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Anzai H, Suzuki Y, Ueno M, Asakawa S, Nagura M, Arai S, Yamazaki O, Tamura Y, Ohashi R, Shibata S, Fujigaki Y. Slowly Progressive ANCA-associated Glomerulonephritis with Strong Mesangial MPO Deposits Following a Diagnosis of Interstitial Lung Disease. Intern Med 2024; 63:1253-1260. [PMID: 37722892 DOI: 10.2169/internalmedicine.2512-23] [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] [Indexed: 09/20/2023] Open
Abstract
An elderly woman showed positive conversion of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibodies (ANCAs) following the diagnosis of interstitial lung disease (ILD) and glomerular hematuria and subsequently experienced slowly progressive glomerulonephritis. A kidney biopsy revealed chronic damage and necrotizing crescentic glomerulonephritis with mesangial MPO deposits. After corticosteroid treatment, the patient's urinalysis results and MPO-ANCA titers almost normalized and her renal function stabilized. This case is similar to recently reported cases of slowly progressive ANCA-associated glomerulonephritis. ILD likely triggered the production of MPO-ANCAs, and the accumulation of MPO deposits in the glomeruli may have contributed to the progression of her renal disease.
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Affiliation(s)
- Hitoshi Anzai
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yuki Suzuki
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Masaki Ueno
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shinichiro Asakawa
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Michito Nagura
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Shigeyuki Arai
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Osamu Yamazaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshifuru Tamura
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Japan
| | - Shigeru Shibata
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yoshihide Fujigaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
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Obrișcă B, Mocanu V, Jurubiță R, Vrabie A, Berechet A, Lujinschi Ș, Sorohan B, Andronesi A, Achim C, Lupușoru G, Micu G, Caceaune N, Gherghiceanu M, Ismail G. Histological reappraisal of IgA nephropathy: the role of glomerular pattern of injury and mesangial complement deposition. BMC Nephrol 2024; 25:145. [PMID: 38658875 PMCID: PMC11040743 DOI: 10.1186/s12882-024-03577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a clear need to refine the histological assessment in IgA Nephropathy (IgAN). We sought to investigate the clinical significance of the light microscopy (LM) pattern of glomerular injury and of the intensity of mesangial C3 staining in IgAN. METHODS We conducted a retrospective, observational study that included all patients with biopsy-proven primary IgAN that had at least 12 months of follow-up. The LM pattern of glomerular injury was reevaluated based on a modified HAAS classification. Mesangial C3 deposition by immunofluorescence (IF) staining was scored semi-quantitatively. The study primary composite endpoint was defined as doubling of serum creatinine or ESRD (dialysis, renal transplant or eGFR < 15 ml/min). The secondary study endpoint was eGFR decline per year. RESULTS This cohort included 214 patients with IgAN (mean age, 41.4 ± 12.6 years), with a mean eGFR and median 24-h proteinuria of 55.2 ± 31.5 ml/min/1.73m2 and 1.5 g/day (IQR:0.8-3.25), respectively. The most frequent LM pattern was the mesangioproliferative (37.4%), followed by the sclerotic (22.5%) and proliferative/necrotizing patterns (21.4%). Regarding the IF findings, mild-moderate and intense mesangial C3 staining was present in 30.6% and 61.1% of patients, respectively. Those with sclerosing and crescentic patterns had the worst renal survival (5-year renal survival of 48.8% and 42.9%) and the highest rate of eGFR change/year (-2.32 ml/min/y and - 2.16 ml/min/y, respectively) compared to those with other glomerular patterns of injury. In addition, those with intense C3 staining reached the composite endpoint more frequently compared to those without intense C3 staining (35.5% vs. 21.4%, p = 0.04). After multivariate adjustment, patients with crescentic and sclerosing patterns had a 3.6-fold and 2.1-fold higher risk for the composite endpoint compared to those with mesangioproliferative pattern, while an intense mesangial C3 deposition being also associated with a worse renal outcome (HR, 3.33; 95%CI, 1.21-9.2). CONCLUSIONS We have shown that the LM pattern of glomerular injury and the intensity of mesangial C3 deposition might stratify more accurately the renal outcome in patients with IgAN.
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Affiliation(s)
- Bogdan Obrișcă
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
| | - Valentin Mocanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Roxana Jurubiță
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Alexandra Vrabie
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andreea Berechet
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Ștefan Lujinschi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Bogdan Sorohan
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andreea Andronesi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Camelia Achim
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriela Lupușoru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Nicu Caceaune
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihaela Gherghiceanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Victor Babes" National Institute of Pathology, Bucharest, Romania
| | - Gener Ismail
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
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Cambier A, Roy JP, Dossier C, Patey N, Rabant M, Boyer O, Delbet JD, Lapeyraque AL, Hogan J. IgA nephropathy in children with minimal proteinuria: to biopsy or not to biopsy? Pediatr Nephrol 2024; 39:781-787. [PMID: 37698655 DOI: 10.1007/s00467-023-06121-7] [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: 03/02/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Tubulointerstitial lesions and glomerular inflammation severity have been shown to correlate with proteinuria in children with IgA nephropathy (cIgAN). However, there is a lack of data regarding severity of histopathologic findings in cIgAN in patients with minimal to absent proteinuria since kidney biopsy indications are not well defined in these cases. METHODS Twenty-eight cIgAN patients with kidney biopsy from 4 different centers in Paris (France) and Montreal (Canada) with a urine protein/creatinine ratio (UPCr) ≤ 0.03 g/mmol and a normal estimated glomerular filtration rate (eGFR > 90 ml/min/1.73 m2) on the day of kidney biopsy prior to treatment were included. RESULTS Median age was 11.82 (9.32-13.45) years, and median follow-up was 4 years (2.87-6.53). At time of biopsy, median eGFR was 116 (102.3-139.7) ml/min/1.73 m2, and median UPCr was 0.02 (0.011-0.03) g/mmol. Microscopic or macroscopic hematuria was present in 35.7% and 64.3% of cases, respectively. Kidney biopsy microscopy analysis showed mesangial (M1), endocapillary (E1), or extracapillary (C1) hypercellularity in 53.5%, 32.1%, and 7.1% of patients, respectively. Chronic histological lesions were also present: glomerulosclerosis (S1) in 42.8% and tubular atrophy/interstitial fibrosis in 7.1%. Podocytopathic features were detected in 21.4%. An ACE inhibitor or immunosuppressive therapy (IS) was prescribed in 42.8% and 21.4% of these patients respectively. One-third (35.7%) received no treatment. At last follow-up, median eGFR was 111.9 (90.47-136.1) ml/min/1.73 m2, and median UPCr was 0.028 (0.01-0.03) g/mmol. CONCLUSION cIgAN with minimal proteinuria at time of biopsy might be linked with acute and chronic glomerular lesions.
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Affiliation(s)
- Alexandra Cambier
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada.
- Sainte-Justine Hospital Pediatric Research Centre: Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, QC, Canada.
| | - Jean-Philippe Roy
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Claire Dossier
- Division of Nephrology, Hôpital Robert Debré, Paris, France
| | - Natacha Patey
- Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Marion Rabant
- Division of Pathology, Hôpital Necker, Paris, France
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Necker-Enfants Malades, APHP, Centre, Institut Imagine, Inserm U1163, Université Paris Cité, Paris, France
| | | | - Anne-Laure Lapeyraque
- Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Julien Hogan
- Division of Nephrology, Hôpital Robert Debré, Paris, France
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4
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Boi R, Ebefors K, Nyström J. The role of the mesangium in glomerular function. Acta Physiol (Oxf) 2023; 239:e14045. [PMID: 37658606 DOI: 10.1111/apha.14045] [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: 05/30/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023]
Abstract
When discussing glomerular function, one cell type is often left out, the mesangial cell (MC), probably since it is not a part of the filtration barrier per se. The MCs are instead found between the glomerular capillaries, embedded in their mesangial matrix. They are in direct contact with the endothelial cells and in close contact with the podocytes and together they form the glomerulus. The MCs can produce and react to a multitude of growth factors, cytokines, and other signaling molecules and are in the perfect position to be a central hub for crosstalk communication between the cells in the glomerulus. In certain glomerular diseases, for example, in diabetic kidney disease or IgA nephropathy, the MCs become activated resulting in mesangial expansion. The expansion is normally due to matrix expansion in combination with either proliferation or hypertrophy. With time, this expansion can lead to fibrosis and decreased glomerular function. In addition, signs of complement activation are often seen in biopsies from patients with glomerular disease affecting the mesangium. This review aims to give a better understanding of the MCs in health and disease and their role in glomerular crosstalk and inflammation.
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Affiliation(s)
- Roberto Boi
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Ebefors
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Nyström
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Arai M, Mii A, Hirama A, Kaneko T, Kashiwagi T, Shimizu A, Sakai Y. A possible role of classical complement pathway activation in the pathogenesis of immunoglobulin G nephropathy: a case report. CEN Case Rep 2023; 12:14-22. [PMID: 35711019 PMCID: PMC9892394 DOI: 10.1007/s13730-022-00710-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
Immunoglobulin G (IgG) nephropathy refers to a rare group of diseases characterized by deposits of IgG in the mesangial region. However, IgG nephropathy is controversial as a single disease entity, and its pathogenesis remains to be elucidated. In the present report, we discuss a case of IgG nephropathy in which we observed activation of the classical complement pathway.A 47-year-old woman was admitted to our hospital with nephrotic syndrome. Light-microscopic examination revealed neither proliferative nor sclerotic lesions in the glomeruli. However, unusual and large deposits were observed in the paramesangial area. An immunofluorescence study revealed predominant IgG and C1q and slight C3 deposits in the paramesangial area, suggesting immune-complex-type glomerular disease. An electron microscopic study also revealed different sizes of non-organized electron-dense deposits with a similar pattern of distribution, which were accompanied by foot process effacement. Clinically, there was no evidence of systemic diseases, such as infectious or autoimmune diseases (including systemic lupus erythematosus). Based on these findings, she was diagnosed with IgG nephropathy and treated with prednisolone. Steroid therapy was effective, and complete remission was maintained.Additional immunological examination revealed that IgG deposits were polyclonal and consisted mainly of the IgG1 and IgG3 subclasses. Furthermore, staining was positive for C4d and C5b-9. The present findings indicate that the pathogenesis of IgG nephropathy in our patient may have involved activation of the classical complement pathway.
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Affiliation(s)
- Momoko Arai
- Department of Nephrology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Akiko Mii
- Department of Nephrology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
| | - Akio Hirama
- Department of Nephrology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Tomohiro Kaneko
- Department of Nephrology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Tetsuya Kashiwagi
- Department of Nephrology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Akira Shimizu
- Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Yukinao Sakai
- Department of Nephrology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
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6
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Schaub JA, O'Connor CL, Shi J, Wiggins RC, Shedden K, Hodgin JB, Bitzer M. Quantitative morphometrics reveals glomerular changes in patients with infrequent segmentally sclerosed glomeruli. J Clin Pathol 2022; 75:121-127. [PMID: 33431484 PMCID: PMC9295693 DOI: 10.1136/jclinpath-2020-207149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/03/2023]
Abstract
AIMS Detection of one segmentally sclerosed glomerulus (SSG) identifies patients with focal segmental glomerulosclerosis (FSGS) but rare SSGs may be missed in kidney biopsies. It is unknown whether alterations of unaffected glomeruli in patients with infrequent SSG can be detected by quantitative morphometrics. METHODS We determined SSG frequency and obtained quantitative morphometrics in glomeruli without a pathologic phenotype in large kidney sections of non-involved kidney tissue from 137 patients undergoing total nephrectomy. We used multivariate modelling to identify morphometrics independently associated with increasing frequency of SSG and Receiver Operator Curve (ROC) analysis to determine the ability of quantitative morphometrics to identify patients with FSGS. We used the geometric distribution to estimate the sensitivity and specificity of a needle biopsy to identify patients with FSGS. RESULTS In seventy-one patients (51.8%), at least one SSG was observed, and of those, 39 (54.9%) had an SSG lesion in less than 2% of all glomeruli (mean of 249 glomeruli per specimen). Increasing percent of SSG was independently associated with decreasing podocyte density and increasing mesangial index in multivariate modelling. For infrequent SSG lesions (<1% of glomeruli), kidney biopsy could miss FSGS diagnosis more than 74% of the time, and podocyte density had an area under the curve (AUC) of 0.77, and mesangial index, an AUC of 0.79 to identify patients with FSGS. CONCLUSIONS More than half of patients had FSGS, although 30% had infrequent SSG. Quantitative morphometrics in glomeruli without pathology, such as podocyte density and mesangial index, identified patients with infrequent SSG and may serve as clinical markers to identify patients with FSGS.
