylyeva TL, Weaver DJ, Wenderfer SE, O'Shaughnessy MM. Racial-ethnic differences in health-related quality of life among adults and children with glomerular disease. Glomerular Dis 2021; 1:105-117. [PMID: 34723246 DOI: 10.1159/000516832] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Disparities in health-related quality of life (HRQOL) have been inadequately studied in patients with glomerular disease. The aim of this study was to identify relationships between race/ethnicity, socioeconomic status, disease severity, and HRQOL in an ethnically and racially diverse cohort of patients with glomerular disease. Methods Cure Glomerulonephropathy (CureGN) is a multinational cohort study of patients with biopsy-proven glomerular disease. Associations between race/ethnicity and HRQOL were determined by the following: 1. Missed school or work due to kidney disease; 2. Responses to Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires. We adjusted for demographics, socioeconomic status, and disease characteristics using multivariable logistic and linear regression. Results Black and Hispanic participants had worse socioeconomic status and more severe glomerular disease than White or Asian participants. Black adults missed work or school most frequently due to kidney disease (30% versus 16-23% in the other three groups, p=0.04), and had the worst self-reported global physical health (median score 44.1 versus 48.0-48.2, p<0.001) and fatigue (53.8 versus 48.5-51.1, p=0.002), compared to other racial/ethnic groups. However, these findings were not statistically significant with adjustment for socioeconomic status and disease severity, both of which were strongly associated with HRQOL in adults. Among children, disease severity but not race/ethnicity or socioeconomic status were associated with HRQOL. Conclusions Among patients with glomerular disease enrolled in CureGN, the worse HRQOL reported by Black adults was attributable to lower socioeconomic status and more severe glomerular disease. No racial/ethnic differences in HRQOL were observed in children.
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Affiliation(s)
- Jill R Krissberg
- Division of Nephrology, Department of Pediatrics, Stanford University, Stanford, California, United States
| | - Margaret E Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - Salem Almaani
- Department of Nephrology, The Ohio State University, Columbus, Ohio, United States
| | - Yi Cai
- Division of Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, United States
| | - Daniel Cattran
- Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada
| | - Debanjana Chatterjee
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - Rasheed A Gbadegesin
- Department of Pediatrics, Duke University, Durham, North Carolina, United States
| | - Keisha L Gibson
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Laurence A Greenbaum
- Division of Nephrology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Sandra Iragorri
- Division of Nephrology and Hypertension, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States
| | - Koyal Jain
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Myda Khalid
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jason M Kidd
- Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jeffrey B Kopp
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Richard Lafayette
- Division of Nephrology and Hypertension, Stanford University, Stanford, California, United States
| | - Jordan G Nestor
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - Rulan S Parekh
- Division of Nephrology, Department of Paediatrics, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Canada
| | - Kimberly J Reidy
- Department of Pediatric Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, United States
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States
| | - C John Sperati
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Katherine R Tuttle
- Division of Nephrology, University of Washington, Seattle, Washington, United States
| | - Katherine Twombley
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Tetyana L Vasylyeva
- Division of Nephrology, Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Donald Jack Weaver
- Division of Pediatric Nephrology, Atrium Health Levine Children's, Charlotte, North Carolina, United States
| | - Scott E Wenderfer
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Michelle M O'Shaughnessy
- Department of Renal Medicine, Cork University Hospital and University College Cork, Cork, Ireland
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21
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De Mutiis C, Wenderfer SE, Orjuela A, Bagga A, Basu B, Sar T, Aggarwal A, Jain A, Yap HK, Ito S, Ohnishi A, Iwata N, Kasapcopur O, Laurent A, Mastrangelo A, Ogura M, Shima Y, Rianthavorn P, Silva CA, Trindade V, Dormi A, Tullus K. Defining renal remission in an international cohort of 248 children and adolescents with lupus nephritis. Rheumatology (Oxford) 2021; 61:2563-2571. [PMID: 34626102 DOI: 10.1093/rheumatology/keab746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/10/2021] [Revised: 09/20/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We studied the rate of remission of lupus nephritis (LN) in an international cohort of 248 children and adolescents with biopsy proven LN. Five different definitions from scientific studies and the definitions recommended by the American College of Rheumatology and Kidney Disease Improving Global Outcomes (KDIGO) were used. METHODS Anonymized clinical data in patients with biopsy proven LN class ≥ III (International Society of nephrology/Royal Pathology Society-ISN/RPS) diagnosed and treated in the last 10 years in 23 international centers from 10 countries were collected. We compared the rate of patients in complete and partial remission applying the different definitions. RESULTS The mean age at diagnosis was 11 years and 4 month and 177 were females.The number of patients in complete and partial remission varied a lot between the different definitions. At 24 months, between 50% and 78.8% of the patients were in full remission as defined by the different criteria. The number of patients in partial remission was low, between 2.3% and 25%. No difference in achieved remission was found between boys and girls or between children and adolescents (P > 0.05). Patients with East Asian ethnicity reached remission more often than other ethnicities (P = 0.03-0.0008). Patients treated in high income countries showed a higher percentage of complete remission at 12 and 24 months (P = 0.002-0.000001). CONCLUSION The rate of children and adolescents with LN achieving remission varied hugely with the definition used. Our results give important information for long awaited treatment studies in children and young people.
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Affiliation(s)
| | - Scott E Wenderfer
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Alvaro Orjuela
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India
| | - Tanmoy Sar
- Division of Pediatric Nephrology, Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Avinash Jain
- Department of Medicine, Sawai Man Singh Medical College, Jaipur, India
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Ai Ohnishi
- Department of Pediatrics, Yokohama City University, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Audrey Laurent
- Department of Pediatric Nephrology, Rheumatology and Dermatology, Hospices Civils de Lyon, Lyon, France
| | - Antonio Mastrangelo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuko Shima
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Pornpimol Rianthavorn
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Trindade
- Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ada Dormi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Kjell Tullus
- Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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22
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Vazzana KM, Daga A, Goilav B, Ogbu EA, Okamura DM, Park C, Sadun RE, Smitherman EA, Stotter BR, Dasgupta A, Knight AM, Hersh AO, Wenderfer SE, Lewandowski LB. Principles of pediatric lupus nephritis in a prospective contemporary multi-center cohort. Lupus 2021; 30:1660-1670. [PMID: 34219529 PMCID: PMC10461610 DOI: 10.1177/09612033211028658] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lupus nephritis (LN) is a life-threatening manifestation of systemic lupus erythematosus (SLE) and is more common in children than adults. The epidemiology and management of childhood-onset SLE (cSLE) have changed over time, prompting the need to reassess expected outcomes. The purpose of this study is to use the Childhood Arthritis and Rheumatology Research Alliance (CARRA) prospective registry to validate historical principles of LN in a contemporary, real-world cohort. After an extensive literature review, six principles of LN in cSLE were identified. The CARRA registry was queried to evaluate these principles in determining the rate of LN in cSLE, median time from cSLE diagnosis to LN, short-term renal outcomes, and frequency of rituximab as an induction therapy. Of the 677 cSLE patients in the CARRA registry, 32% had documented LN. Decline in kidney function was more common in Black cSLE patients than non-Black patients (p = 0.04). Black race was associated with worse short-term renal outcomes. In short-term follow up, most children with LN had unchanged or improved kidney function, and end stage kidney disease (ESKD) was rare. Ongoing follow-up of cSLE patients in the CARRA registry will be necessary to evaluate long-term outcomes to inform risk, management, and prognosis of LN in cSLE.
