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Zaroui A, Kharoubi M, Gounot R, Oghina S, Degoutte C, Bezard M, Galat A, Guendouz S, Roulin L, Audard V, Leroy V, Teiger E, Poullot E, Molinier-Frenkel V, Le Bras F, Belhadj K, Bastard JP, Fellahi S, Shourick J, Lemonier F, Damy T. Prognostic mortality factors in advanced light chain cardiac amyloidosis: A prospective cohort study. ESC Heart Fail 2024. [PMID: 38444090 DOI: 10.1002/ehf2.14671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Abstract
AIMS Predicting mortality in severe AL cardiac amyloidosis is challenging due to elevated biomarker levels and limited thresholds for stratifying severe cardiac damage. METHODS AND RESULTS This prospective, observational, cohort study included de novo, confirmed cardiac AL amyloidosis patients at the Henri Mondor National Reference Centre. The goal was to identify predictors of mortality to enhance prognostic stratification and improve informed decision-making regarding therapy. Over the 12-year study period, among the 233 patients included, 133 were NYHA III-IV and 179 Mayo 2004 III. The independent predictors for mortality identified were hsTnT, NT-proBNP, cardiac output, and conjugated bilirubin. A novel prognostic, conditional stratification, Mondor amyloidosis cardiac staging (MACS) was developed with biomarker cut-off values for Stage 1: hsTnT ≤ 107 ng/L and NT-proBNP ≤ 3867 ng/L (n = 77; 33%); for stage 2 NT-proBNP > 3867 ng/L (n = 72; 30%). For stage 3, if troponin >107 ng/L, regardless of NT-proBNP then CB 4 μmol/L, was added (n = 41; 17.5%) and stage 4: CB > 4 μmol/L (n = 43; 18.5%). The median overall survival was 8 months 95% CI [2-24]. At 1 year, 102 (44%) patients died and the Kaplan-Meier median survival with MACS Stage 1 was not reached, while stage 2 was 15.2 months (95% CI [11-18]) and stage 3, 6.6 months (95% CI [1-13]). Notably, among European stage II patients, 17.1%, n = 8 were MACS stage 3 and European stage IIIb 21.4% (n = 23) were MACS stage 4. Importantly, among European stage IIIb patients 42.2% (n = 29) were classified MACS stage 4 and 12.5% n = 9 were only MACS stage 2. CONCLUSIONS The Mondor prognostic staging system, including conjugate bilirubin may significantly improve prognostic stratification for patients with severe cardiac amyloidosis.
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Affiliation(s)
- Amira Zaroui
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Creteil, France
| | - Mounira Kharoubi
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
- Univ Paris Est Créteil (UPEC), National Institute of Medical Research (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Romain Gounot
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Lymphoid Malignancies Unit, Henri Mondor Teaching Hospital, Creteil, France
| | - Silvia Oghina
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
| | - Charlotte Degoutte
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Lymphoid Malignancies Unit, Henri Mondor Teaching Hospital, Creteil, France
| | - Melanie Bezard
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
- Univ Paris Est Créteil (UPEC), National Institute of Medical Research (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Arnault Galat
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
| | - Soulef Guendouz
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
| | - Louise Roulin
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Univ Paris Est Créteil (UPEC), National Institute of Medical Research (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Lymphoid Malignancies Unit, Henri Mondor Teaching Hospital, Creteil, France
| | - Vincent Audard
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Nephrology and Renal Transplantation Department, Henri Mondor Teaching Hospital, Rare Disease Reference Centre for Idiopathic Nephrotique Syndrome, University Hospital Federation for Innovative Therapy for Immune Disorders, Créteil, France
- Department of Epidemiology, Toulouse Teaching Hospital, Toulouse, France
| | - Vincent Leroy
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Hepatology, Henri Mondor Teaching Hospital, Creteil, France
| | - Emmanuel Teiger
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
- Univ Paris Est Créteil (UPEC), National Institute of Medical Research (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Elsa Poullot
- Department of Pathology, Henri Mondor Teaching Hospital, Creteil, France
| | - Valérie Molinier-Frenkel
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Immunology, LBMR Immunoglobulin deposit diseases and amyloses, France Henri Mondor Teaching Hospital, Creteil, France
| | - Fabien Le Bras
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Lymphoid Malignancies Unit, Henri Mondor Teaching Hospital, Creteil, France
| | - Karim Belhadj
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Lymphoid Malignancies Unit, Henri Mondor Teaching Hospital, Creteil, France
| | | | - Soraya Fellahi
- Biochemistry Department Henri Mondor Teaching Hospital, Creteil, France
| | - Jason Shourick
- Department of Epidemiology, Toulouse Teaching Hospital, Toulouse, France
| | - Francois Lemonier
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Univ Paris Est Créteil (UPEC), National Institute of Medical Research (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Lymphoid Malignancies Unit, Henri Mondor Teaching Hospital, Creteil, France
| | - Thibaud Damy
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, and DHU A-TVB, Henri Mondor Teaching Hospital, APHP, Creteil, France
- Department of Cardiology, Henri Mondor Teaching Hospital, Creteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Creteil, France
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Schwarz C, Georgin-Lavialle S, Lombardi Y, Marion O, Jambon F, Legendre C, Marx D, Levi C, Toure F, Le Quintrec M, Bobot M, Matignon M, Dujardin A, Maanaoui M, Cuozzo S, Jalal-Eddine A, Louis K, Mohamadou I, Brazier F, De Nattes T, Geneste C, Thervet E, Ducloux D, Mayet V, Kormann R, Lanot A, Duveau A, Zaidan M, Mesnard L, Ouali N, Rondeau E, Petit-Hoang C, Audard V, Deshayes A, Moktefi A, Rabant M, Buob D, François H, Luque Y. Kidney Transplantation in Patients With AA Amyloidosis: Outcomes in a French Multicenter Cohort. Am J Kidney Dis 2024; 83:329-339. [PMID: 37741608 DOI: 10.1053/j.ajkd.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/26/2023] [Accepted: 07/24/2023] [Indexed: 09/25/2023]
Abstract
RATIONALE & OBJECTIVE Outcomes of kidney transplantation for patients with renal AA amyloidosis are uncertain, with reports of poor survival and high rates of disease recurrence. However, the data are inconclusive and mostly based on studies from the early 2000s and earlier. STUDY DESIGN Retrospective multicenter cohort study. SETTING & PARTICIPANTS We searched the French national transplant database to identify all patients with renal AA amyloidosis who underwent kidney transplantation between 2008 and 2018. EXPOSURES Age, cause of amyloidosis, use of biotherapies, and C-reactive protein levels. OUTCOMES Outcomes were all-cause mortality and allograft loss. We also reported amyloidosis allograft recurrence, occurrence of acute rejection episodes, as well as infectious, cardiovascular, and neoplastic disease events. ANALYTICAL APPROACH Kaplan-Meier estimator for mortality and cumulative incidence function method for allograft loss. Factors associated with patient and allograft survival were investigated using a Cox proportional hazards model and a cause-specific hazards model, respectively. RESULTS 86 patients who received kidney transplants for AA amyloidosis at 26 French centers were included. The median age was 49.4 years (IQR, 39.7-61.1). The main cause of amyloidosis was familial Mediterranean fever (37 cases; 43%). 16 (18.6%) patients received biotherapy after transplantation. Patient survival rates were 94.0% (95% CI, 89.1-99.2) at 1 year and 85.5% (77.8-94.0) at 5 years after transplantation. Cumulative incidences of allograft loss were 10.5% (4.0-17.0) at 1 year and 13.0% (5.8-20.1) at 5 years after transplantation. Histologically proven AA amyloidosis recurrence occurred in 5 transplants (5.8%). An infection requiring hospitalization developed in 55.8% of cases, and there was a 27.9% incidence of acute allograft rejection. Multivariable analysis showed that C-reactive protein concentration at the time of transplantation was associated with patient survival (HR, 1.01; 95% CI, 1.00-1.02; P=0.01) and allograft survival (HR, 1.68; 95% CI, 1.10-2.57; P=0.02). LIMITATIONS The study lacked a control group, and the effect of biotherapies on transplantation outcomes could not be explored. CONCLUSIONS This relatively contemporary cohort of patients who received a kidney transplant for AA amyloidosis experienced favorable rates of survival and lower recurrence rates than previously reported. These data support the practice of treating these patients with kidney transplantation for end-stage kidney disease. PLAIN-LANGUAGE SUMMARY AA amyloidosis is a severe and rare disease. Kidney involvement is frequent and leads to end-stage kidney disease. Because of the involvement of other organs, these patients are often frail, which has raised concerns about their suitability for kidney transplantation. We reviewed all patients with AA amyloidosis nephropathy who underwent kidney transplantation in France in the recent era (2008-2018) and found that the outcomes after kidney transplantation were favorable, with 85.5% of patients still alive 5 years after transplantation, a survival rate that is comparable to the outcomes of patients receiving a transplant for other forms of kidney diseases. Recurrence of amyloidosis in the transplanted kidney was infrequent (5.8%). These data support the practice of kidney transplantation for patients with AA amyloidosis who experience kidney failure.
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Affiliation(s)
- Chloë Schwarz
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; Université de Paris, Service de Néphrologie-Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, Internal Medicine Department, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, National Reference Center for Autoinflammatory Diseases and Inflammatory Amyloidosis, Groupe de recherche clinique Amylose AA Sorbonne Université (GRAASU), Paris, France
| | - Yannis Lombardi
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Frédéric Jambon
- Centre Hospitalier Universitaire de Bordeaux, Service de Néphrologie, Transplantation Dialyse, Aphérèses, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France
| | | | - David Marx
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Charlène Levi
- Service de Transplantation Rénale, Hôpitaux Civils, Lyon, France
| | - Fatouma Toure
- Department of Nephrology, Dialysis and Transplantation, Hospital University of Limoges, Limoges, France
| | - Moglie Le Quintrec
- Service de Transplantation Rénale, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Mickael Bobot
- Centre de Néphrologie et Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Centre Hospitalier Universitaire de la Conception, Marseille, France
| | - Marie Matignon
- Nephrology and Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Creteil, France
| | - Amaury Dujardin
- Service de Néphrologie et Immunologie Clinique, Nantes Université, Centre Hospitalier Universitaire Nantes, Institut National de la Santé et de la Recherche Médicale, Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche 1064, Institut de Transplantation Urologie Néphrologie, Nantes, France
| | - Mehdi Maanaoui
- Nephrology Department, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sébastien Cuozzo
- Department of Nephrology Dialysis and Transplantation, Pasteur 2 Hospital, Nice University Hospital, Nice, France
| | | | - Kévin Louis
- Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Nephrology and Transplantation Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Inna Mohamadou
- Kidney Transplantation Department, Hôpital Pitié-Salpétriêre, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Brazier
- Nephrology, Internal Medicine, Dialysis and Transplantation Department, Centre Hospitalier Universitaire Amiens, Amiens, France
| | - Tristan De Nattes
- Nephrology-Hemodialysis Department, Centre Hospitalier Universitaire Rouen, Rouen, France
| | - Claire Geneste
- Nephrology Department, Centre Hospitalier Universitaire Tours, Tours, France
| | - Eric Thervet
- Nephrology Department, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Didier Ducloux
- Nephrology Department, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Valentin Mayet
- Nephrology-Hemodialysis Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Raphaël Kormann
- Nephrology Department, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - Antoine Lanot
- Nephrology-Dialysis-Kidney Transplantation Department, Centre Hospitalier Universitaire Caen, Caen, France
| | - Agnès Duveau
- Nephrology Department, Centre Hospitalier Universitaire Angers, Angers, France
| | - Mohamad Zaidan
- Université de Paris, Service de Néphrologie-Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurent Mesnard
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Nacera Ouali
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Eric Rondeau
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Camille Petit-Hoang
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Creteil, France
| | | | - Anissa Moktefi
- Pathology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | - David Buob
- Pathology Department, Sorbonne Université, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène François
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Yosu Luque
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1155, Soins Intensifs Néphrologiques et Rein Aigu, Département de Néphrologie, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France.
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3
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Chauveau B, Gibier JB, Olagne J, Morel A, Aydin S, McAdoo SP, Viallet N, Perrochia H, Pambrun E, Royal V, Demoulin N, Kemeny JL, Philipponnet C, Hertig A, Boffa JJ, Plaisier E, Domenger C, Brochériou I, Deltombe C, Duong Van Huyen JP, Buob D, Roufosse C, Hellmark T, Audard V, Mihout F, Nasr SH, Renaudin K, Moktefi A, Rabant M. Atypical Anti-Glomerular Basement Membrane Nephritis: A Case Series From the French Nephropathology Group. Am J Kidney Dis 2024:S0272-6386(23)01003-X. [PMID: 38171412 DOI: 10.1053/j.ajkd.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
RATIONALE & OBJECTIVE Atypical anti-glomerular basement membrane (GBM) nephritis is characterized by a bright linear immunoglobulin staining along the GBM by immunofluorescence without a diffuse crescentic glomerulonephritis nor serum anti-GBM antibodies by conventional enzyme-linked immunosorbent assay (ELISA). We characterized a series of patients with atypical anti-GBM disease. STUDY DESIGN Case series. SETTING & PARTICIPANTS Patients identified by the French Nephropathology Group as having atypical anti-GBM nephritis between 2003 and 2022. FINDINGS Among 38 potential cases, 25 were included, of whom 14 (56%) were female and 23 (92%) had hematuria. The median serum creatinine at diagnosis was 150 (IQR, 102-203) μmol/L and median urine protein-creatinine ratio (UPCR) was 2.4 (IQR, 1.3-5.2) g/g. Nine patients (36%) had endocapillary proliferative glomerulonephritis (GN), 4 (16%) had mesangial proliferative GN, 4 (16%) had membranoproliferative GN, 2 (8%) had pure and focal crescentic GN, 1 (4%) had focal segmental glomerulosclerosis, and 5 had glomeruli that were unremarkable on histopathology. Nine patients (36%) had crescents, involving a median of 9% of glomeruli. Bright linear staining for IgG was seen in 22 cases (88%) and for IgA in 3 cases (12%). The 9 patients (38%) who had a monotypic staining pattern tended to be older with less proteinuria and rarely had crescents. Kidney survival rate at 1 year was 83% and did not appear to be associated with the light chain restriction. LIMITATIONS Retrospective case series with a limited number of biopsies including electron microscopy. CONCLUSIONS Compared with typical anti-GBM disease, atypical anti-GBM nephritis frequently presents with an endocapillary or mesangial proliferative glomerulonephritis pattern and appears to have a slower disease progression. Further studies are needed to fully characterize its pathophysiology and associated clinical outcomes. PLAIN-LANGUAGE SUMMARY Atypical anti-glomerular basement membrane (GBM) nephritis is characterized histologically by bright linear immunoglobulin staining along the GBM without diffuse crescentic glomerulonephritis or circulating anti-GBM antibodies. We report a case series of 25 atypical cases of anti-GBM nephritis in collaboration with the French Nephropathology Group. Compared with typical anti-GBM disease, we observed a slower disease progression. Patients frequently presented with heavy proteinuria and commonly had evidence of endocapillary or mesangial proliferative glomerulonephritis. About half of the patients displayed a monotypic immune staining pattern; they tended to be older, with less proteinuria, and commonly without glomerular crescents in biopsy specimens. No concomitant circulating monoclonal gammopathy was detected. Further studies are needed to fully characterize its pathophysiology and associated clinical outcomes.
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Affiliation(s)
- Bertrand Chauveau
- Department of Pathology, Pellegrin Hospital, Bordeaux University Hospital, Bordeaux, France; CNRS UMR 5164, ImmunoConcEpT, University of Bordeaux, Bordeaux, France.
| | - Jean-Baptiste Gibier
- UMR9020-U1277, CANTHER, Cancer Heterogeneity Plasticity and Resistance to Therapies, University of Lille, Lille, France; Institute of Pathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jérôme Olagne
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France; Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | - Antoine Morel
- Nephrology and Renal Transplantation Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Henri Mondor Hospital University, Rare Disease Center "Idiopathic Nephrotic Syndrome," Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Selda Aydin
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology & Inflammation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Nicolas Viallet
- Department of Nephrology-Transplantation, Centre Hospitalier Universitaire de la Réunion Felix Guyon, Saint Denis, Réunion, France
| | - Hélène Perrochia
- Pathology Department, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Emilie Pambrun
- Department of Nephrology Dialysis Apheresis, Nîmes University Hospital, Nîmes, France
| | - Virginie Royal
- Department of Pathology, Hôpital Maisonneuve-Rosemont, University of Montreal, Quebec, Canada
| | - Nathalie Demoulin
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-Louis Kemeny
- Pathology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Carole Philipponnet
- Nephrology, Dialysis, and Transplantation Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Jean-Jacques Boffa
- Department of Nephrology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Emmanuelle Plaisier
- Department of Nephrology, Association pour l'Utilisation du Rein Artificiel Paris Plaisance, Paris, France; Unité Mixte de Recherche S1155, Sorbonne Université and Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Camille Domenger
- Department of Nephrology, Dialysis and Transplantation, Polynésie Française Hospital, Pirae, Tahiti
| | - Isabelle Brochériou
- INSERM UMR S1155, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France; Department of Pathology, Pitié-Salpêtrière Hospital, Paris, France
| | - Clément Deltombe
- Nephrology and Transplantation Department, Department of Nephrology and Immunology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Buob
- INSERM UMR S1155, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France; Department of Pathology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Candice Roufosse
- Centre for Inflammatory Disease, Department of Immunology & Inflammation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Thomas Hellmark
- Nephrology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Henri Mondor Hospital University, Rare Disease Center "Idiopathic Nephrotic Syndrome," Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France; Institut Mondor de Recherche Biomédicale, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Université Paris-Est Créteil, Créteil, France
| | - Fabrice Mihout
- Department of Nephrology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Karine Renaudin
- Department of Pathology, Centre Hospitalier Universitaire de Nantes, Nantes, France; Centre de Recherche en Transplantation et en Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Anissa Moktefi
- Institut Mondor de Recherche Biomédicale, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Université Paris-Est Créteil, Créteil, France; Department of Pathology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Marion Rabant
- Department of Pathology, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, University of Paris Cité, Paris, France
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Egbuna O, Audard V, Manos G, Tian S, Hagos F, Chertow GM. Safety and Tolerability of the APOL1 Inhibitor, Inaxaplin, following Single- and Multiple-Ascending Doses in Healthy Adults. Glomerular Dis 2024; 4:64-73. [PMID: 38600955 PMCID: PMC11006409 DOI: 10.1159/000538255] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Abstract
Introduction Toxic gain-of-function Apolipoprotein L1 (APOL1) variants contribute to the development of proteinuric nephropathies collectively referred to as APOL1-mediated kidney disease (AMKD). Despite standard-of-care treatments, patients with AMKD experience accelerated progression to end-stage kidney disease. The identification of two APOL1 variants as the genetic cause of AMKD inspired development of inaxaplin, an inhibitor of APOL1 channel activity that reduces proteinuria in patients with AMKD. Methods We conducted two phase 1 studies evaluating the safety, tolerability, and pharmacokinetics of single-ascending doses (SAD) and multiple-ascending doses (MAD) of inaxaplin in healthy participants. In the SAD cohorts, participants were randomized to receive inaxaplin as a single dose (range, 7.5 mg to 165 mg) or placebo. In the MAD cohorts, participants were randomized to receive multiple doses of inaxaplin (range, 15 to 120 mg daily) or placebo for 14 days. We assessed safety and tolerability based on adverse events (AEs), clinical laboratory values, electrocardiograms (ECGs), and vital signs. Results A total of 178 participants were randomized in the SAD/MAD cohorts of both studies (mean age: 36.7 years; 94.9% male). The proportion of participants with any AEs was similar in the inaxaplin (24.6%) and placebo (22.7%) groups. All AEs were mild or moderate in severity; there were no serious AEs. Headache was the most common AE: 10.4% and 2.3% in the inaxaplin and placebo groups, respectively. There were no drug-related treatment discontinuations and no clinically relevant trends in laboratory values, ECGs, or vital signs. Discussion/Conclusion Inaxaplin is safe and well tolerated at single doses up to 165 mg and multiple doses up to 120 mg daily for 14 days. These results are consistent with the favorable safety profile of inaxaplin in a completed phase 2a proof-of-concept study. Together, these findings support continued evaluation of inaxaplin in an ongoing phase 2/3 pivotal trial as a potential precision medicine for patients with AMKD.
