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Ștefan G, Zugravu A, Stancu S. Glasgow prognostic score as an outcome predictor for patients initiating hemodialysis. Ther Apher Dial 2024; 28:34-41. [PMID: 37596836 DOI: 10.1111/1744-9987.14057] [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: 05/24/2023] [Revised: 07/13/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION This retrospective study examined the relationship between the Glasgow Prognostic Score (GPS) at hemodialysis (HD) initiation and overall/cardiovascular mortality. METHODS A total of 264 patients starting HD between 2014 and 2015 at a single center were studied. Follow-up persisted until therapy change, death, or study end (December 31, 2021), with a median of 6.8 years. RESULTS Patients with a higher GPS more frequently had emergent HD initiation and showed increased eGFR at initiation. During follow-up, 60% of patients died, with cardiovascular disease being the leading cause. Univariate analysis revealed a significant difference in median survival time across GPS classes. Cox proportional hazard models confirmed a significant association between GPS and mortality. CONCLUSIONS We report a significant association between GPS at HD initiation and mortality. GPS may prove useful as a prognostic tool for identifying high-risk patients, underscoring the need for future research to validate these findings and explore the potential of GPS-based interventions.
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Affiliation(s)
- Gabriel Ștefan
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Adrian Zugravu
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Simona Stancu
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
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Ștefan G, Zugravu A, Stancu S. Mortality in IgA Nephropathy: A Long-Term Follow-Up of an Eastern European Cohort. Medicina (Kaunas) 2024; 60:247. [PMID: 38399535 PMCID: PMC10890558 DOI: 10.3390/medicina60020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: IgA nephropathy (IgAN), the most common primary glomerulonephritis, has been extensively studied for renal outcomes, with limited data on patient survival, particularly in Eastern Europe. We aimed to investigate the long-term survival rate of patients with IgAN and the associated risk factors in an Eastern European cohort. Materials and Methods: We conducted a retrospective analysis of 215 IgAN patients (median age 44, 71% male) diagnosed at a Romanian tertiary center between 2010 and 2017. We assessed clinical and pathological attributes, including the Charlson comorbidity index, the prevalence of diabetes, renal function, and treatment with renin-angiotensin-system inhibitors (RASIs). Results: Over a median 7.3-year follow-up, 20% of patients died, mostly due to cardiovascular diseases. Survival rates at 1, 5, and 10 years were 93%, 84%, and 77%, respectively. Deceased patients had higher Charlson comorbidity index scores, greater prevalence of diabetes, and poorer renal function. They were less frequently treated with RASIs and more frequently reached end-stage kidney disease (ESKD). Conclusions: We report a 20% mortality rate in our Eastern European IgAN cohort, primarily due to cardiovascular diseases. Death correlates with increased age, comorbidity burden, decreased renal function at diagnosis, and the absence of RASI use. RASI treatment may potentially improve survival, highlighting its importance in managing IgAN.
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Affiliation(s)
- Gabriel Ștefan
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (A.Z.); (S.S.)
- Nephrology Department, “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Adrian Zugravu
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (A.Z.); (S.S.)
- Nephrology Department, “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Simona Stancu
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (A.Z.); (S.S.)