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Affiliation(s)
- Kathleen M Vazzana
- Lupus Genomics and Global Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ankana Daga
- Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Beatrice Goilav
- Division of Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ekemini A Ogbu
- Department of Pediatrics, 1466Johns Hopkins University, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Daryl M Okamura
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Catherine Park
- Division of Nephrology, Children's National Hospital, Washington, DC, USA
| | | | - Emily A Smitherman
- Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian R Stotter
- Division of Pediatric Nephrology, Hypertension & Pheresis, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Andrea M Knight
- Division of Pediatric Rheumatology, 7979Hospital for Sick Children, Hospital for Sick Children, Toronto, Canada
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Scott E Wenderfer
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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23
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Gilbert M, Goilav B, Hsu JJ, Nietert PJ, Meidan E, Chua A, Ardoin SP, Wenderfer SE, von Scheven E, Ruth NM. Differences in rituximab use between pediatric rheumatologists and nephrologists for the treatment of refractory lupus nephritis and renal flare in childhood-onset SLE. Pediatr Rheumatol Online J 2021; 19:137. [PMID: 34461932 PMCID: PMC8404338 DOI: 10.1186/s12969-021-00627-w] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Consensus treatment plans have been developed for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in childhood-onset systemic lupus erythematosus. However, patients who do not respond to initial therapy, or who develop renal flare after remission, warrant escalation of treatment. Our objective was to assess current practices of pediatric nephrologists and rheumatologists in North America in treatment of refractory proliferative LN and flare. METHODS Members of Childhood Arthritis and Rheumatology Research Alliance (CARRA) and the American Society for Pediatric Nephrology (ASPN) were surveyed in November 2015 to assess therapy choices (other than modifying steroid dosing) and level of agreement between rheumatologists and nephrologists for proliferative LN patients. Two cases were presented: (1) refractory disease after induction treatment with corticosteroid and cyclophosphamide (CYC) and (2) nephritis flare after initial response to treatment. Survey respondents chose treatments for three follow up scenarios for each case that varied by severity of presentation. Treatment options included CYC, mycophenolate mofetil (MMF), rituximab (RTX), and others, alone or in combination. RESULTS Seventy-six respondents from ASPN and foty-one respondents from CARRA represented approximately 15 % of the eligible members from each organization. Treatment choices between nephrologists and rheumatologists were highly variable and received greater than 50 % agreement for an individual treatment choice in only the following 2 of 6 follow up scenarios: 59 % of nephrologists, but only 38 % of rheumatologists, chose increasing dose of MMF in the case of LN refractory to induction therapy with proteinuria, hematuria, and improved serum creatinine. In a follow up scenario showing severe renal flare after achieving remission with induction therapy, 58 % of rheumatologists chose CYC and RTX combination therapy, whereas the top choice for nephrologists (43 %) was CYC alone. Rheumatologists in comparison to nephrologists chose more therapy options that contained RTX in all follow up scenarios except one (p < 0.05). CONCLUSIONS Therapy choices for pediatric rheumatologists and nephrologists in the treatment of refractory LN or LN flare were highly variable with rheumatologists more often choosing rituximab. Further investigation is necessary to delineate the reasons behind this finding. This study highlights the importance of collaborative efforts in developing consensus treatment plans for pediatric LN.
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Affiliation(s)
- Mileka Gilbert
- Medical University of South Carolina, 135 Rutledge Ave, MSC 561, Charleston, SC, 29425, USA.
| | - Beatrice Goilav
- grid.414114.50000 0004 0566 7955The Children’s Hospital at Montefiore, 111 East 210th Street, Bronx, NY 10467 USA
| | - Joyce J. Hsu
- grid.168010.e0000000419368956Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305 USA
| | - Paul J. Nietert
- grid.259828.c0000 0001 2189 3475Medical University of South Carolina, 135 Rutledge Ave, MSC 561, Charleston, SC 29425 USA
| | - Esra Meidan
- grid.38142.3c000000041936754XHarvard Medical School, 300 Longwood Ave, Boston, MA 02115 USA
| | - Annabelle Chua
- grid.26009.3d0000 0004 1936 7961Duke University, Box 3959, 2301 Erwin Road, Durham, NC 27710 USA
| | - Stacy P. Ardoin
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43221 USA
| | - Scott E. Wenderfer
- grid.39382.330000 0001 2160 926XBaylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Emily von Scheven
- grid.266102.10000 0001 2297 6811University of California San Francisco, 550 16th Street, 4th floor, San Francisco, CA 94158 USA
| | - Natasha M. Ruth
- grid.259828.c0000 0001 2189 3475Medical University of South Carolina, 135 Rutledge Ave, MSC 561, Charleston, SC 29425 USA
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24
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Muff-Luett M, Sanderson KR, Engen RM, Zahr RS, Wenderfer SE, Tran CL, Sharma S, Cai Y, Ingraham S, Winnicki E, Weaver DJ, Hunley TE, Kiessling SG, Seamon M, Woroniecki R, Miyashita Y, Xiao N, Omoloja AA, Kizilbash SJ, Mansuri A, Kallash M, Yu Y, Sherman AK, Srivastava T, Nester CM. Eculizumab exposure in children and young adults: indications, practice patterns, and outcomes-a Pediatric Nephrology Research Consortium study. Pediatr Nephrol 2021; 36:2349-2360. [PMID: 33693990 PMCID: PMC8263513 DOI: 10.1007/s00467-021-04965-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/26/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Eculizumab is approved for the treatment of atypical hemolytic uremic syndrome (aHUS). Its use off-label is frequently reported. The aim of this study was to describe the broader use and outcomes of a cohort of pediatric patients exposed to eculizumab. METHODS A retrospective, cohort analysis was performed on the clinical and biomarker characteristics of eculizumab-exposed patients < 25 years of age seen across 21 centers of the Pediatric Nephrology Research Consortium. Patients were included if they received at least one dose of eculizumab between 2008 and 2015. Traditional summary statistics were applied to demographic and clinical data. RESULTS A total of 152 patients were identified, mean age 9.1 (+/-6.8) years. Eculizumab was used "off-label" in 44% of cases. The most common diagnoses were aHUS (47.4%), Shiga toxin-producing Escherichia coli HUS (12%), unspecified thrombotic microangiopathies (9%), and glomerulonephritis (9%). Genetic testing was available for 60% of patients; 20% had gene variants. Dosing regimens were variable. Kidney outcomes tended to vary according to diagnosis. Infectious adverse events were the most common adverse event (33.5%). No cases of meningitis were reported. Nine patients died of noninfectious causes while on therapy. CONCLUSIONS This multi-center retrospective cohort analysis indicates that a significant number of children and young adults are being exposed to C5 blockade for off-label indications. Dosing schedules were highly variable, limiting outcome conclusions. Attributable adverse events appeared to be low. Cohort mortality (6.6%) was not insignificant. Prospective studies in homogenous disease cohorts are needed to support the role of C5 blockade in kidney outcomes.
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Affiliation(s)
- Melissa Muff-Luett
- Department of Pediatrics, Pediatric Nephrology, University of Nebraska Medical School, Children's Hospital and Medical Center, 8200 Dodge St., Omaha, NE, 68114-4113, USA.
| | - Keia R Sanderson
- Department of Medicine-Nephrology, University of North Carolina, Chapel Hill, NC, USA
| | - Rachel M Engen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rima S Zahr
- Division of Pediatric Nephrology and Hypertension, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Scott E Wenderfer
- Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Cheryl L Tran
- Division of Pediatric Nephrology, Mayo Clinic, Rochester, MN, USA
| | - Sheena Sharma
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yi Cai
- Division of Nephrology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Susan Ingraham
- Kapi'olani Medical Center for Women and Children, Honolulu, HI, USA
| | - Erica Winnicki
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Donald J Weaver
- Division of Pediatric Nephrology and Hypertension, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Tracy E Hunley
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Stefan G Kiessling
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | | | - Robert Woroniecki
- Pediatric Nephrology and Hypertension, Stony Brook Children's Hospital, Stony Brook, NY, USA
| | - Yosuke Miyashita
- Department of Pediatrics, Division of Pediatric Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Abiodun A Omoloja
- Nephrology Department, The Children's Medical Center, Dayton, OH, USA
| | - Sarah J Kizilbash
- Department of Pediatric Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - Asif Mansuri
- Children's Hospital of Georgia, Augusta University, Augusta, GA, USA
| | - Mahmoud Kallash
- Division of Nephrology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Yichun Yu
- Department of Medicine-Nephrology, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley K Sherman
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Tarak Srivastava
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Carla M Nester
- Departments of Internal Medicine and Pediatrics, Division of Nephrology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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25
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Soliman SA, Haque A, Mason S, Greenbaum LA, Hicks MJ, Mohan C, Wenderfer SE. Cross-sectional study of plasma Axl, ferritin, IGFBP4 and sTNFR2 as biomarkers of disease activity in childhood-onset SLE: A study of the Pediatric Nephrology Research Consortium. Lupus 2021; 30:1394-1404. [PMID: 33990158 PMCID: PMC8282643 DOI: 10.1177/09612033211016100] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the performance of 4 plasma protein markers for detecting disease activity in childhood-onset systemic lupus erythematosus (SLE) patients. METHODS Eighty-three consecutive pediatric patients fulfilling ≥4 ACR criteria for SLE and twenty-five healthy controls were prospectively recruited for serological testing of 4 protein markers identified by antibody-coated microarray screen, namely Axl, ferritin, IGFBP4 and sTNFR2. SLE disease activity was assessed using SLEDAI-2000 score. Fifty-seven patients had clinically active SLE (SLEDAI score ≥4, or having a flare). RESULTS The plasma concentrations of Axl and ferritin were significantly higher in patients with active SLE than inactive SLE. Plasma Axl levels were significantly higher in active renal versus active non-renal SLE patients. Levels of Axl, ferritin and IGFBP4 correlated significantly with SLEDAI scores. Levels of Axl, IFGBP4 and sTNFR2 inversely correlated with plasma complement C3 levels. Only plasma Axl and ferritin levels correlated with degree of proteinuria. These markers were more specific, but less sensitive, in detecting concurrent SLE activity than elevated anti-dsDNA antibody titer or decreased C3. Ferritin and IGFBP4 levels were more specific for concurrent active lupus nephritis than anti-dsDNA or C3. Plasma ferritin was the best monitor of global SLE activity, followed by C3 then Axl, while both Axl and C3 were best monitors of clinical lupus nephritis activity. CONCLUSION In childhood-onset SLE patients, plasma ferritin and Axl perform better than traditional yardsticks in identifying disease activity, either global or renal. The performance of these plasma markers should be explored further in longitudinal cohorts of SLE patients.