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Affiliation(s)
- Jennifer A Schaub
- Internal Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Jian Shi
- Internal Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Roger C Wiggins
- Internal Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey B Hodgin
- Pathology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Markus Bitzer
- Internal Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
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Watanabe K, Fukui S, Konishi K, Ito Y, Fujimaru T, Nagahama M, Taki F, Suzuki K, Nakayama M. A case of systemic sarcoidosis with mesangial proliferative glomerulonephritis showing predominant deposition of IgG in the mesangial region. CEN Case Rep 2021; 11:231-236. [PMID: 34751926 DOI: 10.1007/s13730-021-00660-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
A 37-year-old African-British man was referred to our hospital for detailed examination because of persistent fever, swelling and pain in both ankle joints, and blurred vision for two months. Inguinal lymph node biopsy showed a large number of epithelioid granulomas without necrosis. Granulomatous anterior uveitis, nephropathy, high serum angiotensin-converting enzyme activity, and high serum-soluble interleukin-2 receptor were observed, and the diagnosis of systemic sarcoidosis was made. His serum creatinine was 1.4 mg/dL and hematuria, leukocyturia, and urine protein were also seen. The renal biopsy finding was mesangial proliferative glomerulonephritis, with no findings of granuloma formation or tubular interstitial nephritis. Immunofluorescence staining showed deposition of IgG, C3, and C1q in the mesangial region. IgG3 was dominant in subclass staining. There was no monoclonality on kappa and lambda staining. Electron microscopy showed predominant deposition in the mesangial region with some subepithelial and endothelial deposition. His hematuria and leukocyturia disappeared with steroid therapy, suggesting sarcoidosis-related nephropathy. A case of systemic sarcoidosis with mesangial proliferative glomerulonephritis showing predominant deposition of IgG in the mesangial region is presented. No cases of such histological findings have been reported so far, and it is necessary to analyze further cases to clarify the pathogenic significance of the renal biopsy findings observed in this case.
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Affiliation(s)
- Kimio Watanabe
- Division of Kidney Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Sho Fukui
- Immuno-Rheumatology Center, St Luke's International Hospital, Tokyo, Japan
| | - Kasumi Konishi
- Division of Kidney Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Yugo Ito
- Division of Kidney Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takuya Fujimaru
- Division of Kidney Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Masahiko Nagahama
- Division of Kidney Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Fumika Taki
- Division of Kidney Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Koyu Suzuki
- Department of Pathology, St Luke's International Hospital, Tokyo, Japan
| | - Masaaki Nakayama
- Division of Kidney Center, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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Abstract
To investigate the clinicopathological features and outcomes of primary IgA nephropathy with nephrotic-range proteinuria in Chinese children. Patients with biopsy-proven IgA nephropathy and nephrotic-range proteinuria between January 2011 and December 2017 were included, and their proteinuria and renal function were followed up. A total of 90 patients were enrolled, and 21.1% (19/90) of them had decreased renal function at diagnosis. Complete remission, partial remission, and no response of proteinuria occurred in 88.6% (70/79), 10.1% (8/79), and 1.3% (1/79), respectively, of the 79 patients who were followed up for 6 to 104 months. 73.7% (14/19) of the patients with decreased renal function at diagnosis recovered to normal level while 26.3% (5/19) of them did not recover or progressed to end-stage renal disease. Two patients with normal renal function at diagnosis progressed to renal insufficiency during follow-up period. By multivariate analysis, the risk for renal function deterioration was significantly higher in the partial remission and no response groups than in the complete remission group. Remission of proteinuria was important for improving renal prognosis in children with IgA nephropathy and nephrotic-range proteinuria. The outcomes for pediatric patients appeared to be better than that reported in adults.
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MESH Headings
- Adolescent
- Biopsy
- Child
- Child, Preschool
- China/epidemiology
- Drug Therapy, Combination/methods
- Female
- Follow-Up Studies
- Glomerular Mesangium/pathology
- Glomerulonephritis, IGA/complications
- Glomerulonephritis, IGA/drug therapy
- Glomerulonephritis, IGA/immunology
- Glomerulonephritis, IGA/pathology
- Glucocorticoids/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/immunology
- Kidney Failure, Chronic/urine
- Male
- Proteinuria/diagnosis
- Proteinuria/epidemiology
- Proteinuria/immunology
- Proteinuria/urine
- Remission Induction/methods
- Retrospective Studies
- Treatment Outcome
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9
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Feitz WJC, van Setten PA, van der Velden TJAM, Licht C, van den Heuvel LPJW, van de Kar NCAJ. Cell Biological Responses after Shiga Toxin-1 Exposure to Primary Human Glomerular Microvascular Endothelial Cells from Pediatric and Adult Origin. Int J Mol Sci 2021; 22:ijms22115615. [PMID: 34070679 PMCID: PMC8199108 DOI: 10.3390/ijms22115615] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 01/16/2023] Open
Abstract
Hemolytic uremic syndrome (HUS) is characterized by a triad of symptoms consisting of hemolytic anemia, thrombocytopenia and acute renal failure. The most common form of HUS is caused by an infection with Shiga toxin (Stx) producing Escherichia coli bacteria (STEC-HUS), and the kidneys are the major organs affected. The development of HUS after an infection with Stx occurs most frequently in children under the age of 5 years. However, the cause for the higher incidence of STEC-HUS in children compared to adults is still not well understood. Human glomerular microvascular endothelial cells (HGMVECs) isolated and cultured from pediatric and adult kidney tissue were investigated with respect to Stx binding and different cellular responses. Shiga toxin-1 (Stx-1) inhibited protein synthesis in both pediatric and adult HGMVECs in a dose-dependent manner at basal conditions. The preincubation of pediatric and adult HGMVECs for 24 hrs with TNFα resulted in increased Stx binding to the cell surface and a 20-40% increase in protein synthesis inhibition in both age groups. A decreased proliferation of cells was found when a bromodeoxyuridine (BrdU) assay was performed. A trend towards a delay in endothelial wound closure was visible when pediatric and adult HGMVECs were incubated with Stx-1. Although minor differences between pediatric HGMVECs and adult HGMVECs were found in the assays applied in this study, no significant differences were observed. In conclusion, we have demonstrated that in vitro primary HGMVECs isolated from pediatric and adult kidneys do not significantly differ in their cell biological responses to Stx-1.
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Affiliation(s)
- Wouter J. C. Feitz
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands; (W.J.C.F.); (T.J.A.M.v.d.V.); (L.P.J.W.v.d.H.)
- Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Department of Pediatrics, Amalia Children’s Hospital, Radboudumc, 6525 GA Nijmegen, The Netherlands;
| | - Petra A. van Setten
- Department of Pediatrics, Amalia Children’s Hospital, Radboudumc, 6525 GA Nijmegen, The Netherlands;
| | - Thea J. A. M. van der Velden
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands; (W.J.C.F.); (T.J.A.M.v.d.V.); (L.P.J.W.v.d.H.)
| | - Christoph Licht
- Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Lambert P. J. W. van den Heuvel
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands; (W.J.C.F.); (T.J.A.M.v.d.V.); (L.P.J.W.v.d.H.)
- Department of Development and Regeneration, Department of Pediatric Nephrology, KU, 3000 Leuven, Belgium
| | - Nicole C. A. J. van de Kar
- Department of Pediatric Nephrology, Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Radboudumc, 6525 GA Nijmegen, The Netherlands; (W.J.C.F.); (T.J.A.M.v.d.V.); (L.P.J.W.v.d.H.)
- Department of Pediatrics, Amalia Children’s Hospital, Radboudumc, 6525 GA Nijmegen, The Netherlands;
- Correspondence: ; Tel.: +31-24-36-14430
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10
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Takahashi Y, Shimizu T, Kato S, Nara M, Suganuma Y, Sato T, Morii T, Yamada Y, Fujita H. Reduction of Superoxide Dismutase 1 Delays Regeneration of Cardiotoxin-Injured Skeletal Muscle in KK/Ta- Ins2Akita Mice with Progressive Diabetic Nephropathy. Int J Mol Sci 2021; 22:5491. [PMID: 34071003 PMCID: PMC8197123 DOI: 10.3390/ijms22115491] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
Superoxide dismutase (SOD) is a major antioxidant enzyme for superoxide removal, and cytoplasmic SOD (SOD1) is expressed as a predominant isoform in all cells. We previously reported that renal SOD1 deficiency accelerates the progression of diabetic nephropathy (DN) via increasing renal oxidative stress. To evaluate whether the degree of SOD1 expression determines regeneration capacity and sarcopenic phenotypes of skeletal muscles under incipient and advanced DN conditions, we investigated the alterations of SOD1 expression, oxidative stress marker, inflammation, fibrosis, and regeneration capacity in cardiotoxin (CTX)-injured tibialis anterior (TA) muscles of two Akita diabetic mouse models with different susceptibility to DN, DN-resistant C57BL/6-Ins2Akita and DN-prone KK/Ta-Ins2Akita mice. Here, we report that KK/Ta-Ins2Akita mice, but not C57BL/6-Ins2Akita mice, exhibit delayed muscle regeneration after CTX injection, as demonstrated by the finding indicating significantly smaller average cross-sectional areas of regenerating TA muscle myofibers relative to KK/Ta-wild-type mice. Furthermore, we observed markedly reduced SOD1 expression in CTX-injected TA muscles of KK/Ta-Ins2Akita mice, but not C57BL/6-Ins2Akita mice, along with increased inflammatory cell infiltration, prominent fibrosis and superoxide overproduction. Our study provides the first evidence that SOD1 reduction and the following superoxide overproduction delay skeletal muscle regeneration through induction of overt inflammation and fibrosis in a mouse model of progressive DN.
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MESH Headings
- Animals
- Cardiotoxins/toxicity
- Collagen Type I/biosynthesis
- Collagen Type I/genetics
- Collagen Type I, alpha 1 Chain
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/genetics
- Diabetic Nephropathies/complications
- Diabetic Nephropathies/enzymology
- Diabetic Nephropathies/genetics
- Diabetic Nephropathies/pathology
- Disease Progression
- Enzyme Induction/drug effects
- Fibrosis
- Gene Expression Regulation, Enzymologic
- Genetic Predisposition to Disease
- Glomerular Mesangium/pathology
- Inflammation
- Insulin/deficiency
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Mutant Strains
- Muscle, Skeletal/drug effects
- Muscle, Skeletal/enzymology
- Muscle, Skeletal/pathology
- Muscle, Skeletal/physiology
- Nerve Regeneration/drug effects
- Oxidative Stress/drug effects
- Sarcopenia/etiology
- Superoxide Dismutase-1/biosynthesis
- Superoxide Dismutase-1/drug effects
- Superoxide Dismutase-1/genetics
- Superoxide Dismutase-1/physiology
- Superoxides/metabolism
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Affiliation(s)
- Yuya Takahashi
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
| | - Tatsunori Shimizu
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
| | - Shunsuke Kato
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
| | - Mitsuhiko Nara
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
| | - Yumi Suganuma
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
| | - Takehiro Sato
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
| | - Tsukasa Morii
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
| | - Yuichiro Yamada
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
- Kansai Electric Power Medical Research Institute, 2-1-7 Fukushima-ku, Osaka 553-0003, Japan
| | - Hiroki Fujita
- Department of Metabolism and Endocrinology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; (Y.T.); (T.S.); (S.K.); (M.N.); (Y.S.); (T.S.); (T.M.); (Y.Y.)