- Nephrology Department, “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
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Ștefan G, Jullien P, Masson I, Alamartine E, Mariat C, Maillard N. Circulating alternative pathway complement cleavage factor Bb is associated with vascular lesions and outcomes in IgA nephropathy. Nephrol Dial Transplant 2023; 38:ii11-ii18. [PMID: 37816675 DOI: 10.1093/ndt/gfad163] [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: 04/13/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Complement alternative pathway (AP) activation is linked to immunoglobulin A nephropathy (IgAN) prognosis severity, but Bb fragment's role is unclear. We examined the relationship between serum Bb fragment concentration at IgAN diagnosis and disease activity and outcomes. METHODS This retrospective study included 125 biopsy-proven IgAN patients [age 39.9 years, 75% male, estimated glomerular filtration rate (eGFR) 82 ml/min, proteinuria 0.5 g/day] enrolled from 1984 to 2010 and followed for a minimum of 18 months. Monitoring continued until the last follow-up, end-stage kidney disease (ESKD) or death. Serum Bb fragment was measured using an enzyme-linked immunosorbent assay at diagnosis. Oxford classification and global optical score (GOS) were utilized for pathology assessment. RESULTS Patients were followed for a median of 16 years; 42% developed chronic kidney disease stage ≥3, 19% reached ESKD and 9% died. Serum Bb fragment concentration negatively correlated with eGFR values at the last follow-up and positively with vascular and tubular histopathological indices. In univariate Cox regression analyses, higher Bb fragment concentration was associated with ESKD alongside older age, increased body mass index, arterial hypertension, lower eGFR, higher proteinuria, E1, S1, T1-2, GOS and corticotherapy. Patients with Bb levels ≥14.3 μg/ml had shorter mean kidney survival time (19.5 versus 22.7 years, P = .07); after adjusting for progression risk factors, the association persisted [hazard ratio 4.76 (95% confidence interval 1.56-14.43)]. CONCLUSIONS Serum Bb fragment concentration at diagnosis may predict long-term IgAN outcomes, potentially due to AP activation at the endothelial surface. Further research is needed to confirm these results and evaluate Bb fragment's role in IgAN management.
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Affiliation(s)
- Gabriel Ștefan
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- University of Medicine and Pharmacy "Carol Davila", Nephrology Department, Bucharest, Romania
| | - Perrine Jullien
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Ingrid Masson
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Eric Alamartine
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Christophe Mariat
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
| | - Nicolas Maillard
- Service de Néphrologie, Hôpital Nord CHU Saint Etienne, Saint Etienne, France
- Groupe Immunité muqueuse et agents pathogènes (GIMAP, team 15 CIRI INSERM U1111/UMR5108), Saint Etienne, France
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Ștefan G, Cinca S, Chiriac C, Zugravu A, Stancu S. Multiple Myeloma and Kidney Impairment at Diagnosis: A Nephrological Perspective from an Eastern European Country. Medicina (Kaunas) 2023; 59:1326. [PMID: 37512137 PMCID: PMC10384718 DOI: 10.3390/medicina59071326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The clinical presentation and survival factors in patients with myeloma-related kidney impairment (MRKI) at diagnosis remain a topic of ongoing research, given the complex interplay between nephrology and hematology. To date, no studies have specifically reported outcomes for these patients in Eastern Europe. Materials and Methods: We conducted a retrospective, unicentric study of consecutive newly diagnosed patients with MRKI in our tertiary nephrology service in Romania between 2015 and 2020; follow-up extended until 1 September 2022, covering a study period of 90 months. Results: We identified 89 consecutive patients with MRKI (median age 66 years, 38% male, median eGFR 5 mL/min). The majority of patients had arterial hypertension (71%) and systemic atherosclerosis (58%), and the most frequent clinical features at presentation were asthenia (75%) and bone pain (51%). Light-chain-restricted myeloma was the most common type (55%), with kappa free light chain being more frequent (53%). Among the patients, 81% presented with acute kidney injury (AKI), and 38% required hemodialysis at diagnosis. During the study period, 65% of the patients died, and hypoalbuminemia and the need for hemodialysis at diagnosis were significantly associated with mortality in multivariate analysis. Conclusions: Patients with MRKI who present to the nephrologist more frequently exhibit light chain restriction and most often present with AKI, with one-third requiring hemodialysis at diagnosis. Moreover, hypoalbuminemia and the initiation of hemodialysis at diagnosis were significantly associated with increased mortality.