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Affiliation(s)
- Samar A Soliman
- Department of Biomedical Engineering, University of Houston, Houston TX, USA
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Anam Haque
- Department of Biomedical Engineering, University of Houston, Houston TX, USA
| | - Sherene Mason
- Connecticut Children's Medical Center, Hartford CT, USA
| | | | - M John Hicks
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Chandra Mohan
- Department of Biomedical Engineering, University of Houston, Houston TX, USA
| | - Scott E Wenderfer
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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26
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Gillespie BW, Laurin LP, Zinsser D, Lafayette R, Marasa M, Wenderfer SE, Vento S, Poulton C, Barisoni L, Zee J, Helmuth M, Lugani F, Kamel M, Hill-Callahan P, Hewitt SM, Mariani LH, Smoyer WE, Greenbaum LA, Gipson DS, Robinson BM, Gharavi AG, Guay-Woodford LM, Trachtman H. Improving data quality in observational research studies: Report of the Cure Glomerulonephropathy (CureGN) network. Contemp Clin Trials Commun 2021; 22:100749. [PMID: 33851061 PMCID: PMC8039553 DOI: 10.1016/j.conctc.2021.100749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/28/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background High data quality is of crucial importance to the integrity of research projects. In the conduct of multi-center observational cohort studies with increasing types and quantities of data, maintaining data quality is challenging, with few published guidelines. Methods The Cure Glomerulonephropathy (CureGN) Network has established numerous quality control procedures to manage the 70 participating sites in the United States, Canada, and Europe. This effort is supported and guided by the activities of several committees, including Data Quality, Recruitment and Retention, and Central Review, that work in tandem with the Data Coordinating Center to monitor the study. We have implemented coordinator training and feedback channels, data queries of questionable or missing data, and developed performance metrics for recruitment, retention, visit completion, data entry, recording of patient-reported outcomes, collection, shipping and accessing of biological samples and pathology materials, and processing, cataloging and accessing genetic data and materials. Results We describe the development of data queries and site Report Cards, and their use in monitoring and encouraging excellence in site performance. We demonstrate improvements in data quality and completeness over 4 years after implementing these activities. We describe quality initiatives addressing specific challenges in collecting and cataloging whole slide images and other kidney pathology data, and novel methods of data quality assessment. Conclusions This paper reports the CureGN experience in optimizing data quality and underscores the importance of general and study-specific data quality initiatives to maintain excellence in the research measures of a multi-center observational study.
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Affiliation(s)
- Brenda W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Dawn Zinsser
- Arbor Research Collaborative for Health, Ann Arbor, MI, 48104, USA
| | | | - Maddalena Marasa
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Suzanne Vento
- NYU Langone Health, Department of Pediatrics, Division of Nephrology, New York, NY, USA
| | - Caroline Poulton
- Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura Barisoni
- Department of Pathology, Division of AI and Computational Pathology, Department of Medicine, Division of Nephrology, Duke University, Durham, NC, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, 48104, USA
| | - Margaret Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, MI, 48104, USA
| | - Francesca Lugani
- Laboratory of Molecular Nephrology, Istituto Giannina Gaslini, IRCCS, Genoa, Italy
| | - Margret Kamel
- Emory University, Department of Pediatrics, Division of Nephrology, Atlanta, GA, USA
| | | | - Stephen M Hewitt
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura H Mariani
- University of Michigan, Division of Nephrology, Ann Arbor, MI, USA
| | - William E Smoyer
- Center for Clinical and Translational Research, the Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Larry A Greenbaum
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Debbie S Gipson
- University of Michigan, Division of Nephrology, Department of Pediatrics, Ann Arbor, MI, USA
| | | | - Ali G Gharavi
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lisa M Guay-Woodford
- Center for Translational Research, Children's National Hospital, Washington, DC, USA
| | - Howard Trachtman
- NYU Langone Health, Department of Pediatrics, Division of Nephrology, New York, NY, USA
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27
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Vasylyeva TL, Page-Hefley S, Almaani S, Ayoub I, Batson A, Hladunewich M, Howard N, Fernandez HE, O'Shaughnessy M, Reynolds ML, Wadhwani S, Zee J, Smoyer WE, Wenderfer SE, Twombley KE. Evaluation of the Reproductive Care Provided to Adolescent Patients in Nephrology Clinics: A Pediatric Nephrology Research Consortium Study. Kidney Int Rep 2021; 6:1411-1415. [PMID: 34013118 PMCID: PMC8116773 DOI: 10.1016/j.ekir.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/05/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tetyana L Vasylyeva
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Shyanne Page-Hefley
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Salem Almaani
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Isabelle Ayoub
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Abigail Batson
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Michelle Hladunewich
- Division of Nephrology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Noel Howard
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Hilda E Fernandez
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Michelle O'Shaughnessy
- Department of Renal Medicine, University College Cork and Cork University Hospital, Wilton, Cork, Ireland
| | - Monica L Reynolds
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shikha Wadhwani
- Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - William E Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Nephrology and Hypertension, Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Scott E Wenderfer
- Department of Pediatrics-Renal, Baylor College of Medicine, Houston, Texas, USA
| | - Katherine E Twombley
- Division of Nephrology, Department of Pediatric, Medical University of South Carolina, Charleston, South Carolina, USA
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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
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Dhande IS, Kneedler SC, Zhu Y, Joshi AS, Hicks MJ, Wenderfer SE, Braun MC, Doris PA. Natural genetic variation in Stim1 creates stroke in the spontaneously hypertensive rat. Genes Immun 2020; 21:182-192. [PMID: 32300198 PMCID: PMC7274944 DOI: 10.1038/s41435-020-0097-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/27/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 12/28/2022]
Abstract
Similar to humans, the risk of cerebrovascular disease in stroke-prone spontaneously hypertensive rats (SHR-A3/SHRSP) arises from naturally occurring genetic variation. In the present study, we show the involvement of genetic variation affecting the store-operated calcium signaling gene, Stim1, in the pathogenesis of stroke in SHR. Stim1 is a key lymphocyte activation signaling molecule and contains functional variation in SHR-A3 that diverges from stroke-resistant SHR-B2. We created a SHR-A3 congenic line in which Stim1 was substituted with the corresponding genomic segment from SHR-B2. Compared with SHR-A3 rats, Stim1 congenic SHR-A3 (SHR-A3(Stim1-B2)) have reduced cerebrovascular disease in response to salt loading including lower neurological deficit scores and cerebral edema. Microbleeds and major hemorrhages occurred in over half of SHR-A3 rats. These lesions were absent in SHR-A3(Stim1-B2) rats. Loss of Stim1 function in mice and humans is associated with antibody-mediated autoimmunity due to defects in T lymphocyte helper function to B cells. We investigated autoantibody formation using a high-density protein array to detect the presence of IgG and IgM autoantibodies in SHR-A3. Autoantibodies to key cerebrovascular stress proteins were detected that were reduced in the congenic line.