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11
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Bagheri B, Owji SM, Torabinezhad S, Raeisi Shahraki H, Kamalinia A, Owji SH, Dehghani F. Electron microscopy study of 496 cases of lupus nephritis: A single-center experience. Lupus 2021; 30:587-596. [PMID: 33413002 DOI: 10.1177/0961203320984539] [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] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Renal involvement is seen in about 40-82% of systemic lupus erythematosus (SLE) Asian patients. The exact diagnosis and classification of lupus nephritis are important for treatment and prognosis. This study aimed to investigate the value of electron microscopy (EM) in the diagnosis and classification of lupus nephritis compared with light microscopy. METHOD In this cross-sectional referral-center 16-year study of lupus nephritis, the final diagnosis was based on the EM study. Primary light microscopy findings were compared with EM diagnosis. Moreover, Immunofluorescence patterns distribution was assessed. RESULTS From 496 patients diagnosed with lupus nephritis based on EM, 225(45.4%) of patients were categorized in class IV, followed by 98(19.7%), 93(18.8%), 46(9.3%), and 14(2.8%) who were categorized into classes of II, III, V, and VI respectively. Only 1(0.2%) patient belonged to class I, and 19(3.8%) cases were diagnosed with mixed two classes. Using EM was essential for diagnosing 25.6% of cases taking the correct classification by light microscopy into account; however, disregarding correct classification, this could change to a 7.4% contribution rate of EM. The most common cause of misdiagnosis, disregarding incorrect classification, was inadequate or wrong tissue. Positive associations were detected between tubular atrophy and interstitial fibrosis of both electron and light microscopy with different classes (P < 0.001). CONCLUSION While light microscopy is highly accurate for diagnosing lupus nephritis regardless of correct classification, EM contributes substantially to the correct classification of lupus nephritis types.
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Affiliation(s)
- Bahar Bagheri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Owji
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Simin Torabinezhad
- Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Seyed Hossein Owji
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farshad Dehghani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Worawichawong S, Plumworasawat S, Liwlompaisan W, Sumethkul V, Phakdeekitcharoen B, Udomsubpayakul U, Chalermsanyakorn P, Kitiyakara C. Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy. PLoS One 2021; 16:e0252638. [PMID: 34081719 PMCID: PMC8174712 DOI: 10.1371/journal.pone.0252638] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 05/20/2021] [Indexed: 02/05/2023] Open
Abstract
Mesangial C4d deposits have been associated with worse outcomes in Western patients with IgA nephropathy (IgAN), but there is limited data in Asians. Previously, a high proportion of stained glomeruli was often required for the classification of C4d positive (C4d+ve). Positive staining in lower proportion of staining would be classified as C4d-ve. This retrospective study evaluated the prognostic value of C4d+ve using a less stringent definition (one C4d+ve glomerulus) in Thai patients with IgAN (n = 120). Baseline findings and outcomes were compared between those with more extensive C4d staining patterns and those with more restricted staining. Clinico-pathologic parameters and risk for kidney outcomes (kidney failure or decline GFR50%) were compared between C4d+ve versus C4d-ve, and between different patterns: Focal (< 50%) versus Diffuse (≥ 50% of glomeruli); or Global (≥ 50) versus Segmental (< 50% of mesangial area). The hazard ratios were estimated using Cox proportional hazard models for Model 1 (Oxford score+ C4d) and Model 2 (Model 1+ clinical factors). C4d+ve (n = 81) had lower eGFR, more global sclerosis, and interstitial fibrosis than C4d-ve at baseline. The 5-year kidney survival for C4d+ve was lower (53.7%) than C4d-ve (89.7%); P = 0.0255. By univariate analysis, T1, T2, C4d+ve, eGFR<60, proteinuria were predictors of kidney outcome. By multivariate analysis, proteinuria, T1, T2 and C4d+ve were independent predictors (Model 2 HR (95% CI) C4d+ve: 3.24 (1.09-9.58), p = 0.034). Segmental had lower eGFR, higher tubulointerstitial fibrosis, and segmental sclerosis compared to Global pattern. Clinicopathological parameters were not different between Focal and Diffuse patterns. Outcomes were similar between staining patterns. In conclusion, C4d staining may be a valuable marker of poor prognosis in Asian patients with IgAN. Less stringent criteria for C4d+ve should be considered as no differences in outcomes were observed between more extensive staining with less extensive patterns. More studies are needed to identify the optimum criteria for C4d+ve.
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Affiliation(s)
- Suchin Worawichawong
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirithep Plumworasawat
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wisit Liwlompaisan
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasant Sumethkul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bunyong Phakdeekitcharoen
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Umaporn Udomsubpayakul
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panus Chalermsanyakorn
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- * E-mail: ,
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13
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Kostic S, Hauke T, Ghahramani N, Filipovic N, Vukojevic K. Expression pattern of apoptosis-inducing factor in the kidneys of streptozotocin-induced diabetic rats. Acta Histochem 2020; 122:151655. [PMID: 33171392 DOI: 10.1016/j.acthis.2020.151655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is believed that tubulo-interstitial fibrosis and atrophy in diabetic patients are directly associated with the progression of chronic kidney disease, CKD. AIF is one of the crucial factors responsible for mitochondrial apoptosis, however, it can also promote cell survival independently from its role in apoptosis, and therefore can be potentially used as a tool in prevention of the onset of CKD in diabetic patients. Our aim was to investigate the significance of AIF expression in the development of CKD by observing the expression of AIF in 2 weeks' and 2 months' kidneys of diabetic rats compared to their controls. METHODS Male Sprague-Dawley rats were treated with 55 mg/kg streptozotocin (model of type 1 diabetes mellitus; DM group) or citrate buffer (control). After 2 weeks and 2 months kidney samples were collected and analysed in different renal areas. RESULTS Characteristic morphologic changes were found between the 2 months' control and 2 months' diabetic groups. Those changes, including fibrosis and possible replacement of podocytes with connective tissue were mainly present in the glomeruli. AIF expression was seen in the both cortex, and in the collecting ducts of the medulla. Strong intensity of AIF expression was seen in proximal and distal convoluted tubules in both diabetic groups. In the control groups the glomeruli showed no AIF staining but moderate staining was seen in both diabetic groups. Overall, the percentage of AIF positive cells in the glomeruli was the lowest. The greatest rise in cell positivity was displayed from the 2 weeks' control group to 2 weeks' diabetes group (38 %) in glomeruli. The cell positivity of the 2 weeks' diabetic group is significantly reduced to 18 % in the 2 months' diabetic group in glomeruli. A similar pattern was seen in the proximal tubular cells (92 % positivity 2 weeks diabetic groups; 89 % positivity 2 months diabetic groups), as well as in the distal tubules. The highest percentage of AIF positive cells was seen in the collecting ducts, more than 80 % in all groups. CONCLUSIONS Our study provides insight into AIF expression pattern during short term diabetes model, confirming possible dual role of AIF, not only in apoptosis but also in cell function and homeostasis, and proving AIF as potential therapeutic target and marker of advancement of CKD.
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MESH Headings
- Animals
- Apoptosis/drug effects
- Apoptosis Inducing Factor/genetics
- Apoptosis Inducing Factor/metabolism
- Diabetes Mellitus, Experimental/chemically induced
- Diabetes Mellitus, Experimental/genetics
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Diabetic Nephropathies/genetics
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/pathology
- Fibrosis
- Gene Expression Regulation
- Glomerular Mesangium/metabolism
- Glomerular Mesangium/pathology
- Kidney Tubules, Collecting/metabolism
- Kidney Tubules, Collecting/pathology
- Kidney Tubules, Distal/metabolism
- Kidney Tubules, Distal/pathology
- Kidney Tubules, Proximal/metabolism
- Kidney Tubules, Proximal/pathology
- Male
- Nephritis, Interstitial/genetics
- Nephritis, Interstitial/metabolism
- Nephritis, Interstitial/pathology
- Podocytes/metabolism
- Podocytes/pathology
- Rats
- Rats, Sprague-Dawley
- Streptozocin/administration & dosage
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Affiliation(s)
- Sandra Kostic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia.
| | - Tim Hauke
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia
| | - Nasrollah Ghahramani
- Penn State College of Medicine Division of Nephrology, Hershey, PA 17033, United States
| | - Natalija Filipovic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia
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14
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Zhu B, Liu WH, Yu DR, Lin Y, Li Q, Tong ML, Li YY, Yang RC, Du YY, Tang XL, Jiang F, Fei D, Wei XY, Zhang FF, Yin JZ, Wang WR, Li XF, Sun Y, Zhong YZ, Zhang MJ, Cheng XX, Zhu CF, Chen HY. The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases. Am J Nephrol 2020; 51:624-634. [PMID: 32694247 DOI: 10.1159/000508770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/05/2020] [Accepted: 05/18/2020] [Indexed: 01/16/2023]
Abstract
AIM To investigate the relationship between hemoglobin levels and the progression of IgA nephropathy (IgAN). METHODS In a two-center cohort of 1,828 cases with biopsy-proven IgAN, we examined the association of hemoglobin levels with the primary outcome of a composite of all-cause mortality or kidney failure defined as a 40% decline in eGFR, or ESKD (defined as eGFR <15 mL/min/1.73 m2 or need for kidney replacement therapy including hemodialysis, peritoneal dialysis, or kidney transplantation), or the outcome of kidney failure, assessed using Cox and logistic regression models, respectively, with adjustment for confounders. RESULTS At baseline, mean age, eGFR, and hemoglobin levels were 33.75 ± 11.03 years, 99.70 ± 30.40 mL/min/1.73 m2, and 123.47 ± 18.36 g/L, respectively. During a median of approximately 7-year follow-up, 183 cases reached the composite outcome. After adjustment for demographic and IgAN-specific covariates and treatments, a lower quartile of hemoglobin was nonlinearly associated with an increased risk of the primary outcome or kidney failure in the Cox proportional hazards models (primary outcome: HR for quartile 3 vs. 4, 1.37; 95% CI, 0.83-2.25; HR for quartile 2 vs. 4, 1.18; 95% CI, 0.68-2.07; HR for quartile 1 vs. 4, 1.91; 95% CI, 1.15-3.17; kidney failure: HR for quartile 3 vs. 4, 1.39; 95% CI, 0.84-2.31; HR for quartile 2 vs. 4, 1.20; 95% CI, 0.68-2.11; HR for quartile 1 vs. 4, 1.83; 95% CI, 1.09-3.07) in the fully adjusted model. Then, hemoglobin levels were transformed to a binary variable for fitting the model according to the criteria for anemia of 110 g/L in the women and 120 g/L in men in China. The participants in the anemia group had an increased risk of developing outcomes compared with the nonanemia group in both genders (primary outcome: male: HR, 1.64; 95% CI, 1.01-2.68; female: HR, 1.68; 95% CI, 1.02-2.76; kidney failure: male: HR, 1.60; 95% CI, 0.97-2.64; female: HR, 1.58; 95% CI, 0.95-2.61) in the fully adjusted model. CONCLUSIONS A low level of hemoglobin was nonlinearly associated with IgAN progression. The anemic IgAN patients presented a higher risk of developing poor outcomes compared with the nonanemic patients.
