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Kuzmuk V, Pranke I, Rollason R, Butler M, Ding WY, Beesley M, Waters AM, Coward RJ, Sessions R, Tuffin J, Foster RR, Mollet G, Antignac C, Edelman A, Welsh GI, Saleem MA. A small molecule chaperone rescues keratin-8 mediated trafficking of misfolded podocin to correct genetic Nephrotic Syndrome. Kidney Int 2024; 105:744-758. [PMID: 37995908 DOI: 10.1016/j.kint.2023.11.006] [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: 03/03/2023] [Revised: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
Podocin is a key membrane scaffolding protein of the kidney podocyte essential for intact glomerular filtration. Mutations in NPHS2, the podocin-encoding gene, represent the commonest form of inherited nephrotic syndrome (NS), with early, intractable kidney failure. The most frequent podocin gene mutation in European children is R138Q, causing retention of the misfolded protein in the endoplasmic reticulum. Here, we provide evidence that podocin R138Q (but not wild-type podocin) complexes with the intermediate filament protein keratin 8 (K8) thereby preventing its correct trafficking to the plasma membrane. We have also identified a small molecule (c407), a compound that corrects the Cystic Fibrosis Transmembrane Conductance Regulator protein defect, that interrupts this complex and rescues mutant protein mistrafficking. This results in both the correct localization of podocin at the plasma membrane and functional rescue in both human patient R138Q mutant podocyte cell lines, and in a mouse inducible knock-in model of the R138Q mutation. Importantly, complete rescue of proteinuria and histological changes was seen when c407 was administered both via osmotic minipumps or delivered orally prior to induction of disease or crucially via osmotic minipump two weeks after disease induction. Thus, our data constitute a therapeutic option for patients with NS bearing a podocin mutation, with implications for other misfolding protein disorders. Further studies are necessary to confirm our findings.
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Affiliation(s)
- Valeryia Kuzmuk
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Iwona Pranke
- INSERM, U1151, Institut Necker Enfants Malades, INEM, Paris, France
| | - Ruth Rollason
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Butler
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Wen Y Ding
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Beesley
- Department of Pathology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Richard J Coward
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jack Tuffin
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca R Foster
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Géraldine Mollet
- Laboratoire des Maladies Rénales Héréditaires, Inserm UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Corinne Antignac
- Laboratoire des Maladies Rénales Héréditaires, Inserm UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | | | - Gavin I Welsh
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Moin A Saleem
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK.
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Buerger F, Merz LM, Saida K, Yu S, Salmanullah D, Lemberg K, Mertens ND, Mansour B, Kolvenbach CM, Yousef K, Braun A, Franken GAC, Endlich N, Schneider R, Shril S, Hildebrandt F. Quantitative phenotyping of Nphs1 knockout mice as a prerequisite for gene replacement studies. Am J Physiol Renal Physiol 2024. [PMID: 38482553 DOI: 10.1152/ajprenal.00412.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
Steroid-resistant nephrotic (SRNS) syndrome is the second most frequent cause of chronic kidney disease before the age of 25 years. Nephrin, encoded by NPHS1, localizes to the slit diaphragm of glomerular podocytes and is the predominant structural component of the glomerular filtration barrier. Biallelic variants in NPHS1 can cause congenital nephrotic syndrome of the Finnish type (CNS-1) for which, to date, no causative therapy is available. Recently, adeno-associated virus (AAV) vectors targeting the glomerular podocyte have been assessed as a means for gene replacement therapy. We here established quantitative and reproducible phenotyping of a published, conditional Nphs1 knockout mouse model (Nphs1tm1.1Pgarg/J and Nphs2-Cre+) in preparation of a gene replacement study employing AAV vectors. Nphs1 knockout mice (Nphs1fl/fl Nphs2-Cre+) exhibited: i) A median survival rate of 18 days (range from 9-43 days; males 16.5 days, females 20 days); ii) Average foot process (FP) density of 1.0 FP/µm compared to 2.0 FP/µm in controls, and mean filtration slit density was 2.64 µm/µm2 compared to 4.36 µm/µm2 in controls; iii) A high number of proximal tubular microcysts; iv) Development of proteinuria within the first week of life as evidenced by urine albumin/creatinine ratios; v) Significantly reduced levels of serum albumin, and elevated BUN and creatinine levels. For none of these phenotypes in Nphs1 knockout mice, significant differences between sexes were observed. We quantitatively characterized 5 different phenotypic features of CNS in Nphs1fl/fl Nphs2-Cre+ mice. Our results will facilitate future gene replacement therapy projects by allowing for sensitive detection of, even subtle molecular, effects.