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Affiliation(s)
- Isha S Dhande
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Sterling C Kneedler
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Yaming Zhu
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Aniket S Joshi
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - M John Hicks
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, 77030, USA
| | - Scott E Wenderfer
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, 77030, USA
| | - Michael C Braun
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, 77030, USA
| | - Peter A Doris
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
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Dhande IS, Zhu Y, Kneedler SC, Joshi AS, Hicks MJ, Wenderfer SE, Braun MC, Doris PA. Stim1 Polymorphism Disrupts Immune Signaling and Creates Renal Injury in Hypertension. J Am Heart Assoc 2020; 9:e014142. [PMID: 32075490 PMCID: PMC7335582 DOI: 10.1161/jaha.119.014142] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Spontaneously hypertensive rats of the stroke‐prone line (SHR‐A3) develop hypertensive renal disease as a result of naturally occurring genetic variation. Our prior work identified a single‐nucleotide polymorphism unique to SHR‐A3 that results in truncation of the carboxy terminus of STIM1. The SHR‐B2 line, which is also hypertensive but resists hypertensive renal injury, expresses the wild‐type STIM1. STIM1 plays a central role in lymphocyte calcium signaling that directs immune effector responses. Here we show that major defects in lymphocyte function affecting calcium signaling, nuclear factor of activated T cells activation, cytokine production, proliferation, apoptosis, and regulatory T‐cell development are present in SHR‐A3 and attributable to STIM1. Methods and Results To assess the role of Stim1 variation in susceptibility to hypertensive renal injury, we created a Stim1 congenic line, SHR‐A3(Stim1‐B2), and STIM1 function was rescued in SHR‐A3. We found that Stim1 gene rescue restores disturbed lymphocyte function in SHR‐A3. Hypertensive renal injury was compared in SHR‐A3 and the SHR‐A3(Stim1‐B2) congenic line. Histologically assessed renal injury was markedly reduced in SHR‐A3(Stim1‐B2), as were renal injury biomarker levels measured in urine. Stim1 deficiency has been linked to the emergence of antibody‐mediated autoimmunity. Renal glomerular immunoglobulin deposition was greater in SHR‐A3 than SHR‐B2 and was reduced by Stim1 congenic substitution. Serum anti–double‐stranded DNA antibody titers in SHR‐A3 were elevated compared with SHR‐B2 and were reduced in SHR‐A3(Stim1‐B2). Conclusions Stim1 deficiency in lymphocyte function originating from Stim1 truncation in SHR‐A3 combines with hypertension to create end organ disease and may do so as a result of antibody formation.
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Affiliation(s)
- Isha S Dhande
- Institute of Molecular Medicine University of Texas Health Science Center at Houston Houston TX
| | - Yaming Zhu
- Institute of Molecular Medicine University of Texas Health Science Center at Houston Houston TX
| | - Sterling C Kneedler
- Institute of Molecular Medicine University of Texas Health Science Center at Houston Houston TX
| | - Aniket S Joshi
- Institute of Molecular Medicine University of Texas Health Science Center at Houston Houston TX
| | - M John Hicks
- Department of Pathology and Immunology Baylor College of Medicine and Texas Children's Hospital Houston TX
| | - Scott E Wenderfer
- Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston TX
| | - Michael C Braun
- Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston TX
| | - Peter A Doris
- Institute of Molecular Medicine University of Texas Health Science Center at Houston Houston TX
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Wenderfer SE, Chang J, Hicks MJ. Approach to Classification and Management of Childhood-Onset Lupus Nephritis. Curr Pediatr Rep 2020. [DOI: 10.1007/s40124-020-00207-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rovin BH, Caster DJ, Cattran DC, Gibson KL, Hogan JJ, Moeller MJ, Roccatello D, Cheung M, Wheeler DC, Winkelmayer WC, Floege J, Alpers CE, Ayoub I, Bagga A, Barbour SJ, Barratt J, Chan DT, Chang A, Choo JCJ, Cook HT, Coppo R, Fervenza FC, Fogo AB, Fox JG, Glassock RJ, Harris D, Hodson EM, Hogan JJ, Hoxha E, Iseki K, Jennette JC, Jha V, Johnson DW, Kaname S, Katafuchi R, Kitching AR, Lafayette RA, Li PK, Liew A, Lv J, Malvar A, Maruyama S, Mejía-Vilet JM, Mok CC, Nachman PH, Nester CM, Noiri E, O'Shaughnessy MM, Özen S, Parikh SM, Park HC, Peh CA, Pendergraft WF, Pickering MC, Pillebout E, Radhakrishnan J, Rathi M, Ronco P, Smoyer WE, Tang SC, Tesař V, Thurman JM, Trimarchi H, Vivarelli M, Walters GD, Wang AYM, Wenderfer SE, Wetzels JF. Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2020; 95:281-295. [PMID: 30665569 DOI: 10.1016/j.kint.2018.11.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [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: 06/26/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023]
Abstract
In November 2017, the Kidney Disease: Improving Global Outcomes (KDIGO) initiative brought a diverse panel of experts in glomerular diseases together to discuss the 2012 KDIGO glomerulonephritis guideline in the context of new developments and insights that had occurred over the years since its publication. During this KDIGO Controversies Conference on Glomerular Diseases, the group examined data on disease pathogenesis, biomarkers, and treatments to identify areas of consensus and areas of controversy. This report summarizes the discussions on primary podocytopathies, lupus nephritis, anti-neutrophil cytoplasmic antibody-associated nephritis, complement-mediated kidney diseases, and monoclonal gammopathies of renal significance.
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Affiliation(s)
- Brad H Rovin
- Division of Nephrology, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
| | - Dawn J Caster
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Daniel C Cattran
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Keisha L Gibson
- University of North Carolina Kidney Center at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan J Hogan
- Division of Nephrology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcus J Moeller
- Division of Nephrology and Clinical Immunology, Rheinisch-Westfälische Technische Hochschule, University of Aachen, Aachen, Germany
| | - Dario Roccatello
- CMID (Center of Research of Immunopathology and Rare Diseases), and Division of Nephrology and Dialysis (ERK-Net member), University of Turin, Italy
| | | | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jürgen Floege
- Division of Nephrology, Rheinisch-Westfälische Technische Hochschule, University of Aachen, Aachen, Germany.
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Dhande IS, Kneedler SC, Joshi AS, Zhu Y, Hicks MJ, Wenderfer SE, Braun MC, Doris PA. Germ-line genetic variation in the immunoglobulin heavy chain creates stroke susceptibility in the spontaneously hypertensive rat. Physiol Genomics 2019; 51:578-585. [PMID: 31608789 DOI: 10.1152/physiolgenomics.00054.2019] [Citation(s) in RCA: 9] [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: 02/07/2023] Open
Abstract
The risk of cerebrovascular disease in stroke-prone spontaneously hypertensive rats (SHR-A3/SHRSP) arises from naturally occurring genetic variation. In the present study we show the involvement of SHR genetic variation that affects antibody formation and function in the pathogenesis of stroke. We have tested the involvement in susceptibility to stroke of genetic variation in IgH, the gene encoding the immunoglobulin heavy chain by congenic substitution. This gene contains functional natural variation in SHR-A3 that diverges from stroke-resistant SHR-B2. We created a SHR-A3 congenic line in which the IgH gene was substituted with the corresponding haplotype from SHR-B2. Compared with SHR-A3 rats, congenic substitution of the IgH locus [SHR-A3(IgH-B2)] markedly reduced cerebrovascular disease. Given the role in antibody formation of the IgH gene, we investigated the presence of IgG and IgM autoantibodies and their targets using a high-density protein array containing ~20,000 recombinant proteins. High titers of autoantibodies to key cerebrovascular stress proteins were detected, including FABP4, HSP70, and Wnt signaling proteins. Serum levels of these autoantibodies were reduced in the SHR-A3(IgH-B2) congenic line.