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Affiliation(s)
- Bin Zhu
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China,
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China,
| | - Wen-Hua Liu
- Department of Nephrology, Qinghai Provincial People's Hospital, Xining, China
| | - Dong-Rong Yu
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Yi Lin
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Qiang Li
- Department of Statistics, the George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Meng-Li Tong
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Ya-Yu Li
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Ru-Chun Yang
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Yuan-Yuan Du
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Xuan-Li Tang
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Fei Jiang
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Dan Fei
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Xin-Yi Wei
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Fei-Fei Zhang
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Jia-Zhen Yin
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Wen-Rong Wang
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Xian-Fa Li
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Yue Sun
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Yong-Zhong Zhong
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Mei-Juan Zhang
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Xiao-Xia Cheng
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Cai-Feng Zhu
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
| | - Hong-Yu Chen
- Department of Nephrology, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
- Key laboratory of Zhejiang Province, Hangzhou Hospital of Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang University of Chinese Medicine, Hangzhou, China
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15
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Morimoto M, Arai T, Matsuura M, Ono Y. Bevacizumab-associated glomerular microangiopathy that occurred after postoperative chemotherapy for ovarian cancer. CEN Case Rep 2020; 10:6-11. [PMID: 32642991 DOI: 10.1007/s13730-020-00504-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/18/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022] Open
Abstract
Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF) that is used to treat patients with various cancers. However, it is known to be associated with adverse events, such as hypertension and proteinuria. The histology of bevacizumab-induced nephropathy is known as thrombotic microangiopathy or minimal change nephrotic syndrome. Recently, however, the terms "bevacizumab-associated glomerular microangiopathy" and "anti-VEGF therapy-induced glomerular microangiopathy" have been proposed. We present a case of a 68-year-old woman who was administered postoperative chemotherapy (carboplatin, paclitaxel, and bevacizumab) for stage IV ovarian cancer. Proteinuria and hypertension appeared after three courses; however, six courses were completed. Then, gemcitabine and carboplatin were administered for recurrence of her cancer. She was diagnosed with nephrotic syndrome after eight courses. Renal biopsy showed accumulation of periodic acid-Schiff (PAS)-positive substances in the capillary walls and para-mesangial areas. Double contouring of basement membranes was also observed. Immunofluorescence microscopy revealed positive staining for IgG, IgA, IgM, C3, C4, and C1q. Immunosuppressive therapy was administered, but was ineffective. Further examination by electron microscopy and immunostaining led to a diagnosis of bevacizumab-associated glomerular microangiopathy.
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Affiliation(s)
- Madoka Morimoto
- Division of Nephrology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, Japan.
| | - Tatsuya Arai
- Division of Nephrology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, Japan
| | - Motoo Matsuura
- Division of Nephrology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, Japan
| | - Yuko Ono
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
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Dumont C, Mérouani A, Ducruet T, Benoit G, Clermont MJ, Lapeyraque AL, Phan V, Patey N. Clinical relevance of membrane attack complex deposition in children with IgA nephropathy and Henoch-Schönlein purpura. Pediatr Nephrol 2020; 35:843-850. [PMID: 31932958 DOI: 10.1007/s00467-019-04445-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND IgA nephropathy (IgAN) and Henoch-Schönlein purpura are common glomerular disorders in children sharing the same histopathologic pattern of IgA deposits within the mesangium, even if their physiopathology may be different. Repeated exposure to pathogens induces the production of abnormal IgA1. The immune complex deposition in the renal mesangium in IgAN or potentially in small vessels in Henoch-Schönlein purpura induces complement activation via the alternative and lectin pathways. Recent studies suggest that levels of membrane attack complex (MAC) in the urine might be a useful indicator of renal injury. Because of the emerging availability of therapies that selectively block complement activation, the aim of the present study is to investigate whether MAC immunostaining might be a useful marker of IgA-mediated renal injury. METHODS We conducted immunohistochemistry analysis of the MAC on renal biopsies from 67 pediatric patients with IgAN and Henoch-Schönlein purpura. We classified their renal biopsies according to the Oxford classification, retrieved symptoms, biological parameters, treatment, and follow-up. RESULTS We found MAC expression was significantly related to impaired renal function and patients whose clinical course required therapy. MAC deposits tend to be more abundant in patients with decreased glomerular filtration rate (p = 0.02), patients with proteinuria > 0.750 g/day/1.73 m2, and with nephrotic syndrome. No correlation with histological alterations was observed. CONCLUSIONS We conclude that MAC deposition could be a useful additional indicator of renal injury in patients with IgAN and Henoch-Schönlein purpura, independent of other indicators.
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Affiliation(s)
- Camille Dumont
- Department of Pathology, CHU Sainte Justine, 3175 Chemin Côte Sainte Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Aicha Mérouani
- Department of Nephrology, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Thierry Ducruet
- Applied Clinical Research Unit, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Benoit
- Department of Nephrology, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Marie-Josée Clermont
- Department of Nephrology, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Anne Laure Lapeyraque
- Department of Nephrology, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Véronique Phan
- Department of Nephrology, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Natalie Patey
- Department of Pathology, CHU Sainte Justine, 3175 Chemin Côte Sainte Catherine, Montréal, Québec, H3T 1C5, Canada.
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Majumder S, Amin M, Pushpakumar S, Sen U. Collagen receptor- and metalloproteinase-dependent hypertensive stress response in mesangial and glomerular endothelial cells. Mol Cell Biochem 2020; 466:1-15. [PMID: 31912277 PMCID: PMC10809865 DOI: 10.1007/s11010-019-03680-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 12/22/2019] [Indexed: 12/25/2022]
Abstract
Progressive alteration of the extracellular matrix (ECM) is the characteristic of hypertensive nephropathy (HN). Both mesangial and endothelial cells have the ability to synthesize and degrade ECM components, including collagens through the activation of matrix metalloproteinases (MMPs) in stress conditions, such as in hypertension. On the other hand, hydrogen sulfide (H2S) has been shown to mitigate hypertensive renal matrix remodeling. Surprisingly, whether H2S ameliorates receptor-mediated (urokinase plasminogen activator receptor-associated protein, uPARAP/Endo180) collagen dysregulation in Ang-II hypertension is not clear. The purpose of this study was to determine whether Ang-II alters the expression of Endo180, tissue plasminogen activator (tPA), MMPs, and their tissue inhibitors (TIMPs) leading to the dysregulation of cellular collagen homeostasis and whether H2S mitigates the collagen turnover. Mouse mesangial cells (MCs) and glomerular endothelial cells (MGECs) were treated without or with Ang-II and H2S donor GYY (GYY4137) for 48 h. Cell lysates were analyzed by Western blot and RT-PCR, and cells were analyzed by immunocytochemistry. The results indicated that, while Ang-II differentially expressed MMP-13 and TIMP-1 in MCs and in MGECs, it predominantly decreased tPA, Endo 180, and increased plasminogen activator inhibitor-1 (PAI-1), MMP-14, and collagen IIIA and IV in both the cell types. Interestingly, H2S donor GYY treatment normalized the above changes in both the cell types. We conclude that Ang-II treatment causes ECM remodeling in MCs and MGECs through PAI-1/tPA/Endo180 and MMP/TIMP-dependent collagen remodeling, and H2S treatment mitigates remodeling, in part, by modulating these pathways.
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Affiliation(s)
- Suravi Majumder
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Matthew Amin
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Sathnur Pushpakumar
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Utpal Sen
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, 40202, USA.
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18
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Gong J, Zhan H, Li Y, Zhang W, Jin J, He Q. Krüppel‑like factor 4 ameliorates diabetic kidney disease by activating autophagy via the mTOR pathway. Mol Med Rep 2019; 20:3240-3248. [PMID: 31432191 PMCID: PMC6755248 DOI: 10.3892/mmr.2019.10585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/05/2019] [Indexed: 12/15/2022] Open
Abstract
Diabetic kidney disease (DKD) is diagnosed increasingly frequently and represents a serious threat to human health. Krüppel‑like factor 4 (KLF4) has aroused attention due to its potential effect on podocytes and in ameliorating proteinuria associated with glomerulopathy. The purpose of the present study was to investigate the potential role of KLF4 in DKD. It was hypothesized that KLF4 impacts diabetic nephropathy by mediating the podocyte autophagic process. A KLF4 plasmid vector was constructed, and podocytes were transfected and incubated with DKD mice serum for in vitro experiments. A db/db spontaneous DKD mouse model was also established for in vivo study. After treatment, the level of serum creatinine (Scr), blood urea nitrogen (BUN), and 24‑h urinary protein was determined. Immunofluorescence and periodic acid‑Schiff staining, western blotting, flow cytometry and a TUNEL assay were performed to observe changes in glomerular morphology and the level of apoptosis, cytoskeleton proteins, epithelial‑mesenchymal transition (EMT) biomarkers, autophagic proteins and mTOR pathway proteins in each group. KLF4 overexpression significantly reduced the level of urinary albumin, Scr, BUN and attenuated mesangial matrix expansion, as well as mesangial cell proliferation in DKD mice. KLF4 overexpression also inhibited podocyte apoptosis and downregulated vimentin and α‑smooth muscle actin, and upregulated E‑cadherin and nephrin, both in vivo and in vitro. Moreover, the microtubule associated protein 1 light chain 3α (LC3)‑II/LC3‑I ratio and LC3‑II fluorescence was significantly increased in the vector‑KLF4 group compared to the negative control vector group both in vivo and in vitro. Finally, a decrease in the level of phosphorylated (p)‑mTOR and p‑S6K protein expression was observed following KLF4 overexpression in vitro. The present findings suggested that KLF4 plays a renoprotective role in DKD, which is associated with the activation of podocyte autophagy, and may be involved in the mTOR signaling pathway.
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Affiliation(s)
- Jianguang Gong
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
- People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
- Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang 310014, P.R. China
| | - Huifang Zhan
- Department of Emergency, Zhejiang University Hospital, Hangzhou, Zhejiang 310058, P.R. China
| | - Yiwen Li
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
- People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
- Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang 310014, P.R. China
| | - Wei Zhang
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
- People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
- Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang 310014, P.R. China
| | - Juan Jin
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
- People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
- Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang 310014, P.R. China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
- People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
- Chinese Medical Nephrology Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang 310014, P.R. China
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19
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Tariq N, Nasir H, Ahmed TA, Usman M, Ahmed KS. C1Q Nephropathy: A Multifaceted Disease With Infrequent Diagnosis. J Ayub Med Coll Abbottabad 2019; 31:308-313. [PMID: 31535496] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND C1q nephropathy (C1qN) is a rare glomerulopathy, with a very low prevalence world wide varying from 0.2 to 2.5%. Even though more than three decades have passed since this entity was first explained, still, it remains a dilemma for many due to the rarity of this lesion. This study was carried out principally to determine the clinical presentation, morphologic features and distribution of C1qN in our region based on renal biopsies studied by light microscopy (LM), and immunofluorescence (IF) so that this entity is better understood both by nephrologists and pathologists as no such study has ever been conducted in Pakistan to our knowledge. METHODS It was a cross-sectional study carried out from 1st January 2012 to 30th December 2016 in Histopathology department, Shifa International Hospital. All cases diagnosed as C1q nephropathy were retrieved from the hospital's computerized database. Their clinical profiles, morphology and immunohistochemical profiles were studied.. RESULTS Over this period a total of 31 cases were diagnosed with C1qN. Mean age of the patients was 32.09±18.66 years. The most common clinical presentation was nephrotic syndrome seen in 22 (71%) patients. The most frequent morphological pattern seen was minimal change disease (MCD) in 13 (41.9%) cases. All cases showed dominant 22 (71%) or codominant 9 (42.9%) mesangial±membranous C1q deposition. No correlation was found (p-value >0.05) between morphological pattern and clinical presentation of the disease or immunofluorescence findings. CONCLUSIONS C1qN is a rare entity which is primarily diagnosed on the basis of immunofluorescence findings with a dominant or codominant fluorescent intensity for C1q. It is recommended that C1qN is sought for preferably with immunofluorescence staining of biopsies for immune reactants, especially for C1q. Studies from this part of the world are strongly recommended to predict clinical outcome and treatment options.