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Affiliation(s)
- Gabriel Ștefan
- Faculty of Medicine, "Carol Davila" University of Medcine and Pharmacy, 050474 Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Simona Cinca
- Faculty of Medicine, "Carol Davila" University of Medcine and Pharmacy, 050474 Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Corina Chiriac
- Faculty of Medicine, "Carol Davila" University of Medcine and Pharmacy, 050474 Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Adrian Zugravu
- Faculty of Medicine, "Carol Davila" University of Medcine and Pharmacy, 050474 Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Simona Stancu
- Faculty of Medicine, "Carol Davila" University of Medcine and Pharmacy, 050474 Bucharest, Romania
- Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, 010731 Bucharest, Romania
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Ștefan G, Chiriac C, Stancu S, Zugravu A, Petre N. Bilateral infiltrative kidney metastasis due to non-keratinizing squamous cell carcinoma of the lung: lesson for the clinical nephrologist. J Nephrol 2023:10.1007/s40620-023-01627-7. [PMID: 37036662 DOI: 10.1007/s40620-023-01627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Gabriel Ștefan
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
- "Dr Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania.
| | - Corina Chiriac
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Simona Stancu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- "Dr Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania
| | - Adrian Zugravu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- "Dr Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania
| | - Nicoleta Petre
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- "Dr Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania
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Busuioc R, Ștefan G, Stancu S, Zugravu A, Mircescu G. Nephrotic Syndrome and Statin Therapy: An Outcome Analysis. Medicina (B Aires) 2023; 59:medicina59030512. [PMID: 36984513 PMCID: PMC10054350 DOI: 10.3390/medicina59030512] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Background and Objectives: Hypercholesterolemia in patients with nephrotic syndrome (NS) may predispose to cardiovascular events and alter kidney function. We aimed to evaluate statins efficiency in NS patients under immunosuppression using four endpoints: remission rate (RR), end-stage kidney disease (ESKD), major cardiovascular events (MACE), and thrombotic complications (VTE). Materials and Methods: We retrospectively examined the outcome at 24 months after diagnosis of 154 NS patients (age 53 (39–64) years, 64% male, estimated glomerular filtration rate (eGFR) 61.9 (45.2–81.0) mL/min). During the follow-up, the lipid profile was evaluated at 6 months and at 1 and 2 years. Results: The median cholesterol level was 319 mg/dL, and 83% of the patients received statins. Patients without statins (17%) had similar age, body mass index, comorbidities, blood lipids levels, NS severity, and kidney function. The most used statin was simvastatin (41%), followed by rosuvastatin (32%) and atorvastatin (27%). Overall, 79% of the patients reached a form of remission, 5% reached ESKD, 8% suffered MACE, and 11% had VTE. The mean time to VTE was longer in the statin group (22.6 (95%CI 21.7, 23.6) versus 20.0 (95%CI 16.5, 23.5) months, p 0.02). In multivariate analysis, statin therapy was not associated with better RR, kidney survival, or fewer MACE; however, the rate of VTE was lower in patients on statins (HR 2.83 (95%CI 1.02, 7.84)). Conclusions: Statins did not improve the remission rate and did not reduce the risk of MACE or ESKD in non-diabetic nephrotic patients. However, statins seemed to reduce the risk of VTE. Further randomized controlled studies are needed to establish statins’ role in NS management.
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Affiliation(s)
- Ruxandra Busuioc
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, “Dr Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Gabriel Ștefan
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, “Dr Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
- Correspondence:
| | - Simona Stancu
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, “Dr Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Adrian Zugravu
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, “Dr Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Gabriel Mircescu
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, “Dr Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
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Ștefan G, Zugravu A, Stancu S. Intravenous cyclophosphamide as an alternative to the oral cyclophosphamide modified Ponticelli regimen for high-risk PLA2R-positive membranous nephropathy. J Nephrol 2023; 36:293-295. [PMID: 35960429 DOI: 10.1007/s40620-022-01426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Gabriel Ștefan
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania.