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Affiliation(s)
- Isha S Dhande
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sterling C Kneedler
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Aniket S Joshi
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Yaming Zhu
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - M John Hicks
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston
| | - Scott E Wenderfer
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Michael C Braun
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Peter A Doris
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
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Holland MJ, Beresford MW, Feldman BM, Huggins J, Norambuena X, Silva CA, Susic G, Sztajnbok F, Uziel Y, Appenzeller S, Ardoin SP, Avcin T, Flores F, Goilav B, Khubchandani R, Klein-Gitelman M, Levy D, Ravelli A, Wenderfer SE, Ying J, Ruperto N, Brunner HI. Measuring Disease Damage and Its Severity in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 70:1621-1629. [PMID: 29409150 DOI: 10.1002/acr.23531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 01/30/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the frequency and types of disease damage occurring with childhood-onset systemic lupus erythematosus (SLE) as measured by the 41-item Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), and to assess the SDI's ability to reflect damage severity. METHODS Information for the SDI was prospectively collected from 1,048 childhood-onset SLE patients. For a subset of 559 patients, physician-rated damage severity measured by visual analog scale (MD VAS damage) was also available. Frequency of SDI items and the association between SDI summary scores and MD VAS damage were estimated. Finally, an international consensus conference, using nominal group technique, considered the SDI's capture of childhood-onset SLE-associated damage and its severity. RESULTS After a mean disease duration of 3.8 years, 44.2% of patients (463 of 1,048) already had an SDI summary score >0 (maximum 14). The most common SDI items scored were proteinuria, scarring alopecia, and cognitive impairment. Although there was a moderately strong association between SDI summary scores and MD VAS damage (Spearman's r = 0.49, P < 0.0001) in patients with damage (SDI summary score >0), mixed-effects analysis showed that only 4 SDI items, each occurring in <2% of patients overall, were significantly associated with MD VAS damage. There was consensus among childhood-onset SLE experts that the SDI in its current form is inadequate for estimating the severity of childhood-onset SLE-associated damage. CONCLUSION Disease damage as measured by the SDI is common in childhood-onset SLE, even with relatively short disease durations. Given the shortcomings of the SDI, there is a need to develop new tools to estimate the impact of childhood-onset SLE-associated damage.
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Affiliation(s)
| | - Michael W Beresford
- Alder Hey Children's National Health Service Foundation Trust and University of Liverpool, Liverpool, UK
| | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Clovis A Silva
- Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Flavio Sztajnbok
- Hospital Universitario Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yosef Uziel
- Meir Medical Centre, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Stacy P Ardoin
- Nationwide Children's Hospital, Ohio State University Wexner College of Medicine, Columbus
| | - Tadej Avcin
- Ljubljana University Medical Center, University of Ljubljana Medical Faculty, Ljubljana, Slovenia
| | | | - Beatrice Goilav
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | | | | | - Deborah Levy
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Angelo Ravelli
- Istituto Giannina Gaslini and Università degli Studi di Genova, Genoa, Italy
| | | | - Jun Ying
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Hanson CS, Gutman T, Craig JC, Bernays S, Raman G, Zhang Y, James LJ, Ralph AF, Ju A, Manera KE, Teixeira-Pinto A, Viecelli AK, Alexander SI, Blydt-Hansen TD, Dionne J, McTaggart S, Michael M, Walker A, Carter S, Wenderfer SE, Winkelmayer WC, Bockenhauer D, Dart A, Eddy AA, Furth SL, Gipson DS, Goldstein SL, Groothoff J, Samuel S, Sinha A, Webb NJ, Yap HK, Zappitelli M, Currier H, Tong A. Identifying Important Outcomes for Young People With CKD and Their Caregivers: A Nominal Group Technique Study. Am J Kidney Dis 2019; 74:82-94. [DOI: 10.1053/j.ajkd.2018.12.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/23/2018] [Indexed: 11/11/2022]
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Ardoin SP, Daly RP, Merzoug L, Tse K, Ardalan K, Arkin L, Knight A, Rubinstein T, Ruth N, Wenderfer SE, Hersh AO. Research priorities in childhood-onset lupus: results of a multidisciplinary prioritization exercise. Pediatr Rheumatol Online J 2019; 17:32. [PMID: 31262324 PMCID: PMC6600895 DOI: 10.1186/s12969-019-0327-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/08/2019] [Accepted: 05/07/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Childhood-onset systemic erythematosus lupus (cSLE) is characterized by more severe disease, widespread organ involvement and higher mortality compared to adult-onset SLE. However, cSLE is largely underfunded to carry out necessary research to advance the field. Few commonly used SLE medications have been studied in children, and important knowledge gaps exist concerning epidemiology, genetics, pathophysiology and optimal treatments for cSLE. METHODS In order to assess highest cSLE research priority areas, the Lupus Foundation of America (LFA) and Childhood Arthritis and Rheumatology Research Alliance (CARRA) administered a cSLE research prioritization survey to pediatric rheumatologists, dermatologists and nephrologists with expertise in lupus. Members of LFA and CARRA's SLE Committee identified a list of cSLE research domains and developed a 17-item tiered, web-based survey asking respondents to categorize the research domains into high, medium, or low priority areas. For domains identified as high priority, respondents ranked research topics within that category. For example, for the domain of nephritis, respondents ranked importance of: epidemiology, biomarkers, long-term outcomes, quality improvement, etc. The survey was distributed to members of CARRA, Midwestern Pediatric Nephrology Consortium (MWPNC) and Pediatric Dermatology Research Alliance (PeDRA) Connective Tissue Disease group. RESULTS The overall response rate was 256/752 (34%). The highest prioritized research domains were: nephritis, clinical trials, biomarkers, neuropsychiatric disease and refractory skin disease. Notably, nephritis, clinical trials and biomarkers were ranked in the top five by all groups. Within each research domain, all groups showed agreement in identifying the following as important focus areas: determining best treatments, biomarkers/pathophysiology, drug discovery/novel treatments, understanding long term outcomes, and refining provider reported quality measures. CONCLUSION This survey identified the highest cSLE research priorities among leading rheumatology, dermatology and nephrology clinicians and investigators engaged in care of children with lupus. There is a strong need for multidisciplinary collaboration moving forward, which was indicated as highly important among stakeholders involved in the survey. These survey results should be used as a roadmap to guide funding and specific research programs in cSLE to address urgent, unmet needs among this population.
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Affiliation(s)
- Stacy P. Ardoin
- 0000 0004 0392 3476grid.240344.5Division of Pediatric Rheumatology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - R Paola Daly
- 0000 0004 0616 4647grid.429277.dLupus Foundation of America, Washington, DC USA
| | - Lyna Merzoug
- 0000 0004 0616 4647grid.429277.dLupus Foundation of America, Washington, DC USA
| | - Karin Tse
- 0000 0004 0616 4647grid.429277.dLupus Foundation of America, Washington, DC USA
| | - Kaveh Ardalan
- 0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital, Chicago, IL USA
| | - Lisa Arkin
- 0000 0001 0701 8607grid.28803.31University of Wisconsin, Madison, WI USA
| | | | - Tamar Rubinstein
- 0000 0004 0566 7955grid.414114.5Children’s Hospital at Montefiore, Bronx, NY USA
| | - Natasha Ruth
- 0000 0001 2189 3475grid.259828.cMedical University of South Carolina, Charleston, SC USA
| | - Scott E. Wenderfer
- 0000 0001 2200 2638grid.416975.8Texas Children’s Hospital, Houston, TX USA
| | - Aimee O. Hersh
- 0000 0001 2193 0096grid.223827.eUniversity of Utah, Salt Lake City, UT USA
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Brunner HI, Holland MJ, Beresford MW, Ardoin SP, Appenzeller S, Silva CA, Flores F, Goilav B, Aydin POA, Wenderfer SE, Levy DM, Ravelli A, Khubchandani R, Avcin T, Klein-Gitelman MS, Ruperto N, Feldman BM, Ying J. American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 71:579-590. [PMID: 30680946 PMCID: PMC6483875 DOI: 10.1002/acr.23834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 05/24/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a Childhood Lupus Improvement Index (CHILI) as a tool to measure response to therapy in childhood-onset systemic lupus erythematosus (cSLE), with a focus on clinically relevant improvement (CRIc SLE ). METHODS Pediatric nephrology and rheumatology subspecialists (n = 213) experienced in cSLE management were invited to define CRIc SLE and rate a total of 433 unique patient profiles for the presence/absence of CRIc SLE . Patient profiles included the following cSLE core response variables (CRVs): global assessment of patient well-being (patient-global), physician assessment of cSLE activity (MD-global), disease activity index score (here, we used the Systemic Lupus Erythematosus Disease Activity Index), urine protein-to-creatinine ratio, and Child Health Questionnaire physical summary score. Percentage and absolute changes in these cSLE-CRVs (baseline versus follow-up) were considered in order to develop candidate algorithms and validate their performance (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]; range 0-1). RESULTS During an international consensus conference, unanimous agreement on a definition of CRIc SLE was achieved; cSLE experts (n = 13) concurred (100%) that the preferred CHILI algorithm considers absolute changes in the cSLE-CRVs. After transformation to a range of 0-100, a CHILI score of ≥54 had outstanding accuracy for identifying CRIc SLE (AUC 0.93, sensitivity 81.1%, and specificity 84.2%). CHILI scores also reflect minor, moderate, and major improvement for values exceeding 15, 68, and 92, respectively (all AUC ≥0.92, sensitivity ≥93.1%, and specificity ≥73.4%). CONCLUSION The CHILI is a new, seemingly highly accurate index for measuring CRI in cSLE over time. This index is useful to categorize the degree of response to therapy in children and adolescents with cSLE.