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Affiliation(s)
- Naima Tariq
- Department of Histopathology,Shifa International Hospital, Islamabad, Pakistan
| | - Humaira Nasir
- Department of Histopathology,Shifa International Hospital, Islamabad, Pakistan
| | - Tahir Aziz Ahmed
- Department of Immunology, Shifa International Hospital, Islamabad, Pakistan
| | - Mariam Usman
- Department of Histopathology,Shifa International Hospital, Islamabad, Pakistan
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20
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Wada Y, Matsumoto K, Suzuki T, Saito T, Kanazawa N, Tachibana S, Iseri K, Sugiyama M, Iyoda M, Shibata T. Clinical significance of serum and mesangial galactose-deficient IgA1 in patients with IgA nephropathy. PLoS One 2018; 13:e0206865. [PMID: 30388165 PMCID: PMC6214568 DOI: 10.1371/journal.pone.0206865] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 08/04/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Galactose-deficient IgA1 (Gd-IgA1) is a critical pathogenic factor for IgA nephropathy (IgAN), but its value as a disease-specific biomarker remains controversial. We aimed to clarify the clinical significance of Gd-IgA1 in patients with IgAN. Methods We retrospectively reviewed 111 patients who were diagnosed with IgAN based on the findings of renal biopsies (RB) at Showa University Hospital since 2007. Serum Gd-IgA1 (s-Gd-IgA1) at the time of RB was compared among 111 IgAN patients, 18 Henoch-Schönlein purpura nephritis (HSPN) patients, 29 lupus nephritis (LN) patients, 28 ANCA-associated vasculitis (AAV) patients, and 13 minimal change disease (MCD) patients using ELISA with an anti-human Gd-IgA1-specific monoclonal antibody (KM55). We also immunohistochemically stained paraffin-embedded sections for mesangial Gd-IgA1 (m-Gd-IgA1) deposition using KM55. Results Although levels of s-Gd-IgA1 were comparable among IgAN and HSPN, s-Gd-IgA1 levels were significantly elevated in patients with IgAN compared with LN, AAV and MCD (IgAN vs. HSPN, LN, AAV, and MCD: 16.2 ± 9.1 vs. 14.2 ± 10.8, p = 0.263; 12.7 ± 9.4, p = 0.008; 13.1 ± 7.3, p = 0.059; and 8.2 ± 4.8 μg/mL, p<0.001, respectively). Mesangial-Gd-IgA1 deposition was specifically detected in IgAN or HSPN. The increase in s-Gd-IgA1 significantly correlated with m-Gd-IgA1 positivity in patients with IgAN, and s-Gd-IgA1 elevation and m-Gd-IgA1 deposition were evident in patients with histopathologically advanced IgAN. Moreover, s-Gd-IgA1 levels were significantly higher in IgAN patients with glomerular sclerosis and tubulo-interstitial lesions. Mesangial-Gd-IgA1 intensity negatively correlated with eGFR in IgAN. Multivariate analysis selected s-Gd-IgA1 elevation as a significant risk factor for a 30%-reduction in eGFR in IgAN (HR, 1.37; 95% CI, 1.02–1.89; p = 0.038). Conclusions Although IgAN and HSPN remain difficult to differentiate, s-Gd-IgA1 elevation and m-Gd-IgA1 deposition are reliable diagnostic factors that reflect IgAN severity. Serum-Gd-IgA1 could serve as a predictor of renal outcomes in IgAN. Thus, Gd-IgA1 could be significant biomarker for patients with IgAN.
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Affiliation(s)
- Yukihiro Wada
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Kei Matsumoto
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Taihei Suzuki
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Saito
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Nobuhiro Kanazawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shohei Tachibana
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Ken Iseri
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Motonori Sugiyama
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Masayuki Iyoda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takanori Shibata
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Backer G, Eddy S, Sheehan SM, Takemon Y, Reznichenko A, Savage HS, Kretzler M, Korstanje R. FAR2 is associated with kidney disease in mice and humans. Physiol Genomics 2018; 50:543-552. [PMID: 29652635 PMCID: PMC6139637 DOI: 10.1152/physiolgenomics.00118.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/22/2022] Open
Abstract
Mesangial matrix expansion is an important process in the initiation of chronic kidney disease, yet the genetic factors driving its development are unknown. Our previous studies have implicated Far2 as a candidate gene associated with differences in mesangial matrix expansion between mouse inbred strains. Consistent with the hypothesis that increased expression of Far2 leads to mesangial matrix expansion through increased production of platelet-activating factor precursors, we show that FAR2 is capable of mediating de novo platelet-activating factor synthesis in vitro and driven by the transcription factor NKX3.2. We demonstrate that knockdown of Far2 in mice delays the progression of mesangial matrix expansion with at least six months (equivalent to ~15 yr in human). Furthermore, we show that increased FAR2 expression in human patients is associated with diabetic nephropathy, lupus nephritis, and IgA nephropathy. Taken together, these results highlight FAR2's role in the development of mesangial matrix expansion and chronic kidney disease.
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Affiliation(s)
| | - Sean Eddy
- Department of Internal Medicine, the Division of Nephrology, University of Michigan , Ann Arbor, Michigan
| | | | | | | | | | - Matthias Kretzler
- Department of Internal Medicine, the Division of Nephrology, University of Michigan , Ann Arbor, Michigan
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Xiao YH, He XY, Han Q, Yang F, Zhou SX. Atorvastatin prevents glomerular extracellular matrix formation by interfering with the PKC signaling pathway. Mol Med Rep 2018; 17:6441-6448. [PMID: 29532876 PMCID: PMC5928626 DOI: 10.3892/mmr.2018.8724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 01/25/2018] [Indexed: 01/21/2023] Open
Abstract
Platelet-activating factor (PAF) promotes glomerular extracellular matrix (ECM) deposition, primarily through activation of the protein kinase C (PKC) pathway. The present study was designed to investigate whether atorvastatin, which mediates a protective effect against glomerular ECM deposition and diabetic neuropathy, may interfere with the PKC‑transforming growth factor‑β1 (TGF‑β1) pathway in a model of human mesangial cells (HMCs) exposed to a high glucose (HG) and lysophosphatidylcholine (LPC) environment. HMCs were divided into three treatment groups: Control, high glucose and lysophosphatidylcholine (HG+LPC), and HG+LPC+atorvastatin. Cells were cultured for 24 h. The levels of the ECM‑associated molecules collagen IV (Col IV) and fibronectin (Fn) in the supernatant were detected using an ELISA kit. PKC‑β1, TGF‑β1 and PAF‑receptor gene expression was detected by reverse transcription‑quantitative polymerase chain reaction. PKC‑β1 and TGF‑β1 protein expression was detected by western blotting, and the subcellular localization of PKC‑β1 was assessed using immunofluorescence. The results indicated that atorvastatin may reduce the secretion of ECM components (Fn and Col IV) in HMCs in a HG and LPC environment, by inhibiting the increase in PAF secretion and the activation of the PKC‑TGF‑β1 signaling pathway.
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Affiliation(s)
- Yan-Hua Xiao
- Department of Endocrinology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541001, P.R. China
| | - Xiao-Yun He
- Department of Endocrinology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541001, P.R. China
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410078, P.R. China
| | - Qing Han
- Department of Endocrinology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541001, P.R. China
| | - Fan Yang
- Department of Endocrinology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541001, P.R. China
| | - Su-Xian Zhou
- Department of Endocrinology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541001, P.R. China
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Segarra A, Romero K, Agraz I, Ramos N, Madrid A, Carnicer C, Jatem E, Vilalta R, Lara LE, Ostos E, Valtierra N, Jaramillo J, Arredondo KV, Ariceta G, Martinez C. Mesangial C4d Deposits in Early IgA Nephropathy. Clin J Am Soc Nephrol 2018; 13:258-264. [PMID: 29146701 PMCID: PMC5967419 DOI: 10.2215/cjn.02530317] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 03/07/2017] [Accepted: 10/04/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The prognostic value of mesangial C4d deposits in IgA nephropathy has been analyzed in patients with reduced GFR but has not been analyzed in those with normal kidney function. The main objective of the study was to analyze the prognostic value of C4d deposits and association with response to treatment in patients with IgA nephropathy and normal GFR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective cohort study included 190 patients with idiopathic IgA nephropathy diagnosed by kidney biopsy between 1988 and 2005. The patients had GFR≥80 ml/min per 1.73 m2 at the time of diagnosis, and they had a paraffin-embedded kidney biopsy with eight glomeruli available. RESULTS In total, 170 (89%) and 20 (11%) patients were >18 and <18 years old, respectively; median (interquartile range) follow-up was 15 (12-22) years. Mesangial C4d deposit prevalence was 20% (38 of 190). At diagnosis, C4d-positive versus -negative patients had higher protein-to-creatinine ratio (median [interquartile range]: 1.94 g/g [0.9-3.1] versus 1.45 g/g [0.9-2.2]; P=0.04). During follow-up, C4d-positive patients showed a higher number of nephritic flares (median [range]: 1.4 [0-5] versus 0.9 [0-2]; P=0.04), had a higher protein-to-creatinine ratio (median [interquartile range]: 1.32 g/g [0.7-1.7] versus 0.89 g/g [0.1-1.3]; P<0.01), were more prone to receive repeated treatment with corticosteroids (45% versus 24%; P<0.01), and showed a larger reduction in eGFR (-1.6 versus -0.8 ml/min per 1.73 m2 per year; P=0.04). Furthermore, the presence of mesangial C4d deposits was an independent predictor of long-term kidney survival. CONCLUSIONS C4d deposits may be one of the earliest poor prognostic variables available for patients with idiopathic IgA nephropathy and normal kidney function at the time of diagnosis. However, Cd4 deposits alone are not associated with the response to angiotensin blockers or corticosteroid treatment.
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Affiliation(s)
| | | | | | | | | | | | - Elias Jatem
- Unidad de Investigación de Nefrologia Clínica, Hospital Vall d’Hebron, Barcelona, Spain; and
| | | | | | - Elena Ostos
- Unidad de Investigación de Nefrologia Clínica, Hospital Vall d’Hebron, Barcelona, Spain; and
| | - Naiara Valtierra
- Unidad de Investigación de Nefrologia Clínica, Hospital Vall d’Hebron, Barcelona, Spain; and
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Abstract
Recently, a number of reports have described dominant C3 deposits in renal biopsies of patients with infection-related glomerulonephritis (GN). While acute post-infectious GN and membranoproliferative GN are commonly characterized by immune deposits containing C3 and/or C4, the absence of immunoglobulin (Ig) and/or immune complexes at light or electron microscopy is a rather unusual observation. Dominant C3 deposition is believed to result from the alternative pathway of complement activation via the C3bBb "tickover" convertase. The actual occurrence of C3 glomerulopathy could be underestimated, since infection-related GN often quickly subsides without the need for a renal biopsy. A more thorough understanding of the pathways that lead to complement assembly and deposition within the kidney is needed to support a new classification of complement-related lesions, including entities such as dense deposit disease, (atypical) hemolytic-uremic syndrome, dominant C1q, CFHR5, C4d, and C3 glomerulopathies. We will briefly review recent work in this area, focusing on GN with selective complement C3 deposits.