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Affiliation(s)
- Florian Buerger
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Lea M Merz
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, United States
| | - Ken Saida
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Seyoung Yu
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Daanya Salmanullah
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Katharina Lemberg
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Nils D Mertens
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Bshara Mansour
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | | | - Kirollos Yousef
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Alina Braun
- Pediatrics, Boston Children's Hospital, Boston, MA, United States
| | - Gijs A C Franken
- Pediatrics, Boston Children's Hospital, Boston, MA, United States
| | | | - Ronen Schneider
- Pediatrics, Nephrology, Boston Children's Hospital, Boston, MA, United States
| | - Shrilee Shril
- Nephrology, Boston Children's Hospital, Boston, MA, United States
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3
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Rosenbloom S, Ramanand A, Stark A, Varghese V, Chalmers D, Au-Yeung N, Kanduri SR, Lukitsch I, Poloni JAT, Keitel E, Franz AP, Martínez-Figueroa C, Sarkar A, Alix-Arbatin MC, Fogo AB, Buchkremer F, Seltzer JR, Velez JCQ. Urinary Vacuolar Casts Are a Unique Type of Casts in Advanced Proteinuric Glomerulopathies. Kidney360 2024; 5:216-227. [PMID: 38240639 PMCID: PMC10914204 DOI: 10.34067/kid.0000000000000346] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/08/2023] [Indexed: 03/01/2024]
Abstract
Key Points Vacuolar casts are a distinct type of casts identifiable by urinary sediment microscopy. Identification of urinary vacuolar casts is associated with the presence of an advanced and severe form of a proteinuric glomerular disease. Background Identification of casts by urinary sediment microscopy is a valuable diagnostic clinical tool for the evaluation of kidney disease. Vacuolar casts are an unrecognized unique type of casts characterized by the presence of nonpolarizable, clear vesicles of various sizes contained within a cast matrix, different from lipid casts, erythrocyte casts, or any other casts. We aimed to gain better understanding of the clinical relevance of these casts by establishing a multinational collaborative group to search for cases in which vacuolar casts were identified. Methods Leveraging an educational social media platform, we conducted a multinational observational study extracting cases of patients who presented with urinary vacuolar casts during evaluation for impaired kidney function. Parameters assessed included degree of proteinuria and kidney dysfunction, clinical and histopathological diagnosis, and severity of renal parenchymal scarring on biopsy. A control group of patients without vacuolar casts was included for comparison. Results Forty-six patients with urinary vacuolar casts were compiled from six countries. Nephrotic range proteinuria (82%), glomerular etiology (98%), and advanced CKD stage (62% 3B-5) were salient features. Histopathological diagnosis was available in 26 (57%) patients. Combining clinical and pathological diagnoses, diabetic nephropathy (48%), arterionephrosclerosis (30%), podocytopathies (15%), and proliferative glomerulonephritides (15%) accounted for most patients. Vacuolization of tubules or podocytes was present in 61% of the specimens. When compared with patients with histopathological diagnoses in which vacuolar casts were not found (n =186), patients with vacuolar casts more frequently had a glomerular etiology (100% versus 71%, P = 0.002), had greater proteinuria (median urine protein-to-creatinine 10.3 versus 2.2 g/g, P < 0.001), and had greater proportion of patients with ≥30% glomerular obsolescence (46% versus 20%, P = 0.003). Conclusions Thus, urinary vacuolar casts are strongly associated with advanced glomerulopathies with severe proteinuria. Future studies should examine their origin, composition, and prognostic value. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2024_01_26_KID0000000000000346.mp3
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Affiliation(s)
- Sarah Rosenbloom
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
| | - Akanksh Ramanand
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Anabella Stark
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
| | - Vipin Varghese
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dustin Chalmers
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Au-Yeung
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Swetha R. Kanduri
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Ivo Lukitsch
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
| | | | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Center for Nephrology and Kidney Transplantation, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ana Paula Franz
- Laboratório de Análises Clínicas, Hospital de Clínicas, Passo Fundo, Rio Grande do Sul, Brazil
| | | | | | | | - Agnes B. Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Florian Buchkremer
- Division of Nephrology, Medical University Department, Kantonsspital Aarau, Aargau, Switzerland
| | - Jay R. Seltzer
- Department of Nephrology, Missouri Baptist Medical Center, St. Louis, Missouri
| | - Juan Carlos Q. Velez
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
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4
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Kim A, Mahgoub A, Parajuli A, Towfiq B. COVID-19-Associated Nephropathy: A Devastating Complication. Cureus 2023; 15:e43558. [PMID: 37719542 PMCID: PMC10502762 DOI: 10.7759/cureus.43558] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
With the rapid emergence and prevalence of SARS-CoV-2 worldwide, cases of COVID-19-associated nephropathy (COVAN) from collapsing focal segmental glomerulosclerosis (cFSGS) have been reported, and the associations between the two are actively being studied. Creating appropriate treatment guidelines for COVAN requires further understanding of the pathophysiology of this type of kidney injury. This case report outlines the case of a 77-year-old patient admitted to the hospital for COVID-19 infection with a subsequent renal biopsy indicating cFSGS, adding to the data exploring the relationship between COVID-19 infections, cFSGS and the associated risk factors. Current guidelines on the treatment of COVAN are similar to those of other causes of cFSGS but continue to have poor outcomes and resistance to treatments. Further research needs to be done on both the clinical assessment and pathophysiology of COVAN to provide timely and life-saving interventions.