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Affiliation(s)
- Hermine I. Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael J. Holland
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael W. Beresford
- Department of Paediatric Rheumatology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Stacy P. Ardoin
- Department of Pediatrics and Internal Medicine, Ohio State University, Division of Rheumatology, Nationwide Children’s Hospital and Wexner Medical Center, Columbus, OH
| | - Simone Appenzeller
- Rheumatology Unit-School of Medical Science; University of Campinas, Campinas, Brazil
| | - Clovis A. Silva
- Children’s Institute, Hospital das Clinicas HCFMUSP; Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Francisco Flores
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Beatrice Goilav
- Department of Pediatrics, The Children’s Hospital at Montefiore, Division of Nephrology and Albert Einstein College of Medicine, Bronx, NY
| | - Pinar Ozge Avar Aydin
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Scott E. Wenderfer
- Department of Pediatrics, Baylor College of Medicine; Renal Section, Texas Children’s Hospital Houston, TX
| | - Deborah M. Levy
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Angelo Ravelli
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | | | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Centre Ljubljana, Slovenia
| | - Marisa S. Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Division of Rheumatology, Ann and Robert Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Nicolino Ruperto
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Brian M. Feldman
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Jun Ying
- Department of Environmental Health Sciences, University of Cincinnati, Cincinnati, OH
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Pelletier JH, Kumar KR, Engen R, Bensimhon A, Varner JD, Rheault MN, Srivastava T, Straatmann C, Silva C, Davis TK, Wenderfer SE, Gibson K, Selewski D, Barcia J, Weng P, Licht C, Jawa N, Kallash M, Foreman JW, Wigfall DR, Chua AN, Chambers E, Hornik CP, Brewer ED, Nagaraj SK, Greenbaum LA, Gbadegesin RA. Correction to: Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings : A Midwest Pediatric Nephrology Consortium (MWPNC) study. Pediatr Nephrol 2019; 34:539. [PMID: 30443740 DOI: 10.1007/s00467-018-4103-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The original version of this article unfortunately contained a mistake. The subtitle "A Midwest Pediatric Nephrology Consortium (MWPNC) study" was missing. The correct title including subtitle is given above.
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Affiliation(s)
- Jonathan H Pelletier
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Karan R Kumar
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Rachel Engen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois and Children's Hospital, Seattle, Washington, USA
| | - Adam Bensimhon
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Jennifer D Varner
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Michelle N Rheault
- University of Minnesota Masonic Children's Hospitals, Minneapolis, MN, USA
| | | | | | - Cynthia Silva
- Connecticut Children's Medical Center, Hartford, CT, USA
| | | | - Scott E Wenderfer
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Keisha Gibson
- North Carolina Children's Hospital, Chapel Hill, NC, USA
| | | | - John Barcia
- University of Virginia Children's Hospital, Charlottesville, VA, USA
| | - Patricia Weng
- Mattel Children's Hospital University of California, Los Angeles, CA, USA
| | | | - Natasha Jawa
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - John W Foreman
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Delbert R Wigfall
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Annabelle N Chua
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Eileen Chambers
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Christoph P Hornik
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Eileen D Brewer
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Shashi K Nagaraj
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA
| | - Larry A Greenbaum
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rasheed A Gbadegesin
- Department of Pediatrics, Divisions of Nephrology and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA.
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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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Mariani LH, Bomback AS, Canetta PA, Flessner MF, Helmuth M, Hladunewich MA, Hogan JJ, Kiryluk K, Nachman PH, Nast CC, Rheault MN, Rizk DV, Trachtman H, Wenderfer SE, Bowers C, Hill-Callahan P, Marasa M, Poulton CJ, Revell A, Vento S, Barisoni L, Cattran D, D'Agati V, Jennette JC, Klein JB, Laurin LP, Twombley K, Falk RJ, Gharavi AG, Gillespie BW, Gipson DS, Greenbaum LA, Holzman LB, Kretzler M, Robinson B, Smoyer WE, Guay-Woodford LM. CureGN Study Rationale, Design, and Methods: Establishing a Large Prospective Observational Study of Glomerular Disease. Am J Kidney Dis 2018; 73:218-229. [PMID: 30420158 PMCID: PMC6348011 DOI: 10.1053/j.ajkd.2018.07.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Abstract
RATIONALE & OBJECTIVES Glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and immunoglobulin A (IgA) nephropathy, share clinical presentations, yet result from multiple biological mechanisms. Challenges to identifying underlying mechanisms, biomarkers, and new therapies include the rarity of each diagnosis and slow progression, often requiring decades to measure the effectiveness of interventions to prevent end-stage kidney disease (ESKD) or death. STUDY DESIGN Multicenter prospective cohort study. SETTING & PARTICIPANTS Cure Glomerulonephropathy (CureGN) will enroll 2,400 children and adults with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (including IgA vasculitis) and a first diagnostic kidney biopsy within 5 years. Patients with ESKD and those with secondary causes of glomerular disease are excluded. EXPOSURES Clinical data, including medical history, medications, family history, and patient-reported outcomes, are obtained, along with a digital archive of kidney biopsy images and blood and urine specimens at study visits aligned with clinical care 1 to 4 times per year. OUTCOMES Patients are followed up for changes in estimated glomerular filtration rate, disease activity, ESKD, and death and for nonrenal complications of disease and treatment, including infection, malignancy, cardiovascular, and thromboembolic events. ANALYTICAL APPROACH The study design supports multiple longitudinal analyses leveraging the diverse data domains of CureGN and its ancillary program. At 2,400 patients and an average of 2 years' initial follow-up, CureGN has 80% power to detect an HR of 1.4 to 1.9 for proteinuria remission and a mean difference of 2.1 to 3.0mL/min/1.73m2 in estimated glomerular filtration rate per year. LIMITATIONS Current follow-up can only detect large differences in ESKD and death outcomes. CONCLUSIONS Study infrastructure will support a broad range of scientific approaches to identify mechanistically distinct subgroups, identify accurate biomarkers of disease activity and progression, delineate disease-specific treatment targets, and inform future therapeutic trials. CureGN is expected to be among the largest prospective studies of children and adults with glomerular disease, with a broad goal to lessen disease burden and improve outcomes.
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Affiliation(s)
- Laura H Mariani
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI.
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Pietro A Canetta
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Michael F Flessner
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | | | - Michelle A Hladunewich
- Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jonathan J Hogan
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Patrick H Nachman
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michelle N Rheault
- Division of Nephrology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Dana V Rizk
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Howard Trachtman
- Division of Nephrology, Department of Pediatrics, New York University Langone Medical Center, New York, NY
| | - Scott E Wenderfer
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Corinna Bowers
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | | | - Maddalena Marasa
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Caroline J Poulton
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Adelaide Revell
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Suzanne Vento
- Division of Nephrology, Department of Pediatrics, New York University Langone Medical Center, New York, NY
| | | | - Dan Cattran
- Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vivette D'Agati
- Department of Pathology, Columbia University Medical Center, New York, NY
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
| | - Jon B Klein
- Department of Medicine, The University of Louisville School of Medicine, and Robley Rex VA Medical Center, Louisville, KY
| | | | - Katherine Twombley
- Pediatric Nephrology, Medical University of South Carolina, Charleston, SC
| | - Ronald J Falk
- Division of Nephrology and Hypertension, Kidney Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Ali G Gharavi
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Brenda W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | | | - Lawrence B Holzman
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthias Kretzler
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Bruce Robinson
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI
| | - William E Smoyer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System, Washington, DC
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41
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Gutman T, Hanson CS, Bernays S, Craig JC, Sinha A, Dart A, Eddy AA, Gipson DS, Bockenhauer D, Yap HK, Groothoff J, Zappitelli M, Webb NJ, Alexander SI, Goldstein SL, Furth S, Samuel S, Blydt-Hansen T, Dionne J, Michael M, Wenderfer SE, Winkelmayer WC, Currier H, McTaggart S, Walker A, Ralph AF, Ju A, James LJ, Carter S, Tong A. Child and Parental Perspectives on Communication and Decision Making in Pediatric CKD: A Focus Group Study. Am J Kidney Dis 2018; 72:547-559. [DOI: 10.1053/j.ajkd.2018.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/02/2018] [Indexed: 11/11/2022]
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42
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Pelletier JH, Kumar KR, Engen R, Bensimhon A, Varner JD, Rheaul MN, Srivastava T, Straatmann C, Silva C, Davis TK, Wenderfer SE, Gibson K, Selewski D, Barcia J, Weng P, Licht C, Jawa N, Kallash M, Foreman JW, Wigfall DR, Chua AN, Chambers E, Hornik CP, Brewer ED, Nagaraj SK, Greenbaum LA, Gbadegesin RA. Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings. Pediatr Nephrol 2018; 33:1773-1780. [PMID: 29982878 PMCID: PMC6129203 DOI: 10.1007/s00467-018-3994-3] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence. METHODS Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence. RESULTS We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3-23.7) compared to FSGS predicted disease recurrence. CONCLUSIONS Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence.