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Affiliation(s)
- Nicola Pirozzi
- Department of Clinical and Molecular Medicine, University of Rome "La Sapienza", Rome, Italy
- Chair and Division of Nephrology, Sant'Andrea University Hospital, Rome, Italy
| | - Antonella Stoppacciaro
- Department of Clinical and Molecular Medicine, University of Rome "La Sapienza", Rome, Italy
- Division of Pathology, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Menè
- Department of Clinical and Molecular Medicine, University of Rome "La Sapienza", Rome, Italy.
- Chair and Division of Nephrology, Sant'Andrea University Hospital, Rome, Italy.
- UOC Nefrologia, A.O. Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
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Bera A, Das F, Ghosh-Choudhury N, Mariappan MM, Kasinath BS, Ghosh Choudhury G. Reciprocal regulation of miR-214 and PTEN by high glucose regulates renal glomerular mesangial and proximal tubular epithelial cell hypertrophy and matrix expansion. Am J Physiol Cell Physiol 2017; 313:C430-C447. [PMID: 28701356 PMCID: PMC5668576 DOI: 10.1152/ajpcell.00081.2017] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 04/05/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 02/06/2023]
Abstract
Aberrant expression of microRNAs (miRs) contributes to diabetic renal complications, including renal hypertrophy and matrix protein accumulation. Reduced expression of phosphatase and tensin homolog (PTEN) by hyperglycemia contributes to these processes. We considered involvement of miR in the downregulation of PTEN. In the renal cortex of type 1 diabetic mice, we detected increased expression of miR-214 in association with decreased levels of PTEN and enhanced Akt phosphorylation and fibronectin expression. Mesangial and proximal tubular epithelial cells exposed to high glucose showed augmented expression of miR-214. Mutagenesis studies using 3'-UTR of PTEN in a reporter construct revealed PTEN as a direct target of miR-214, which controls its expression in both of these cells. Overexpression of miR-214 decreased the levels of PTEN and increased Akt activity similar to high glucose and lead to phosphorylation of its substrates glycogen synthase kinase-3β, PRAS40, and tuberin. In contrast, quenching of miR-214 inhibited high-glucose-induced Akt activation and its substrate phosphorylation; these changes were reversed by small interfering RNAs against PTEN. Importantly, respective expression of miR-214 or anti-miR-214 increased or decreased the mammalian target of rapamycin complex 1 (mTORC1) activity induced by high glucose. Furthermore, mTORC1 activity was controlled by miR-214-targeted PTEN via Akt activation. In addition, neutralization of high-glucose-stimulated miR-214 expression significantly inhibited cell hypertrophy and expression of the matrix protein fibronectin. Finally, the anti-miR-214-induced inhibition of these processes was reversed by the expression of constitutively active Akt kinase and hyperactive mTORC1. These results uncover a significant role of miR-214 in the activation of mTORC1 that contributes to high-glucose-induced mesangial and proximal tubular cell hypertrophy and fibronectin expression.
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Affiliation(s)
- Amit Bera
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Falguni Das
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Nandini Ghosh-Choudhury
- Veterans Affairs Biomedical Laboratory Research, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Pathology, UT Health San Antonio, San Antonio, Texas; and
| | | | - Balakuntalam S Kasinath
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
- Veterans Affairs Biomedical Laboratory Research, South Texas Veterans Health Care System, San Antonio, Texas
| | - Goutam Ghosh Choudhury
- Department of Medicine, UT Health San Antonio, San Antonio, Texas;
- Veterans Affairs Biomedical Laboratory Research, South Texas Veterans Health Care System, San Antonio, Texas
- Geriatric Research, Education and Clinical Research, South Texas Veterans Health Care System, San Antonio, Texas
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Lu G, Zhang X, Shen L, Qiao Q, Li Y, Sun J, Zhang J. CCL20 secreted from IgA1-stimulated human mesangial cells recruits inflammatory Th17 cells in IgA nephropathy. PLoS One 2017; 12:e0178352. [PMID: 28552941 PMCID: PMC5446182 DOI: 10.1371/journal.pone.0178352] [Citation(s) in RCA: 16] [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: 01/15/2017] [Accepted: 05/11/2017] [Indexed: 12/22/2022] Open
Abstract
IgA nephropathy (IgAN) is the most common primary glomerulonephritis characterized by human mesangial cells (HMC) proliferation and extracellular matrix expansion associated with immune deposits consisting of galactose-deficient IgA1. However, how IgA1 contributes to IgAN has yet to be completely elucidated. In this study, the expression profile of chemokines was more altered in IgA1-treated HMC than in the control group. CCL20 was significantly higher either in the serum of IgAN patients or in IgA1-treated HMC. Further experiments demonstrated that CCR6, the only receptor of CCL20, was highly expressed in activated T cells. Intracellular staining assay and cytokine expression profile implied that CCR6+ T cells produced high IL-17 levels. Transwell experiment immunohistochemistry and immunofluorescence experiments extensively demonstrated that CCL20 could recruit inflammatory Th17 cells to the kidneys. These phenomena caused a series of immune inflammatory responses and further damaged the kidneys. Therefore, HMC stimulated by IgA1 could produce CCL20 and consequently recruit inflammatory Th17 cells to the kidneys to induce further lesion in IgA nephropathy.
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Affiliation(s)
- Guoyuan Lu
- Department of Internal Medicine, Division of Nephrology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Xiaopan Zhang
- Department of Internal Medicine, Division of Nephrology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Lei Shen
- Department of Internal Medicine, Division of Nephrology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Qing Qiao
- Department of Internal Medicine, Division of Nephrology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Yuan Li
- Department of Internal Medicine, Division of Nephrology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Jieqiong Sun
- Department of Internal Medicine, Division of Nephrology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Jinping Zhang
- Institutes of Biology and Medical Sciences, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
- * E-mail:
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27
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徐 小, 祝 爽, 王 晓, 邵 小, 李 宾, 张 瑛, 刘 琴, 黎 嘉, 王 红, 李 永, 邹 和. [Clinical and pathological features in IgA nephropathy with IgG deposition in the glomerular mesangial area]. Nan Fang Yi Ke Da Xue Xue Bao 2017; 37:308-311. [PMID: 28377344 PMCID: PMC6780451 DOI: 10.3969/j.issn.1673-4254.2017.03.05] [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] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the relationship between the clinical and pathological findings in IgA nephropathy with or without IgG deposition in the glomerular mesangial area. METHODS The data were collected from 122 patients with a diagnosis of IgA nephropathy by renal biopsy in the Third Affiliated Hospital of Southern Medical University between November, 2009 and February, 2016. All the samples were examined by light microscopy, immunofluorescence and electron microscopy. According to the results of immunofluorescence assay, the patients were divided into IgA group (n=63) and IgA-IgG group (n=59). The pathological classification of IgA nephropathy was analyzed according to Oxford classification and Lee's classification. The clinical and pathological findings were compared between the two groups. RESULTS Compared with the patients with IgA nephropathy but without IgG deposition, patients with IgA nephropathy with IgG deposition had higher serum creatinine, higher 24-h urine protein, higher blood uric acid, higher triglyceride levels (P<0.05) and lower eGFR (P<0.05); more of these patients were in Lee's grade IV-V, had renal tubular atrophy and/or interstitial fibrosis, and had MEST scores more than 3 (P<0.05). CONCLUSION Patients with IgA nephropathy with IgG deposition in the glomerular mesangial have severer clinical symptoms and more serious pathological changes. Measures should be taken to control IgG deposition in patients with IgA nephropathy to delay the progress of the disease.
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Affiliation(s)
- 小蒙 徐
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 爽爽 祝
- 广州金域医学检验中心肾脏病理室,广东 广州 510630Department of Renal Pathology, King Medical Diagnostics Center, Guangzhou, 510630, China
| | - 晓红 王
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 小飞 邵
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 宾 李
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 瑛 张
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 琴 刘
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 嘉敏 黎
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 红蕾 王
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 永强 李
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 和群 邹
- 南方医科大学第三附属医院肾内科//泌尿疾病研究所,广东 广州 510630Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
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28
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Crivellenti LZ, Silva GEB, Borin-Crivellenti S, Cianciolo R, Adin CA, Dantas M, dos Anjos DS, Tinucci-Costa M, Santana AE. Prevalence of Glomerulopathies in Canine Mammary Carcinoma. PLoS One 2016; 11:e0164479. [PMID: 27764139 PMCID: PMC5072677 DOI: 10.1371/journal.pone.0164479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/12/2016] [Accepted: 09/25/2016] [Indexed: 12/22/2022] Open
Abstract
The incidence and prevalence of paraneoplastic glomerulopathy, especially associated with carcinoma, are a matter of debate and the causal link between cancer and glomerular diseases remains unclear. The aim of this study was to evaluate renal biopsies of selected bitches with spontaneous mammary gland carcinoma. We hypothesized that dogs with mammary carcinomas would show histologic evidence of glomerular pathology. A prospective study was performed in dogs with naturally occurring mammary carcinoma that were undergoing tumor resection and ovariohysterectomy. We evaluated renal biopsies of 32 bitches with spontaneous mammary gland carcinoma and 11 control dogs without mammary gland neoplasia. Samples were obtained from the left kidney and the biopsy material was divided for light microscopy (LM), immunofluorescence (IF) and transmission electron microscopy (TEM). Light microscopy abnormalities were identified in 78.1% of dogs with mammary carcinoma (n = 25) and in none of the dogs in the control group. Focal glomerular mesangial matrix expansion was the most common alteration (n = 15, 60.0%), but mesangial cell proliferation (n = 9, 36.0%) and focal segmental glomerulosclerosis (n = 9, 36.0%), synechiae (n = 7, 28.0%), and globally sclerotic glomeruli (n = 6, 24.0%) were also frequent in dogs with malignancy. Immunofluorescence microscopy revealed strong IgM staining was demonstrated in 64.3% (n = 18) of carcinoma dogs. Transmission electron microscopy from dogs with carcinoma revealed slight changes, the most frequent of which was faint sub-endothelial and mesangial deposits of electron-dense material (78%). Mesangial cell interpositioning and segmental effacement of podocyte foot processes were identified in some specimens (45%). Changes in the glomerulus and proteinuria are common in dogs with naturally occurring mammary carcinoma and this condition appears to provide an excellent large animal model for cancer-associated glomerulopathy in humans.