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Affiliation(s)
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Henri Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Paris Est Créteil University, Créteil, France
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5
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Sakhi H, Beaumier M, Couchoud C, Prezelin-Reydit M, Radenac J, Lobbedez T, Morin D, Audard V, Chatelet V. Social deprivation and kidney failure due to an undiagnosed nephropathy. Nephrol Dial Transplant 2023; 39:133-140. [PMID: 37580138 DOI: 10.1093/ndt/gfad174] [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: 04/11/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND In France, kidney diseases of undetermined origin account for 5%-20% of all causes of end-stage kidney disease. We investigated the impact of social disadvantage on the lack of aetiological diagnosis of nephropathies. METHODS Data from patients who started dialysis in France between 1 January 2017 and 30 June 2018 were extracted from the French Renal Epidemiology and Information Network registry. The social deprivation of each individual was estimated by the European Deprivation Index (EDI) defined by the patient's address. Logistic regression was used to perform mediation analysis to study the potential association between social deprivation and unknown nephropathy. RESULTS Of the 7218 patients included, 1263 (17.5%) had unknown kidney disease. A total of 394 (31.4%) patients in the unknown kidney disease belonged to the most deprived quintile of the EDI [fifth quintile (Q5)], vs 1636 (27.5%) patients in the known kidney disease group. In the multivariate analysis, unknown kidney disease was associated with Q5 (odds ratio 1.40, 95% confidence interval 1.12-1.74, P = .003). Mediation analysis did not identify any variables (e.g. obesity, initiation of dialysis in emergency, number of visits to the general practitioner and nephrologist before initiation of dialysis, date of first nephrology consultation) that mediated the association between social deprivation and nephropathy of unknown origin. CONCLUSIONS Our results show that, compared with nondeprived subjects, individuals experiencing social deprivation have a higher risk of unknown nephropathy at dialysis initiation. However, mediation analysis did not identify any variables that explained the association between social deprivation and nephropathy of unknown origin.
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Affiliation(s)
- Hamza Sakhi
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Nephrology, Dialysis and Transplantation, CHU Necker, Paris, France
| | - Mathilde Beaumier
- Centre Universitaire des maladies rénales, CHU de Caen Normandie, Caen, France
- Unit INSERM 1086 ANTICIPE, centre de lutte contre le cancer François Baclesse, Caen, France
| | - Cécile Couchoud
- REIN Registry, Biomedecine Agency, Saint-Denis-La-Plaine, France
| | - Mathilde Prezelin-Reydit
- Maison du Rein AURAD Aquitaine, Gradignan, France
- Université de Bordeaux, INSERM, CIC1401-EC, Bordeaux, France
| | - Jennifer Radenac
- Filière ORKiD (Orphan Rare Kidney Disease), CHU de Montpellier, Montpellier, France
| | - Thierry Lobbedez
- Centre Universitaire des maladies rénales, CHU de Caen Normandie, Caen, France
- Unit INSERM 1086 ANTICIPE, centre de lutte contre le cancer François Baclesse, Caen, France
| | - Denis Morin
- Filière ORKiD (Orphan Rare Kidney Disease), CHU de Montpellier, Montpellier, France
- Department of Pediatric Nephrology and Endocrinology, CHU de Montpellier, Montpellier, France
| | - Vincent Audard
- Filière ORKiD (Orphan Rare Kidney Disease), CHU de Montpellier, Montpellier, France
- AP-HP, Department of Nephrology and Transplantation, Henri Mondor Hospital University, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Valérie Chatelet
- Centre Universitaire des maladies rénales, CHU de Caen Normandie, Caen, France
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6
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d'Izarny-Gargas T, Isnard P, Boudhabhay I, Buob D, Moktefi A, Linster C, Hummel A, Esteve E, Audard V, Lazareth H, Maroun N, Hertig A, Gosset C, Jouzel C, Permal S, Domenger C, Kosmider O, Rabant M, Karras A, Duong Van Huyen JP. The spectrum of glomerular and vascular kidney pathology associated with myeloproliferative neoplasms. Kidney Int 2023; 104:1206-1218. [PMID: 37769965 DOI: 10.1016/j.kint.2023.09.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
A high prevalence of chronic kidney disease (CKD) occurs in patients with myeloproliferative neoplasms (MPN). However, MPN-related glomerulopathy (MPN-RG) may not account for the entirety of CKD risk in this population. The systemic vasculopathy encountered in these patients raises the hypothesis that vascular nephrosclerosis may be a common pattern of injury in patients with MPN and with CKD. In an exhaustive, retrospective, multicenter study of MPN kidney biopsies in four different pathology departments, we now describe glomerular and vascular lesions and establish clinicopathologic correlations. Our study encompassed 47 patients with MPN who underwent a kidney biopsy that included 16 patients with chronic myeloid leukemia (CML) and 31 patients with non-CML MPN. Fourteen cases met a proposed definition of MPN-RG based on mesangial sclerosis and hypercellularity, as well as glomerular thrombotic microangiopathy. MPN-RG was significantly associated with both myelofibrosis and poorer kidney survival. Thirty-three patients had moderate-to-severe arteriosclerosis while 39 patients had moderate-to-severe arteriolar hyalinosis. Multivariable models that included 188 adult native kidney biopsies as controls revealed an association between MPN and chronic kidney vascular damage, which was independent of established risk factors such as age, diabetes mellitus and hypertension. Therefore, MPN-RG is associated with myelofibrosis and has a poor kidney prognosis. Thus, our findings suggest that the kidney vasculature is a target during MPN-associated vasculopathy and establish a new link between MPN and CKD. Hence, these results may raise new hypotheses regarding the pathophysiology of vascular nephrosclerosis in the general population.
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Affiliation(s)
| | - Pierre Isnard
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Idris Boudhabhay
- Department of Nephrology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - David Buob
- Department of Pathology, Tenon Hospital, APHP, Paris, France
| | - Anissa Moktefi
- Department of Pathology, Henri Mondor Hospital, APHP, Créteil, France
| | - Charel Linster
- Department of Nephrology, Luxembourg Hospital Center, Luxembourg City, Luxembourg
| | - Aurélie Hummel
- Department of Nephrology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Emmanuel Esteve
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, Sorbonne Université, Paris, France; Department of Nephrology, Tenon Hospital, APHP, Paris, France
| | - Vincent Audard
- Department of Nephrology and Renal Transplantation, Henri Mondor Hospital, APHP, Créteil, France; Institut National de la Santé et de la Recherche Médicale, Institut Mondor de Recherche Biomédicale U955, Université Paris Est Créteil, Créteil, France
| | - Hélène Lazareth
- Department of Nephrology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Nadine Maroun
- Department of Nephrology, Poissy Intercommunal Hospital, Poissy, France
| | | | - Clément Gosset
- Department of Nephrology, CHU de la Réunion, Saint-Denis, France
| | | | - Sarah Permal
- Department of Internal Medicine, Mamoudzou Hospital, Mayotte, France
| | | | - Olivier Kosmider
- Hematology Laboratory, Cochin Hospital, Paris, France; UFR Médecine, Université Paris Cité, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Georges Pompidou European Hospital, APHP, Paris, France; UFR Médecine, Université Paris Cité, Paris, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris, France; UFR Médecine, Université Paris Cité, Paris, France.
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7
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Albenque G, Bézard M, Kharoubi M, Odouard S, Lunati A, Poullot E, Zaroui A, Teiger E, Hittinger L, Audard V, El Karoui K, Funalot B, Fanen P, Damy T, Oghina S. Comparison of cardiac involvement, extracardiac manifestations and outcomes between homozygote and heterozygote transthyretin p.Val142Ile (V122I) variant in patients with hereditary transthyretin amyloidosis: a cohort study. Amyloid 2023; 30:407-415. [PMID: 37377439 DOI: 10.1080/13506129.2023.2227322] [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: 01/13/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv) p.Val142Ile (V122I) mutation is the most common inherited cause of cardiac amyloidosis and little is known about the phenotype and outcome of the rare homozygotic genotype. This study aimed to compare phenotypic characteristics and outcomes between heterozygous and homozygous patients with ATTRv V122I amyloidosis. MATERIAL AND METHODS This monocentric, observational, retrospective study conducted at the French National Referral Centre for Cardiac Amyloidosis (Henri Mondor Hospital, Créteil), described clinical, electrocardiographic, cardiac imaging features and prognostic data for patients with ATTRv V122I amyloidosis. RESULTS Among 185 ATTRv V122I patients identified, 161 were heterozygous and 24 were homozygous. The homozygous frequency was 13%. Onset occured significantly earlier in the homozygotes compared to heterozygotes with earlier median age at diagnosis (67[63-71] years vs 76[70-79] years, p < .001), age at first cardiac symptom (66[61-71] years vs 74[68-78] years, p < .001) and age at first extracardiac symptom (59[52-70] years vs 69[62-75] years, p = .003). Homozygous ATTRv V122I was also associated with greater disease burden with earlier events (death, transplant or hospitalisation for acute heart failure) compared with heterozygotes (71[67-74] vs 78[76-79] years, p = .018). CONCLUSION This rare, homozygous V122I cohort confirmed the earlier age of onset, death and cardiac events in this population.
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Affiliation(s)
- Grégoire Albenque
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Mélanie Bézard
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Mounira Kharoubi
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Shirley Odouard
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Ariane Lunati
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Elsa Poullot
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Pathology, Henri Mondor Teaching Hospital, APHP, Creteil, France
| | - Amira Zaroui
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Emmanuel Teiger
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Luc Hittinger
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Vincent Audard
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Nephrology and Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Henri Mondor teaching Hospital, APHP, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Khalil El Karoui
- Department of Nephrology, Tenon Teaching Hospital, APHP, Paris, France
| | - Benoît Funalot
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Genetics, Henri Mondor Teaching Hospital, APHP, Creteil, France
| | - Pascale Fanen
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
- Department of Genetics, Henri Mondor Teaching Hospital, APHP, Creteil, France
| | - Thibaud Damy
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Silvia Oghina
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
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8
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Zegrari S, Mouallem A, Audard V, Jouan N, Grimbert P, Jung C, Sakhi H, Souied EH, Miere A. Optical coherence tomography angiography analysis of changes in the retina and the choroid after hemodialysis for end stage kidney disease. Int Ophthalmol 2023; 43:4473-4479. [PMID: 37589862 DOI: 10.1007/s10792-023-02847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To study effects of hemodialysis (HD) on retinal and choroidal vasculature in patients with end-stage kidney disease (ESKD) using optical coherence tomography angiography (OCTA). METHODS In this prospective study, we investigated eyes of patients undergoing hemodialysis for ESKD from Mondor University Hospital. Only one eye/patient was considered. Subfoveal choroidal thickness (SCT) was measured on enhanced-depth imaging optical coherence tomography (EDI-OCT) before and after the hemodialysis session. OCTA was used to extract retinal vascular density (superficial and deep capillary plexus, SCP, DCP) and choriocapillaris non-perfusion. Clinical, demographic and biological parameters (Blood B-Nitric Peptid rate prior to HD session) were reviewed. RESULTS Twenty patients (mean age 53.2 ± 13.6 years, 10 males and 10 females) were included in this prospective study. SCT significantly decreased after the HD session (234.3 ± 56.14 µm before HD to 211.9 ± 60.79 µm after hemodialysis (Wilcoxon signed-rank test, p = 0.003)). Non-perfusion in the choriocapillaris significantly increased after HD (41.65 ± 3.58 before HD, 42.95 ± 3.19 after HD, p = 0.036) while no significant modification of the vascular density was observed in the retinal vasculature (SCP, DCP) around the macular zone or the optic nerve. An increased plasma B-Nitric Peptide (BNP) level prior to the onset of the HD session was significantly correlated with the decrease of the SCT (r = 0.45, p = 0.043). CONCLUSION Hemodialysis in patients with ESKD is associated with a significant decrease in SCT and an increase in non-perfusion in the choriocapillaris on OCTA. A High BNP level prior to the onset of the hemodialysis appears to be correlated with the decrease in SCT.
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Affiliation(s)
- Samira Zegrari
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France
| | - Alexandra Mouallem
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France
| | - Vincent Audard
- Department of Nephrology, Henri Mondor Hospital, Créteil, France
| | - Narindra Jouan
- Department of Nephrology, Henri Mondor Hospital, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, GRC Macula and Biological Ressources Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Hichem Sakhi
- Department of Cardiology, Marie-Lannelongue Hospital, Plessis-Robinson, France
| | - Eric H Souied
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, 94010, Créteil, France.
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9
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Meuleman MS, Vieira-Martins P, El Sissy C, Audard V, Baudouin V, Bertrand D, Bridoux F, Louillet F, Dossier C, Esnault V, Jourde-Chiche N, Karras A, Morin MP, Provot F, Remy P, Ribes D, Rousset-Rouviere C, Servais A, Thervet E, Tricot L, Zaidan M, Wynckel A, Zuber J, Le Quintrec M, Frémeaux-Bacchi V, Chauvet S. Rare Variants in Complement Gene in C3 Glomerulopathy and Immunoglobulin-Mediated Membranoproliferative GN. Clin J Am Soc Nephrol 2023; 18:1435-1445. [PMID: 37615951 PMCID: PMC10637453 DOI: 10.2215/cjn.0000000000000252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND C3 glomerulopathy and idiopathic immunoglobulin-mediated membranoproliferative GN (Ig-MPGN) are rare complement-mediated kidney diseases. Inherited forms of C3 glomerulopathy/Ig-MPGN are rarely described. METHODS Three hundred ninety-eight patients with C3 glomerulopathy ( n =296) or Ig-MPGN ( n =102) from a national registry were screened for three complement genes: factor H ( CFH ), factor I ( CFI ), and C3 . Patients with rare variant (minor allele frequency <0.1%) were included. Epidemiologic, clinical, and immunologic data at diagnosis and kidney outcomes of patients were retrospectively collected. RESULTS Fifty-three different rare variants, including 30 (57%), 13 (24%), and ten (19%) in CFH , CFI , and C3 variants, were identified in 66/398 (17%) patients. Thirty-eight (72%) variants were classified as pathogenic, including 20/30 (66%) and 11/13 (84%) variants in CFH and CFI , respectively, impairing synthesis of factor H or factor I regulators. Fifteen of 53 (27%) variants were of unknown significance. At diagnosis, 69% of patients were adult (median age of 31 years). With the exception of biologic stigma of thrombotic microangiopathy, which was more frequent in patients with CFI variants (5/14 [36%] versus 1/37 [3%] and 0% in the CFH group and C3 group, respectively, P < 0.001), the clinical and histologic features were similar among the three variants groups. The kidney outcome was poor regardless of the age at onset and treatment received. Sixty-five percent (43/66) of patients with rare variant reach kidney failure after a median delay of 41 (19-104) months, compared with 28% (55/195) after a median delay of 34 (12-143) months in the nonvariant group. Among 36 patients who received a kidney transplant, 2-year recurrence was frequent, occurring in 39% (12/31), without difference between variant groups, and led to graft failure in three cases. CONCLUSIONS In our cohort, 17% of C3 glomerulopathy/Ig-MPGN cases were associated with rare variants in the CFH , CFI , or C3 genes. In most cases, a quantitative deficiency in factor H or factor I was identified. The presence of a rare variant was associated with poor kidney survival. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_11_08_CJN0000000000000252.mp3.
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Affiliation(s)
- Marie Sophie Meuleman
- Team “Inflammation, Complement and Cancer,” INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France
| | - Paula Vieira-Martins
- Department of Immunology Biology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Paris, France
| | - Carine El Sissy
- Team “Inflammation, Complement and Cancer,” INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Immunology Biology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Paris, France
| | - Vincent Audard
- Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
- INSERM U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Véronique Baudouin
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | | | - Frank Bridoux
- Department of Nephrology, Poitiers University Hospital, Poitiers, France
| | | | - Claire Dossier
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
| | - Vincent Esnault
- Department of Nephrology, Nice University Hospital, Nice, France
| | - Noémie Jourde-Chiche
- Department of Nephrology, Assistance Publique-Hôpitaux de Marseille, CHU Conception, Marseille, France
- INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France
| | - Alexandre Karras
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Paris, France
| | | | - François Provot
- Department of Nephrology, Lille University Hospital, Lille, France
| | - Philippe Remy
- Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Henri-Mondor Hospital, Créteil, France
| | - David Ribes
- Department of Nephrology, Toulouse University Hospital, Toulouse, France
| | - Caroline Rousset-Rouviere
- Department of Pediatric Nephrology, Assistance Publique-Hôpitaux de Marseille, Timone Hospital, Marseille, France
| | - Aude Servais
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Necker Hospital, Paris, France
| | - Eric Thervet
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Paris, France
| | - Leila Tricot
- Department of Nephrology, Foch Hospital, Suresnes, France
| | - Mohamad Zaidan
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Bicetre Hospital, Le Kremlin-Bicêtre, France
| | - Alain Wynckel
- Department of Nephrology, Reims University Hospital, Reims, France
| | - Julien Zuber
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Necker Hospital, Paris, France
| | - Moglie Le Quintrec
- Department of Nephrology, Montpellier University Hospital, Montpellier, France
| | - Véronique Frémeaux-Bacchi
- Team “Inflammation, Complement and Cancer,” INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Immunology Biology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Paris, France
| | - Sophie Chauvet
- Team “Inflammation, Complement and Cancer,” INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Paris, France
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10
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Damy T, Zaroui A, de Tournemire M, Kharoubi M, Gounot R, Galat A, Guendouz S, Funalot B, Itti E, Roulin L, Audard V, Fanen P, Leroy V, Poulot E, Belhadj K, Mallet S, Deep Singh Chadah G, Planté-Bordeneuve V, Gendre T, Chevalier X, Guignard S, Bequignon E, Bartier S, Folliguet T, Lemonier F, Audureau E, Tixier D, Canoui-Poitrine F, Lefaucheur JP, Souvannanorath S, Authier FJ, Maupou S, Hittinger L, Molinier-Frenkel V, David JP, Broussier A, Oghina S, Teiger E. Changes in amyloidosis phenotype over 11 years in a cardiac amyloidosis referral centre cohort in France. Arch Cardiovasc Dis 2023; 116:433-446. [PMID: 37640624 DOI: 10.1016/j.acvd.2023.07.003] [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: 02/13/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Early cardiac amyloidosis (CA) diagnosis enables patients to access effective treatments for better long-term outcomes, yet it remains under-recognised, misdiagnosed and inadequately managed. AIM To reduce diagnostic delays, we aimed to describe the epidemiological and clinical characteristics and changes over an 11-year period. METHODS This was a retrospective, observational cohort study of all patients referred to the Henri-Mondor Hospital for suspected CA. RESULTS Overall, 3194 patients were identified and 3022 were included and analysed. Our patients came from varied ethnic backgrounds, and more than half (55.2%) had confirmed CA. Over 11 years, referrals increased 4.4-fold, mostly from cardiologists. Notably, wild-type transthyretin amyloidosis (ATTRwt) became the predominant diagnosis, with referrals increasing 15-fold from 20 in 2010-2012 to 308 in 2019-2020. The number of amyloid light chain (AL) diagnoses increased, whilst variant transthyretin amyloidosis (ATTRv) numbers remained relatively stable. Concerning disease severity, AL patients presented more frequently with severe cardiac involvement whereas an increasing number of ATTRwt patients presented with National Amyloid Centre stage I (22.0% in 2013-2014 to 45.9% in 2019-2020). Lastly, among patients diagnosed with ATTRv in 2019-2020, 83.9% had ATTR Val122Ile cardiac phenotype. CONCLUSIONS This study shows that increasing cardiologist awareness and referrals have increased CA diagnoses. With improved awareness and non-invasive diagnostic techniques, more patients with ATTRwt with milder disease and more ATTRv Val122Ile mutations are being referred and diagnosed. Although more AL cases are being recognised, patients are diagnosed with severe cardiac involvement.