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Affiliation(s)
- Jonathan H. Pelletier
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Karan R. Kumar
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Rachel Engen
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois and Children’s Hospital Seattle, Washington
| | - Adam Bensimhon
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Jennifer D. Varner
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | | | | | | | - Cynthia Silva
- Connecticut Children’s Medical Center, Hartford, Connecticut
| | | | - Scott E. Wenderfer
- Baylor College of Medicine, and Texas Children’s Hospital, Houston, Texas
| | | | | | - John Barcia
- University of Virginia Children’s Hospital, Charlottesville, Virginia
| | - Patricia Weng
- Mattel Children’s Hospital University of California, Los Angeles, California
| | | | - Natasha Jawa
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - John W. Foreman
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Delbert R. Wigfall
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Annabelle N. Chua
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Eileen Chambers
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Christoph P. Hornik
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | - Eileen D. Brewer
- Baylor College of Medicine, and Texas Children’s Hospital, Houston, Texas
| | - Shashi K. Nagaraj
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC
| | | | - Rasheed A. Gbadegesin
- Department of Pediatrics, Divisions of Nephrology and Critical Care Duke University Medical Center, Durham, NC,To whom correspondence should be addressed: Rasheed Gbadegesin, Department of Pediatrics, Divisions of Nephrology, Duke University Medical Center, Durham, NC 27710, Phone: +19196815543,
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43
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Dhande IS, Kneedler SC, Zhu Y, Hicks MJ, Wenderfer SE, Braun MC, Doris PA. Abstract 028: Susceptibility to Strokes in Spontaneously Hypertensive Rats Due to a Mutation in
Stim1. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke-prone spontaneously hypertensive rats (SHR-A3/SHRSP) develop cerebrovascular disease as a result of naturally occurring genetic variation. We recently identified a novel truncating mutation in the SHR-A3 line affecting the C-terminus of STIM1, a protein involved in the store-operated Ca
2+
entry (SOCE) pathway. The SHR-B2 line, which is also hypertensive but resists end organ injury, expresses the ‘wild type’
Stim1
. Here, we test whether the emergence of cerebrovascular disease in SHR-A3 is prevented by gene rescue of
Stim1
. We created a
Stim1
congenic line (SHR-A3(
Stim1
-B2)), in which the functional
Stim1
allele was transferred from the SHR-B2 line into the stroke-prone SHR-A3 genome. SHR-A3 and SHR-A3(
Stim1
-B2) rats were salt loaded (1% NaCl in drinking water) for 8 weeks starting at 20 weeks of age to induce strokes. Baseline BP measured by telemetry before salt loading was not different between SHR-A3 and SHR-A3(
Stim1
-B2) rats (199.5±6.49 vs 196.26±2.431 mmHg, ns). Salt loading resulted in a progressive increase in BP in SHR-A3 rats, but was blunted in SHR-A3(
Stim1
-B2) rats. Compared to SHR-A3 rats,
Stim1
-rescue congenic rats had improved survival (% survival: 100 (9 of 9) vs 22.2% (2 of 9) at the end of 8 weeks) and lower neurological deficit scores (2.45±0.412 vs 1±0.00, p<0.01). Salt loading resulted in significant cerebral edema in SHR-A3 rats but not in the SHR-A3(
Stim1
-B2) rats (% brain wt/body wt: 0.805±0.045 vs 0.617±0.009, p<0.01). Gross morphology of the brain revealed microbleeds and hemorrhages in 5 of 9 SHR-A3 rats. These lesions were absent in SHR-A3(
Stim1
-B2) rats.
Stim1
gene rescue in the congenic line was also associated with decreased susceptibility to renal injury assessed histologically at 40 weeks of age (glomerular injury: 1.915±0.086 vs 1.355±0.071, p<0.001; tubulointerstitial injury: 3.2±0.102 vs 1.69±0.112, p<0.001). Our findings identify
Stim1
as a major candidate gene that promotes susceptibility to strokes as well as renal injury in spontaneously hypertensive rats.
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Affiliation(s)
| | | | - Yaming Zhu
- Univ of Texas Health Science Cntr at Houston, Houston, TX
| | - M J Hicks
- Baylor College of Medicine, Houston, TX
| | | | | | - Peter A Doris
- Univ of Texas Health Science Cntr at Houston, Houston, TX
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44
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Affiliation(s)
- Michelle N. Rheault
- Department of Pediatrics, Division of Pediatric Nephrology, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota; and
| | - Scott E. Wenderfer
- Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, Texas
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45
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Alge JL, Wenderfer SE. 50 Years Ago in The Journal of Pediatrics: The Hemolytic-Uremic Syndrome: Renal Status of 76 Patients at Long-Term Follow-Up. J Pediatr 2018; 197:185. [PMID: 29801537 DOI: 10.1016/j.jpeds.2017.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Joseph L Alge
- Department of Pediatrics Renal Section Baylor College of Medicine Houston, Texas
| | - Scott E Wenderfer
- Department of Pediatrics Renal Section Baylor College of Medicine Houston, Texas
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46
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Brunner HI, Holland M, Beresford MW, Ardoin SP, Appenzeller S, Silva CA, Flores F, Goilav B, Wenderfer SE, Levy DM, Ravelli A, Khunchandani R, Avcin T, Klein-Gitelman MS, Feldman BM, Ruperto N, Ying J. American College of Rheumatology Provisional Criteria for Global Flares in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 70:813-822. [PMID: 29693328 DOI: 10.1002/acr.23557] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 07/08/2017] [Accepted: 03/08/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To validate the preliminary criteria of global flare for childhood-onset SLE (cSLE). METHODS Pediatricians experienced in cSLE care (n = 268) rated unique patient profiles; results of standard cSLE laboratory testing and information about the cSLE flare descriptors were presented as follows: global assessment of patient well-being, physician global assessment of disease activity (MD-global), Disease Activity Index score, protein/creatinine ratio (PCR), and erythrocyte sedimentation rate (ESR). Using rater interpretation of the course of cSLE (baseline versus followup as the gold standard), performance (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]) of the preliminary flare criteria was tested. An international consensus conference was held to rank the preliminary flare criteria as per the American College of Rheumatology recommendations and delineate threshold scores for minor, moderate, and major flares. RESULTS The accuracy of the 2 highest-ranked candidate criteria that consider absolute changes (∆) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG) (numeric scoring: A = 12, B = 8, C = 1, and D/E = 0), MD-global, PCR, and ESR were confirmed (both AUC >0.93). For the SLEDAI-based criteria (0.5 × ∆SLEDAI + 0.45 × ∆PCR + 0.5 × ∆MD-global + 0.02 × ∆ESR) flare scores ≥6.4/3.0/0.6 constituted major/moderate/minor flares, respectively. For the BILAG-based algorithm (0.4 × ∆BILAG + 0.65 × ∆PCR + 0.5 × ∆MD-global + 0.02 × ∆ESR) flare scores ≥7.4/3.7/2.2 delineated major/moderator/minor flares, respectively. These threshold values (SLEDAI, BILAG) were all >82% sensitive and specific for capturing flare severity. CONCLUSION Provisional criteria for global flares in cSLE are available to identify patients who experienced a flare. These criteria also allow for discrimination of the severity of cSLE exacerbations.