| | - Adrian Zugravu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania
| | - Simona Stancu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania
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Ștefan G, Stancu S, Zugravu A, Petre N, Secăreanu S, Popa O, Capusa C. Immunosuppressive therapy versus supportive care in IgA nephropathy patients with stage 3 and 4 chronic kidney disease. Medicine (Baltimore) 2022; 101:e30422. [PMID: 36086774 PMCID: PMC10980450 DOI: 10.1097/md.0000000000030422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
The use of immunosuppressive therapy for immunoglobulin A nephropathy (IgAN) patients with stage 3 or 4 chronic kidney disease (CKD) is controversial. We performed a monocentric retrospective study on 83 consecutive IgAN patients with stage 3 or 4 CKD and proteinuria ≥0.75 g/d (age 41 [33-56] years, 72% male, estimated glomerular filtration rate 36.1 [25.4-47.5] mL/min/1.73 m2) who received uncontrolled supportive care (Supp) (n = 36), corticosteroids/corticotherapy (CS) (n = 14), or CS combined with monthly pulses of cyclophosphamide (CS + CFM) (n = 33) between 2010 and 2017. Patients were followed until composite endpoint (doubling of serum creatinine, end-stage kidney disease (dialysis or kidney transplant) or death, whichever came first) or end of study (January 2020). Patients were followed for a median of 29 (95% confidence interval = 25.2-32.7) months, and 12 (15%) patients experienced the composite endpoint. Within the limitation of a retrospective study, our results suggest no benefit from immunosuppressive therapy in patients with IgAN with stage 3 and 4 CKD as compared with supportive care. There were no differences between the 3 studied groups regarding age, estimated glomerular filtration rate, proteinuria, Oxford classification score, arterial hypertension, and therapy with renin-angiotensin system inhibitors. Mean kidney survival time for the entire cohort was 81.0 (95% confidence interval = 73.1-89.0) months, without significant differences between the 3 groups. In univariate and multivariate Cox regression analysis adjusted for IgAN progression factors, immunosuppressive therapy was not associated with better kidney survival when compared with supportive therapy.
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Affiliation(s)
- Gabriel Ștefan
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Simona Stancu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Adrian Zugravu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Nicoleta Petre
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Silviu Secăreanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Otilia Popa
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Cristina Capusa
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Dr. Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
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Ștefan G, Stancu S. Clinical Images: β 2 -Microglobulin amyloidosis. ACR Open Rheumatol 2021; 4:275-276. [PMID: 34913618 PMCID: PMC8992464 DOI: 10.1002/acr2.11394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gabriel Ștefan
- "Dr. Carol Davila" Teaching Hospital of Nephrology and "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Stancu
- "Dr. Carol Davila" Teaching Hospital of Nephrology and "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Jurubiță R, Obrișcă B, Achim C, Micu G, Sorohan B, Bobeică R, Vornicu A, Găman M, Căpușă C, Ștefan G, Viașu L, Mircescu G, Ismail G. Anti-phospholipase A2 receptor antibody screening in nephrotic syndrome may identify a distinct subset of patients with primary membranous nephropathy. Int Urol Nephrol 2021; 54:1713-1723. [PMID: 34799809 DOI: 10.1007/s11255-021-03061-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We sought to investigate the utility of anti-PLA2R antibody as a non-invasive screening method for the diagnosis of primary MN in patients with nephrotic syndrome (NS). METHODS All consecutive patients with NS admitted in our department, between 01.01.2015 and 31.12.2019 were screened for anti-PLA2R antibodies by an ELISA assay (EUROIMMUN, Lübeck, DE). A positive anti-PLA2R serology was defined as an ELISA value over 2 RU/ml. Subsequently, all patients underwent kidney biopsy to confirm the histological diagnosis. RESULTS Of the 203 patients with NS, we identified 67 patients with "high" titer of anti-PLA2R antibodies (> 20 RU/ml) and 47 patients with "intermediate" titer (2-20 RU/ml). In the entire cohort, the area under the curve (AUC) was 0.83 (95% CI 0.78-0.89; p < 0.001). With a cutoff of 20 RU/ml, the anti-PLA2R antibodies had a 64% sensitivity (95% CI 53-73%) and 94% specificity (95% CI 88-97%) to discriminate MN from other causes of NS. In addition, the PPV and NPV were 91% (95% CI 82-95%) and 75% (95% CI 69-79%). When