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Affiliation(s)
- Thibaud Damy
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France.
| | - Amira Zaroui
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France
| | - Marie de Tournemire
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France
| | - Mounira Kharoubi
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France
| | - Romain Gounot
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Lymphoid Malignancies Unit, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Arnault Galat
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Soulef Guendouz
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Benoit Funalot
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Genetic Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Emmanuel Itti
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Nuclear Medicine, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Louise Roulin
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Lymphoid Malignancies Unit, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Vincent Audard
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Nephrology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Hepatology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Pascale Fanen
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Genetic Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Vincent Leroy
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Hepatology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Elsa Poulot
- Genetic Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Pathology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Karim Belhadj
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Lymphoid Malignancies Unit, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Sophie Mallet
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Gagan Deep Singh Chadah
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Violaine Planté-Bordeneuve
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Neurology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Thierry Gendre
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Neurology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Xavier Chevalier
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Rheumatology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Sandra Guignard
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Rheumatology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Emilie Bequignon
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Otorhinolaryngologist Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Sophie Bartier
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Otorhinolaryngologist Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Thierry Folliguet
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Cardiovascular Surgery Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - François Lemonier
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Lymphoid Malignancies Unit, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Etienne Audureau
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France
| | - Denis Tixier
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; DMU care, Henri Mondor Teaching Hospital, 94010 Creteil, France
| | - Florence Canoui-Poitrine
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France
| | - Jean-Pascal Lefaucheur
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Neurophysiology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Sarah Souvannanorath
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Neurohistomyology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Francois-Jerome Authier
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Neurohistomyology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Steven Maupou
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Luc Hittinger
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France
| | - Valérie Molinier-Frenkel
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Immunology Department, Henri-Mondor Teaching Hospital, 94010 Creteil, France
| | - Jean-Philippe David
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Department of Geriatrics, AP-HP, Hopitaux Henri-Mondor/Emile-Roux, 94456 Limeil-Brevannes, France
| | - Amaury Broussier
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France; Department of Geriatrics, AP-HP, Hopitaux Henri-Mondor/Emile-Roux, 94456 Limeil-Brevannes, France
| | - Silvia Oghina
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France
| | - Emmanuel Teiger
- French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Amyloidosis Mondor Network, all at Henri-Mondor Teaching Hospital, AP-HP, 94010 Creteil, France; Cardiology department, Henri-Mondor Teaching Hospital, 94010 Creteil, France; Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, 94010 Créteil, France; Université Paris Est Creteil, Inserm, IMRB, 94010 Creteil, France
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11
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Gauckler P, Kesenheimer JS, Geetha D, Odler B, Eller K, Laboux T, Alberici F, Zappa M, Chebotareva N, Moiseev S, Bonilla M, Jhaveri KD, Oniszczuk J, Audard V, Costa D, Mastroianni-Kirsztajn G, Bruchfeld A, Muto M, Windpessl M, Mayer G, Kronbichler A. COVID-19 outcomes in patients with a history of immune-mediated glomerular diseases. Front Immunol 2023; 14:1228457. [PMID: 37767096 PMCID: PMC10520971 DOI: 10.3389/fimmu.2023.1228457] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Patients with immune-mediated glomerular diseases are considered at high risk for severe COVID-19 outcomes. However, conclusive evidence for this patient population is scarce. Methods We created a global registry and retrospectively collected clinical data of patients with COVID-19 and a previously diagnosed immune-mediated glomerular disease to characterize specific risk factors for severe COVID-19 outcomes. Results Fifty-nine patients with a history of immune-mediated glomerular diseases were diagnosed with COVID-19 between 01.03.2020 and 31.08.2021. Over a mean follow-up period of 24.79 ± 18.89 days, ten patients (16.9%) developed acute kidney injury. Overall, 44.1% of patients were managed in an outpatient setting and therefore considered as having "non-severe" COVID-19, while 55.9% of patients had severe COVID-19 requiring hospitalization including worse outcomes. Comparing both groups, patients with severe COVID-19 were significantly older (53.55 ± 17.91 versus 39.77 ± 14.95 years, p = .003), had lower serum albumin levels at presentation (3.00 ± 0.80 g/dL versus 3.99 ± 0.68 g/dL, p = .016) and had a higher risk of developing acute kidney injury (27% versus 4%, p = .018). Male sex (p <.001) and ongoing intake of corticosteroids at presentation (p = .047) were also significantly associated with severe COVID-19 outcomes, while the overall use of ongoing immunosuppressive agents and glomerular disease remission status showed no significant association with the severity of COVID-19 (p = .430 and p = .326, respectively). Conclusion Older age, male sex, ongoing intake of corticosteroids and lower serum albumin levels at presentation were identified as risk factors for severe COVID-19 outcomes in patients with a history of various immune-mediated glomerular diseases.
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Affiliation(s)
- Philipp Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | | | - Duvuru Geetha
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, United States
| | - Balazs Odler
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Timothee Laboux
- Nephrology Department, Univ. Lille, Centre Hospitalier Universitaire de Lille (CHU Lille), Lille, France
- Institut Pasteur de Lille, Univ. Lille, Inserm, Centre Hospitalier Universitaire de Lille (CHU Lille), Lille, France
| | - Federico Alberici
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Mattia Zappa
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Natasha Chebotareva
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marco Bonilla
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, United States
| | - Kenar D. Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, United States
| | - Julie Oniszczuk
- Department of Nephrology and Transplantation, Rare French Disease Centre “Idiopathic Nephrotic Syndrome”, Henri-Mondor/Albert-Chenevier Hospital Assistance Publique-Hôpitaux de Paris, Inserm U955, Paris-East University, Créteil, France
| | - Vincent Audard
- Department of Nephrology and Transplantation, Rare French Disease Centre “Idiopathic Nephrotic Syndrome”, Henri-Mondor/Albert-Chenevier Hospital Assistance Publique-Hôpitaux de Paris, Inserm U955, Paris-East University, Créteil, France
| | - Denise Costa
- Department of Nephrology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil
- Recife Medical School, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköpings Universitet, Linköping, Sweden
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine Karolinska Institutet, Stockholm, Sweden
| | - Masahiro Muto
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Martin Windpessl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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12
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Chabannes M, Rabant M, El Sissy C, Dragon-Durey MA, Vieira Martins P, Meuleman MS, Karras A, Buob D, Bridoux F, Daugas E, Audard V, Caillard S, Olagne J, Kandel C, Ferlicot S, Philipponnet C, Crepin T, Thervet E, Ducloux D, Frémeaux-Bacchi V, Chauvet S. C3 Glomerulopathy With Concurrent Thrombotic Microangiopathy: Clinical and Immunological Features. Am J Kidney Dis 2023; 82:279-289. [PMID: 37061020 DOI: 10.1053/j.ajkd.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/31/2022] [Indexed: 04/17/2023]
Abstract
RATIONALE & OBJECTIVE C3 glomerulopathy (C3GN) and atypical hemolytic uremic syndrome (aHUS) are 2 distinct rare kidney diseases caused by dysregulation of the alternative complement pathway. Patients with C3GN and concurrent kidney lesions of thrombotic microangiopathy (TMA) have been rarely reported. We characterized the clinical features and underlying immunological abnormalities in these patients. STUDY DESIGN Case series. SETTING & PARTICIPANTS Patients with C3GN and concomitant TMA lesions on biopsy registered from 2009 to 2019 in the French National Registry of C3GN. FINDINGS Among 278 registered patients with C3GN, 16 (6%) had biopsy-proven glomerular and/or vascular TMA lesions. Their median age at diagnosis was 39 years (range, 7-76), and 59% were female. Fourteen of the 16 patients (88%) had an estimated glomerular filtration rate of<30mL/min/1.73m2 and 3 of 16 (19%) required dialysis. Twelve of the 14 evaluated patients (86%) showed evidence of mechanical hemolysis. Fifty percent of the patients had low C3 levels. Six of the 14 evaluated patients had a rare variant in complement genes, and 4 of the 16 patients (25%) had monoclonal gammopathy. Among the 16 patients, 10 (63%) received eculizumab, 5 (31%) received immunosuppressive therapy, and 4 (25%) received clone-targeted chemotherapy. Median kidney survival was 49 months. LIMITATIONS Small retrospective case series with a limited number of biopsies including electron microscopy. CONCLUSIONS Concomitant C3GN and TMA is extremely rare and is associated with poor kidney outcomes. Genetic or acquired abnormalities of the alternative complement pathway are common as is the presence of monoclonal gammopathy, which may inform the selection of treatment approaches.
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Affiliation(s)
- Melchior Chabannes
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital, Besançon
| | - Marion Rabant
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris; Université de Paris Cité, Paris, France
| | - Carine El Sissy
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris
| | - Marie-Agnès Dragon-Durey
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris; INSERM UMRS 1138, Cordelier Research Center, Paris; Université de Paris Cité, Paris, France
| | - Paula Vieira Martins
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris
| | - Marie Sophie Meuleman
- INSERM UMRS 1138, Cordelier Research Center, Paris; Université de Paris Cité, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris
| | - David Buob
- Department of Pathology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris
| | - Frank Bridoux
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital, Poitiers
| | - Eric Daugas
- Department of Nephrology, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris
| | - Vincent Audard
- Department of Nephrology and Transplantation, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg
| | - Jérôme Olagne
- Department of Pathology, University Hospital, Strasbourg
| | | | - Sophie Ferlicot
- Department of Pathology, Hôpital Kremlin-Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre
| | | | - Thomas Crepin
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital, Besançon
| | - Eric Thervet
- INSERM UMRS 1138, Cordelier Research Center, Paris
| | - Didier Ducloux
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital, Besançon
| | - Véronique Frémeaux-Bacchi
- Department of Biological Immunology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris
| | - Sophie Chauvet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris; INSERM UMRS 1138, Cordelier Research Center, Paris; Université de Paris Cité, Paris, France.
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13
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Dang J, Ferlicot S, Misrahi M, Mussini C, Kounis I, Rémy P, Samuel D, Planté-Bordeneuve V, Adams D, Funalot B, Snanoudj R, Damy T, Moktefi A, Audard V, Zaidan M. Pathological spectrum of hereditary transthyretin renal amyloidosis and clinicopathologic correlation: a French observational study. Nephrol Dial Transplant 2023; 38:2019-2030. [PMID: 36646436 DOI: 10.1093/ndt/gfad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cardiac and neurological involvements are the main clinical features of hereditary transthyretin (ATTRv) amyloidosis. Few data are available about ATTRv amyloid nephropathy (ATTRvN). METHODS We retrospectively included 30 patients with biopsy-proven ATTRvN [V30M (26/30) including two domino liver recipients, S77Y (2/30), V122I (1/30) and S50R (1/30) variants] from two French reference centers. We described the pathological features by comparing amyloid deposits distribution to patients with AL or AA amyloidosis, and sought to determine clinicopathological correlation with known disease-modifying factors such as TTR variant, gender and age at diagnosis. RESULTS In comparison with AL and AA amyloidosis, ATTRv patients had similar glomerular, arteriolar and arterial amyloid deposits, but more cortical and medullary tubulointerstitial (33%, 44%, 77%, P = .03) involvement. While the presence of glomerular deposits is associated with the range of proteinuria, some patients with abundant glomerular ATTRv amyloidosis had no significant proteinuria. V30M patients had more glomerular (100% and 25%, odds ratio = 114, 95% confidence interval 3.85-3395.00, P = .001) deposits, and higher estimated glomerular filtration rate [50 (interquartile range 44-82) and 27 (interquartile range 6-31) mL/min/1.73 m², P = .004] than non-V30M patients. We did not find difference in amyloid deposition according to gender or age at diagnosis. CONCLUSION ATTRvN affects all kidney compartments, but compared with AL/AA amyloidosis, ATTRvN seems to involve more frequently tubulointerstitial areas. V30M patients represents the dominant face of the disease with a higher risk of glomerular/arteriolar involvement. ATTRvN should thus be considered in patients, and potential relatives, with ATTRv amyloidosis and kidney dysfunction, regardless of proteinuria level.
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Affiliation(s)
- Julien Dang
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares « Syndrome Néphrotique Idiopathique », Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sophie Ferlicot
- AP-HP, Université Paris-Saclay, Hôpital de Bicêtre, Service d'Anatomie Pathologique, Le Kremlin-Bicêtre, France
| | - Micheline Misrahi
- AP-HP, Université Paris-Saclay, Hôpital de Bicêtre, Unité de Génétique Moléculaire des Maladies Métaboliques et de la Reproduction, Le Kremlin-Bicêtre, France
| | - Charlotte Mussini
- AP-HP, Université Paris-Saclay, Hôpital de Bicêtre, Service d'Anatomie Pathologique, Le Kremlin-Bicêtre, France
| | - Ilias Kounis
- AP-HP, Université Paris-Saclay, Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Saclay, Physiopathogénèse et traitement des maladies du Foie, Fédération Hospitalo-Universitaire (FHU) Hepatinov, Villejuif, France
| | - Philippe Rémy
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France
- Univ Paris Est Créteil, INSERM U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Didier Samuel
- AP-HP, Université Paris-Saclay, Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Saclay, Physiopathogénèse et traitement des maladies du Foie, Fédération Hospitalo-Universitaire (FHU) Hepatinov, Villejuif, France
| | - Violaine Planté-Bordeneuve
- Univ Paris Est Créteil, INSERM U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Neurologie, Créteil, France
| | - David Adams
- AP-HP, Université Paris-Saclay, Hôpital de Bicêtre, Service de Neurologie, Le Kremlin-Bicêtre, France
| | - Benoit Funalot
- Univ Paris Est Créteil, INSERM U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département de Biochimie, Biologie Moléculaire, Pharmacologie et Génétique Médicale, Créteil, France
| | - Renaud Snanoudj
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares « Syndrome Néphrotique Idiopathique », Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Thibaud Damy
- Univ Paris Est Créteil, INSERM U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Cardiologie, Centre de Référence National Amyloses Cardiaques, GRC Amyloid Research Institute, Créteil, France
| | - Anissa Moktefi
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
| | - Vincent Audard
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France
- Univ Paris Est Créteil, INSERM U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Mohamad Zaidan
- Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital de Bicêtre, Service de Néphrologie et Transplantation, Le Kremlin-Bicêtre, France
- Centre de Compétence Maladies Rares « Syndrome Néphrotique Idiopathique », Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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14
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Morel A, Remy P, Sakhi H, El Karoui K, Sahali D, Audard V, Moktefi A. CD44 staining in parietal epithelial cells and early steroid response in patients with minimal change disease. Clin Kidney J 2023; 16:1355-1358. [PMID: 37529642 PMCID: PMC10387389 DOI: 10.1093/ckj/sfad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Indexed: 08/03/2023] Open
Affiliation(s)
- Antoine Morel
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Fédération Hospitalo-Universitaire “Innovative Therapy for Immune Disorders”, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Philippe Remy
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Fédération Hospitalo-Universitaire “Innovative Therapy for Immune Disorders”, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Hamza Sakhi
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Fédération Hospitalo-Universitaire “Innovative Therapy for Immune Disorders”, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Khalil El Karoui
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Fédération Hospitalo-Universitaire “Innovative Therapy for Immune Disorders”, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Dil Sahali
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Fédération Hospitalo-Universitaire “Innovative Therapy for Immune Disorders”, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Fédération Hospitalo-Universitaire “Innovative Therapy for Immune Disorders”, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
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15
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Chaba A, Devresse A, Audard V, Boffa JJ, Karras A, Cartery C, Deltombe C, Chemouny J, Contamin C, Courivaud C, Duquennoy S, Garcia H, Joly D, Goumri N, Hanouna G, Halimi JM, Plaisier E, Hamidou M, Landron C, Launay D, Lebas C, Legendre M, Masseau A, Mathian A, Mercadal L, Morel N, Mutinelli-Szymanski P, Palat S, Pennaforte JL, Peraldi MN, Pozdzik A, Schleinitz N, Thaunat O, Titeca-Beauport D, Mussini C, Touati S, Prinz E, Faller AL, Richter S, Vilaine E, Ferlicot S, Von-Kotze C, Belliere J, Olagne J, Mesbah R, Snanoudj R, Nouvier M, Ebbo M, Zaidan M. Clinical and Prognostic Factors in Patients with IgG4-Related Kidney Disease. Clin J Am Soc Nephrol 2023; 18:1031-1040. [PMID: 37283461 PMCID: PMC10564355 DOI: 10.2215/cjn.0000000000000193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND IgG4-related kidney disease is a major manifestation of IgG4-related disease, a systemic fibroinflammatory disorder. However, the clinical and prognostic kidney-related factors in patients with IgG4-related kidney disease are insufficiently defined. METHODS We conducted an observational cohort study using data from 35 sites in two European countries. Clinical, biologic, imaging, and histopathologic data; treatment modalities; and outcomes were collected from medical records. Logistic regression was performed to identify the possible factors related to an eGFR ≤30 ml/min per 1.73 m 2 at the last follow-up. Cox proportional hazards model was performed to assess the factors associated with the risk of relapse. RESULTS We studied 101 adult patients with IgG4-related disease with a median follow-up of 24 (11-58) months. Of these, 87 (86%) patients were male, and the median age was 68 (57-76) years. Eighty-three (82%) patients had IgG4-related kidney disease confirmed by kidney biopsy, with all biopsies showing tubulointerstitial involvement and 16 showing glomerular lesions. Ninety (89%) patients were treated with corticosteroids, and 18 (18%) patients received rituximab as first-line therapy. At the last follow-up, the eGFR was below 30 ml/min per 1.73 m 2 in 32% of patients; 34 (34%) patients experienced a relapse, while 12 (13%) patients had died. By Cox survival analysis, the number of organs involved (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.01 to 1.55) and low C3 and C4 concentrations (HR, 2.31; 95% CI, 1.10 to 4.85) were independently associated with a higher risk of relapse, whereas first-line therapy with rituximab was protective (HR, 0.22; 95% CI, 0.06 to 0.78). At their last follow-up, 19 (19%) patients had an eGFR ≤30 ml/min per 1.73 m 2 . Age (odd ratio [OR], 1.11; 95% CI, 1.03 to 1.20), peak serum creatinine (OR, 2.74; 95% CI, 1.71 to 5.47), and serum IgG4 level ≥5 g/L (OR, 4.46; 95% CI, 1.23 to 19.40) were independently predictive for severe CKD. CONCLUSIONS IgG4-related kidney disease predominantly affected middle-aged men and manifested as tubulointerstitial nephritis with potential glomerular involvement. Complement consumption and the number of organs involved were associated with a higher relapse rate, whereas first-line therapy with rituximab was associated with lower relapse rate. Patients with high serum IgG4 concentrations (≥5 g/L) had more severe kidney disease.