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Affiliation(s)
- Andrew Kim
- Internal Medicine, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, USA
| | - Abdullahi Mahgoub
- Internal Medicine, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, USA
| | - Abinash Parajuli
- Internal Medicine, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, USA
| | - Basim Towfiq
- Internal Medicine, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, USA
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5
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Waldman M, Sinaii N, Lerma EV, Kurien AA, Jhaveri KD, Uppal NN, Wanchoo R, Avasare R, Zuckerman JE, Liew A, Gallan AJ, El-Meanawy A, Yagil Y, Lebedev L, Baskaran K, Vilayur E, Cohen A, Weerasinghe N, Petrakis I, Stylianou K, Gakiopoulou H, Hamilton AJ, Edney N, Millner R, Marinaki S, Rein JL, Killen JP, Rodríguez Chagolla JM, Bassil C, Lopez del Valle R, Evans J, Urisman A, Zawaideh M, Baxi PV, Rodby R, Vankalakunti M, Mejia Vilet JM, Ramirez Andrade SE, Homan MP, Vásquez Jiménez E, Perinpanayagam N, Velez JCQ, Mohamed MM, Mohammed KM, Sekar A, Ollila L, Aron AW, Arellano Arteaga KJ, Islam M, Berrio EM, Maoujoud O, Morales RR, Seipp R, Schulze CE, Yenchek RH, Vancea I, Muneeb M, Howard L, Caza TN. COVID-19 Vaccination and New Onset Glomerular Disease: Results from the IRocGN2 International Registry. Kidney360 2023; 4:349-362. [PMID: 36996301 PMCID: PMC10103269 DOI: 10.34067/kid.0006832022] [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] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Key Points IgAN and MCD are the most common de novo glomerular diseases reported after COVID-19 vaccination, particularly after mRNA vaccination. Membranous nephropathy, pauci-immune GN, and collapsing GN have also been attributed to COVID-19 vaccination, some with dual histologies. Recovery of kidney function and proteinuria remission is more likely in IgAN and MCD by 4–6 months compared with the other glomerular diseases. Background Patients with de novo glomerular disease (GD) with various renal histologies have been reported after vaccination against SARS-CoV-2. Causality has not been established, and the long-term outcomes are not known. To better characterize the GDs and clinical courses/outcomes, we created the International Registry of COVID-19 vaccination and Glomerulonephritis to study in aggregate patients with de novo GN suspected after COVID-19 vaccine exposure. Methods A REDCap survey was used for anonymized data collection. Detailed information on vaccination type and timing and GD histology were recorded in the registry. We collected serial information on laboratory values (before and after vaccination and during follow-up), treatments, and kidney-related outcomes. Results Ninety-eight patients with GD were entered into the registry over 11 months from 44 centers throughout the world. Median follow-up was 89 days after diagnosis. IgA nephropathy (IgAN) and minimal change disease (MCD) were the most common kidney diseases reported. Recovery of kidney function and remission of proteinuria were more likely in IgAN and MCD at 4–6 months than with pauci-immune GN/vasculitis and membranous nephropathy. Conclusions The development of GD after vaccination against SARS-CoV-2 may be a very rare adverse event. Temporal association is present for IgAN and MCD, but causality is not firmly established. Kidney outcomes for IgAN and MCD are favorable. No changes in vaccination risk-benefit assessment are recommended based on these findings.
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Affiliation(s)
- Meryl Waldman
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Edgar V. Lerma
- University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois
| | | | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Nupur N. Uppal
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York
| | - Rupali Avasare
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jonathan E. Zuckerman
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Adrian Liew
- The Kidney and Transplant Practice, Mount Elizabeth Novena Hospital, Singapore
| | | | - Ashraf El-Meanawy
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yoram Yagil
- Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Larissa Lebedev
- Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Krishoban Baskaran
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan,New South Wales, Australia
| | - Eswari Vilayur
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Adrienne Cohen
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Nethmi Weerasinghe
- Department of Nephrology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Ioannis Petrakis
- Department of Nephrology, General University Hospital of Heraklion, Crete, Greece
| | | | | | - Alexander J. Hamilton
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
| | - Naomi Edney
- Exeter Kidney Unit, Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
| | - Rachel Millner
- Department of Pediatrics, Pediatric Nephrology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, NKUA, Medical School, Laiko General Hospital, Athens, Greece
| | - Joshua L. Rein
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Paul Killen
- Department of Nephrology, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia
| | | | - Claude Bassil
- Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida
- Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida
| | | | - Jordan Evans
- Department of Nephrology, David Grant Medical Center, Travis Air Force Base, California
| | - Anatoly Urisman
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Mona Zawaideh
- Division of Pediatric Nephrology, Peyton Manning Children's Hospital, Indianapolis, Indiana
| | - Pravir V. Baxi
- Division of Nephrology, Rush University Medical Center, Chicago, Illinois
| | - Roger Rodby
- Division of Nephrology, Rush University Medical Center, Chicago, Illinois
| | | | - Juan M. Mejia Vilet
- Department of Nephrology, Instituto Nacional de Ciencas Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Silvia E. Ramirez Andrade
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Mal P. Homan
- Division of Nephrology, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | | | - Juan Carlos Q. Velez
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Muner M.B. Mohamed
- Department of Nephrology, Ochsner Health, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Arjun Sekar
- Rochester General Hospital, Rochester, New York
| | - Laura Ollila
- Helsinki University Central Hospital, Helsinki, Finland
| | - Abraham W. Aron
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin Javier Arellano Arteaga
- Internal Medicine Department, Nuevo Hospital Civil De Guadalajara Dr. Juan I Menchaca, Guadalajara, Mexico; Department of Clinical Medicine, University Center for Health Science, University of Guadalajara
| | - Mahmud Islam
- Division of Nephrology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
| | - Esperanza Moral Berrio
- Department of Nephrology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Omar Maoujoud
- Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | | | | | - Carl E. Schulze
- Division of Nephrology, Department of Medicine, University of California, Los Angeles, California
| | - Robert H. Yenchek
- Division of Nephrology, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Irina Vancea
- Southern Colorado Nephrology Associates, Pueblo, Colorado
| | | | - Lilian Howard
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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6
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Allam N, Bashar A, Eid R. Assessment of health-related quality of life in Sudanese children with nephrotic syndrome: a questionnaire-based study. Pan Afr Med J 2022; 43:154. [PMID: 36785691 PMCID: PMC9922076 DOI: 10.11604/pamj.2022.43.154.34980] [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: 04/19/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction nephrotic syndrome (NS) is a common glomerular disease in children. The long relapsing nature of the disease along with medication-related complications can affect all aspects of the life of the affected children. This study points to estimate the health-related quality of life (HRQOL) in Sudanese children with NS. Methods this case-control questionnaire-based descriptive study included 100 children with NS aged 2-18 years and 100 healthy children. HRQOL was assessed using the Arabic copy of the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL™ 4.0 GCS). Results most of the patients were males (64%) and 17% were steroid resistant. Mean PedsQL™ 4.0 summary and domains´ scores in NS were significantly lower than controls (p≤ 0.05 for all) except for the social domain (p=0.266) with the lowest patients´ scores being for school functioning (mean ± SD, 74.4 ± 26.4). The QOL scores considerably differed between the various clinical phenotypes of NS with patients in the initial episode (N=25) having considerably lower total, school, and social domains scores compared to other clinical types (p=0.027, 0.017, 0.006 respectively). Conclusion this study assesses for the first time the QOL in Sudanese children with NS. Sudanese children with NS had lower life quality scores in comparison to healthy children and need tireless efforts to improve their lives. PedsQL™ 4.0 scale is simple and can be used in everyday clinical practice to evaluate QOL in children with NS.