analyzing the posttest effect, we identified a LR+ of 11.56 (95% CI 5.2-25.2) and LR- of 0.38 (95% CI 0.29-0.5). The overall accuracy of the test was 80.3% (95% CI 74-85%) and the diagnostic odds ratio was 30.42. When performing subgroup analysis, we identified that in younger patients, in those with preserved renal function or with negative workup for secondary causes, the diagnostic performance of anti-PLA2R antibodies was improved, the sensitivity increasing to 68-71%, the PPV to 93-95% and the LR+ to 12.23-15.4. CONCLUSION Serum anti-PLA2R antibody screening in patients with NS is a useful method for the diagnosis of primary MN. In younger patients (less than 60 years old) who have a preserved renal function and a negative workup for secondary causes of NS, a positive anti-PLA2R test highly predicts a diagnosis of primary MN.
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Affiliation(s)
- Roxana Jurubiță
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Bogdan Obrișcă
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania. .,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Camelia Achim
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Bogdan Sorohan
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Bobeică
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Alexandra Vornicu
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Maria Găman
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania
| | - Cristina Căpușă
- Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gabriel Ștefan
- Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Liliana Viașu
- Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gabriel Mircescu
- Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Nephrology, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gener Ismail
- Department of Nephrology, Fundeni Clinical Institute, Fundeni street 258, 022328, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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11
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Ștefan G, Cinca S, Zugravu A, Stancu S. Diffuse calcification of a nonfunctioning kidney allograft. Clin Case Rep 2021; 9:e04765. [PMID: 34484782 PMCID: PMC8405525 DOI: 10.1002/ccr3.4765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022] Open
Abstract
Diffuse calcification of nonfunctioning kidney graft may rarely occur in clinical practice, and it is generally benign and does not require transplant removal in most cases.
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Affiliation(s)
- Gabriel Ștefan
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Simona Cinca
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
| | - Adrian Zugravu
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Simona Stancu
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
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Ștefan G, Terinte-Balcan G, Stancu S, Zugravu A, Gherghiceanu M, Mircescu G. IgA nephropathy with serum ANCA positivity: case series and literature review. Rheumatol Int 2021; 41:1347-1355. [PMID: 33999289 DOI: 10.1007/s00296-021-04888-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022]
Abstract
The co-occurrence of IgA nephropathy (IgAN) and positive anti-neutrophil cytoplasmic autoantibodies (ANCA) serology is uncommon. In the present case series and literature review, we aimed to clarify the impact of ANCA on pathogenesis, clinical and histopathology presentation, and outcome in IgAN patients. We report four patients with an overlap lesion of IgAN-ANCA positive. Also, we performed a narrative review of all biopsy-proven published case series. Only 1.2% patients had ANCA in our 330-biopsy-proven IgAN cohort. We compared our data with previous reports-6 case series and 3 small retrospective studies-a total of 103 patients. All patients but one had eGFR below 15 mL/min at diagnosis. Besides rapidly decreasing eGFR, all presented with proteinuria around 1.5 g/day and dysmorphic microhematuria, suggesting glomerular inflammation. Systemic symptoms suggestive for ANCA vasculitis were seen in half of our patients, but only one patient had hemorrhagic alveolitis. Patients from our cohort responded to the intensive immunosuppressive regimens used in ANCA-positive vasculitis with renal involvement. However, in the follow-up, one patient had a relapse followed by septic shock related to immunosuppression and one patient started hemodialysis. In the review, we found that IgAN-ANCA -positive patients are characterized by vasculitis-like lesions and clinically by a rapidly progressive decline in kidney function, which was reversed by an aggressive induction immunosuppressive protocol used in ANCA vasculitis. Checking ANCA serology seems useful in patients with rapidly progressive IgAN for therapeutic and prognostic reasons.