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Affiliation(s)
- Anis Chaba
- Departement of Nephrology-Dialysis-Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Arnaud Devresse
- Department of Nephrology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Henri Mondor Hospital University, Rare Disease Center « Idiopathic Nephrotic syndrome », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | | | | | - Claire Cartery
- Department of Nephrology, CH Valenciennes, Valenciennes, France
| | - Clément Deltombe
- Institute for Transplantation, Urology and Nephrology (ITUN) Nantes University Hospital, Nantes, France
| | | | | | | | - Simon Duquennoy
- Department of Nephrology, Fondation AUB Santé Avranches, France
| | - Hugo Garcia
- Department of Nephrology, Hôpitaux Sorbonne Université, Paris, France
| | | | - Nabila Goumri
- Department of Nephrology, CH Chartres, Chartres, France
| | | | | | | | | | - Cédric Landron
- Department of Internal Medicine, CHU Poitier, Poitier, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
| | - Celine Lebas
- Department of Nephrology, CHU Valenciennes, Valenciennes, France
| | | | - Agathe Masseau
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - Alexis Mathian
- Department of Internal Medicine, Hôpital Cochin, APHP, Paris, France
| | - Lucile Mercadal
- Department of Nephrology, Hôpitaux Sorbonne Université, Paris, France
| | - Nathalie Morel
- Department of Internal Medicine, Hôpital Cochin, APHP, Paris, France
| | | | - Sylvain Palat
- Department of Internal Medicine, CHU Limoges, Limoges, France
| | | | | | | | | | | | | | - Charlotte Mussini
- Departement of Pathology, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Sonia Touati
- Department of Nephrology, CH Pontoise, Pontoise, France
| | - Eric Prinz
- Department of Nephrology, NHC Strasbourg, France
| | | | - Sarah Richter
- Department of Nephrology, Clinique Sainte Anne, Strasbourg, France
| | - Eve Vilaine
- Department of Nephrology, CHU Ambroise Paré, France
| | - Sophie Ferlicot
- Departement of Pathology, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | | | - Julie Belliere
- Departement of Nephrology, CHU Toulouse, Toulouse, France
| | | | - Rafik Mesbah
- Department of Nephrology, Hopital Boulogne-sur-mer, Boulogne-sur-mer, France
| | - Renaud Snanoudj
- Departement of Nephrology-Dialysis-Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
| | | | - Mikael Ebbo
- Department of Internal Medicine, CHU Timone, Marseille, France
| | - Mohamad Zaidan
- Departement of Nephrology-Dialysis-Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France
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16
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Stehlé T, Ouamri Y, Morel A, Vidal-Petiot E, Fellahi S, Segaux L, Prié D, Grimbert P, Luciani A, Audard V, Haymann JP, Mulé S, De Kerviler E, Peraldi MN, Boutten A, Matignon M, Canouï-Poitrine F, Flamant M, Pigneur F. Development and validation of a new equation based on plasma creatinine and muscle mass assessed by CT scan to estimate glomerular filtration rate: a cross-sectional study. Clin Kidney J 2023; 16:1265-1277. [PMID: 37529645 PMCID: PMC10387393 DOI: 10.1093/ckj/sfad012] [Citation(s) in RCA: 5] [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: 10/04/2022] [Indexed: 08/03/2023] Open
Abstract
Background Inter-individual variations of non-glomerular filtration rate (GFR) determinants of serum creatinine, such as muscle mass, account for the imperfect performance of estimated GFR (eGFR) equations. We aimed to develop an equation based on creatinine and total lumbar muscle cross-sectional area measured by unenhanced computed tomography scan at the third lumbar vertebra. Methods The muscle mass-based eGFR (MMB-eGFR) equation was developed in 118 kidney donor candidates (iohexol clearance) using linear regression. Validation cohorts included 114 healthy subjects from another center (51Cr-EDTA clearance, validation population 1), 55 patients with chronic diseases (iohexol, validation population 2), and 60 patients with highly discordant creatinine and cystatin C-based eGFR, thus presumed to have atypical non-GFR determinants of creatinine (51Cr-EDTA, validation population 3). Mean bias was the mean difference between eGFR and measured GFR, precision the standard deviation (SD) of the bias, and accuracy the percentage of eGFR values falling within 20% and 30% of measured GFR. Results In validation population 1, performance of MMB-eGFR was not different from those of CKD-EPICr2009 and CKD-EPICr2021. In validation population 2, MMB-eGFR was unbiased and displayed better precision than CKD-EPICr2009, CKD-EPICr2021 and EKFC (SD of the biases: 13.1 vs 16.5, 16.8 and 15.9 mL/min/1.73 m2). In validation population 3, MMB-eGFR had better precision and accuracy {accuracy within 30%: 75.0% [95% confidence interval (CI) 64.0-86.0] vs 51.5% (95% CI 39.0-64.3) for CKD-EPICr2009, 43.3% (95% CI 31.0-55.9) for CKD-EPICr2021, and 53.3% (95% CI 40.7-66.0) for EKFC}. Difference in bias between Black and white subjects was -2.1 mL/min/1.73 m2 (95% CI -7.2 to 3.0), vs -8.4 mL/min/1.73 m2 (95% CI -13.2 to -3.6) for CKD-EPICr2021. Conclusion MMB-eGFR displayed better performances than equations based on demographics, and could be applied to subjects of various ethnic backgrounds.
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Affiliation(s)
| | - Yaniss Ouamri
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Antoine Morel
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France
| | - Emmanuelle Vidal-Petiot
- Université Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM), U1149, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Département de Physiologie-Explorations Fonctionnelles, Hôpital Bichat, Paris, France
| | - Soraya Fellahi
- Université Pierre et Marie Curie Paris 6, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Département de Biochimie, Créteil, France
| | - Lauriane Segaux
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France
| | - Dominique Prié
- Université de Paris Cité, Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale (INSERM) U1151, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Groupe Hospitalier Necker Enfants Malades, Service de Physiologie et Explorations Fonctionnelles, Paris, France
| | - Philippe Grimbert
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Alain Luciani
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Vincent Audard
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Jean Philippe Haymann
- Univ. Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM), U1155
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux de Paris, hôpital Tenon, Département de Physiologie-Explorations Fonctionnelles, Paris, France
| | - Sébastien Mulé
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Eric De Kerviler
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux de Paris, Hôpital Tenon, Département de Physiologie-Explorations Fonctionnelles, Paris, France
| | - Marie-Noëlle Peraldi
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Saint Louis, Service de Néphrologie, Paris, France
| | - Anne Boutten
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux de Paris, hôpital Bichat, Département de Biochimie Clinique, Paris, France
| | - Marie Matignon
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Florence Canouï-Poitrine
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France
| | - Martin Flamant
- Université Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM), U1149, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Département de Physiologie-Explorations Fonctionnelles, Hôpital Bichat, Paris, France
| | - Frédéric Pigneur
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
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17
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Chhuon C, Herrera-Marcos LV, Zhang SY, Charrière-Bertrand C, Jung V, Lipecka J, Savas B, Nasser N, Pawlak A, Boulmerka H, Audard V, Sahali D, Guerrera IC, Ollero M. Proteomics of Plasma and Plasma-Treated Podocytes: Application to Focal and Segmental Glomerulosclerosis. Int J Mol Sci 2023; 24:12124. [PMID: 37569500 PMCID: PMC10418338 DOI: 10.3390/ijms241512124] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Focal and segmental glomerulosclerosis (FSGS) is a severe form of idiopathic nephrotic syndrome (INS), a glomerulopathy of presumably immune origin that is attributed to extrarenal pathogenic circulating factors. The recurrence of FSGS (rFSGS) after transplant occurs in 30% to 50% of cases. The direct analysis of patient plasma proteome has scarcely been addressed to date, mainly due to the methodological difficulties associated with plasma complexity and dynamic range. In this study, first, we compared different methods of plasma preparation, second, we compared the plasma proteomes of rFSGS and controls using two preparation methods, and third, we analyzed the early proximal signaling events in podocytes subjected to patient plasma, through a combination of phosphoproteomics and lipid-raft proteomics (raftomics). By combining immunodepletion and high pH fractionation, we performed a differential proteomic analysis of soluble plasma proteins and of extracellular vesicles (EV) obtained from healthy controls, non-INS patient controls, and rFSGS patients (n = 4). In both the soluble- and the EV-protein sets from the rFSGS patients, we found a statistically significant increase in a cluster of proteins involved in neutrophil degranulation. A group of lipid-binding proteins, generally associated with lipoproteins, was found to be decreased in the soluble set from the rFSGS patients. In addition, three amino acid transporters involved in mTORC1 activation were found to be significantly increased in the EV from the rFSGS. Next, we incubated human podocytes for 30 min with 10% plasma from both groups of patients. The phosphoproteomics and raftomics of the podocytes revealed profound differences in the proteins involved in the mTOR pathway, in autophagy, and in cytoskeleton organization. We analyzed the correlation between the abundance of plasma and plasma-regulated podocyte proteins. The observed changes highlight some of the mechanisms involved in FSGS recurrence and could be used as specific early markers of circulating-factor activity in podocytes.
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Affiliation(s)
- Cerina Chhuon
- Proteomic Platform Necker, Université Paris Cité Structure Fédérative de Recherche SFR Necker US24, 75015 Paris, France; (C.C.); (V.J.); (J.L.)
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - Luis Vicente Herrera-Marcos
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - Shao-Yu Zhang
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - Cécile Charrière-Bertrand
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - Vincent Jung
- Proteomic Platform Necker, Université Paris Cité Structure Fédérative de Recherche SFR Necker US24, 75015 Paris, France; (C.C.); (V.J.); (J.L.)
| | - Joanna Lipecka
- Proteomic Platform Necker, Université Paris Cité Structure Fédérative de Recherche SFR Necker US24, 75015 Paris, France; (C.C.); (V.J.); (J.L.)
| | - Berkan Savas
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - Nour Nasser
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - André Pawlak
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - Hocine Boulmerka
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
| | - Vincent Audard
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie, F-94010 Creteil, France
| | - Dil Sahali
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie, F-94010 Creteil, France
| | - Ida Chiara Guerrera
- Proteomic Platform Necker, Université Paris Cité Structure Fédérative de Recherche SFR Necker US24, 75015 Paris, France; (C.C.); (V.J.); (J.L.)
| | - Mario Ollero
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; (L.V.H.-M.); (S.-Y.Z.); (C.C.-B.); (B.S.); (N.N.); (A.P.); (H.B.); (V.A.); (D.S.)
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18
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Caillard P, Vigneau C, Halimi JM, Hazzan M, Thervet E, Heitz M, Juillard L, Audard V, Rabant M, Hertig A, Subra JF, Vuiblet V, Guerrot D, Tamain M, Essig M, Lobbedez T, Quemeneur T, Legendre M, Ganea A, Peraldi MN, Vrtovsnik F, Daroux M, Makdassi R, Choukroun G, Titeca-Beauport D. Prognostic value of complement serum C3 level and glomerular C3 deposits in anti-glomerular basement membrane disease. Front Immunol 2023; 14:1190394. [PMID: 37475859 PMCID: PMC10354545 DOI: 10.3389/fimmu.2023.1190394] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Background and objectives Activation of the complement system is involved in the pathogenesis of anti-glomerular basement membrane (anti-GBM) disease. Glomerular deposits of complement 3 (C3) are often detected on kidney biopsies. The primary objective of this study was to analyze the prognostic value of the serum C3 level and the presence of C3 glomerular deposits in patients with anti-GBM disease. Methods We conducted a retrospective cohort study of 150 single-positive patients with anti-GBM disease diagnosed between 1997 and 2017. Patients were categorized according to the serum C3 level (forming a low C3 (C3<1.23 g/L) and a high C3 (C3≥1.23 g/L) groups) and positivity for C3 glomerular staining (forming the C3+ and C3- groups). The main outcomes were kidney survival and patient survival. Results Of the 150 patients included, 89 (65%) were men. The median [interquartile range (IQR)] age was 45 [26-64]. At diagnosis, kidney involvement was characterized by a median [IQR] peak serum creatinine (SCr) level of 578 [298-977] µmol/L, and 106 (71%) patients required dialysis. Patients in the low C3 group (72 patients) had more severe kidney disease at presentation, as characterized by higher prevalences of oligoanuria, peak SCr ≥500 µmol/L (69%, vs. 53% in the high C3 group; p=0.03), nephrotic syndrome (42%, vs. 24%, respectively; p=0.02) and fibrous forms on the kidney biopsy (21%, vs. 8%, respectively; p=0.04). Similarly, we observed a negative association between the presence of C3 glomerular deposits (in 52 (41%) patients) and the prevalence of cellular forms (83%, vs. 58% in the C3- group; p=0.003) and acute tubulo-interstitial lesions (60%, vs. 36% in the C3- group; p=0.007). When considering patients not on dialysis at diagnosis, the kidney survival rate at 12 months was poorer in the C3+ group (50% [25-76], vs. 91% [78-100] in the C3- group; p=0.01), with a hazard ratio [95% confidence interval] of 5.71 [1.13-28.85] (p=0.04, after adjusting for SCr). Conclusion In patients with anti-GBM disease, a low serum C3 level and the presence of C3 glomerular deposits were associated with more severe disease and histological kidney involvement at diagnosis. In patients not on dialysis at diagnosis, the presence of C3 deposits was associated with worse kidney survival.
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Affiliation(s)
- Pauline Caillard
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
- Mécanismes Physiopathologiques et Conséquences des Calcifications Cardiovasculaires (MP3CV) laboratory, Centre de Recherche en Santé (CURS), Amiens, France
| | - Cécile Vigneau
- Rennes University Hospital, Inserm, Ecole des hautes études en santé publique (EHESP), Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Jean-Michel Halimi
- Department of Nephrology, Tours University Hospital and EA4245, University of Tours, Tours, France
| | - Marc Hazzan
- Nephrology Department, Lille University Hospital, University of Lille, UMR 995, Lille, France
| | - Eric Thervet
- Department of Nephrology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris and INSERM UMRS970, Boulogne-Billancourt, France
| | - Morgane Heitz
- Department of Nephrology and Dialysis, Annecy Genevois Hospital, Pringy, France
| | - Laurent Juillard
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Carmen INSERM 1060 and Univ Lyon, Lyon, France
| | - Vincent Audard
- Department of Nephrology and Renal Transplantation, Reference Center-Idiopathic Nephrotic Syndrome, Henri-Mondor Hospital/Albert-Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP) Créteil, INSERMU955, Paris Est Créteil University, Créteil, France
| | - Marion Rabant
- Pathology Department, Necker University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre-Université de Paris, Paris, France
| | - Alexandre Hertig
- Department of Nephrology, Dialysis and Transplantation, Foch Hospital, Paris-Saclay University, Suresnes, France
| | - Jean-François Subra
- Department of Nephrology, Dialysis and Transplantation, University Hospital, Angers and Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), INSERM, Nantes University, Angers University, Angers, France
| | - Vincent Vuiblet
- Department of Nephrology and Renal Transplantation, Reims University Hospital, Reims, France
| | - Dominique Guerrot
- Department of Nephrology, Rouen University Hospital, Rouen and INSERM, U1096 Rouen, France
| | - Mathilde Tamain
- Department of Nephrology and Dialysis, Vichy Hospital, Vichy, France
| | - Marie Essig
- Department of Nephrology, Dialysis, and Renal Transplantation, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Boulogne-Billancourt, France
| | - Thierry Lobbedez
- Department of Nephrology, Caen University Hospital, Caen, France and the French Registry of Peritoneal Dialysis, Langue Française, Pontoise, France
| | - Thomas Quemeneur
- Department of Nephrology and Internal Medicine, Valenciennes General Hospital, Valenciennes, France
| | - Mathieu Legendre
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital, Dijon, France
| | | | - Marie-Noëlle Peraldi
- Department of Nephrology, Dialysis and Renal Transplantation, Necker University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Paris, France
| | - François Vrtovsnik
- Nephrology Department, Bichat-Claude Bernard Hospital, APHP, Paris, France. Faculty of Medicine, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Maïté Daroux
- Department of Nephrology, Duchenne Hospital, Boulogne-Sur-Mer, France
| | - Raïfah Makdassi
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
| | - Gabriel Choukroun
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
- Mécanismes Physiopathologiques et Conséquences des Calcifications Cardiovasculaires (MP3CV) laboratory, Centre de Recherche en Santé (CURS), Amiens, France
| | - Dimitri Titeca-Beauport
- Department of Nephrology, Dialysis, and Transplantation, University of Picardie Jules Verne, Amiens University Hospital, Amiens, France
- Mécanismes Physiopathologiques et Conséquences des Calcifications Cardiovasculaires (MP3CV) laboratory, Centre de Recherche en Santé (CURS), Amiens, France
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19
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Kharoubi M, Bézard M, Broussier A, Galat A, Gounot R, Poullot E, Molinier-Frenkel V, Fanen P, Funalot B, Itti E, Lemonnier F, Sing Chadha GD, Guendouz S, Mallet S, Zaroui A, Audard V, Audureau E, Le Corvoisier P, Hittinger L, Planté Bordeneuve V, Lefaucheur JP, Amiot A, Bequignon E, Bartier S, Leroy V, Teiger E, Oghina S, Damy T. Amylo-AFFECT-QOL, a self-reported questionnaire to assess health-related quality of life and to determine the prognosis in cardiac amyloidosis. Front Cardiovasc Med 2023; 10:1124660. [PMID: 36998975 PMCID: PMC10043221 DOI: 10.3389/fcvm.2023.1124660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Abstract
Background and aimsSelf-reported questionnaires are useful for estimating the health-related quality of life (HR-QoL), impact of interventions, and prognosis. To our knowledge, no HR-QoL questionnaire has been developed for cardiac amyloidosis (CA). This study aimed to validate Amylo-AFFECT-QOL questionnaire to assess HR-QoL and its prognostic value in CA.MethodsA self-reported questionnaire, “Amylo-AFFECT” had been designed and validated for CA symptoms evaluation and screening by physicians. It was adapted here to assess HR-QoL (Amylo-AFFECT-QOL) and its prognostic value in CA. To validate the theoretical model, internal consistency and convergent validity were assessed, particularly correlations between Amylo-AFFECT-QOL and the HR-QoL Minnesota Living Heart Failure (MLHF) questionnaire.ResultsAmylo-AFFECT-QOL was completed by 515 patients, 425 of whom (82.5%) had CA. Wild-type and hereditary transthyretin amyloidosis (ATTRwt and ATTRv) and immunoglobulin light-chain amyloidosis (AL) were diagnosed in 47.8, 14.7, and 18.8% of cases, respectively. The best HR-QoL evaluation was obtained with five dimensions: “Heart failure,” “Vascular dysautonomia,” “Neuropathy,” “Ear, gastrointestinal, and urinary dysautonomia,” and “Skin or mucosal involvement.” The global Amylo-AFFECT-QOL and MLHF scores showed significant positive correlations (rs = 0.72, p < 0.05). Patients with a final diagnosis of CA had a global Amylo-AFFECT-QOL score significantly higher than the control group composed by patients with other diagnoses (22.2 ± 13.6 vs. 16.2 ± 13.8, respectively, p-value < 0.01). According to the Amylo-AFFECT-QOL global results, ATTRv patients’ QoL was more affected than AL patients’ QoL or ATTRwt patients’ QoL. Patients with a higher HR-QoL score had a greater risk of death or heart transplant after 1 year of follow-up (log-rank < 0.01).ConclusionAmylo-AFFECT-QOL demonstrates good psychometric properties and is useful for quantifying HR-QoL and estimating CA prognosis. Its use may help to improve overall management of patients with CA.