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Affiliation(s)
- Nahla Allam
- Noura Center for Pediatric Kidney Diseases and Renal Transplantation, Al Neelain University, Khartoum, Sudan
| | - Asmaa Bashar
- Noura Center for Pediatric Kidney Diseases and Renal Transplantation, Al Neelain University, Khartoum, Sudan
| | - Riham Eid
- Pediatric Nephrology Unit, Mansoura University Children’s Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt,Corresponding author: Riham Eid, Pediatric Nephrology Unit, Mansoura University Children’s Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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7
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Odler B, Windpessl M, Krall M, Steiner M, Riedl R, Hebesberger C, Ursli M, Zitt E, Lhotta K, Antlanger M, Cejka D, Gauckler P, Wiesholzer M, Saemann M, Rosenkranz AR, Eller K, Kronbichler A. The Risk of Severe Infections Following Rituximab Administration in Patients With Autoimmune Kidney Diseases: Austrian ABCDE Registry Analysis. Front Immunol 2021; 12:760708. [PMID: 34777374 PMCID: PMC8586204 DOI: 10.3389/fimmu.2021.760708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To characterize the incidence, type, and risk factors of severe infections (SI) in patients with autoimmune kidney diseases treated with rituximab (RTX). Methods We conducted a multicenter retrospective cohort study of adult patients with immune-related kidney diseases treated with at least one course of RTX between 2015 and 2019. As a part of the ABCDE Registry, detailed data on RTX application and SI were collected. SI were defined by Common Terminology Criteria for Adverse Events v5.0 as infectious complications grade 3 and above. Patients were dichotomized between “nephrotic” and “nephritic” indications. The primary outcome was the incidence of SI within 12 months after the first RTX application. Results A total of 144 patients were included. Twenty-five patients (17.4%) presented with SI, mostly within the first 3 months after RTX administration. Most patients in the nephritic group had ANCA-associated vasculitis, while membranous nephropathy was the leading entity in the nephrotic group. Respiratory infections were the leading SI (n= 10, 40%), followed by urinary tract (n=3, 12%) and gastrointestinal infections (n=2, 8%). On multivariable analysis, body mass index (BMI, 24.6 kg/m2versus 26.9 kg/m2, HR: 0.88; 95%CI: 0.79-0.99; p=0.039) and baseline creatinine (HR: 1.25; 95%CI: 1.04-1.49; p=0.017) were significantly associated with SI. All patients in the nephritic group (n=19; 100%) who experienced a SI received oral glucocorticoid (GC) treatment at the time of infection. Hypogammaglobulinemia was frequent (58.5%) but not associated with SI. Conclusions After RTX administration, impaired kidney function and lower BMI are independent risk factors for SI. Patients with nephritic glomerular diseases having concomitant GC treatment might be at higher risk of developing SI.
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Affiliation(s)
- Balazs Odler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Windpessl
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria.,Department of Internal Medicine IV, Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Marcell Krall
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Maria Steiner
- Department of Internal Medicine IV, Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Carina Hebesberger
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Ursli
- Department of Internal Medicine I, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, Karl Landsteiner Institute for Nephrology and Hematooncology, St. Poelten, Austria
| | - Emanuel Zitt
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Karl Lhotta
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Marlies Antlanger
- Department of Internal Medicine 2, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - Daniel Cejka
- Department of Medicine III-Nephrology, Hypertension, Transplantation, Rheumatology, Geriatrics, Ordensklinikum Linz-Elisabethinen Hospital, Linz, Austria
| | - Philipp Gauckler
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Wiesholzer
- Department of Internal Medicine I, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, Karl Landsteiner Institute for Nephrology and Hematooncology, St. Poelten, Austria
| | - Marcus Saemann
- Department of 6Internal Medicine with Nephrology and Dialysis with Outpatient Department, Clinic Ottakring, Vienna, Austria
| | - Alexander R Rosenkranz
- 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
| | - 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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8
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Jain S, Chauhan S, Dixit S, Garg N, Sharma S. Role of Direct Immunofluorescence Microscopy in Spectrum of Diffuse Proliferative Glomerulonephritis: A Single-Center Study. J Microsc Ultrastruct 2021; 9:177-182. [PMID: 35070693 PMCID: PMC8751678 DOI: 10.4103/jmau.jmau_62_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Immunofluorescence (IF) microscopy is an essential tool for the analysis of glomerular diseases. In this study, we studied the significance of the IF technique together with light microscopy (LM) and clinical details in the diagnosis of different types of diffuse proliferative glomerulonephritis (GN). We intended to evaluate the spectrum of Diffuse Proliferative Glomerulonephritis (DPGN) in our institute. Materials and Methods We evaluated a total of 95 kidney biopsies received in the past 10 years. All biopsies were scrutinized by LM and IF techniques. Clinical details were documented in a predesigned form. Results The predominant clinical presentation in this study was nephrotic syndrome (49.4%) followed by systemic lupus erythromatosus with suspected renal involvement (24.2%). On microscopy, lupus nephritis (LN) was the most common DPGN in the study (35.7%), followed by immunoglobulin (Ig) A nephropathy (25.2%) and postinfectious GN (PIGN) (16.8%). The majority of patients were in the <30 years age group (72.6%), with the average age of patients being 24.4 years. The dominant deposit on IF in LN was C3 and IgG (100%). A high deposit of IgA (100%) in IgA nephropathy and of IgG and C3 (100%) in membranoproliferative GN was seen. PIGN showed dominant positive staining of IgG (92.8%). Conclusion The predominant clinical presentation was of nephrotic syndrome and on LM LN was the most commonly diagnosed DPGN in this study. Direct IF is vital for classifying DPGN, followed by electron microscopy, which is an essential tool. This article describes a rational evaluation of kidney biopsies with DPGN pattern on LM in a way that guides toward the logical assessment to reach the diagnosis. Using the IF technique and comparing it with LM and clinical details, we evaluated the spectrum DPGN in our center.