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Affiliation(s)
- Gabriel Ștefan
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania. .,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - George Terinte-Balcan
- Ultrastructural Pathology, "Victor Babes" National Institute of Pathology, Bucharest, Romania
| | - Simona Stancu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Adrian Zugravu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihaela Gherghiceanu
- Department of Cell Biology and Histology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Ultrastructural Pathology, "Victor Babes" National Institute of Pathology, Bucharest, Romania
| | - Gabriel Mircescu
- "Dr. Carol Davila" Teaching Hospital of Nephrology, Romanian Renal Registry, Street Calea Grivitei, No. 4, 010731, Bucharest, Romania.,Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Ștefan G, Zugravu A, Stancu S, Gherghiceanu M, Terinte‐Balcan G. Atheroembolic kidney disease: The under-recognized silent killer. Clin Case Rep 2021; 9:1824-1825. [PMID: 33768956 PMCID: PMC7981600 DOI: 10.1002/ccr3.3874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 11/11/2022] Open
Abstract
While kidney biopsy demonstrating cholesterol crystal emboli is the method of definitive diagnosis; the triad of acute to subacute renal failure with skin findings in the setting of recent precipitating event should raise clinical suspicion for atheroembolic kidney disease.
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Affiliation(s)
- Gabriel Ștefan
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Adrian Zugravu
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Simona Stancu
- “Dr. Carol Davila” Teaching Hospital of NephrologyBucharestRomania
- Department of Nephrology“Carol Davila” University of Medicine and PharmacyBucharestRomania
| | - Mihaela Gherghiceanu
- Department of Cell Biology and Histology“Carol Davila” University of Medicine and PharmacyBucharestRomania
- Ultrastructural Pathology“Victor Babes” National Institute of PathologyBucharestRomania
| | - George Terinte‐Balcan
- Ultrastructural Pathology“Victor Babes” National Institute of PathologyBucharestRomania
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Abstract
Background: We aimed to evaluate the relationship between biopsy-proven kidney lesions, subclinical markers of atherosclerosis and intrarenal resistive index (RRI) in chronic kidney disease (CKD) patients. Methods: This cross-sectional, single-center study prospectively enrolled 44 consecutive CKD patients (57% male gender, 54.1 (95%CI, 49.7–58.6) years, median eGFR 28.1 (15.0–47.7) mL/min) diagnosed by renal biopsy during 6 months in our clinic. RRI, carotid intima-media thickness (IMT), Kauppila score for abdominal aortic calcification (AACs) were assessed. Traditional and nontraditional atheroscleosis risk factors were also evaluated. Results: Most of the patients had a diagnosis of glomerular nephropathy, with IgA nephropathy and diabetic nephropathy being the most frequent. RRI increased proportionally with CKD stages. Patients with RRI >0.7 (39%) were older, had diabetic and vascular nephropathies more frequently, higher mean arterial blood pressure, increased systemic atherosclerosis burden (IMT and AACs), higher percentage of global glomerulosclerois, GBM thickness, arteriolosclerosis and interstitial fibrosis/tubular atrophy. RRI directly correlated with age (rs = 0.55, p < 0.001) and with all the studied atherosclerosis markers (clinical atherosclerosis score rs = 0.50, p = 0.02; AACs rs = 0.50, p < 0.01; IMT rs = 0.34, p = 0.02). Also, global glomerulosclerosis (rs = 0.31, p = 0.03) and interstitial fibrosis/tubular atrophy (rs = 0.35, p = 0.01) were directly correlated with RRI. In multivariable adjusted binomial logistic regression models, only arteriolosclerosis was retained as independent predictor of RRI >0.7. Conclusion: The analysis of RRI may be useful in the evaluation of the general vascular condition of the patient with CKD, supplying information about both microvascular and macrovascular impairment. Moreover, RRI correlates well with renal histopathologic characteristics, particularly with arteriolosclerosis.