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Affiliation(s)
- Leandro Z. Crivellenti
- Department of Veterinary Clinic and Surgery, Franca University (UNIFRAN), Franca, Brazil
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
- Department of Renal Pathology, Faculty of Medicine of Ribeirão Preto, Universidade do Estado de São Paulo (USP), São Paulo, Brazil
- * E-mail:
| | - Gyl E. B. Silva
- Department of Renal Pathology, Faculty of Medicine of Ribeirão Preto, Universidade do Estado de São Paulo (USP), São Paulo, Brazil
| | - Sofia Borin-Crivellenti
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
| | - Rachel Cianciolo
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, United States of America
| | - Christopher A. Adin
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, United States of America
| | - Márcio Dantas
- Department of Internal Medicine (Division of Nephrology), Faculty of Medicine of Ribeirão Preto, Universidade do Estado de São Paulo (USP), São Paulo, Brazil
| | - Denner S. dos Anjos
- Department of Veterinary Clinic and Surgery, Franca University (UNIFRAN), Franca, Brazil
| | - Mirela Tinucci-Costa
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
| | - Aureo E. Santana
- Department of Veterinary Clinic and Surgery, São Paulo State University (UNESP), Jaboticabal, Brazil
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29
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Kim IH, Xu J, Liu X, Koyama Y, Ma HY, Diggle K, You YH, Schilling JM, Jeste D, Sharma K, Brenner DA, Kisseleva T. Aging increases the susceptibility of hepatic inflammation, liver fibrosis and aging in response to high-fat diet in mice. Age (Dordr) 2016; 38:291-302. [PMID: 27578257 PMCID: PMC5061686 DOI: 10.1007/s11357-016-9938-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 07/14/2016] [Indexed: 04/17/2023]
Abstract
We aimed to investigate whether aging increases the susceptibility of hepatic and renal inflammation or fibrosis in response to high-fat diet (HFD) and explore the underlying genetic alterations. Middle (10 months old) and old (20 months old) aged, male C57BL/6N mice were fed either a low-fat diet (4 % fat) or HFD (60 % fat) for 4 months. Young (3 months old) aged mice were included as control group. HFD-induced liver and kidney injuries were analyzed by serum and urine assay, histologic staining, immunohistochemistry, and reverse-transcription real-time quantitative polymerase chain reaction. Total RNA sequencing with next-generation technology was done with RNA extracted from liver tissues. With HFD feeding, aged was associated with higher serum alanine aminotransferase levels, marked infiltration of hepatic macrophages, and increased expression of inflammatory cytokines (MCP1, TNF-α, IL-1β, IL-6, IL-12, IL-17A). Importantly, aged mice showed more advanced hepatic fibrosis and increased expression of fibrogenic markers (Col-I-α1, αSMA, TGF-β1, TGF-β2, TGFβRII, PDGF, PDGFRβII, TIMP1) in response to HFD. Aged mice fed on HFD also showed increased oxidative stress and TLR4 expression. In the total RNA seq and gene ontology analysis of liver, old-aged HFD group showed significant up-regulation of genes linked to innate immune response, immune response, defense response, inflammatory response compared to middle-aged HFD group. Meanwhile, aging and HFD feeding showed significant increase in glomerular size and mesangial area, higher urine albumin/creatinine ratio, and advanced renal inflammation or fibrosis. However, the difference of HFD-induced renal injury between old-aged group and middle-aged group was not significant. The susceptibility of hepatic fibrosis as well as hepatic inflammation in response to HFD was significantly increased with aging. In addition, aging was associated with glomerular alterations and increased renal inflammation or fibrosis, while the differential effect of aging on HFD-induced renal injury was not remarkable as shown in the liver.
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Affiliation(s)
- In Hee Kim
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
- Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Jun Xu
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
| | - Xiao Liu
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
| | - Yukinori Koyama
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
| | - Hsiao-Yen Ma
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
| | - Karin Diggle
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
| | - Young-Hyun You
- Center for Renal Translational Medicine, Division of Nephrology-Hypertension, University of California, La Jolla, San Diego, CA, USA
| | - Jan M Schilling
- Department of Anesthesiology, University of California, La Jolla, San Diego, CA, USA
| | - Dilip Jeste
- Departments of Psychiatry and Neurosciences, and the Sam and Rose Stein Institute for Research on Aging, University of California, La Jolla, San Diego, CA, USA
| | - Kumar Sharma
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
| | - David A Brenner
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA
| | - Tatiana Kisseleva
- Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive # 0702, La Jolla, San Diego, CA, 92093, USA.
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30
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Hirano K, Amano H, Kawamura T, Watanabe K, Koike K, Shimizu A, Endo S, Tsuboi N, Okonogi H, Miyazaki Y, Ikeda M, Hanaoka K, Ogura M, Komatsumoto S, Yokoo T. Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification. Clin Exp Nephrol 2016; 20:425-32. [PMID: 26415960 PMCID: PMC4891371 DOI: 10.1007/s10157-015-1170-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/12/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND In patients with IgA nephropathy (IgAN), recurrence after steroid pulse therapy is associated with reduced renal survival. However, the predictors of recurrence have not yet been clarified. METHODS All patients who received 6-month steroid pulse therapy from 2004 to 2010 in our four affiliated hospitals and achieved a reduction of proteinuria to <0.4 g/day 1 year after treatment were retrospectively evaluated. The primary outcome was proteinuria ≥1.0 g/day during follow-up or additional antiproteinuric therapy. Two histological classifications were evaluated, the Oxford Classification with a split system and Japanese histological grades (HGs) with a lumped system. RESULTS During a median follow-up of 3.4 years, 27 (26.7 %) of the 101 patients showed recurrence. Multivariate analysis showed that HG was the only significant predictor of recurrence, with HG 2+3+4 vs HG 1 having a hazard ratio of 7.38 (95 % confidence interval 1.52-133). Furthermore, in patients with mesangial hypercellularity according to the Oxford Classification, cumulative rate of recurrence-free survival was greater in patients with steroid therapy plus tonsillectomy compared with those who received steroid therapy alone (Log-rank test, P = 0.022). However, this association was not observed in patients without mesangial hypercellularity. CONCLUSIONS HG is a novel predictor of recurrence after steroid pulse therapy in patients with IgAN. Moreover, the combination of steroid pulse therapy plus tonsillectomy may indicate a lower risk of recurrence in patients with mesangial hypercellularity, as defined by the Oxford Classification.
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Affiliation(s)
- Keita Hirano
- Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan.
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
| | - Hoichi Amano
- Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Tetsuya Kawamura
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Kyoko Watanabe
- Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Akihiro Shimizu
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Satoshi Endo
- Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Hideo Okonogi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Yoichi Miyazaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Masato Ikeda
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Kazushige Hanaoka
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Makoto Ogura
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Satoru Komatsumoto
- Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan
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31
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Ossoli A, Neufeld EB, Thacker SG, Vaisman B, Pryor M, Freeman LA, Brantner CA, Baranova I, Francone NO, Demosky SJ, Vitali C, Locatelli M, Abbate M, Zoja C, Franceschini G, Calabresi L, Remaley AT. Lipoprotein X Causes Renal Disease in LCAT Deficiency. PLoS One 2016; 11:e0150083. [PMID: 26919698 PMCID: PMC4769176 DOI: 10.1371/journal.pone.0150083] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 09/25/2015] [Accepted: 02/09/2016] [Indexed: 12/31/2022] Open
Abstract
Human familial lecithin:cholesterol acyltransferase (LCAT) deficiency (FLD) is characterized by low HDL, accumulation of an abnormal cholesterol-rich multilamellar particle called lipoprotein-X (LpX) in plasma, and renal disease. The aim of our study was to determine if LpX is nephrotoxic and to gain insight into the pathogenesis of FLD renal disease. We administered a synthetic LpX, nearly identical to endogenous LpX in its physical, chemical and biologic characteristics, to wild-type and Lcat-/- mice. Our in vitro and in vivo studies demonstrated an apoA-I and LCAT-dependent pathway for LpX conversion to HDL-like particles, which likely mediates normal plasma clearance of LpX. Plasma clearance of exogenous LpX was markedly delayed in Lcat-/- mice, which have low HDL, but only minimal amounts of endogenous LpX and do not spontaneously develop renal disease. Chronically administered exogenous LpX deposited in all renal glomerular cellular and matrical compartments of Lcat-/- mice, and induced proteinuria and nephrotoxic gene changes, as well as all of the hallmarks of FLD renal disease as assessed by histological, TEM, and SEM analyses. Extensive in vivo EM studies revealed LpX uptake by macropinocytosis into mouse glomerular endothelial cells, podocytes, and mesangial cells and delivery to lysosomes where it was degraded. Endocytosed LpX appeared to be degraded by both human podocyte and mesangial cell lysosomal PLA2 and induced podocyte secretion of pro-inflammatory IL-6 in vitro and renal Cxl10 expression in Lcat-/- mice. In conclusion, LpX is a nephrotoxic particle that in the absence of Lcat induces all of the histological and functional hallmarks of FLD and hence may serve as a biomarker for monitoring recombinant LCAT therapy. In addition, our studies suggest that LpX-induced loss of endothelial barrier function and release of cytokines by renal glomerular cells likely plays a role in the initiation and progression of FLD nephrosis.
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Affiliation(s)
- Alice Ossoli
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Edward B. Neufeld
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Seth G. Thacker
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Boris Vaisman
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Milton Pryor
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Lita A. Freeman
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Christine A. Brantner
- NHLBI Electron Microscopy Core Facility, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Irina Baranova
- Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nicolás O. Francone
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Stephen J. Demosky
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Cecilia Vitali
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Monica Locatelli
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Mauro Abbate
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Carlamaria Zoja
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Guido Franceschini
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Laura Calabresi
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Alan T. Remaley
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
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Ueno T, Kikuchi K, Hazue R, Mise K, Sumida K, Hayami N, Suwabe T, Hoshino J, Sawa N, Arizono K, Hara S, Takaichi K, Fujii T, Ohashi K, Ubara Y. Five Sequential Evaluations of Renal Histology in a Patient with Light Chain Deposition Disease. Intern Med 2016; 55:2993-2999. [PMID: 27746438 PMCID: PMC5109568 DOI: 10.2169/internalmedicine.55.6213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old man was referred to our institution for an evaluation of nephrotic range proteinuria. Renal biopsy showed a marked expansion of the mesangial matrix and thickening of glomerular basement membrane (GBM) in periodic acid-silver methenamine (PAM). Immunofluorescence (IF) revealed strong staining for the monoclonal kappa light chain. EM demonstrated massive subendothelial and mesangial dense deposits. As a result, light chain deposition disease (LCDD) was diagnosed. Melphalan and prednisolone (MP) therapy was started, which was continued for 10 years with minimal complications. Serial evaluations of renal histology revealed the resolution of nodular lesions and the glomeruli became nearly normal. MP therapy can therefore be an effective therapeutic option for LCDD if it is continued over the long term.
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Sweetwyne MT, Gruenwald A, Niranjan T, Nishinakamura R, Strobl LJ, Susztak K. Notch1 and Notch2 in Podocytes Play Differential Roles During Diabetic Nephropathy Development. Diabetes 2015; 64:4099-111. [PMID: 26293507 PMCID: PMC4657584 DOI: 10.2337/db15-0260] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 08/04/2015] [Indexed: 12/29/2022]
Abstract
Notch pathway activation in podocytes has been shown to play an important role in diabetic kidney disease (DKD) development; however, the receptors and ligands involved in the process have not been identified. Here, we report that conditional deletion of Notch1 in podocytes using NPHS2(cre)Notch1(flox/flox) animals resulted in marked amelioration of DKD. On the contrary, podocyte-specific genetic deletion of Notch2 had no effect on albuminuria and mesangial expansion. Notch1-null podocytes were protected from apoptosis and dedifferentiation in vitro, likely explaining the protective phenotype in vivo. Deletion of Notch1 in podocytes also resulted in an increase in Notch2 expression, indicating an interaction between the receptors. At the same time, transgenic overexpression of Notch2 in podocytes did not induce phenotypic changes, while constitutive expression of Notch1 caused rapid development of albuminuria and glomerulosclerosis. In summary, our studies indicate that Notch1 plays a distinct (nonredundant) role in podocytes during DKD development.