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Affiliation(s)
- Sonal Jain
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Shivangi Chauhan
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Sonali Dixit
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Neha Garg
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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9
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Abstract
Upper respiratory and pulmonary diseases are the primary manifestations of coronavirus disease 2019 (COVID-19). However, kidney involvement has also been recognized and extensively described. A large percentage of affected patients present with acute kidney injury (AKI). However, specific phenotypic aspects of AKI or other renal manifestations of COVID-19 remain sparsely characterized. Many reports indicate that proteinuria can be detected in AKI associated with COVID-19 (CoV-AKI) despite CoV-AKI being largely described as a form of acute tubular injury. On the other hand, individuals of African ancestry with the high-risk APOL1 genotype are uniquely at risk of developing collapsing glomerulopathy when they are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the entity now known as COVID-19-associated nephropathy (COVAN). Patients with COVAN typically present with nephrotic-range proteinuria. The exact incidence of proteinuria in COVID-19 is unclear due to heterogeneity in the frequency with which proteinuria has been assessed in cases of COVID-19, as well as methodological differences in the way proteinuria is measured and/or reported. In this review we discuss the current evidence of proteinuria as a manifestation of COVID-19 and elaborate on potential pathophysiological mechanisms associated with it.
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Affiliation(s)
- Muner M B Mohamed
- Department of Nephrology, Ochsner Health System, New Orleans, LA, USA
| | - Juan Carlos Q Velez
- Department of Nephrology, Ochsner Health System, New Orleans, LA, USA
- Ochsner Clinical School, University of Queensland (Australia), New Orleans, LA, USA
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10
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Abstract
Psoriasis vulgaris is a complex immune-mediated disorder that manifests as a chronic skin disorder, characterized by well-circumscribed inflammatory, erythematous plaques. In this case report, we present a patient with generalized pustular psoriasis (GPP) who presented to the nephrology department with rapidly progressive decline in renal function. The diagnosis of GPP was made a month ago, secondary to a coagulase-negative staphylococcal superinfection. Intrinsically, this introduced a diagnostic challenge as the presumed diagnosis of immunoglobulin A (IgA) nephropathy had to be distinguished from IgA-dominant infection-related glomerulonephritis. We further discuss the current evidence and immunohistological profiles of IgA nephropathy in psoriasis and detail the evolution of renal function of our patient over 25 months after he presented to our department.
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Affiliation(s)
- Artsiom Klimko
- Division of Physiology and Neuroscience, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Georgiana A Toma
- General Medicine, University of Medicine Pharmacy Science and Technology Targu Mures, Targu Mures, ROU
| | - Laura Ion
- Department of Nephrology and Dialysis, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, ROU
| | - Ana Maria Mehedinti
- Department of Nephrology and Dialysis, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, ROU.,Department of Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Iuliana Andreiana
- Department of Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU.,Department of Nephrology and Dialysis, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, ROU
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11
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Abstract
Introduction: The COVID-19 outbreak has become a worldwide public health emergency. The renal histopathological features of acute tubular necrosis or thrombotic microangiopathy have been previously reported in adults with severe COVID-19 infections. In children, the renal manifestations associated with COVID-19 disease are not widely reported. Here we describe a case report of a child with new-onset nephrotic syndrome associated with COVID-19 infection. Case Presentation: An 8-year-old boy with no previous significant medical history presented with bilateral eyelid and facial swelling soon after his parents were diagnosed with COVID-19 infection. He had diarrhea but no fever or shortness of breath. At 1 week after the onset of swelling, the boy tested positive for the COVID-19 virus. Based on clinical findings of significant proteinuria (urine protein and creatinine ratio of 11.4), hypoalbuminemia (serum albumin of 2 g/dl), and hypercholesterolemia (total cholesterol of 384 mg/dl), he was diagnosed with nephrotic syndrome. He responded well to standard-dose prednisone treatment for nephrotic syndrome. At 1 week after starting the prednisone treatment, he went into clinical remission. Lymphopenia continued to be present for 4 weeks after the onset of symptoms. There were no complications related to clot formation or secondary infections with this presentation. Conclusion: COVID-19 can be associated with new-onset nephrotic syndrome in children. The patient responded well to the standard-dose prednisone treatment that is typically used for new-onset nephrotic syndrome. Summary: We describe the unique presentation of COVID-19 in a child as new-onset nephrotic syndrome. We offer insight on the success of standard treatment of nephrotic syndrome with COVID-19.
