Collapsing Glomerulopathy: A Review by the Collapsing Brazilian Consortium

Collapsing glomerulopathy (CG) is a clinicopathologic entity characterized by segmentar or global collapse of the glomerulus and hypertrophy and hyperplasia of podocytes. The Columbia classification of 2004 classified CG as a histological subtype of focal segmental glomerulosclerosis (FSGS). A growing number of studies have demonstrated a high prevalence of CG in many countries, especially among populations with a higher proportion of people with African descent. The present study is a narrative review of articles extracted from PubMed, Medline, and Scielo databases from September 1, 2020 to December 31, 2021. We have focused on populational studies (specially cross-sectional and cohort articles). CG is defined as a podocytopathy with a distinct pathogenesis characterized by strong podocyte proliferative activity. The most significant risk factors for CG include APOL1 gene mutations and infections with human immunodeficiency virus and severe acute respiratory syndrome coronavirus 2. CG typically presents with more severe symptoms and greater renal damage. The prognosis is notably worse than that of other FSGS subtypes.

Antibrush Border Antibody Disease: A Case Report and Literature Review

Anti-brush border antibody (ABBA) disease, also called anti-low-density lipoprotein receptor-related protein 2 (anti-LRP2) nephropathy, occurs due to the formation of antibodies against brush border antigens of the renal proximal convoluted tubule. We report a case of ABBA disease in a male farmer in his 30s who presented with 2 years of polyuria, dysuria, nocturia, and urinary urgency. He described a history of long-term occupational exposure to pesticides and silica, evolving into possible pneumoconiosis, and prior pulmonary tuberculosis. At presentation, he had reduced kidney function (serum creatinine 3.6 mg/dL) with hyponatremia, hypokalemia, hypophosphatemia, a normal anion gap, metabolic acidosis, and respiratory acidosis, and 2.2 g/day of urine proteinuria. The kidney biopsy was consistent with ABBA, showing amorphous immune-deposits in the tubular basement membrane and strong positivity on indirect immunofluorescence in the brush border of the proximal tubules. The trigger for production of ABBA is still unknown, but it may be associated with chronic conditions such as pulmonary tuberculosis and occupational exposures such as silica and pesticides, as seen in the patient in this report. Most cases do not respond to immunosuppression, and the prognosis is poor.

Non-lupus full-house nephropathy: a case series

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.

Brazilian Consortium for the Study on Renal Diseases Associated With COVID-19: A Multicentric Effort to Understand SARS-CoV-2-Related Nephropathy

Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2.

Renal involvement in systemic lupus erythematosus: additional histopathological lesions

A common criticism of the classification of lupus nephritis is the relative scarcity of information regarding tubular, interstitial, and vascular changes compared to the available information regarding glomerular changes, even though their potential for independent progression is known. This study reviewed the importance of less explored lesions by the current and widely used 2003 classification of lupus nephritis of the International Society of Nephrology/Renal Pathology Society (ISN/RPS), with emphasis on the tubulointerstitial, podocyte, and vascular lesions, increasingly recognised as being important in the pathogenesis and prognosis of the disease. Recognition of these lesions can help with therapeutic decision-making, thereby allowing better results for patients with systemic lupus erythematosus.

Translumbar hemodialysis long-term catheters: an alternative for vascular access failure

Introduction:

Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option.

Objectives:

To describe placement technic, complications, and patency of 12 TLDC.

Methods:

A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency.

Results:

All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%.

Conclusion:

TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.

Genetic control of the number of leaves above the ear in maize

In this study, we examined the genetic control of the number of leaves above the first ear in maize. The F₂ generations and the backcrosses were obtained from 2 contrasting lines for this trait. All generations were assessed in a completely randomized block design with 2 replications. The number of leaves above the ear was counted when the plants were in the tasseling stage at the level of plants per plot. Mean and variance components were estimated using the weighted least square method. We observed a predominance of non-additive effects in the genetic control of number of leaves above the ear. These results indicate that this trait shows high heritability.

Genetic control of leaf curl in maize

Among the many implications of climatic change on agriculture, drought is expected to continue to have a major impact on agribusinesses. Leaf curling is an anatomical characteristic that might be potentially used to enhance plant tolerance to water deficit. Hence, we aimed to study the genetic control of leaf curl in maize. From 2 contrasting inbred lines for the trait, generations F1, F2, and the backcrosses were obtained. All of these generations were evaluated in a randomized block design with 2 replicates. Leaf curl samples were collected from 3 leaves above the first ear at the tasseling stage, and quantified by dividing the width of the leaf blade with natural curling against its extended width. The mean and variance components were estimated by the weighted least square method. It was found that the trait studied has predominance of the additive effects, with genetic control being attributed to few genes that favor selection and exhibit minimal influence from the environment.