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Affiliation(s)
- Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
- *Correspondence: Mounira Kharoubi,
| | - Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Amaury Broussier
- Université Paris-Est Créteil (UPEC), Creteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hopitaux Henri-Mondor/Emile Roux, Department of Geriatrics, Limeil-Brévannes, France
| | - Arnault Galat
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Romain Gounot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Pathology, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Pascale Fanen
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Département de Génétique, Hôpital Universitaire Henri Mondor, Créteil, France
| | - Benoit Funalot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Département de Génétique, Hôpital Universitaire Henri Mondor, Créteil, France
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Nuclear Medicine, Henri Mondor University Hospital, Créteil, France
| | - François Lemonnier
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
| | - Gagan Deep Sing Chadha
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Soulef Guendouz
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Sophie Mallet
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Amira Zaroui
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Vincent Audard
- University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Henri Mondor Hospital University, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire « Innovative Therapy for Immune Disorders », Créteil, France
| | - Etienne Audureau
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Hospital, Créteil, France
| | - Philippe Le Corvoisier
- INSERM Clinical Investigation Centre 1430, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
| | - Luc Hittinger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Violaine Planté Bordeneuve
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Neurology, Henri Mondor University Hospital, Créteil, France
| | - Jean-Pascal Lefaucheur
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Neurophysiology, Henri Mondor University Hospital, Créteil, France
| | - Aurélien Amiot
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hepato Gastro Enterology Department, Henri Mondor University Hospital, Créteil, France
| | - Emilie Bequignon
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Otolaryngology, Henri Mondor University Hospital, Créteil, France
| | - Sophie Bartier
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Otolaryngology, Henri Mondor University Hospital, Créteil, France
| | - Vincent Leroy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hepato Gastro Enterology Department, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Department of Cardiology, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), French National Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, Créteil, France
- INSERM Clinical Investigation Centre 1430, AP-HP (Assistance Publique-Hôpitaux de Paris), Henri Mondor University Hospital, Créteil, France
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20
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Dang J, Segaux L, Moktefi A, Stehlé T, Kharoubi M, El Karoui K, Rémy P, Grimbert P, Plante-Bordeneuve V, Guendouz S, Galat A, Mallet S, Oghina S, Chadha GDS, Zaroui A, Fanen P, Canoui-Poitrine F, Damy T, Audard V. Natural course and determinants of short-term kidney function decline in hereditary transthyretin amyloidosis: a French observational study. Amyloid 2023; 30:38-48. [PMID: 35848215 DOI: 10.1080/13506129.2022.2098011] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Data regarding renal involvement in patients with hereditary transthyretin (ATTRv) amyloidosis are scarce and the natural course of chronic kidney disease (CKD) in this population remains unclear. This observational study, including adult patients diagnosed with ATTRv amyloidosis at the French Reference Centre for Cardiac Amyloidosis, investigated renal function outcome and its determinants. Multivariable logistic regression models identified factors associated with CKD at baseline. Determinants of the change in estimated glomerular filtration rate (eGFR) over 24 months of follow-up were assessed with a multivariable linear mixed-effects model. In total, 232 patients (78 women [34%], mean age: 64 years) with ATTRv amyloidosis were classified on the basis of their TTR variants: ATTRV122I (37%), ATTRV30M (29%), and other variants (34%). Median baseline eGFR was 78 ml/min/1.73 m2. Seventy-two patients (31%) had an eGFR below 60 ml/min/1.73m2 and 27/137 patients (20%) had significant proteinuria (urine protein/creatinine ratio ≥30 mg/mmol). Renal biopsy, performed in four cases, found typical Congo red-positive and TTR-labelled amyloid deposits in all cases. Older age (OR 1.07, p < .001) and a prior history of hypertension (OR 2.09, p = .04) were associated with a higher prevalence of CKD at baseline, whereas higher left ventricular global longitudinal strain (LVGLS) (OR 0.83, p < .001) was associated with a lower prevalence. The estimated change in eGFR was -7.12 [-9.61, -4.63] and -8.21 [-10.81, -5.60] ml/min/1.73 m2 after 12 and 24 months of follow-up, respectively. eGFR decline was independently associated with older age ((67-74], coefficient= -14.35 mL/min/1.73 m2, p < .01, >74, coefficient = -22.93 mL/min/1.73 m2, p < .001, versus <56), ATTRV122I (coefficient = -17.17 mL/min/1.73m2, p < .01, versus ATTRV30M) and LVGLS (coefficient = 1.22, p < .01). These data suggest that CKD is a common finding in patients with ATTRv amyloidosis, and that eGFR decline is rapid during the first year of evaluation. Older age, lower LVGLS and ATTRV122I were associated with a worse renal outcome. Further studies are now needed to evaluate effects of new targeted therapies on long term renal function.
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Affiliation(s)
- Julien Dang
- Service de Néphrologie et Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Equipe "Pathophysiology of Glomerular Diseases", Université Paris-Est Créteil, Créteil, France
| | - Lauriane Segaux
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France
| | - Anissa Moktefi
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Equipe "Pathophysiology of Glomerular Diseases", Université Paris-Est Créteil, Créteil, France.,Département de Pathologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thomas Stehlé
- Service de Néphrologie et Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Equipe "Pathophysiology of Glomerular Diseases", Université Paris-Est Créteil, Créteil, France
| | - Mounira Kharoubi
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Equipe "Pathophysiology of Glomerular Diseases", Université Paris-Est Créteil, Créteil, France
| | - Philippe Rémy
- Service de Néphrologie et Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Equipe "Pathophysiology of Glomerular Diseases", Université Paris-Est Créteil, Créteil, France
| | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Equipe "Pathophysiology of Glomerular Diseases", Université Paris-Est Créteil, Créteil, France
| | - Violaine Plante-Bordeneuve
- INSERM, IMRB, Université Paris-Est Créteil, Créteil, France.,Service de Neurologie, AP-HP, Hôpitaux Universitaires Henri Mondor, GRC Amyloid Research Institute, Créteil, France
| | - Soulef Guendouz
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Arnault Galat
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Sophie Mallet
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Silvia Oghina
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Gagan Deep Singh Chadha
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Amira Zaroui
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Pascale Fanen
- INSERM, IMRB, Université Paris-Est Créteil, Créteil, France.,Département de Biochimie, Biologie Moléculaire, Pharmacologie et Génétique Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.,INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France
| | - Thibaud Damy
- INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology And Aging), Université Paris-Est Créteil, Créteil, France.,Service de Cardiologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Centre de Référence National Amyloses Cardiaques GRC Amyloid Research Institute, Créteil, France.,INSERM, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Vincent Audard
- Service de Néphrologie et Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Centre de Référence Maladie Rare 'Syndrome Néphrotique Idiopathique', Fédération Hospitalo-Universitaire 'Innovative Therapy for Immune Disorders', Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Equipe "Pathophysiology of Glomerular Diseases", Université Paris-Est Créteil, Créteil, France
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21
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Georgin-Lavialle S, Savey L, Buob D, Bastard JP, Fellahi S, Karras A, Boffa JJ, Grateau G, Audard V, Bridoux F, Damade R, Deshayes S, Giurgea I, Granel B, Hachulla E, Hot A, Jaccard A, Knebelmann B, Marciano S, Pelcot F, Sarrabay G, Boursier G, Sellam J, Terre A, Bourguiba R. French practical guidelines for the diagnosis and management of AA amyloidosis. Rev Med Interne 2023; 44:62-71. [PMID: 36759076 DOI: 10.1016/j.revmed.2022.12.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 01/25/2023]
Abstract
AA amyloidosis is secondary to the deposit of excess insoluble Serum Amyloid A (SAA) protein fibrils. AA amyloidosis complicates chronic inflammatory diseases, especially chronic inflammatory rheumatisms such as rheumatoid arthritis and spondyloarthritis; chronic infections such as tuberculosis, bronchectasia, chronic inflammatory bowel diseases such as Crohn's disease; and auto-inflammatory diseases including familial Mediterranean fever. This work consists of the French guidelines for the diagnosis workup and treatment of AA amyloidosis. We estimate in France between 500 and 700 cases in the whole French population, affecting both men and women. The most frequent organ impaired is kidney which usually manifests by oedemas of the lower extremities, proteinuria, and/or renal failure. Patients are usually tired and can display digestive features anf thyroid goiter. The diagnosis of AA amyloidosis is based on detection of amyloid deposits on a biopsy using Congo Red staining with a characteristic green birefringence in polarized light. Immunohistochemical analysis with an antibody directed against Serum Amyloid A protein is essential to confirm the diagnosis of AA amyloidosis. Peripheral inflammatory biomarkers can be measured such as C Reactive protein and SAA. We propose an algorithm to guide the etiological diagnosis of AA amyloidosis. The treatement relies on the etiologic treatment of the undelying chronic inflammatory disease to decrease and/or normalize Serum Amyloid A protein concentration in order to stabilize amyloidosis. In case of renal failure, dialysis or even a kidney transplant can be porposed. Nowadays, there is currently no specific treatment for AA amyloidosis deposits which constitutes a therapeutic challenge for the future.
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Affiliation(s)
- S Georgin-Lavialle
- Sorbonne University, Internal medicine department, Tenon hospital, National reference center for autoinflamamtory diseases and AA amylodiosis (CEREMAIA), 4 rue de la Chine, 75020 Paris, France.
| | - L Savey
- Sorbonne University, Internal medicine department, Tenon hospital, National reference center for autoinflamamtory diseases and AA amylodiosis (CEREMAIA), 4 rue de la Chine, 75020 Paris, France
| | - D Buob
- Sorbonne University, department of pathology, Tenon hospital, Paris, France
| | - J-P Bastard
- Biochemistry department, Henri-Mondor hospital, Créteil, France
| | - S Fellahi
- Sorbonne University, Nephrology department, Tenon hospital, Paris, France
| | - A Karras
- Paris centre university, Nephrology department, Georges Pompidou European hospital, Paris, France
| | - J-J Boffa
- Sorbonne University, Nephrology department, Tenon hospital, Paris, France
| | - G Grateau
- Sorbonne University, Internal medicine department, Tenon hospital, National reference center for autoinflamamtory diseases and AA amylodiosis (CEREMAIA), 4 rue de la Chine, 75020 Paris, France
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22
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Fakhouri F, Schwotzer N, Cabiddu G, Barratt J, Legardeur H, Garovic V, Orozco-Guillen A, Wetzels J, Daugas E, Moroni G, Noris M, Audard V, Praga M, Llurba E, Wuerzner G, Attini R, Desseauve D, Zakharova E, Luders C, Wiles K, Leone F, Jesudason S, Costedoat-Chalumeau N, Kattah A, Soto-Abraham V, Karras A, Prakash J, Lightstone L, Ronco P, Ponticelli C, Appel G, Remuzzi G, Tsatsaris V, Piccoli GB. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management. Kidney Int 2023; 103:264-281. [PMID: 36481180 DOI: 10.1016/j.kint.2022.10.029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022]
Abstract
Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.
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Affiliation(s)
- Fadi Fakhouri
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland.
| | - Nora Schwotzer
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland
| | - Gianfranca Cabiddu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Hélène Legardeur
- Gynaecology, Woman Mother Child Department of the Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Vesna Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Alejandra Orozco-Guillen
- National Institute of Perinatology Isidro Espinosa de los Reyes (INPER), Department of Nephrology, Ciudad de Mexico, Mexico
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eric Daugas
- Service de Néphrologie, Hôpital Bichat and Université Paris Cité, Paris, France; Institut national de la santé et de la recherche médicale Inserm U1149, Paris, France
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Nephrology and Dialysis Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Marina Noris
- Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Laboratory of Immunology and Genetics of Rare Diseases, Bergamo, Italy
| | - Vincent Audard
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France; Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre, Complutense University Madrid, Madrid, Spain
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau - IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - Grégoire Wuerzner
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland
| | - Rossella Attini
- Department of Obstetrics and Gynecology, University of Turin, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy
| | - David Desseauve
- Gynaecology, Woman Mother Child Department of the Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. Sergey Petrovich Botkin, Moscow, Russian Federation; Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Claudio Luders
- Centro de Nefrologia e Dialise, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Kate Wiles
- Department of Women's Health, Barts Health NHS Trust, London, UK
| | - Filomena Leone
- Clinical Nutrition Unit, S. Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Nathalie Costedoat-Chalumeau
- Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Cochin Hospital, Université Paris Cité, Paris, France; Unité de l'Institut national de la santé et de la recherche médicale (INSERM) Unité 1153, Center for Epidemiology and Statistics (CRESS), Paris, France
| | - Andrea Kattah
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Virgilia Soto-Abraham
- Pathology Department, Hospital General de México Dr Eduardo Liceaga, México City, México
| | - Alexandre Karras
- Paris University, Paris, France; Renal Division, Georges Pompidou European Hospital, Paris, France
| | - Jai Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Liz Lightstone
- Imperial Lupus Centre, Department of Medicine, Imperial College London, London, UK; Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, London, UK
| | - Pierre Ronco
- Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1155, Paris, France; Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | | | - Gerald Appel
- Division of Nephrology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Laboratory of Immunology and Genetics of Rare Diseases, Bergamo, Italy
| | - Vassilis Tsatsaris
- Maternité Port-Royal, Fédération Hospitalo-Universitaire Prématurité (FHU PREMA), Assistance Publique des Hôpitaux de Paris AP-HP, Hôpital Cochin, AP-HP, Paris, France; Centre-Université de Paris, Université de Paris, Paris, France
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23
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Kharoubi M, Bézard M, Broussier A, Galat A, Le Bras F, Fanen P, Funalot B, Deux JF, Lemonnier F, Guendouz S, Mallet S, Zaroui A, Itti E, Audard V, Audureau E, Hittinger L, Teiger E, Oghina S, Damy T. Validation of Amylo-AFFECT, a self-reported questionnaire to assess health-related quality of life and to determine the prognosis in cardiac amyloidosis. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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24
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Albenque G, Bézard M, Kharoubi M, Odouard S, Lunati A, Poullot E, Zaroui A, Teiger E, Hittinger L, El Karoui K, Audard V, Funalot B, Fanen P, Damy T, Oghina S. Homozygote and heterozygote transthyretin p.Val142Ile (V122I) genetic variant: Comparison of cardiac involvement, extracardiac manifestations and outcomes. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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25
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Mahevas M, Audard V, Rousseau A, Cez A, Guerrot D, Verhelst D, Delahousse M, Hanrotel C, Pillebout E, Daugas E, Krastinova E, Valeyre D, Boffa JJ. Efficacy and safety of methylprednisolone pulse followed by oral prednisone versus oral prednisone alone in sarcoidosis tubulointerstitial nephritis. A randomized, open-label, controlled clinical trial. Nephrol Dial Transplant 2022; 38:961-968. [PMID: 36066903 DOI: 10.1093/ndt/gfac227] [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: 12/29/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the benefit of pulsed methylprednisolone for improving renal function in sarcoidosis tubulointerstitial nephritis (TIN). PATIENTS AND METHODS A multicenter, prospective, randomized, open-labeled, controlled trial in patients with biopsy-proven acute TIN due to sarcoidosis was conducted in 21 sites in France. Patients were randomly assigned to receive a methylprednisolone pulse 15 mg/kg/day for 3 days then oral prednisone (MP group) or oral prednisone 1 mg/kg/day alone (PRD group). The primary endpoint was a positive response at 3 months, defined as a doubling of eGFR as compared with before randomization. RESULTS We randomized 40 participants. Baseline eGFR before PRD was 22 ml/min/1.73m2 (interquartile range [IQR] 16-44) and before MP was 25 ml/min/1.73m2 (IQR 22-36) (P = 0.3). The two groups did not differ in underlying pathological lesions, including mean percentage of interstitial fibrosis and intensity of interstitial infiltrate. In the intent-to-treat population, the median eGFR at 3 months did not significantly differ between the PRD and MP groups: 45 (IQR 34-74) and 46 (IQR 39-65) ml/min/1.73m2. The primary endpoint at 3 months was achieved in 16/20 (80%) PRD patients and 10/20 (50%) MP patients (P = 0.0467). eGFR was similar between the two groups after 1, 3, 6, and 12 months of treatment. For both groups, eGFR at 1 month was highly correlated with eGFR at 12 months (P < 0.0001). The two groups did not differ in severe adverse events. CONCLUSION As compared with a standard oral-steroid regimen, intravenous MP may have no supplemental benefit for renal function in patients with TIN due to sarcoidosis. ClinicalTrials.gov: NCT01652417; EudraCT: 2012-000149-11.
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Affiliation(s)
- Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Alexandra Rousseau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital Saint Antoine, Paris, France
| | - Alexandre Cez
- Sorbonne Université, INSERM UMRS 1155, Nephrology Department, AP-HP, Hôpital Tenon, Paris, France
| | - Dominique Guerrot
- Nephrology Department, Rouen University Hospital, Normandie Univ, INSERM U1096, Rouen, France
| | | | - Michel Delahousse
- Nephrology and Renal Transplantation department, Hôpital Foch, Suresnes, France
| | - Catherine Hanrotel
- Nephrology, Dialysis and Renal Transplantation Department, Hôpital Universitaire de la Cavale Blanche, BREST, France
| | - Evangeline Pillebout
- Service de néphrologie, Hôpital St-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Daugas
- Department of Nephrology, Hôpital Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris; Université de Paris; INSERM U1149, Paris, France
| | - Evguenia Krastinova
- Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital Saint Antoine, Paris, France
| | - Dominique Valeyre
- INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, hôpital Avicenne, Bobigny, France
| | - Jean-Jacques Boffa
- Sorbonne Université, INSERM UMRS 1155, Nephrology Department, AP-HP, Hôpital Tenon, Paris, France
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Caillard P, Vigneau C, Halimi J, Hazzan M, Thervet E, Heitz M, Juillard L, Audard V, Choukroun G, Titeca-Beauport D. Intérêt pronostique du taux sérique de C3 et des dépôts rénaux de C3 dans la maladie à anticorps anti-membrane basale glomérulaire. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Van Wynsberghe M, Flejeo J, Ben Ali C, Morvan M, Audard V, Sahali D, Hénique C. Le podocyte perd pieds sous l’effet du sorafenib. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Seitz-Polski B, Audard V, Ghiggeri GM, Tomas NM. Editorial: Immune dysfunction in nephrotic syndrome - recent advances and new roads ahead. Front Immunol 2022; 13:985925. [PMID: 35983048 PMCID: PMC9379314 DOI: 10.3389/fimmu.2022.985925] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Barbara Seitz-Polski
- Centre de Référence Maladies Rares Syndrome Néphrotique Idiopathique, CHU de Nice, Université Côte d’Azur, Nice, France
- Unité de Recherche Clinique de la Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France
- Laboratoire d’Immunologie, CHU de Nice, Université Côte d’Azur, Nice, France
- Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d’Azur, Nice, France
- *Correspondence: Barbara Seitz-Polski, ; Vincent Audard, ;Gian Marco Ghiggeri, ; Nicola M. Tomas,
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare “Syndrome Néphrotique Idiopathique”, Fédération Hospitalo-Universitaire, Innovative Therapy for Immune Disorders, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- *Correspondence: Barbara Seitz-Polski, ; Vincent Audard, ;Gian Marco Ghiggeri, ; Nicola M. Tomas,
| | - Gian Marco Ghiggeri
- Laboratory on Molecular Medicine, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- Division of Nephrology, Dialysis, Transplantation, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Barbara Seitz-Polski, ; Vincent Audard, ;Gian Marco Ghiggeri, ; Nicola M. Tomas,
| | - Nicola M. Tomas
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Barbara Seitz-Polski, ; Vincent Audard, ;Gian Marco Ghiggeri, ; Nicola M. Tomas,
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29
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Violon F, Burns R, Mihoubi F, Audard V, Biau D, Feydy A, Larousserie F. Intramedullary, periosteal, and extraskeletal Ewing sarcomas: retrospective study of a series of 126 cases in a reference center. Skeletal Radiol 2022; 51:1659-1670. [PMID: 35179621 DOI: 10.1007/s00256-021-03983-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the proportion of extraskeletal, periosteal, and intramedullary Ewing sarcomas among musculoskeletal Ewing sarcomas. MATERIAL AND METHOD Our single-center retrospective study included patients with musculoskeletal Ewing sarcoma diagnosed between 2005 and 2019 in our pathology center (cases from our adult bone tumor referral center and adult and pediatric cases referred for review). Recurrences, metastases, and visceral Ewing sarcomas were excluded. Intramedullary Ewing sarcomas were defined by involvement of the medullary cavity. Periosteal cases were defined by involvement of the subperiosteal area without extension to the medullary cavity. Extraskeletal cases were defined by the absence of involvement of the bone tissue and the subperiosteal area. RESULTS Our series included 126 patients with musculoskeletal Ewing sarcoma, including 118 skeletal Ewing sarcomas (93.7%) and 8 extraskeletal Ewing sarcomas (6.3%). Of the 118 skeletal Ewing sarcomas 112 were intramedullary (88.9%) and 6 were periosteal (4.8%). Extraskeletal Ewing sarcomas were more common in women and in patients older than 40 (p < 0.05). DISCUSSION The 6.3% proportion of extraskeletal Ewing sarcoma is lower than the median of 30% estimated from the literature. This difference could be explained by an overestimation of extraskeletal Ewing sarcomas of the chest wall (Askin tumors), an underestimation of periosteal cases confused with extraskeletal cases, and the presence of "Ewing-like" soft tissue sarcomas in previous series. Because of its prognostic and therapeutic impact, the distinction of morphologic subtypes requires the cooperation of experienced radiologists and pathologists.