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Affiliation(s)
- Siddharth A. Shah
- Department of Pediatrics, University of Louisville, Louisville, KY, United States
| | - Helen P. Carter
- Bowling Green Internal Medicine and Pediatric Associates, Bowling Green, KY, United States
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12
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Wu H, Larsen CP, Hernandez-Arroyo CF, Mohamed MMB, Caza T, Sharshir M, Chughtai A, Xie L, Gimenez JM, Sandow TA, Lusco MA, Yang H, Acheampong E, Rosales IA, Colvin RB, Fogo AB, Velez JCQ. AKI and Collapsing Glomerulopathy Associated with COVID-19 and APOL 1 High-Risk Genotype. J Am Soc Nephrol 2020; 31:1688-1695. [PMID: 32561682 PMCID: PMC7460910 DOI: 10.1681/asn.2020050558] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [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: 05/01/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Kidney involvement is a feature of COVID-19 and it can be severe in Black patients. Previous research linked increased susceptibility to collapsing glomerulopathy, including in patients with HIV-associated nephropathy, to apo L1 (APOL1) variants that are more common in those of African descent. METHODS To investigate genetic, histopathologic, and molecular features in six Black patients with COVID-19 presenting with AKI and de novo nephrotic-range proteinuria, we obtained biopsied kidney tissue, which was examined by in situ hybridization for viral detection and by NanoString for COVID-19 and acute tubular injury-associated genes. We also collected peripheral blood for APOL1 genotyping. RESULTS This case series included six Black patients with COVID-19 (four men, two women), mean age 55 years. At biopsy day, mean serum creatinine was 6.5 mg/dl and mean urine protein-creatinine ratio was 11.5 g. Kidney biopsy specimens showed collapsing glomerulopathy, extensive foot process effacement, and focal/diffuse acute tubular injury. Three patients had endothelial reticular aggregates. We found no evidence of viral particles or SARS-CoV-2 RNA. NanoString showed elevated chemokine gene expression and changes in expression of genes associated with acute tubular injury compared with controls. All six patients had an APOL1 high-risk genotype. Five patients needed dialysis (two of whom died); one partially recovered without dialysis. CONCLUSIONS Collapsing glomerulopathy in Black patients with COVID-19 was associated with high-risk APOL1 variants. We found no direct viral infection in the kidneys, suggesting a possible alternative mechanism: a "two-hit" combination of genetic predisposition and cytokine-mediated host response to SARS-CoV-2 infection. Given this entity's resemblance with HIV-associated nephropathy, we propose the term COVID-19-associated nephropathy to describe it.
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Affiliation(s)
- Huijuan Wu
- Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Muner M B Mohamed
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana
| | | | - Moh'd Sharshir
- Division of Nephrology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Liping Xie
- Ascension All Saint Nephrology, Racine, Wisconsin
| | - Juan M Gimenez
- Department of Diagnostic and Interventional Radiology, Ochsner Health System, New Orleans, Louisiana
| | - Tyler A Sandow
- Department of Diagnostic and Interventional Radiology, Ochsner Health System, New Orleans, Louisiana
| | - Mark A Lusco
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Haichun Yang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ellen Acheampong
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ivy A Rosales
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert B Colvin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Juan Carlos Q Velez
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Australia
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13
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Lee WC, Li LC, Ng HY, Lin PT, Chiou TT, Kuo WH, Lee CT. Urinary Exosomal MicroRNA Signatures in Nephrotic, Biopsy-Proven Diabetic Nephropathy. J Clin Med 2020; 9:E1220. [PMID: 32340338 DOI: 10.3390/jcm9041220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD). Elucidating the mechanisms underlying proteinuria in DKD is crucial because it is a common problem in DKD-related mortality and morbidity. MicroRNAs (miRs) associated with DKD have been detected in experimental diabetes models and in patients with both diabetes and CKD. Here, we aimed to investigate pathologic miRs in diabetic nephropathy (DN) by prospectively following six nephrotic, biopsy-proven isolated DN patients (enrolled between August 2015 and July 2017) for one year. The urinary exosomes were isolated at the time of the biopsy and the contained miRs were analyzed by next-generation sequencing. The results were compared to the control group, composed of age-, gender-, and CKD stage-matched patients with proteinuric CKD who did not present diabetes. Among the 72 identified miRs, we investigated eight (miR-188-5p, miR-150-3p, miR-760, miR-3677-3p, miR-548ah-3p, miR-548p, miR-320e, and miR-23c) exhibiting the strongest upregulation (13–15 fold) and two (miR-133a-3p and miR-153-3p) with the strongest downregulation (7–9 fold). The functional analysis of these miRs showed that they were involved in known and novel pathways of DN, supporting their pathologic roles. The bioinformatics-based prediction of the target genes of these miRs will inspire future research on the mechanisms underlying DN pathogenesis.