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Affiliation(s)
- Hermine I Brunner
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Holland
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael W Beresford
- Institute of Translational Medicine and Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Stacy P Ardoin
- Ohio State University, Nationwide Children's Hospital, and Wexner Medical Center, Columbus, Ohio
| | | | - Clovis A Silva
- Children's Institute, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Flores
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beatrice Goilav
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Scott E Wenderfer
- Baylor College of Medicine and Texas Children's Hospital Houston, Texas
| | - Deborah M Levy
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, and Università degli Studi di Genova, Genoa, Italy
| | | | - Tadej Avcin
- University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Marisa S Klein-Gitelman
- Northwestern University Feinberg School of Medicine and Ann and Robert Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Brian M Feldman
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, and Università degli Studi di Genova, Genoa, Italy
| | - Jun Ying
- University of Cincinnati, Cincinnati, Ohio
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Dhande IS, Kneedler SC, Zhu Y, Mamenko M, Hicks MJ, Pochynyuk O, Wenderfer SE, Braun MC, Doris PA. Increased susceptibility to hypertensive renal disease in spontaneously hypertensive rats due to a mutation in
Stim1. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.716.20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Isha S. Dhande
- Institute of Molecular Medicine ‐ Center for Human GeneticsUniversity of Texas Health Science Center at HoustonHoustonTX
| | - Sterling C. Kneedler
- Institute of Molecular Medicine ‐ Center for Human GeneticsUniversity of Texas Health Science Center at HoustonHoustonTX
| | - Yaming Zhu
- Institute of Molecular Medicine ‐ Center for Human GeneticsUniversity of Texas Health Science Center at HoustonHoustonTX
| | - Mykola Mamenko
- Department of Integrative Biology and PharmacologyUniversity of Texas Health Science Center at HoustonHoustonTX
| | - M John Hicks
- Department of PediatricsBaylor College of MedicineHoustonTX
| | - Oleh Pochynyuk
- Department of Integrative Biology and PharmacologyUniversity of Texas Health Science Center at HoustonHoustonTX
| | | | | | - Peter A. Doris
- Institute of Molecular Medicine ‐ Center for Human GeneticsUniversity of Texas Health Science Center at HoustonHoustonTX
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48
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Dhande IS, Cranford SM, Zhu Y, Kneedler SC, Hicks MJ, Wenderfer SE, Braun MC, Doris PA. Susceptibility to Hypertensive Renal Disease in the Spontaneously Hypertensive Rat Is Influenced by 2 Loci Affecting Blood Pressure and Immunoglobulin Repertoire. Hypertension 2018; 71:700-708. [PMID: 29437896 DOI: 10.1161/hypertensionaha.117.10593] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/02/2017] [Accepted: 12/27/2017] [Indexed: 12/11/2022]
Abstract
High blood pressure exerts its deleterious effects on health largely through acceleration of end-organ diseases. Among these, progressive loss of renal function is particularly important, not only for the direct consequences of kidney damage but also because loss of renal function is associated with amplification of other adverse cardiovascular outcomes. Genetic susceptibility to hypertension and associated end-organ disease is non-Mendelian in both humans and in a rodent model, the spontaneously hypertensive rat (SHR). Here, we report that hypertensive end-organ disease in the inbred SHR-A3 line is attributable to genetic variation in the immunoglobulin heavy chain on chromosome 6. This variation coexists with variation in a 10 Mb block on chromosome 17 that contains genetic variation in 2 genes involved in immunoglobulin Fc receptor signaling. Substitution of these genomic regions into the SHR-A3 genome from the closely related, but injury-resistant, SHR-B2 line normalizes both biomarker and histological measures of renal injury. Our findings indicate that genetic variation leads to a contribution by immune mechanisms hypertensive end-organ injury and that, in this rat model, disease is influenced by differences in germ line antibody repertoire.
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Affiliation(s)
- Isha S Dhande
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX
| | - Stacy M Cranford
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX
| | - Yaming Zhu
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX
| | - Sterling C Kneedler
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX
| | - M John Hicks
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX
| | - Scott E Wenderfer
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX
| | - Michael C Braun
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX
| | - Peter A Doris
- From the Institute of Molecular Medicine, University of Texas HSC at Houston (I.S.D., S.M.C., Y.Z., S.C.K., P.A.D.); and Department of Pediatrics (S.E.W., M.C.B.) and Department of Pathology and Immunology (M.J.H.), Baylor College of Medicine, Houston, TX.
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Abstract
Unique challenges exist in the diagnosis and treatment of glomerular diseases with their onset during childhood. Mounting evidence supports the notion that earlier onset cases occur due to larger numbers of genetic risk alleles. Nearly all causes of adult-onset glomerulonephritis, nephrotic syndrome, and thrombotic microangiopathy have also been described in children, although the prevalence of specific causes differs. Postinfectious glomerulonephritis, Henoch-Schönlein purpura nephritis, and minimal change disease remain the most common causes of glomerular disease in younger children in the United States and can be diagnosed clinically without need for biopsy. IgA nephropathy is the most common pediatric glomerular disease diagnosed by kidney biopsy and is considered the most common chronic glomerulopathy worldwide. In both developing and developed countries, there is a strong relationship between infectious diseases and nephritis onset or relapse. Although research has led to a better understanding of how to classify and manage glomerular diseases in children, the need for disease-specific biomarkers of activity and chronicity remains a hurdle. The strength of the immune system and the growth and maturation that occurs during adolescence are unique and require age-specific approaches to disease management.
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Boneparth A, Radhakrishna SM, Greenbaum LA, Yen E, Okamura DM, Cooper JC, Mason S, Levy DM, Sule SD, Jensen PT, Yildirim-Toruner C, Ardoin SP, Wenderfer SE. Approach to Membranous Lupus Nephritis: A Survey of Pediatric Nephrologists and Pediatric Rheumatologists. J Rheumatol 2017; 44:1619-1623. [PMID: 28916546 DOI: 10.3899/jrheum.170502] [Citation(s) in RCA: 6] [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] [Accepted: 07/14/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe treatment practices for childhood pure membranous lupus nephritis (MLN). METHODS Survey study of Childhood Arthritis and Rheumatology Research Alliance and American Society of Pediatric Nephrology members. RESULTS There were 117 respondents who completed the survey (60 pediatric nephrologists, 57 pediatric rheumatologists). Steroids and nonsteroid immunosuppression (NSI) were routinely used by the majority for MLN. Mycophenolate mofetil was the favored initial NSI. Nephrologists used steroids (60% vs 93%) and NSI (53% vs 87%) less often than did rheumatologists for MLN without nephrotic syndrome (NS). CONCLUSION Pediatric rheumatologists and nephrologists both recommend steroids and NSI for children with MLN, with or without NS.
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Affiliation(s)
- Alexis Boneparth
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. .,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine.
| | - Suhas M Radhakrishna
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Larry A Greenbaum
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Eric Yen
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Daryl M Okamura
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Jennifer C Cooper
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Sherene Mason
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Deborah M Levy
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Sangeeta D Sule
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Paul T Jensen
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Cagri Yildirim-Toruner
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Stacy P Ardoin
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
| | - Scott E Wenderfer
- Columbia University Medical Center, New York, New York; Rady Children's Hospital, University of California San Diego, San Diego; University of California Los Angeles, Los Angeles; University of California San Francisco, San Francisco, California; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Seattle Children's Hospital Research Institute, University of Washington, Seattle, Washington; Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut; Johns Hopkins University, Baltimore, Maryland; Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,A. Boneparth, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Columbia University Medical Center; S.M. Radhakrishna, MD, Assistant Clinical Professor of Pediatrics, Pediatric Rheumatologist, Rady Children's Hospital, University of California San Diego; L.A. Greenbaum, MD, PhD, Marcus Professor of Pediatrics, Pediatric Nephrologist, Children's Healthcare of Atlanta, Emory University; E. Yen, MD, Pediatric Rheumatology Fellow, University of California Los Angeles; D.M. Okamura, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Seattle Children's Hospital Research Institute, University of Washington; J.C. Cooper, MD, PharmD, Pediatric Rheumatology Fellow, University of California San Francisco; S. Mason, MD, MBA, Assistant Professor of Pediatrics, Pediatric Nephrologist, Connecticut Children's Hospital, University of Connecticut; D.M. Levy, MD, MS, FRCPC, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Hospital for Sick Children, University of Toronto; S.D. Sule, MD, Associate Professor of Pediatrics, Pediatric Nephrologist, Johns Hopkins University; P.T. Jensen, MD, Pediatric and Adult Rheumatology Fellow, Nationwide Children's Hospital, The Ohio State University; C. Yildirim-Toruner, MD, Assistant Professor of Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.P. Ardoin, MD, Associate Professor of Medicine and Pediatrics, Pediatric Rheumatologist, Nationwide Children's Hospital, The Ohio State University; S.E. Wenderfer, MD, PhD, Assistant Professor of Pediatrics, Pediatric Nephrologist, Texas Children's Hospital, Baylor College of Medicine
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