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Affiliation(s)
- F Violon
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France.,Faculté de Médecine de Nancy, Université de Lorraine, Nancy, France
| | - R Burns
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - F Mihoubi
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France
| | - V Audard
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France
| | - D Biau
- Université de Paris, Paris, France.,Service de Chirurgie Orthopédique, Hôpital Cochin, AP-HP, Paris, France
| | - A Feydy
- Service de Radiologie, Hôpital Cochin, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - F Larousserie
- Service de Pathologie, Hôpital Cochin, AP‑HP, Paris, France. .,Université de Paris, Paris, France.
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Abroud H, Beldi‐Ferchiou A, Audard V, Lemonnier F, Le Bras F, Belhadj K, Moktefi A, Poullot E, El Karoui K, Dupuis J, Maarek A, Roulin L, Delfau‐Larue M, Oghina S, Kharoubi M, Bézard M, Zaroui A, Damy T, Molinier‐Frenkel V. Evaluation of a new ELISA assay for monoclonal free‐light chain detection in patients with cardiac amyloidosis. eJHaem 2022; 3:828-837. [PMID: 36051065 PMCID: PMC9421952 DOI: 10.1002/jha2.516] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022]
Abstract
The causal protein of amyloid light‐chain (AL) amyloidosis is a monoclonal immunoglobulin free light chain (mFLC), which must be quantified in the serum for patient diagnosis and monitoring. Several manufacturers commercialize immunoassays that quantify total kappa (κ) and lambda (λ) FLC, but results can differ greatly between these tests. Here, we compared a recently developed enzyme‐linked immunosorbent assay (ELISA) (Sebia) with N‐Latex immunonephelometry (Siemens) in 96 patients diagnosed with AL amyloidosis (histologically confirmed) and 48 non‐AL patients sent to our referral center for suspicion of cardiac amyloidosis. ELISA free‐light chain difference (dFLC) were lower than N‐Latex values, and agreement between methods was reduced in the case of involved λ FLC. Diagnosis sensitivity and specificity were >85% with both assays. A receiver operating characteristic analysis indicated that ELISA performances could be improved by using a higher value for the lower limit of the κ/λ ratio. We also assessed Freelite (The Binding Site) in a subgroup of these same AL patients, including 18 cases with normal κ/λ ratio by at least one assay. Only two patients had normal κ/λ ratio with all three assays. Overall, ELISA demonstrated slightly lower sensitivity than N‐Latex but may be an alternative to nephelometry/turbidimetry in certain difficult cases.
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Affiliation(s)
- Hajer Abroud
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Asma Beldi‐Ferchiou
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM IMRB Univ Paris Est Creteil Creteil France
| | - Vincent Audard
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Service de Néphrologie et Transplantation AP‐HP, Hopital Henri Mondor Creteil France
| | - François Lemonnier
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Fabien Le Bras
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Karim Belhadj
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Anissa Moktefi
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Pathologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Elsa Poullot
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Pathologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Khalil El Karoui
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Service de Néphrologie et Transplantation AP‐HP, Hopital Henri Mondor Creteil France
| | - Jehan Dupuis
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Alizée Maarek
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Louise Roulin
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Unité Hémopathies Lymphoïdes AP‐HP, Hopital Henri Mondor Creteil France
| | - Marie‐Hélène Delfau‐Larue
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM IMRB Univ Paris Est Creteil Creteil France
| | - Silvia Oghina
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Mounira Kharoubi
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Mélanie Bézard
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Amira Zaroui
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
| | - Thibaud Damy
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
- Département de Cardiologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM, IMRB, CEPiaA Univ Paris Est Creteil Creteil France
| | - Valérie Molinier‐Frenkel
- Département d'Hématologie‐Immunologie AP‐HP, Hopital Henri Mondor Creteil France
- INSERM IMRB Univ Paris Est Creteil Creteil France
- French Referral Centre for Cardiac Amyloidosis Cardiogen Network GRC Amyloid Research Institute Henri Mondor Hospital Creteil France
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Eshagh D, Quéméneur T, Karras A, Queyrel V, Augusto J, Agard C, Audard V, Couderc M, Duffau P, Durel C, Faguer S, Jourde-Chiche N, Lavergne A, Christian L, Limal N, Servettaz A, Smets P, Régent A, Mouthon L, Terrier B. Particularités phénotypiques et thérapeutiques des vascularites à ANCA au cours de la sclérodermie systémique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hummel A, Oniszczuk J, Kervella D, Charbit M, Guerrot D, Testa A, Philipponnet C, Chauvet C, Guincestre T, Brochard K, Benezech A, Figueres L, Belenfant X, Guarnieri A, Demoulin N, Benetti E, Miglinas M, Dessaix K, Morelle J, Angeletti A, Sellier-Leclerc AL, Ranchin B, Goussard G, Hudier L, Bacchetta J, Servais A, Audard V. Idiopathic nephrotic syndrome relapse following SARS-CoV-2 vaccination: a series of 25 cases. Clin Kidney J 2022; 15:1574-1582. [PMID: 35979142 PMCID: PMC9129143 DOI: 10.1093/ckj/sfac134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several cases of idiopathic nephrotic syndrome (INS) relapse following the administration of coronavirus disease 2019 (COVID-19) vaccines have recently been reported, raising questions about the potential relationship between the immune response to COVID-19 vaccination and INS pathogenesis. Methods We performed a retrospective multicentre survey describing the clinical and biological characteristics of patients presenting a relapse of INS after COVID-19 vaccination, with an assessment of outcome under treatment. Results We identified 25 patients (16 men and 9 women) presenting a relapse within 1 month of a COVID-19 vaccine injection. The glomerular disease was of childhood onset in half of the patients and most patients (21/25) had received at least one immunosuppressive drug in addition to steroids for frequently relapsing or steroid-dependent nephrotic syndrome (NS). All patients were in a stable condition at the time of injection and 11 had no specific treatment. In five patients, the last relapse was reported >5 years before vaccine injection. The Pfizer-BioNTech (BNT162b2) vaccine was used in 80% of the patients. In 18 cases, INS relapse occurred after the first injection, a mean of 17.5 days after vaccination. A second injection was nevertheless administered in 14 of these patients. Five relapses occurred after administration of the second dose and two relapses after the administration of the third dose. All but one of the patients received steroids as first-line treatment, with an additional immunosuppressive agent in nine cases. During follow-up, complete remission was achieved in 21 patients, within 1 month in 17 cases. Only one patient had not achieved at least partial remission after 3 months of follow-up. Conclusions This case series suggests that, in rare patients, COVID-19 vaccination may trigger INS relapse that is generally easy to control. These findings should encourage physicians to persuade their patients to complete the COVID-19 vaccination schedule.
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Affiliation(s)
- Aurélie Hummel
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique » (SNI), Paris, France
| | - Julie Oniszczuk
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare SNI, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Delphine Kervella
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalo Universitaire (CHU) Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche (UMR) 1064, INSERM, Université de Nantes, Nantes, France
| | - Marina Charbit
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie pédiatrique, Centre de référence MARHEA, centre de référence SNI, Institut Imagine, Université de Paris, Paris, France
| | - Dominique Guerrot
- Department of Nephrology, Hemodialysis and Transplantation, Rouen University Hospital, Rouen, France
- Normandy University, UNIROUEN, INSERM U1096, Rouen, France
| | - Angelo Testa
- E.C.H.O. (Expansion Centre Hémodialyse de l'Ouest) Site Confluent REZE, France
| | - Carole Philipponnet
- Service Nephrologie Dialyse et Transplantation rénale CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécile Chauvet
- Service de Néphrologie, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Thomas Guincestre
- Service de Néphrologie, Centre Hospitalier de Roubaix, Roubaix, France
| | - Karine Brochard
- Service de Néphrologie-Rhumatologie-Médecine Interne pédiatrique, Centre de Référence des Maladies rénales Rares du Sud-Ouest (SORARE), Hôpital des enfants, Toulouse, France
| | - Ariane Benezech
- Service de Néphrologie-Rhumatologie-Médecine Interne pédiatrique, Centre de Référence des Maladies rénales Rares du Sud-Ouest (SORARE), Hôpital des enfants, Toulouse, France
| | - Lucile Figueres
- Institut de Transplantation Urologie Néphrologie, Centre Hospitalo Universitaire (CHU) Nantes, Nantes, France
- Centre de Recherche en Transplantation et Immunologie, Unité Mixte de Recherche (UMR) 1064, INSERM, Université de Nantes, Nantes, France
| | - Xavier Belenfant
- Groupe Hospitalier Grand Paris Nord Est, Hôpital André Grégoire, Service de Néphrologie-Dialyse, Montreuil, France
| | | | - Nathalie Demoulin
- Nephrology Division, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Marius Miglinas
- Nephrology Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kathleen Dessaix
- Université de Montpellier, Service de Nephrologie, CHU Montpellier, Hôpital Lapeyronie, Montpellier, France
| | - Johann Morelle
- Nephrology Division, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, Transplantation, IRCCS Giannini Gaslini Children's Hospital, Via Gerolamo Gaslini 5, Genova, Italy
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Guillaume Goussard
- Service de Néphrologie et Transplantation CHU Poitiers, Poitiers, France
| | - Laurent Hudier
- Service de Néphrologie, Centre Hospitalier Broussais, Saint Malo, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares Néphrogones, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Faculté de Médecine Lyon Est, Bron, France
| | - Aude Servais
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants Malades, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique » (SNI), Paris, France
| | - Vincent Audard
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare SNI, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
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Van Wynsberghe M, Flejeo J, Ben Ali C, Audard V, Sahali D, Hénique C. FC016: Nephrotoxicity of Antiangiogenic Therapies: Direct Impact of Sorafenib on the Podocyte via GSK3Β. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac097.003] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Tumor angiogenesis is one of the therapeutic targets used in oncology, to limit cancer growth and spreading. The main angiogenesis signalling pathway is mediated by the vascular endothelial growth factor (VEGF) that binds to its tyrosine kinase receptor (VEGFR), mainly expressed on endothelial cells. The antiangiogenic therapy could target the VEGF ligand (anti-VEGF), or its receptors by inhibition of kinase activity (tyrosine kinase inhibitor, TKI) such as sorafenib. The toxicity of antiangiogenic therapies is a growing concern in clinical use. Indeed, nephrotoxicity is a critical side-effect that leads to discontinuation of therapy. Renal histological illustration of this toxicity is minimal change nephropathy/focal segmental glomerulosclerosis (MCNS/FSGS) and thrombotic micro-angiopathy (TMA), involving two distinct cell types, podocytes and endothelial cells respectively. Podocytes are the main source of VEGF and express VEGFR in the glomerulus. Mechanisms linking TKI therapy to podocyte dysfunction and nephrotic level proteinuria are still poorly understood. The working hypothesis is that nephrotoxicity of sorafenib is primarily through its effect on glomerular podocytes.
METHOD
Based on LC-MS/MS proteomic analysis, we have identified dysregulated cellular pathways on sorafenib-exposed podocytes. We validated these results by western blotting and immunofluorescence staining, on a cultured podocyte line exposed to sorafenib (2.5 µmol/L, 24-h).
RESULTS
Our results showed that sorafenib inhibits the downstream signalling pathways of VEGFR on podocytes, which induce injury by decreasing the expression of podocyte-specific markers (WT1, podocin). This is associated with podocyte morphology changes with podocyte cytoskeleton damages (actin and microtubules) and focal adhesions loss. We identified a novel podocyte target of sorafenib: the GSK3β. Indeed, sorafenib reduces significantly GSK3β inhibitory phosphorylation. Moreover, GSK3β regulates Tau, microtubule-associated proteins (MAP) and key regulator of microtubules remodelling. We show that tau phosphorylation increases significantly in sorafenib-treated cells. Furthermore, we found that sorafenib impairs the autophagic flux in podocytes, as indicated by an increase in LC3-II/LC3-I ratio in western blot, reflect of autophagosomes accumulation in podocytes. These results indicate that GSK3β overactivity induced by sorafenib participates in the disruption of the microtubules through tau phosphorylation, which interferes with cellular vesicle trafficking and blocks autophagic flux in podocytes. In addition, sorafenib leads to podocyte apoptosis through induction of endoplasmic reticulum (ER) stress (GADD153 protein induction and its nuclear translocation) and mitochondrial dysfunction. ER stress induced a decrease in podocyte protein synthesis with increased eIF2α phosphorylation. Sorafenib also causes mitochondrial membrane potential loss and mitochondrial depolarization.
CONCLUSION
Thus, in the current study, we show that sorafenib has a direct effect on podocytes, modulating specific signalling pathways to induce podocyte damage and ultimately glomerular lesions. However, we have to confirm the clinical relevance of our results on kidney biopsies from patients diagnosed with nephrotic syndrome following sorafenib treatment.
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Affiliation(s)
- Margaux Van Wynsberghe
- Institut Mondor Recherche Biomédicale- Inserm U955 UPEC, Team Sahali-Pathophysiology of Glomerular Diseases , Créteil , France
| | - Joanne Flejeo
- CHU Pontchaillou, Service de Néphrologie , Rennes , France
| | - Chloé Ben Ali
- Institut Mondor Recherche Biomédicale- Inserm U955 UPEC, Team Sahali-Pathophysiology of Glomerular Diseases , Créteil , France
| | - Vincent Audard
- Institut Mondor Recherche Biomédicale- Inserm U955 UPEC, Team Sahali-Pathophysiology of Glomerular Diseases , Créteil , France
| | - Dil Sahali
- Institut Mondor Recherche Biomédicale- Inserm U955 UPEC, Team Sahali-Pathophysiology of Glomerular Diseases , Créteil , France
| | - Carole Hénique
- Institut Mondor Recherche Biomédicale- Inserm U955 UPEC, Team Sahali-Pathophysiology of Glomerular Diseases , Créteil , France
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Chhuon C, Savas B, Charrière-Bertrand C, Audard V, Sahali D, Chiara Guerrera I, Ollero M. FC065: Combined Proteomic Analyses of Recurrent Idiopathic Nephrotic Syndrome Plasma and Plasma-Treated Human Podocytes. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac111.001] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Idiopathic nephrotic syndrome (INS) comprises a group of rare glomerulopathies attributed to direct or indirect interaction of putative circulating factors with podocytes. One of the pathological manifestations of INS is the rapid recurrence of focal and segmental glomerulosclerosis (rFSGS) after renal transplant, which occurs in 30–50% of cases. To date, the nature and identity of circulating factors have not been confirmed, while the pathogenic mechanisms in the podocyte are partially understood. Direct analysis of patient plasma proteome has been scarcely addressed, mainly due to methodological difficulties associated with plasma complexity and dynamic range. To better understand the mechanisms involved in FSGS recurrence, the present study had two main objectives: (i) to perform a differential proteomic analysis of soluble plasma proteins and of extracellular vesicles (EV) from rFSGS patients and from controls; and (ii) to study the early proximal signaling events in podocytes in response to plasma from post-transplant rFSGS patients as compared to plasma from controls, by a combination of phosphoproteomics and lipid raft proteomics (raftomics).
METHOD
We obtained first post-transplant plasma exchange fluid from either rFSGS or non-INS patients (n = 4), the latter used as controls, as well as blood plasma from healthy individuals (n = 4). In a first study, by a combination of immunodepletion and high pH fractionation, we performed in parallel a differential proteomic analysis of soluble plasma proteins and of extracellular vesicles (EV) from the three groups. In a second study, we incubated differentiated human podocytes for 30 min with 10% of plasma exchange fluid from either rFSGS or non-INS patients. Then, we isolated lipid rafts from podocytes by a detergent-free method and performed differential proteomics. In addition, we performed differential phosphoproteomics after phosphopeptide enrichment in a TiO2 column. Proteomics by LC-MS/MS analysis was performed in a TimsTOF Pro mass spectrometer on plasma samples, and in a nanoRSLC-Q Exactive PLUS instrument on podocyte samples.
RESULTS
The approximate number of proteins identified was 500 in immunodepleted plasma, 1400 in EV, 2500 in podocyte rafts and 4900 podocyte phosphosites. In both soluble and EV protein sets from rFSGS patients, we found a statistically significant increase in a cluster of proteins involved in neutrophil degranulation. A group of lipid binding proteins, generally associated with lipoproteins, was found decreased in the soluble set from rFSGS patients. In addition, several aminoacid transporters involved in mTORC1 activation were found significantly increased in EV from rFSGS individuals. As regards podocyte proteome analyses, the differences found in protein expression and phosphorylation associated with rFSGS plasma incubation suggested alterations in the mTOR pathway, in autophagy, in mitochondrial metabolism and in cytoskeleton organization. In particular, validation experiments indicated an altered phosphorylation pattern of Hsp27.
CONCLUSION
The technological approaches used in the plasma study show the feasibility of direct proteomic analysis of this material, as well as the potential of some of the identified differential proteins as FSGS biomarkers. The observed changes in podocyte proteome associated with rFSGS plasma incubation highlight some of the potential mechanisms involved in FSGS recurrence and could be used as specific early markers of circulating factor activity on podocytes. Further research will be necessary to confirm and validate these findings.
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Affiliation(s)
| | - Berkan Savas
- Institut mondor de Recherche Biomédicale, INSERM U955, Créteil, France
| | | | | | - Dil Sahali
- Institut mondor de Recherche Biomédicale, INSERM U955, Créteil, France
| | | | - Mario Ollero
- Institut mondor de Recherche Biomédicale, INSERM U955, Créteil, France
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Ben Ali C, Lafargue MC, Morvan M, Van Wynsberghe M, Audard V, Sahali D, Hénique C. FC019: Parietal Epithelial Cells Activation During Gemcitabine-Induced Nephrotoxicity: Communication With Endothelial Cells? Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac098.002] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Gemcitabine (GEM) is an anticancer drug, indicated in the treatment of several types of solid cancers such as pancreatic, breast, bladder cancer, etc. This molecule is effective in tumor processes but causes adverse effects on other organs, including the haematopoietic system and the kidney. The renal toxicity of gemcitabine is illustrated by thrombotic microangiopathy (TMA), whose onset is dramatic and associated in more than 97% of cases with acute renal failure. This adverse effect induces discontinuation of treatment with negative consequences on tumor control. It is, therefore, essential to understand the pathophysiological mechanisms of gemcitabine nephrotoxicity. TMA at the glomerular level reflects damage to the endothelial cell (ECs). However, previously, data of our team show that other glomerular cells, parietal epithelial cells (PECs), could be involved in these lesions. Thus, in this project, we want: i) to describe the modifications of the PEC and EC proteome exposed to gemcitabine and ii) to analyse PEC and EC secretome exposed to gemcitabine and to study the cell communication between PECs and ECs.
METHOD
In our in vitro experiments, we used a murine PEC cell line and a murine EC cell line. The PECs are exposed to 100 μM GEM for 24-h and the culture supernatants are recovered. These PEC supernatants are used in conditioned media experiments to expose ECs for 24-h. On the other hand, ECs were directly exposed to 1 μM GEM for 24-h and culture supernatants were also recovered. Analyses of protein expression are carried out by western blot and immunofluorescence staining.