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14
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Goonewardene ST, Tang C, Tan LTH, Chan KG, Lingham P, Lee LH, Goh BH, Pusparajah P. Safety and Efficacy of Pneumococcal Vaccination in Pediatric Nephrotic Syndrome. Front Pediatr 2019; 7:339. [PMID: 31456997 PMCID: PMC6700369 DOI: 10.3389/fped.2019.00339] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/29/2019] [Indexed: 12/04/2022] Open
Abstract
Nephrotic syndrome affects both children and adults. Idiopathic nephrotic syndrome is reported to be one of the most frequent renal pathologies in childhood. Nephrotic children are at high risk for severe pneumococcal infections as one of the life-threatening complications of nephrotic syndrome due to involvement of the immunosuppressive regimen and the acquired immune deficiency induced by nephrotic syndrome including decreased plasma IgG and low complement system components. Aiming to prevent pneumococcal infection is of paramount importance especially in this era of ever-increasing pneumococcal resistance to penicillins and cephalosporins. The pneumococcal vaccines currently available are inactivated vaccines-the two main forms in use are polysaccharide vaccines and conjugated vaccines. However, the data supporting the use of these vaccines and to guide the timing and dosage recommendations is still limited for nephrotic children. Thus, this review discusses the evidences of immunogenicity and safety profile of both vaccinations on nephrotic patients as well as the effect of nephrotic syndrome treatment on vaccine seroresponses.
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Affiliation(s)
- Shamitha Thishakya Goonewardene
- Medical Health and Translational Research Group, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Calyn Tang
- Medical Health and Translational Research Group, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Loh Teng-Hern Tan
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, China
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia.,International Genome Centre, Jiangsu University, Zhenjiang, China
| | - Prithvy Lingham
- Medical Health and Translational Research Group, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Bey-Hing Goh
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia.,Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Priyia Pusparajah
- Medical Health and Translational Research Group, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Malaysia
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15
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Aboobacker IN, Krishnakumar A, Narayanan S, Hafeeque B, Gopinathan JC, Aziz F. Nail-Patella Syndrome: A Rare Cause of Nephrotic Syndrome in Pregnancy. Indian J Nephrol 2018. [PMID: 29515307 PMCID: PMC5830815 DOI: 10.4103/ijn.ijn_362_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/22/2022] Open
Abstract
Nail–Patella syndrome (NPS) is an inherited disease with characteristic nail, limb, and renal anomalies. While almost all patients manifest classical skeletal and nail abnormalities, renal involvement is seen in only 40% of patients. Asymptomatic proteinuria is the most common renal presentation. Although a substantial number of patients can progress to nephrotic range proteinuria, development of end-stage kidney disease is rare. Pathological abnormalities are appreciable only by electron microscopy. Our patient who had not been diagnosed with NPS previously presented with new-onset proteinuria during the second trimester of her first pregnancy. The characteristic physical and radiological features confirmed the diagnosis of NPS. Her clinical course was complicated by nephrotic syndrome with fetal loss at 22 weeks and postpartum renal vein thrombosis. Nephrotic state improved after termination of pregnancy. She was managed with angiotensin receptor blocker and anticoagulation. At the end of 2 years of follow-up, she has normal glomerular filtration rate with minimal proteinuria.
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Affiliation(s)
- I N Aboobacker
- Department of Nephrology and Transplantation, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
| | - A Krishnakumar
- Department of Nephrology and Transplantation, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
| | - S Narayanan
- Department of Nephrology and Transplantation, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
| | - B Hafeeque
- Department of Nephrology and Transplantation, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
| | - J C Gopinathan
- Department of Nephrology and Transplantation, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
| | - F Aziz
- Department of Nephrology and Transplantation, Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
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16
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Sexton DJ, de Freitas DG, Little MA, McHugh T, Magee C, Conlon PJ, O'Seaghdha CM. Direct-Acting Oral Anticoagulants as Prophylaxis Against Thromboembolism in the Nephrotic Syndrome. Kidney Int Rep 2018; 3:784-93. [PMID: 29989039 DOI: 10.1016/j.ekir.2018.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/10/2023] Open
Abstract
We report 2 cases of apixaban use as prophylaxis against thromboembolism in the nephrotic syndrome (NS), and review the existing literature on direct-acting oral anticoagulant (DOAC) use in this scenario. Our cases appear to be the first reported use of apixaban as prophylaxis against thromboembolism in NS. We report our systematic review of the existing literature on direct-acting oral anticoagulant (DOAC) use in NS, and discuss theoretical issues relevant to their therapeutic use in this clinical scenario. We searched electronic databases such as OVID, EMBASE, PubMed, and CENTRAL, DARE. The search to identify studies and the application of inclusion and exclusion criteria was performed in duplicate independently. We identified 1 pilot randomized study, 3 case reports, and 3 conference proceedings abstracts relating to DOAC use in NS. These reports all pertain to the treatment of clinically evident thrombosis in NS with rivaroxaban, edoxaban, and dabigatran rather than prophylaxis against thrombosis. Although the existing literature on DOAC use in NS is limited, initial preliminary experience appears promising.
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17
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Groves AP, Reich P, Sigdel B, Davis TK. Pneumococcal hemolytic uremic syndrome and steroid resistant nephrotic syndrome. Clin Kidney J 2016; 9:572-5. [PMID: 27478599 PMCID: PMC4957713 DOI: 10.1093/ckj/sfw025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 02/08/2016] [Accepted: 03/14/2016] [Indexed: 12/31/2022] Open
Abstract
Pneumococcal-associated hemolytic uremic syndrome (pHUS) is a rare but severe complication of invasive Streptococcus pneumoniae infection. We report the case of a 12-year-old female with steroid-resistant nephrotic syndrome treated with adrenocorticotrophic hormone (H.P. Acthar(®) Gel), who developed pneumococcal pneumonia and subsequent pHUS. While nephrotic syndrome is a well-known risk factor for invasive pneumococcal disease, this is the first reported case of pHUS in an adolescent patient with nephrotic syndrome, and reveals novel challenges in the diagnosis, treatment and potential prevention of this complication.