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MESH Headings
- Animals
- Apoptosis
- Biomarkers/metabolism
- Cell Dedifferentiation
- Cell Line, Transformed
- Cells, Cultured
- Crosses, Genetic
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/pathology
- Diabetic Nephropathies/prevention & control
- Glomerular Mesangium/metabolism
- Glomerular Mesangium/pathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Peptide Fragments/genetics
- Peptide Fragments/metabolism
- Podocytes/metabolism
- Podocytes/pathology
- Protein Interaction Domains and Motifs
- RNA, Messenger/metabolism
- Receptor, Notch1/chemistry
- Receptor, Notch1/genetics
- Receptor, Notch1/metabolism
- Receptor, Notch2/chemistry
- Receptor, Notch2/genetics
- Receptor, Notch2/metabolism
- Recombinant Proteins/chemistry
- Recombinant Proteins/metabolism
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Affiliation(s)
- Mariya T Sweetwyne
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Antje Gruenwald
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thiruvur Niranjan
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ryuichi Nishinakamura
- Department of Kidney Development, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Japan
| | - Lothar J Strobl
- Department of Gene Vectors, Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Katalin Susztak
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Yang G, Cheng Q, Liu S, Zhao J. The Role of Bone Marrow Cells in the Phenotypic Changes Associated with Diabetic Nephropathy. PLoS One 2015; 10:e0137245. [PMID: 26340671 PMCID: PMC4560440 DOI: 10.1371/journal.pone.0137245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 05/22/2015] [Accepted: 08/14/2015] [Indexed: 12/13/2022] Open
Abstract
The aim of our study was to investigate the role of bone marrow cells in the phenotypic changes that occur in diabetic nephropathy. Bone marrow cells were obtained from either streptozotocin-induced diabetic or untreated control C3H/He mice and transplanted into control C3H/He mice. Eight weeks after bone marrow cell transplantation, renal morphologic changes and clinical parameters of diabetic nephropathy, including the urine albumin/creatinine ratio and glucose tolerance, were measured in vivo. Expression levels of the genes encoding α1 type IV collagen and transforming growth factor-β1 in the kidney were assayed. Our results demonstrated that glucose tolerance was normal in the recipients of bone marrow transplants from both diabetic and control donors. However, compared with recipients of the control bone marrow transplant, the urinary albumin/creatinine ratio, glomerular size, and the mesangial/glomerular area ratio increased 3.3-fold (p < 0.01), 1.23-fold (p < 0.01), and 2.13-fold (p < 0.001), respectively, in the recipients of the diabetic bone marrow transplant. Expression levels of the genes encoding glomerular α1 type IV collagen and transforming growth factor-β1 were also significantly increased (p < 0.01) in the recipients of the diabetic bone marrow transplant. Our data suggest that bone marrow cells from the STZ-induced diabetic mice can confer a diabetic phenotype to recipient control mice without the presence of hyperglycemia.
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Affiliation(s)
- Guang Yang
- Department of Geriatric Nephrology, Chinese People’s Liberation Army General Hospital, State Key Laboratory of Kidney Disease, Beijing, China
| | - Qingli Cheng
- Department of Geriatric Nephrology, Chinese People’s Liberation Army General Hospital, State Key Laboratory of Kidney Disease, Beijing, China
- * E-mail:
| | - Sheng Liu
- Department of Geriatric Nephrology, Chinese People’s Liberation Army General Hospital, State Key Laboratory of Kidney Disease, Beijing, China
| | - Jiahui Zhao
- Department of Geriatric Nephrology, Chinese People’s Liberation Army General Hospital, State Key Laboratory of Kidney Disease, Beijing, China
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Mokhtar GA, Jalalah SM. A clinicopathological study of C1q nephropathy at King Abdulaziz University. Iran J Kidney Dis 2015; 9:279-285. [PMID: 26174454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION C1q nephropathy is a relatively rare idiopathic glomerulopathy characterized by mesangial immunoglobulin and complement deposits with dominance or co-dominance of C1q, with no evidence of systemic lupus erythematosus. We describe the incidence, clinical manifestation, histopathological features, and follow-up of patients with C1q nephropathy at our institute. MATERIALS AND METHODS Of 750 kidney biopsy specimens obtained in the period of January 2000 to December 2011, all the cases that meet the criteria for the diagnosis of C1q nephropathy were retrieved. The histological slides were examined and the clinical charts were reviewed by 2renal pathologists. RESULTS We had 11 patients, all children, that met the criteria for the diagnosis of C1q nephropathy accounting for an incidence of 1.5%. The mean age at the time of presentation was 3.7 years and all the patients were presented with nephrotic syndrome. Two patients had microhematuria and 2 had hypertension. Histological examination of these cases showed variable degrees of mesangial cells hypercellularity and matrix expansion with focal segmental glomerulosclerosis observed in 2 cases. Nine patients were steroid resistant (82%) and 2 were steroid dependent. Six patients required immunosuppressive therapy and 1 patient developed end-stage renal disease. CONCLUSIONS In our series, C1q nephropathy affected predominantly young children. Mesangioproliferative pattern was the most frequent histopathological finding in these patients. Clinically, despite steroid resistance, the patients had a relatively good outcome; the worst prognostic outcome was associated with collapsing glomerulopathy.
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Affiliation(s)
- Ghadeer A Mokhtar
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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36
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Zhu K, Kakehi T, Matsumoto M, Iwata K, Ibi M, Ohshima Y, Zhang J, Liu J, Wen X, Taye A, Fan C, Katsuyama M, Sharma K, Yabe-Nishimura C. NADPH oxidase NOX1 is involved in activation of protein kinase C and premature senescence in early stage diabetic kidney. Free Radic Biol Med 2015; 83:21-30. [PMID: 25701431 DOI: 10.1016/j.freeradbiomed.2015.02.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/16/2015] [Accepted: 02/09/2015] [Indexed: 11/24/2022]
Abstract
Increased oxidative stress and activation of protein kinase C (PKC) under hyperglycemia have been implicated in the development of diabetic nephropathy. Because reactive oxygen species derived from nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, NOX1 accelerate the translocation of PKC isoforms, NOX1 is postulated to play a causative role in the development of diabetic nephropathy. Hyperglycemia was induced in wild-type and Nox1-deficient mice (KO) by two doses of streptozotocin injection. At 3 weeks after the induction of hyperglycemia, glomeruli and cortical tubules were isolated from kidneys. The mRNA level of Nox1 was significantly upregulated in the renal cortex at 3 weeks of hyperglycemia. Urinary albumin and expression of inflammatory or fibrotic mediators were similarly elevated in diabetic wild-type and KO; however, increases in glomerular volume and mesangial matrix area were attenuated in diabetic KO. Nox1 deficiency significantly reduced the levels of renal thiobarbituric acid-reacting substances and 8-hydroxydeoxyguanosine, membranous translocation of PKCα/β, activity of PKC, and phosphorylation of p38 mitogen-activated protein kinase in the diabetic kidney. Furthermore, increased staining of senescence-associated β-galactosidase in glomeruli and cortical tubules of diabetic mice was significantly suppressed in KO. Whereas the levels of cyclin-dependent kinase inhibitors, p16(INK4A) and p21(Cip1), were equivalent between the genotypes, increased levels of p27(Kip1) and γ-H2AX, a biomarker for DNA double-strand breaks, were significantly attenuated in isolated glomeruli and cortical tubules of diabetic KO. Taken together, NOX1 modulates the p38/p27(Kip1) signaling pathway by activating PKC and promotes premature senescence in early stage diabetic nephropathy.
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Affiliation(s)
- Kai Zhu
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Tomoko Kakehi
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Misaki Matsumoto
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Kazumi Iwata
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Masakazu Ibi
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Yoichi Ohshima
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Jia Zhang
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Junjie Liu
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Xiaopeng Wen
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Ashraf Taye
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Chunyuan Fan
- Dujiangyan City Medical Center, Dujiangyan Chengdu, 611830 Sichuan, China
| | - Masato Katsuyama
- Radioisotope Center, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Kumar Sharma
- Center for Renal Translational Medicine, Division of Nephrology-Hypertension, Department of Medicine, University of California at San Diego and VA San Diego Healthcare System, La Jolla, CA 92093, USA
| | - Chihiro Yabe-Nishimura
- Department of Pharmacology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
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37
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White K. Glomerular structure in diabetes - can it predict the future? Am J Nephrol 2015; 41:275-6. [PMID: 26021407 DOI: 10.1159/000430850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kathryn White
- Newcastle University - EM Research Services, Faculty of Medical Sciences, Newcastle upon Tyne, UK
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38
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Harindhanavudhi T, Parks A, Mauer M, Caramori ML. Podocyte structural parameters do not predict progression to diabetic nephropathy in normoalbuminuric type 1 diabetic patients. Am J Nephrol 2015; 41:277-83. [PMID: 26021523 DOI: 10.1159/000381992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Podocyte injury has been implicated in diabetic nephropathy (DN) ranging from normoalbuminuria to proteinuria in both type 1 and type 2 diabetes. METHODS To determine whether podocyte structural parameters predict DN risk in initially normoalbuminuric long-standing type 1 diabetic patients, we performed a nested case-control study in sex and diabetes duration-matched progressors (progression to proteinuria or ESRD, n = 10), non-progressors (normoalbuminuric at follow-up, n = 10), and non-diabetic controls (n = 10). RESULTS HbA1c and diastolic blood pressure were higher in progressors versus non-progressors. Podocyte number per glomerulus, numerical density of podocyte per glomerulus, and foot process width were not different among groups. The glomerular basement membrane width was greater in progressors versus non-progressors or controls, and in non-progressors versus controls. As expected, the mesangial fractional volume was greater in progressors and non-progressors versus controls, with no differences between progressors and non-progressors. CONCLUSION This study does not indicate that podocyte structural changes are preconditions for later DN progression in initially normoalbuminuric type 1 diabetic patients. However, this does not preclude an important role for podocyte injury at a later stage of DN.
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Gesualdo L, Di Paolo S, Ranieri E, Schena FP. Growth factors and their receptors in the progression of renal damage. Contrib Nephrol 2015; 111:38-44. [PMID: 7758345 DOI: 10.1159/000423875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- L Gesualdo
- Division of Nephrology, University of Bari, Italy
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40
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Eng E, Floege J, Young BA, Alpers CE, Couser WG, Johnson RJ. Is mesangial cell proliferation required for extracellular matrix expansion in glomerular disease? Contrib Nephrol 2015; 107:156-62. [PMID: 8004962 DOI: 10.1159/000422974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- E Eng
- Department of Medicine, University of Washington, Seattle
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41
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Affiliation(s)
- G Tesch
- Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
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42
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Affiliation(s)
- R Waldherr
- Department of Pathology, University of Heidelberg, Mannheim, FRG
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43
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Kashgarian M, Oshima S, Takeuchi A, Throckmorton D, Rasmussen H. The contribution of mesangial cell collagen synthesis to the pathogenesis of diabetic nephropathy. Contrib Nephrol 2015; 107:132-9. [PMID: 8004959 DOI: 10.1159/000422971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Kashgarian
- Yale University School of Medicine, New Haven, Conn
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44
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Gómez-Guerrero C, González E, Hernando P, Ruiz-Ortega M, Egido J. Interaction of mesangial cells with IgA and IgG immune complexes: a possible mechanism of glomerular injury in IgA nephropathy. Contrib Nephrol 2015; 104:127-37. [PMID: 8391962 DOI: 10.1159/000422405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- C Gómez-Guerrero
- Renal Unit, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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45
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Gómez-Guerrero C, Alonso J, López-Armada MJ, Ruiz-Ortega M, Gómez-Garre D, Alcazar R, Gonzalez E, Egido J. Potential factors governing extracellular matrix production by mesangial cells: their relevance for the pathogenesis of IgA nephropathy. Contrib Nephrol 2015; 111:45-54. [PMID: 7758346 DOI: 10.1159/000423876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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46
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47
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Coppo R, Amore A, Gianoglio B, Reyna A, Peruzzi L, Roccatello D, Alessi D, Sena LM. Serum IgA and macromolecular IgA reacting with mesangial matrix components. Contrib Nephrol 2015; 104:162-71. [PMID: 8325027 DOI: 10.1159/000422409] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R Coppo
- Nephrology and Dialysis Department, Regina Margherita Children's Hospital, Turin, Italy
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48
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Affiliation(s)
- J Grond
- Department of Pathology, University of Groningen, The Netherlands
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49
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Affiliation(s)
- G D'Amico
- Division of Nephrology, S. Carlo Hospital, Milano, Italia
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50
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Affiliation(s)
- W F Keane
- Department of Medicine, Hennepin County Medical Center, University of Minnesota Medical School, USA
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