RESULTS
When PECs are exposed to GEM (100 µM, 24-h), we observe an increase in apoptosis (caspase 3 cleavage) as well as DNA damage (γH2AX). However, PECs specific markers, such as PAX2 and Claudin-1, do not appear to be affected. Our results also show an increase in the expression of the transcription factor CHOP and the chaperone protein BIP, suggesting the presence of endoplasmic reticulum (ER) stress in PECs exposed to gemcitabine.
In order to study cell communication between PECs and ECs, we set up conditioned media experiments. We first studied the expression of different endothelial markers on ECs exposed to PEC supernatants. The expression of the endothelial markers such as E-cadherin, CD31 and PDGFRβ decreases compared with control cells when ECs are exposed to PEC supernatants. Actin cytoskeleton reorganization is also observed with an increase in cortical actin. Moreover, the microtubule network seems to be also affected with a tendency to decrease tubulin expression. Finally, there is an increase in γH2AX suggesting the presence of DNA damage in ECs exposed to PEC supernatant. The next experiments aim at identifying the factors responsible for this cell communication (proteins, lipid mediators, non-coding RNA, extracellular vesicles).
CONCLUSION
Our results show GEM has a direct effect on PECs (apoptosis, DNA damage, ER stress). In addition, we show the effect of PEC supernatants exposed to GEM on ECs (decrease in endothelial markers, cytoskeleton modifications, DNA damage).
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Arrestier R, Gendreau S, Mokrani D, Bastard JP, Fellahi S, Bagate F, Masi P, d’Humières T, Razazi K, Carteaux G, De Prost N, Audard V, Mekontso-Dessap A. Acute Kidney Injury in Critically-Ill COVID-19 Patients. J Clin Med 2022; 11:jcm11072029. [PMID: 35407639 PMCID: PMC8999255 DOI: 10.3390/jcm11072029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: Acute kidney injury (AKI) is common in patients with COVID-19, however, its mechanism is still controversial, particularly in ICU settings. Urinary proteinuria profile could be a non-invasive tool of interest to scrutinize the pathophysiological process underlying AKI in COVID-19 patients. Material and Methods: We conducted a retrospective study between March 2020 and April 2020. All patients with laboratory-confirmed COVID-19 and without end-stage kidney disease requiring renal replacement therapy before ICU admission were included. Our objectives were to assess the incidence and risk factors for AKI and to describe its clinical and biological characteristics, particularly its urinary protein profile. Results: Seventy patients were included; 87% needed mechanical ventilation and 61% needed vasopressor during their ICU stay; 64.3% of patients developed AKI and half of them needed dialysis. Total and tubular proteinuria on day 1 were higher in patients with AKI, whereas glomerular proteinuria was similar in both groups. The main risk factor for AKI was shock at admission (OR = 5.47 (1.74−17.2), p < 0.01). Mortality on day 28 was higher in AKI (23/45, 51.1%) than in no-AKI patients (1/25, 4%), p < 0.001. Risk factors for 28-days mortality were AKI with need for renal replacement therapy, non-renal SOFA score and history of congestive heart failure. Conclusions: AKI is common in COVID-19 patients hospitalized in ICU; it seems to be related to tubular lesions rather than glomerular injury and is related to shock at ICU admission.
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Affiliation(s)
- Romain Arrestier
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
- Correspondence: ; Tel.: +33-01-4981-2399; Fax: +33-01-4981-2542
| | - Ségolène Gendreau
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - David Mokrani
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
| | - Jean-Philippe Bastard
- Département de Biochimie-Pharmacologie-Biologie Moléculaire-Génétique Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (J.-P.B.); (S.F.)
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
| | - Soraya Fellahi
- Département de Biochimie-Pharmacologie-Biologie Moléculaire-Génétique Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (J.-P.B.); (S.F.)
- Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-Métabolisme et Nutrition (ICAN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR S938, Sorbonne Université, 75006 Paris, France
| | - François Bagate
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Paul Masi
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Thomas d’Humières
- Service de Physiologie Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France
| | - Keyvan Razazi
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Guillaume Carteaux
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
| | - Nicolas De Prost
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
| | - Vincent Audard
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
- Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Assistance Publique-Hôpitaux de Paris (AP-HP), Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France; (S.G.); (D.M.); (F.B.); (P.M.); (K.R.); (G.C.); (N.D.P.); (A.M.-D.)
- GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France;
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Fourdinier O, Ulrich M, Karras A, Olagne J, Buob D, Audard V, Vigneau C, Gibier JB, Guerrot D, Massy Z, Vuiblet V, Rabot N, Goujon JM, Cordonnier C, Choukroun G, Titeca-Beauport D. Glomerulonephritis with non-Randall-type, non-cryoglobulinemic monoclonal immunoglobulin G deposits [PGNMID and ITG]. Clin Kidney J 2022; 15:1727-1736. [PMID: 36003672 PMCID: PMC9394706 DOI: 10.1093/ckj/sfac085] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Glomerulonephritis (GN) with non-Randall-type, non-cryoglobulinemic monoclonal immunoglobulin G deposits encompasses rare diseases [proliferative GN with non-organized deposits (PGNMID) and immunotactoid GN] that cannot be distinguished without ultrastructural analysis by electron microscopy (EM).
Methods
Here, we report and analyze the prognosis of 41 EM-proven (PGNMID for 39/41) and 22 non-EM-proven/DNAJB9-negative cases, diagnosed between 2001 and 2019 in 12 French nephrology centers.
Results
Median serum creatinine (SCr) at presentation was 150 [92-256] μmol/L. The predominant histological pattern was membranoproliferative GN (79%), with IgG3 (74%) kappa (78%) deposits the most frequently observed. Disease presentation and patient management were similar between EM-proven and non-EM-proven cases. A serum monoclonal spike was detected for 21 patients and 10 had an underlying hematological malignancy. First-line therapy was mixed between clone-targeted therapy (n = 33), corticosteroids (n = 9), and RAAS-inhibitors (n = 19). After six months, nine patients achieved complete and 23 partial renal recovery. In univariate analysis, renal recovery was associated with baseline SCr (OR 0.70, p = 0.07). After a median follow-up of 52 [35–74] months, 38% of patients had progressed to end-stage kidney disease independently associated with baseline SCr (HR 1.41, p = 0.003) and glomerular crescentic proliferation (HR 4.38, p = 0.004).
Conclusions
Our results confirm that non-cryoglobulinemic and non-Randall GN with monoclonal IgG deposits are rarely associated with hematological malignancy. The prognosis is uncertain but may be improved by early introduction of a specific therapy.
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Affiliation(s)
- Ophélie Fourdinier
- Department of Nephrology, Dialysis and Transplantation, University Hospital, and MP3CV Research Laboratory, Jules Verne Picardie University, Amiens, France
| | - Marc Ulrich
- Department of Nephrology, Hôpital Jean Bernard, Valenciennes, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Jérôme Olagne
- Department of Nephrology and Transplantation, Department of Pathology, University Hospital, Strasbourg, France
| | - David Buob
- Department of Pathology, Hôpital Tenon, APHP, Paris, France
| | - Vincent Audard
- Department of Nephrology and Transplantation, Henri Mondor University Hospital, APHP, and Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U 955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | | | | | - Ziad Massy
- Department of Nephrology, Ambroise Paré Hospital, APHP, Boulogne Billancourt, Paris, and Inserm Unit 1018, Team 5, CESP, Versailles Saint-Quentin-en-Yvelines University, Paris Saclay University, Villejuif, France
| | - Vincent Vuiblet
- Department of Nephrology and Transplantation, University Hospital, Reims, France
| | - Nolwenn Rabot
- Department of Nephrology, University Hospital, Tours, France
| | - Jean-Michel Goujon
- Department of Nephrology, and Department of Pathology and Ultrastructural Pathology, University Hospital, Poitiers, France
| | | | - Gabriel Choukroun
- Department of Nephrology, Dialysis and Transplantation, University Hospital, and MP3CV Research Laboratory, Jules Verne Picardie University, Amiens, France
| | - Dimitri Titeca-Beauport
- Department of Nephrology, Dialysis and Transplantation, University Hospital, and MP3CV Research Laboratory, Jules Verne Picardie University, Amiens, France
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38
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Nezam D, Porcher R, Grolleau F, Morel P, Titeca-Beauport D, Faguer S, Karras A, Solignac J, Jourde-Chiche N, Maurier F, Sakhi H, El Karoui K, Mesbah R, Carron PL, Audard V, Ducloux D, Paule R, Augusto JF, Aniort J, Tiple A, Rafat C, Beaudreuil S, Puéchal X, Gobert P, Massy Z, Hanrotel C, Bally S, Martis N, Durel CA, Desbuissons G, Godmer P, Hummel A, Perrin F, Néel A, De Moreuil C, Goulenok T, Guerrot D, Grange S, Foucher A, Deroux A, Cordonnier C, Guilbeau-Frugier C, Modesto-Segonds A, Nochy D, Daniel L, Moktefi A, Rabant M, Guillevin L, Régent A, Terrier B. Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges. J Am Soc Nephrol 2022; 33:628-637. [PMID: 35074934 PMCID: PMC8975074 DOI: 10.1681/asn.2021060771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 06/08/2021] [Accepted: 10/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. METHODS We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). RESULTS No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. CONCLUSIONS PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
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Affiliation(s)
- Dorian Nezam
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Raphaël Porcher
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - François Grolleau
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - Pauline Morel
- Service de dialyse et aphérèse, AURA Paris Plaisance, Paris, France
| | | | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’organes, Hôpital Rangueil, Toulouse, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Justine Solignac
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - François Maurier
- Hôpital Belle-Isle, Groupe Hospitalier Associatif UNEOS, Metz, France
| | - Hamza Sakhi
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Rafik Mesbah
- Service de Néphrologie, Centre Hospitalier, Boulogne-sur-mer, France
| | | | - Vincent Audard
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Didier Ducloux
- Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, France
| | - Romain Paule
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | | | - Julien Aniort
- Service de Néphrologie, Dialyse et Transplantation rénale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Aurélien Tiple
- Service de Néphrologie, CHU Jacques Lacarin, Vichy, France
| | - Cédric Rafat
- Unité de Néphrologie, Transplantation Rénale, Hôpital Tenon (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Séverine Beaudreuil
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Pierre Gobert
- Service de Médecine Interne et Immunologie clinique, Clinique Rhône Durance, Avignon, France
| | - Ziad Massy
- Département de Néphrologie, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Catherine Hanrotel
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital La Cavale Blanche, Brest, France
| | - Stéphane Bally
- Service de Néphrologie Dialyse, Centre Hospitalier Métropole Savoie, Chambery, France
| | | | - Cécile-Audrey Durel
- Service de Médecine, Interne Hôpital Edouard Herriot, Hospices civils de Lyon, France
| | | | - Pascal Godmer
- Service de Médecine Interne, CHBA site de Vannes, Vannes, France
| | - Aurélie Hummel
- Service de Néphrologie et Transplantation Rénale, Hôpital Necker-Enfants Malades (Assistance Publique des Hôpitaux de Paris), Paris, France
| | | | - Antoine Néel
- Service de Médecine Interne, CHU de Nantes, France
| | | | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Dominique Guerrot
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Steven Grange
- Service de Réanimation médicale, CHU Charles Nicolle, Rouen, France
| | - Aurélie Foucher
- Service de Médecine Interne, CHU site Sud Saint-Pierre, Saint-Pierre, France
| | - Alban Deroux
- Service de Médecine Interne, CHU de Grenoble, France
| | - Carole Cordonnier
- Service d’anatomie et de cytologie pathologiques, Hôpital Nord, CHU d’Amiens, France
| | - Céline Guilbeau-Frugier
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Anne Modesto-Segonds
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Dominique Nochy
- Service d’Anatomie et Cytologie Pathologiques, Hôpital Européen Georges Pompidou (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Laurent Daniel
- Service d’Anatomie et cytologie pathologiques, Hôpital La Timone (APHM), Marseille, France
| | - Anissa Moktefi
- Assistance Publique des Hôpitaux de Paris, Department of Pathology, Groupe Hospitalier Henri-Mondor 94010 Creteil, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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Jobbé‐Duval A, Bézard M, Moutereau S, Kharoubi M, Oghina S, Zaroui A, Galat A, Chalard C, Hugon‐Vallet E, Lemonnier F, Eyharts D, Poulot E, Fanen P, Funalot B, Molinier‐Frenkel V, Audard V, Hittinger L, Delbarre MA, Teiger E, Damy T. Prevalence and determinants of iron deficiency in cardiac amyloidosis. ESC Heart Fail 2022; 9:1314-1327. [PMID: 35128833 PMCID: PMC8934992 DOI: 10.1002/ehf2.13818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/23/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022] Open
Abstract
Aims Iron deficiency (ID) is common in patient with chronic heart failure (HF) and has been widely studied. In contrast, data concerning ID in cardiac amyloidosis (CA) are limited. Amyloidosis is a severe and fatal systemic disease, characterized by an accumulation of amyloid fibrils in various tissues/organs, including nerves, kidneys, gastrointestinal tract, and heart. Amyloid deposits in the heart eventually cause HF. The main subtypes of CA are light chain (AL), hereditary transthyretin (ATTRv), and wild‐type transthyretin (ATTRwt). We performed this study to determine the prevalence, clinical outcome (all‐cause mortality), and determinants of ID among the three main subtypes of CA. Methods and results Iron deficiency status were analysed in 816 CA patients enrolled at the French Referral Centre for Cardiac Amyloidosis: 271 (33%) had AL, 164 (20%) ATTRv, and 381 (47%) ATTRwt. ID affected 49% of CA patients, 45% with AL, 58% with ATTRv, and 48% with ATTRwt. We identified ATTR status (ATTRv P = 0.003, ATTRwt P = 0.037), diabetes (P = 0.003), aspirin treatment (P = 0.009), haemoglobin levels (P = 0.006), and altered global longitudinal strain (P = 0.02) as independent ID determinants. There is no difference in all‐cause mortality considering ID status. Conclusions Iron deficiency is common in patients with CA, irrespective of the subtype. Patients seem more likely to have ID if diagnosed with ATTR, if diabetic, and/or treated with aspirin. In CA, the benefit of intravenous iron therapy, for ID, on morbidity and mortality needs further study.
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Affiliation(s)
- Antoine Jobbé‐Duval
- Heart Failure and Transplant Department ‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de Lyon Lyon France
| | - Mélanie Bézard
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Stéphane Moutereau
- Department of Biochemistry Henri Mondor Teaching Hospital, APHP Creteil France
| | - Mounira Kharoubi
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Silvia Oghina
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Amira Zaroui
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Arnault Galat
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Coraline Chalard
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Elisabeth Hugon‐Vallet
- Heart Failure and Transplant Department ‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de Lyon Lyon France
| | - Francois Lemonnier
- Department of Haematology Henri Mondor Teaching Hospital, APHP Creteil France
| | - Damien Eyharts
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Elsa Poulot
- Department of Pathology Henri Mondor Teaching Hospital, APHP Creteil France
| | - Pascale Fanen
- Department of Genetics Henri Mondor Teaching Hospital, APHP Creteil France
| | - Benoit Funalot
- Department of Genetics Henri Mondor Teaching Hospital, APHP Creteil France
| | | | - Vincent Audard
- Department of Nephrology Henri Mondor Teaching Hospital, APHP Creteil France
| | - Luc Hittinger
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Marc Antoine Delbarre
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Emmanuel Teiger
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
| | - Thibaud Damy
- Department of Cardiology, French Referral Centre for Cardiac Amyloidosis, Cardiogen Network GRC Amyloid Research Institute, DHU A‐TVB, InsermU955, Henri Mondor Teaching Hospital, APHP 51 Avenue Marechal de Lattre de Tassigny Creteil 94000 France
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Stehlé T, Grimbert P, Remy P, Moktefi A, Audard V, El Karoui K. Anti-CD38 therapy for PLA2R-positive membranous nephropathy resistant to conventional immunosuppression. Kidney Int 2022; 101:416-418. [DOI: 10.1016/j.kint.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
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Morel A, Ouamri Y, Canouï-Poitrine F, Mulé S, Champy CM, Ingels A, Audard V, Luciani A, Grimbert P, Matignon M, Pigneur F, Stehlé T. Myosteatosis as an independent risk factor for mortality after kidney allograft transplantation: a retrospective cohort study. J Cachexia Sarcopenia Muscle 2022; 13:386-396. [PMID: 34738343 PMCID: PMC8818595 DOI: 10.1002/jcsm.12853] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients with end-stage renal disease may display both a loss of skeletal muscle mass and an increase in muscle fat deposits. We aimed to analyse the impact of low skeletal muscle mass index (SMI, surrogate marker of sarcopenia) and low muscle density (MD, surrogate marker of myosteatosis) on patient survival after kidney transplantation (KT). METHODS In a retrospective cohort of 200 kidney transplant recipients (KTr), we measured on an unenhanced cross-sectional computed tomography scan taken at the level of the third lumbar vertebra within the previous year or at the time of KT, both SMI (muscle cross-sectional area normalized for height2 , reported in cm2 /m2 ) and MD (mean attenuation of muscle cross-sectional area, expressed in Hounsfield units). We determined age-specific and sex-specific normality thresholds on 130 healthy subjects. The baseline factors associated with low MD were assessed by logistic regression analysis. Cox proportional hazard univariable and multivariable models were constructed to identify predictive factors of patient survival. RESULTS Among the 200 patients of the cohort, 123 were male (62%), and mean age was 54.8 ± 13.8 years. A total of 181 KTr required renal replacement therapy before KT (91%), and 36 KTr (18%) received repeat kidney transplant after previous failed KT. Mean MD was 30.6 ± 9 HU in men and 29.7 ± 8.3 HU in women, whereas SMI was 49.7 ± 8.6 cm2 /m2 in men and 42.3 ± 7.3 cm2 /m2 in women. MD was below the 2.5th percentile for the healthy population in 49 KTr (25%), defining the myosteatosis group, while SMI was below the 2.5th percentile for the reference population in 10 KTr (5%). Independent risk factors for myosteatosis were two or more KT [adjusted odds ratio (aOR) 5.2, 95% confidence interval (95% CI): 2.22-12.4, P = 0.0001], a history of stroke (aOR 3.7, 95% CI: 1.30-10.7, P = 0.015), and body mass index > 25 kg/m2 (aOR 2.94, 95% CI: 1.4-6.18, P = 0.004). Myosteatosis was independently associated with mortality [adjusted hazard ratio (aHR) 2.12, 95% CI: 1.06-4.24, P = 0.033], as were cardiovascular disease (HR 2.06, 95% CI: 1.02-4.15, P = 0.043) and age (aHR 1.06, 95% CI: 1.03-1.09, P = 0.0003). Low SMI was not associated with mortality. CONCLUSIONS Myosteatosis, which was more prevalent than low skeletal muscle mass, might be an important prognostic marker in patients undergoing KT.