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Affiliation(s)
- Andrew P Groves
- Washington University School of Medicine , St Louis, MO , USA
| | - Patrick Reich
- Division of Infectious Disease, Department of Pediatrics , Washington University School of Medicine , St Louis, MO , USA
| | - Binayak Sigdel
- Division of Critical Care Medicine, Department of Pediatrics , Washington University School of Medicine , St Louis, MO , USA
| | - T Keefe Davis
- Division of Nephrology, Department of Pediatrics , Washington University School of Medicine , St Louis, MO , USA
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18
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Abstract
The podocyte is a highly specialized cell, forming within the developing glomerulus from a mesenchymal origin, acquiring some but not complete features of an epithelial cell as it matures. Once mature, this cell has the potential to receive signals from several different directions and sits within a dynamic microenvironment. By taking an overview of many lines of evidence, it is clear that we already know many signals that are tightly controlled in keeping the podocyte healthy. For example, vascular endothelial growth factor, insulin and integrins are all known to have bidirectional effects on podocyte functionality, depending on whether there is too much or too little. It is of little surprise therefore that disrupting this delicate balance can result in a dramatic loss of function, and manifestation of glomerular disease originating from many different primary insults. The cues directing podocyte phenotype and functionality for the purpose of this review will be divided into four main sources: (i) genetic, (ii) paracrine signals from endothelial and mesangial cells, (iii) direct contact signals to/from the glomerular basement membrane and (iv) signals from circulating plasma. Of course there are other influences, which we still know little about, such as flow and shear stresses, signals from the urinary space that should all be considered in the overall healthy environment.
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Affiliation(s)
- Moin A Saleem
- Bristol Children's Hospital, University of Bristol, Bristol, UK
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19
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Moradveisi B, Rashidi A, Alavi S, Eskandarifar A. Nephrotic syndrome in acute promyelocytic leukemia. Clin Kidney J 2014; 7:424-5. [PMID: 25852928 PMCID: PMC4377808 DOI: 10.1093/ckj/sfu062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/28/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Borhan Moradveisi
- Department of Pediatric Hematology and Oncology , Besat Hospital , Kurdistan University of Medical Sciences and Health Services , Sanandaj , Iran
| | - Armin Rashidi
- Division of Oncology , Washington University School of Medicine , St. Louis, MO , US
| | - Samin Alavi
- Pediatric Congenital Hematologic Disorders Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Alireza Eskandarifar
- Department of Pediatric Nephrology , Besat Hospital , Kurdistan University of Medical Sciences and Health Services , Sanandaj , Iran
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20
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Brito PN, Silva SE, Cotta JS, Falcão-Reis F. Severe ocular hypertension secondary to systemic corticosteroid treatment in a child with nephrotic syndrome. Clin Ophthalmol 2012; 6:1675-9. [PMID: 23097611 PMCID: PMC3476485 DOI: 10.2147/opth.s36261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report a case of severe, acute ocular hypertension in a 6-year-old child, 7 days after initiating treatment with oral prednisolone, due to nephrotic syndrome. METHODS A 6-year-old female Caucasian child was diagnosed with nephrotic syndrome and treated with oral prednisolone (60 mg/day). Seven days later the child initiated complaints of headache, vomiting, ocular pain, and photophobia. Ophthalmologic examination revealed a severely increased intraocular pressure (IOP) of 52 mmHg in the right eye and 56 mmHg in the left eye. Anterior segment morphology was evaluated with ultrasound biomicroscopy. Optic disc status was evaluated by disc photography, kinetic perimetry, and optical coherence tomography. RESULTS Treatment was initiated with latanoprost, brimonidine, and the fixed association of timolol and dorzolamide. At each follow-up examination, progressively better control of IOP was obtained. Simultaneous with corticosteroid dosage decrease we were able to reduce antiglaucomatous medication while maintaining IOP under control. Ultrasound biomicroscopy revealed an open angle with normal anterior segment echographic findings. Perimetric evaluation revealed normal visual fields in both eyes. Four months after presentation, steroid treatment had been completed and IOP was 10 mmHg in both eyes without any antiglaucomatous medication. Optical coherence tomography revealed normal retinal nerve fiber layer thickness in all peripapillary sectors. CONCLUSIONS Systemic steroid treatment can cause a severe, acute increase in IOP in children. Children undergoing steroid treatment should have routine ophthalmologic examinations during treatment duration. Prompt antiglaucomatous treatment prevents retinal nerve fiber layer damage and visual acuity loss.
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Affiliation(s)
| | | | | | - Fernando Falcão-Reis
- Ophthalmology Department, Hospital S João, Porto, Portugal
- Faculty of Medicine of Porto, University of Porto, Porto, Portugal
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Keddis MT, Stegall MD, Textor SC. Renal ablation using bilateral ureteral ligation for nephrotic syndrome due to renal amyloidosis. Clin Kidney J 2012; 5:153-154. [PMID: 29497519 PMCID: PMC5783203 DOI: 10.1093/ndtplus/sfr160] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 10/31/2011] [Indexed: 12/03/2022] Open
Abstract
Nephrotic syndrome is common in immunoglobulin light chain amyloidosis (AL). In patients who do not achieve renal recovery, renal ablation has been reported for intractable proteinuria. We describe a patient with renal-limited AL who failed therapy and developed disabling proteinuria. He underwent laparoscopic ligation of the native ureters. Post-operatively, blood pressure improved. Hemodialysis was initiated. We conclude that bilateral ureteral ligation is a novel and minimally invasive method of renal ablation and may be considered for patients with refractory nephrotic syndrome.
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Affiliation(s)
- Mira T Keddis
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Division of Transplantation Surgery, Mayo Clinic, Rochester, MN
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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