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Affiliation(s)
- Gabriel Ștefan
- Dr. Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Cosmin Florescu
- Department of Anatomic and Molecular Pathology, Laboratoire National de Santé , Dudelange , Luxembourg
| | - Alexandru-Anton Sabo
- Nephrology Department, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Simona Stancu
- Dr. Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - Gabriel Mircescu
- Dr. Carol Davila Teaching Hospital of Nephrology, University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
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Obrișcă B, Ștefan G, Gherghiceanu M, Mandache E, Ismail G, Stancu S, Boitan B, Ion O, Mircescu G. "Associated" or "Secondary" IgA nephropathy? An outcome analysis. PLoS One 2019; 14:e0221014. [PMID: 31398224 PMCID: PMC6688810 DOI: 10.1371/journal.pone.0221014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Whether differences in outcome between primary (pIgAN) and secondary IgA nephropathy (sIgAN) exist is uncertain. METHODS We conducted a retrospective, observational study that included all histologically diagnosed IgAN patients between 2010-2017 (N = 306), 248 with pIgAN and 58 with sIgAN. To obtain samples with similar risk of progression, sIgAN patients were grouped as liver disease and autoimmune/viral disease and propensity score matched to corresponding pIgAN samples. Univariate (Kaplan Meier) and multivariate time-dependent (Cox modelling) analyses were performed to identify predictors of the composite end-point (doubling of serum creatinine, end-stage kidney disease or death). RESULTS Of the whole cohort, 20% had sIgAN (6% alcoholic cirrhosis, 6% autoimmune disease and 8% viral infections). sIgAN patients were older, had more comorbidities, lower proteinuria and higher haematuria, but similar distribution in MESTC lesions and eGFR as those with pIgAN. They reached the end-point in similar proportions with those with pIgAN (43 vs. 30%; p = 0.09) but their mortality was higher (19 vs. 3%; p<0.0001). Both in unmatched (HR 0.80, 95%CI 0.42-1.52; p = 0.5) and matched samples (log-rank test: liver disease-IgAN vs. pIgAN, p = 0.1; autoimmune/viral-IgAN vs. pIgAN, p = 0.3), sIgAN was not predictive for end-point. In analyses restricted only to sIgAN, those with viral infections (HR, 10.98; 95% CI, 1.12-107.41; p = 0.03) and lower eGFR (HR, 0.94; 95%CI, 0.89-0.98; p = 0.007) had a worse prognosis. Immunosuppression did not influence outcome. CONCLUSIONS The differences in MESTC score and outcome between pIgAN and sIgAN seems to be minimal, suggesting that "associated" describes better than "secondary" the relationship among the two. Immunosuppression did not to influence outcome of sIgAN.
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Affiliation(s)
- Bogdan Obrișcă
- Nephrology Department, Fundeni Clinical Institute, Bucharest, Romania
- Nephrology Department,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriel Ștefan
- Nephrology Department,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- ”Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Mihaela Gherghiceanu
- Nephrology Department,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- ”Victor Babes” National Institute of Pathology, Bucharest, Romania
| | - Eugen Mandache
- ”Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Gener Ismail
- Nephrology Department, Fundeni Clinical Institute, Bucharest, Romania
- Nephrology Department,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Stancu
- Nephrology Department,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- ”Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Bianca Boitan
- ”Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
| | - Oana Ion
- Nephrology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriel Mircescu
- Nephrology Department,”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- ”Dr. Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania
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