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Affiliation(s)
- Antoine Morel
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Yaniss Ouamri
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Clinical Epidemiology and Ageing Unit (CEpiA), Institut Mondor de Recherche Biomédicale, Paris-Est University, Créteil, France
| | - Sébastien Mulé
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Cécile Maud Champy
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service d'Urologie, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Créteil, France
| | - Alexandre Ingels
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service d'Urologie, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Créteil, France
| | - Vincent Audard
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Alain Luciani
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Philippe Grimbert
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Marie Matignon
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Frédéric Pigneur
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Thomas Stehlé
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
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Colucci M, Oniszczuk J, Vivarelli M, Audard V. B-Cell Dysregulation in Idiopathic Nephrotic Syndrome: What We Know and What We Need to Discover. Front Immunol 2022; 13:823204. [PMID: 35140723 PMCID: PMC8819007 DOI: 10.3389/fimmu.2022.823204] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
The therapeutic efficacy of B-cell depletion by anti-CD20 treatment in pediatric and, more recently, in adult idiopathic nephrotic syndrome patients suggests a key role of B cells in the pathogenesis of the disease. However, their exact role is still unclear. B cells are able to secrete a large variety of antibodies that can protect against infections. However, B-cell dysregulation is well-established in a variety of autoimmune diseases. In parallel with their ability to produce antibodies, pathogenic B cells display altered effector functions by expressing activating surface molecules, which can strongly modify the immune homeostasis, or by producing specific cytokines, which can directly affect either podocyte structure and functions or modulate T-cell homeostasis. Herein, we report the most relevant clinical and experimental evidences of a pathogenic role of B cells in idiopathic nephrotic syndrome. We further highlight similarities and differences between children and adults affected by non-genetic forms of the disease and discuss what needs to be investigated in order to define the exact mechanisms underlying the pathogenic role of B cells and to identify more tailored therapeutic approaches.
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Affiliation(s)
- Manuela Colucci
- Renal Diseases Research Unit, Genetics and Rare Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Manuela Colucci,
| | - Julie Oniszczuk
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare “Syndrome Néphrotique Idiopathique”, Fédération Hospitalo-Universitaire, Innovative Therapy for Immune Disorders, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Marina Vivarelli
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare “Syndrome Néphrotique Idiopathique”, Fédération Hospitalo-Universitaire, Innovative Therapy for Immune Disorders, Créteil, France
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
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Dauvergne M, Buob D, Rafat C, Hennino MF, Lemoine M, Audard V, Chauveau D, Ribes D, Cornec-Le Gall E, Daugas E, Pillebout E, Vuiblet V, Boffa JJ. Renal diseases secondary to interferon-β treatment: a multicentre clinico-pathological study and systematic literature review. Clin Kidney J 2021; 14:2563-2572. [PMID: 34950468 PMCID: PMC8690152 DOI: 10.1093/ckj/sfab114] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background The spectrum of interferon-β (IFN-β)-associated nephropathy remains poorly described and the potential features of this uncommon association remain to be determined. Methods In this study we retrospectively analysed the clinical, laboratory, histological and therapeutic data of patients with biopsy-proven renal disease in a context of IFN-β treatment administered for at least 6 months. Results Eighteen patients (13 women, median age 48 years) with biopsy-proven renal disease occurring during IFN-β therapy were included. The median exposure to IFN-β (14 patients were treated with IFN-β1a and 4 patients with IFN-β1b) was 67 months (range 23–165 months). The clinical presentation consists in hypertension (HT; 83%), malignant HT (44%), proteinuria (protU) >1 g/g (94%), reduced renal function (78%), biological hallmark suggesting thrombotic microangiopathy (TMA; 61%), oedematous syndrome (17%) or nephritic syndrome (11%). The pathological findings included typical features of isolated TMAs in 11 cases, isolated focal segmental glomerulosclerosis (FSGS) lesions in 2 cases and 5 cases with concomitant TMA and FSGS lesions. An exploration of the alternative complement pathway performed in 10 cases (63%) did not identify mutations in genes that regulate the complement system. The statistical analysis highlighted that the occurrence of IFN-β-associated TMA was significantly associated with Rebif, with a weekly dose >50 µg and with multiple weekly injections. In all cases, IFN-β therapy was discontinued. Patients with TMA lesions received other therapies, including corticosteroids (44%), eculizumab (13%) and plasma exchanges (25%). At the end of a 36-month median follow-up, persistent HT and persistent protU were observed in 61% and 22% of patients, respectively. Estimated glomerular filtration rate <60 mL/min/1.73 m2 was present in 61% of patients. Conclusions IFN-β-associated nephropathy must be sought in the case of HT and/or protU onset during treatment. When TMA and/or FSGS are observed on renal biopsy, early discontinuation of IFN-β is essential.
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Affiliation(s)
- Maxime Dauvergne
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service de Néphrologie et Dialyses, Paris, France
| | - David Buob
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Cédric Rafat
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | - Marie-Flore Hennino
- Centre Hospitalier de Valenciennes, Service de Néphrologie, Valenciennes, France
| | - Mathilde Lemoine
- CHU de Rouen, Service de Néphrologie, Dialyse et Transplantation, Rouen, France
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Créteil, France
| | - Dominique Chauveau
- CHU Rangueil, Département de Néphrologie et Transplantation d'Organes et Centre de Référence Maladies Rénales Rares SORARE, Toulouse, France
| | - David Ribes
- CHU Rangueil, Département de Néphrologie et Transplantation d'Organes et Centre de Référence Maladies Rénales Rares SORARE, Toulouse, France
| | | | - Eric Daugas
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat, Service de Néphrologie, Paris, France
| | - Evangéline Pillebout
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service de Néphrologie, Paris, France
| | - Vincent Vuiblet
- Département de Néphro-Pathologie, Unité de Pathologie, CHU Reims, Reims, France
| | - Jean-Jacques Boffa
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service de Néphrologie et Dialyses, Paris, France
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Oniszczuk J, Bettuzzi T, Anjou L, Audard V, Sbidian E, El Karoui K, Moktefi A. De novo IgA vasculitis following adenovirus-based SARS-CoV-2 vaccination. Clin Kidney J 2021; 15:587-589. [PMID: 35211316 PMCID: PMC8862086 DOI: 10.1093/ckj/sfab257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julie Oniszczuk
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire TRUE, Créteil, France
- UnivParis Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Thomas Bettuzzi
- AP-HP, Hôpitaux Universitaires Henri Mondor, Dermatology Department, Fédération Hospitalo-Universitaire TRUE, Créteil, France
| | - Louis Anjou
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire TRUE, Créteil, France
- UnivParis Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Vincent Audard
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire TRUE, Créteil, France
- UnivParis Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Emilie Sbidian
- AP-HP, Hôpitaux Universitaires Henri Mondor, Dermatology Department, Fédération Hospitalo-Universitaire TRUE, Créteil, France
| | - Khalil El Karoui
- AP-HP, Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », Fédération Hospitalo-Universitaire TRUE, Créteil, France
- UnivParis Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - Anissa Moktefi
- UnivParis Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France
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Bonnefous L, Kharoubi M, Bézard M, Oghina S, Le Bras F, Poullot E, Molinier-Frenkel V, Fanen P, Deux JF, Audard V, Itti E, Damy T, Audureau E. Assessing Cardiac Amyloidosis Subtypes by Unsupervised Phenotype Clustering Analysis. J Am Coll Cardiol 2021; 78:2177-2192. [PMID: 34823661 DOI: 10.1016/j.jacc.2021.09.858] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/17/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cardiac amyloidosis (CA) is a set of amyloid diseases with usually predominant cardiac symptoms, including light-chain amyloidosis (AL), hereditary variant transthyretin amyloidosis (ATTRv), and wild-type transthyretin amyloidosis (ATTRwt). CA are characterized by high heterogeneity in phenotypes leading to diagnosis delay and worsened outcomes. OBJECTIVES The authors used clustering analysis to identify typical clinical profiles in a large population of patients with suspected CA. METHODS Data were collected from the French Referral Center for Cardiac Amyloidosis database (Hôpital Henri Mondor, Créteil), including 1,394 patients with suspected CA between 2010 and 2018: 345 (25%) had a diagnosis of AL, 263 (19%) ATTRv, 402 (29%) ATTRwt, and 384 (28%) no amyloidosis. Based on comprehensive clinicobiological phenotyping, unsupervised clustering analyses were performed by artificial neural network-based self-organizing maps to identify patient profiles (clusters) with similar characteristics, independent of the final diagnosis and prognosis. RESULTS Mean age and left ventricular ejection fraction were 72 ± 13 years and 52% ± 13%, respectively. The authors identified 7 clusters of patients with contrasting profiles and prognosis. AL patients were distinctively located within a typical cluster; ATTRv patients were distributed across 4 clusters with varying clinical presentations, 1 of which overlapped with patients without amyloidosis; interestingly, ATTRwt patients spread across 3 distinct clusters with contrasting risk factors, biological profiles, and prognosis. CONCLUSIONS Clustering analysis identified 7 clinical profiles with varying characteristics, prognosis, and associations with diagnosis. Especially in patients with ATTRwt, these results suggest key areas to improve amyloidosis diagnosis and stratify prognosis depending on associated risk factors.
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Affiliation(s)
- Louis Bonnefous
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France
| | - Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France
| | - Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France
| | - Fabien Le Bras
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Hematology Department, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Pascale Fanen
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Radiology Department, Henri Mondor University Hospital, Créteil, France
| | - Vincent Audard
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology Department, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France; AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Investigation Center 1430, Henri Mondor University Hospital, Créteil, France
| | - Etienne Audureau
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Hospital, Créteil, France; Univ Paris Est Creteil, INSERM, IMRB, Créteil, France.
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Morel A, Buob D, Goujon JM, Belhadj K, Verpont MC, Audard V, Moktefi A. Thrombospondin type-1 domain-containing 7A-related membranous nephropathy associated with glomerular AL amyloidosis. Pathology 2021; 54:654-657. [PMID: 34774302 DOI: 10.1016/j.pathol.2021.08.008] [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] [Received: 03/11/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Antoine Morel
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire, Innovative Therapy for Immune Disorders, Créteil, France; Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France
| | - David Buob
- Sorbonne Université, AP-HP, Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, Paris, France
| | - Jean-Michel Goujon
- Département de Pathologie, Unité de Pathologie Ultrastructurale, CHU Poitiers, Poitiers, France; Centre de Référence Maladies Rares Amylose AL et Autres Maladies Par Dépôts D'immunoglobulines Monoclonales, Poitiers, France
| | - Karim Belhadj
- AP-HP, Hôpitaux Universitaires Henri Mondor, Unité Hémopathies Lymphoïdes, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Réseau Amylose Mondor, Groupe de Recherche Clinique sur les Amyloses, Amyloid Research Institute, Créteil, France
| | | | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Fédération Hospitalo-Universitaire, Innovative Therapy for Immune Disorders, Créteil, France; Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Réseau Amylose Mondor, Groupe de Recherche Clinique sur les Amyloses, Amyloid Research Institute, Créteil, France
| | - Anissa Moktefi
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Equipe 21, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Réseau Amylose Mondor, Groupe de Recherche Clinique sur les Amyloses, Amyloid Research Institute, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Département de Pathologie, Créteil, France.
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47
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Kharoubi M, Bézard M, Galat A, Le Bras F, Poullot E, Molinier-Frenkel V, Fanen P, Funalot B, Moktefi A, Lefaucheur JP, Abulizi M, Deux JF, Lemonnier F, Guendouz S, Chalard C, Zaroui A, Audard V, Bequignon E, Bodez D, Itti E, Hittinger L, Audureau E, Teiger E, Oghina S, Damy T. History of extracardiac/cardiac events in cardiac amyloidosis: prevalence and time from initial onset to diagnosis. ESC Heart Fail 2021; 8:5501-5512. [PMID: 34714605 PMCID: PMC8712826 DOI: 10.1002/ehf2.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 11/09/2022] Open
Abstract
Aims Cardiac amyloidosis (CA) has a poor prognosis which is aggravated by diagnostic delay. Amyloidosis extracardiac and cardiac events (AECE and ACE) may help improve CA diagnosis and typing. The aim of this study was to compare AECE and ACE between different CA types and assess their relationship with survival. Methods and results This retrospective cohort study conducted in France from June 2008 to May 2019, at the Henry Mondor Hospital. This cohort included 983 patients with CA. Mean age at inclusion was 73.1 ± 11.4 years, 726 (75.1%) were male and the mean body mass index was 24.5 ± 4.1 kg/m2. Among them, 321 had immunoglobulin light chain (AL) amyloidosis, 434 had wild‐type transthyretin (ATTRwt), and 212 had hereditary transthyretin (ATTRv). The first AECE and/or ACE occurred at a mean age of 63 ± 11 years for AL and ATTRv, and 70 ± 12 years for ATTRwt (P < 0.01). The median (Q1–Q3) delay between declaration of the first events and diagnosis varied from 11.1 (5.9; 34.8) months for AL to 92.2 (39.0; 174.7) months for ATTRwt (P < 0.01). The nature of the onset of AECE or ACE varied based on amyloidosis type, heart failure symptoms for AL (26%) and integumentary symptoms for ATTRv with cardiologic or mixed phenotype (39%) and ATTRwt (42%). In AL and ATTRwt, a short delay between the onset of the first AECE or ACE and diagnosis was associated with reduced survival rate (log‐rank test P‐value <0.01). Conclusions This study highlights the impact of amyloidosis type and evolution on diagnostic delay and on prognosis. Physicians must be aware and vigilant in front of extracardiac and cardiac events to considerably improve early diagnosis of amyloidosis.
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Affiliation(s)
- Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Arnault Galat
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Fabien Le Bras
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France
| | - Pascale Fanen
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Genetics Department, Henri Mondor University Hospital, Créteil, France
| | - Anissa Moktefi
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Biology-Pathology Department, Henri Mondor University Hospital, Créteil, France
| | - Jean-Pascal Lefaucheur
- EA4391, ENT, Université Paris Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Neurophysiology Unit, Henri Mondor University Hospital, Créteil, France
| | - Mukedaisi Abulizi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Radiology Department, Henri Mondor University Hospital, Créteil, France
| | - François Lemonnier
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Lymphoid Malignancies, Henri Mondor University Hospital, Créteil, France
| | - Soulef Guendouz
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Coraline Chalard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Amira Zaroui
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Vincent Audard
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Nephrology and Renal Transplantation Department, Henri Mondor University Hospital, Créteil, France
| | - Emilie Bequignon
- AP-HP (Assistance Publique-Hôpitaux de Paris), Otorhinolaryngologic Department, Henri Mondor University Hospital, Créteil, France
| | - Diane Bodez
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,Cardiology Outpatients Unit, Centre Cardiologique du Nord, Paris, France
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), University Paris Est Créteil, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Nuclear Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Luc Hittinger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Etienne Audureau
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Departement, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France
| | - Silvia Oghina
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Hospital, Créteil, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), DHU A-TVB, Henri Mondor University Hospital, 51 Avenue du Marechal de Lattre de Tassigny, Créteil, F-94010, France.,AP-HP (Assistance Publique-Hôpitaux de Paris), Clinical Investigation Center 1430, Henri Mondor University Hospital, Créteil, France
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Melin A, Chosidow O, Foulet F, Ingen-Housz-Oro S, Limal N, Audard V, Le Bras F, Botterel F, Fardet L, Bernigaud C. Don't Judge a Book by its Cover. 'Steroid Acne': an unrecognized role of Malassezia and Demodex? J Eur Acad Dermatol Venereol 2021; 36:e229-e231. [PMID: 34657328 DOI: 10.1111/jdv.17759] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- A Melin
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - O Chosidow
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France
| | - F Foulet
- EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France.,Department of Microbiology, Parasitology and Mycology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - S Ingen-Housz-Oro
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - N Limal
- Department of Internal Medicine, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - V Audard
- Department of Nephrology and Transplantation, Faculté de Santé, AP-HP, Hôpitaux Universitaires Henri Mondor, UPEC, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Univ Paris Est Créteil, Créteil, France
| | - F Le Bras
- Lymphoid Hemopathy Unit, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - F Botterel
- EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France.,Department of Microbiology, Parasitology and Mycology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - L Fardet
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - C Bernigaud
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France
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Bézard M, Oghina S, Vitiello D, Kharoubi M, Kordeli E, Galat A, Zaroui A, Guendouz S, Gilles F, Shourick J, Hamon D, Audard V, Teiger E, Poullot E, Molinier-Frenkel V, Lemonnier F, Agbulut O, Le Bras F, Damy T. Dexamethasone is associated with early deaths in light chain amyloidosis patients with severe cardiac involvement. PLoS One 2021; 16:e0257189. [PMID: 34525116 PMCID: PMC8443042 DOI: 10.1371/journal.pone.0257189] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cardiac light chain amyloidosis (AL-CA) patients often die within three months of starting chemotherapy. Chemotherapy for non-immunoglobulin M gammopathy with AL-CA frequently includes bortezomib (Bor), cyclophosphamide (Cy), and dexamethasone (D). We previously reported that NT-ProBNP levels can double within 24h of dexamethasone administration, suggesting a deleterious impact on cardiac function. In this study, we evaluate the role of dexamethasone in early cardiovascular mortality during treatment. Methods and findings We retrospectively assessed 100 de novo cardiac AL patients (62% male, mean age 68 years) treated at our institute between 2009 and 2018 following three chemotherapy regimens: CyBorDComb (all initiated on day 1; 34 patients), DCyBorSeq (D, day 1; Cy, day 8; Bor, day 15; 17 patients), and CyBorDSeq (Cy, day 1; Bor, day 8; D, day 15; 49 patients). The primary endpoint was cardiovascular mortality and cardiac transplantation at days 22 and 455. At day 22, mortality was 20.6% with CyBorDComb, 23.5% with DCyBorSeq, and 0% with CyBorDSeq (p = 0.003). At day 455, mortality was not significantly different between regimens (p = 0.195). Acute toxicity of dexamethasone was evaluated on myocardial function using a rat model of isolated perfused heart. Administration of dexamethasone induced a decrease in left ventricular myocardium contractility and relaxation (p<0.05), supporting a potential negative inotropic effect of dexamethasone in AL-CA patients with severe cardiac involvement. Conclusion Delaying dexamethasone during the first chemotherapy cycle reduces the number of early deaths without extending survival. It is clear that dexamethasone is beneficial in the long-term treatment of patients with AL-CA. However, the initial introduction of dexamethasone during treatment is critical, but may be associated with early cardiac deaths in severe CA. Thus, it is important to consider the dosage and timing of dexamethasone introduction on a patient-severity basis. The impact of dexamethasone in the treatment of AL-CA needs further investigation.
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Affiliation(s)
- Mélanie Bézard
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
- * E-mail:
| | - Silvia Oghina
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Damien Vitiello
- Sport and Health Sciences Institute (I3SP–EA3625), Paris University, Paris, France
- Sorbonne University, Institut de Biologie Paris-Seine (IBPS), CNRS UMR 8256, Inserm ERL U1164, Adaptation biologique et vieillissement, Paris, France
| | - Mounira Kharoubi
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Ekaterini Kordeli
- Sorbonne University, Institut de Biologie Paris-Seine (IBPS), CNRS UMR 8256, Inserm ERL U1164, Adaptation biologique et vieillissement, Paris, France
| | - Arnault Galat
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Amira Zaroui
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Soulef Guendouz
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Floriane Gilles
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | | | - David Hamon
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Vincent Audard
- Nephrology and Transplantation Department, Rare Disease Reference Center «Syndrome Néphrotique Idiopathique», Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Emmanuel Teiger
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Elsa Poullot
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Anatomy and Cytopathology, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Valérie Molinier-Frenkel
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Immunology Laboratory, Créteil, France
| | - François Lemonnier
- Hematopathology-Lymphoid Unit, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Onnik Agbulut
- Sorbonne University, Institut de Biologie Paris-Seine (IBPS), CNRS UMR 8256, Inserm ERL U1164, Adaptation biologique et vieillissement, Paris, France
| | - Fabien Le Bras
- Hematopathology-Lymphoid Unit, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
| | - Thibaud Damy
- The French Cardiac Amyloidosis Reference Center, GRC Amyloid Research Institute, Réseau amylose Mondor, and DHU A-TVB, Créteil, France
- Cardiology Department, Assistance Publique des Hôpitaux de Paris, University Hospital Henri Mondor, Créteil, France
- Université Paris Est Créteil (UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
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Morel A, Ouamri Y, Canoui-Poitrine F, Ingels A, Audard V, Luciani A, Grimbert P, Pigneur F, Stehle T. La myostéatose comme facteur de risque indépendant de mortalité après transplantation rénale: une étude de cohorte rétrospective. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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