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Miquelestorena-Standley E, Jaulerry C, Machet MC, Rabot N, Barbet C, Hummel A, Karras A, Garrouste C, Crepin T, Ducloux D, Cousin M, Albert C, Rivalan J, Cornec-Le Gall E, Pourreau F, Deltombe C, Nochy D, Szlavik N, Felix S, Croué A, Buob D, Rioux-Leclerc N, Doucet L, Goujon JM, Renaudin K, Blanchard E, Eymieux S, Rabant M, Halimi JM. Clinicopathologic features of infection-related glomerulonephritis with IgA deposits: a French Nationwide study. Diagn Pathol 2020; 15:62. [PMID: 32460869 PMCID: PMC7254713 DOI: 10.1186/s13000-020-00980-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Infection-related glomerulonephritis with IgA deposits (IRGN-IgA) is a rare disease but it is increasingly reported in the literature. Data regarding epidemiology and outcome are lacking, especially in Europe. We aimed to assess the clinical, pathologic and outcome data of IRGN-IgA. Methods Clinical and outcome data from patients from 11 French centers over the 2007–2017 period were collected retrospectively. We reviewed pathologic patterns and immunofluorescence of renal biopsies and evaluated C4d expression in IRGN-IgA. We analyzed the correlation between histological presentation and outcome. Results Twenty-seven patients (23 men, mean age: 62 ± 15 years) were included. Twenty-one (78%) had Staphylococcus aureus infection and twelve (44%) were diabetic. At the time of biopsy, 95.2% had haematuria, 48.1% had a serum creatinine level of > 4 mg/dL, and 16% had hypocomplementemia. The most common pathologic presentation included mesangial (88.9%) and endocapillary proliferative glomerulonephritis (88.9%) with interstitial fibrosis and tubular atrophy (IF/TA) (85.1%). Diffuse and global glomerular C4d expression was found in 17.8%, mostly in biopsies with acute or subacute patterns, and was associated with a short delay between infection and renal biopsy compared to segmental and focal staining. After median follow-up of 13.2 months, 23.1% died, 46.2% had persistent renal dysfunction and 15.4% reached end-stage renal disease. Renal outcome was correlated to IF/TA severity. Conclusions Infection-related glomerulonephritis with IgA deposits is usually associated with Staphylococcus infections and mainly affects adult men. This entity has a poor prognosis which is correlated to interstitial fibrosis and tubular atrophy severity.
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Affiliation(s)
- Elodie Miquelestorena-Standley
- Service d'anatomie et cytologie pathologiques, Hôpital Trousseau, CHRU Tours, Tours, France. .,Université de Tours, PRES Centre-Val de Loire, Tours, France.
| | - Charlotte Jaulerry
- Université de Tours, PRES Centre-Val de Loire, Tours, France.,Service de néphrologie, CHRU de Tours, Tours, France
| | - Marie-Christine Machet
- Service d'anatomie et cytologie pathologiques, Hôpital Trousseau, CHRU Tours, Tours, France.,Université de Tours, PRES Centre-Val de Loire, Tours, France
| | - Nolwenn Rabot
- Service de néphrologie, CHRU de Tours, Tours, France
| | | | - Aurélie Hummel
- Service de néphrologie, Hôpital Necker-enfants malades, Paris, France
| | - Alexandre Karras
- Service de néphrologie, Hôpital européen Georges Pompidou, Paris, France
| | - Cyril Garrouste
- Service de néphrologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Crepin
- Service de néphrologie, CHU de Besançon, Besançon, France
| | - Didier Ducloux
- Service de néphrologie, CHU de Besançon, Besançon, France
| | - Maud Cousin
- Service de néphrologie, CHU d'Angers, Angers, France
| | | | | | | | | | - Clément Deltombe
- Service de néphrologie et immunologie clinique, Institut de transplantation urologie et néphrologie ITUN, CHU de Nantes, Nantes, France
| | - Dominique Nochy
- Service d'anatomie pathologique, Hôpital européen Georges Pompidou, Paris, France
| | - Nora Szlavik
- Service d'anatomie pathologique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sophie Felix
- Service d'anatomie pathologique, CHU de Besançon, Besançon, France
| | - Anne Croué
- Service d'anatomie pathologique, CHU d'Angers, Angers, France
| | - David Buob
- Service d'anatomie pathologique, Hôpital Tenon, Paris, France
| | | | - Laurent Doucet
- Service d'anatomie pathologique, CHU de Brest, Brest, France
| | | | - Karine Renaudin
- Service d'anatomie pathologique, CHU de Nantes, Nantes, France
| | - Emmanuelle Blanchard
- Université de Tours, PRES Centre-Val de Loire, Tours, France.,Plateforme IBiSA de Microscopie Electronique, CHRU de Tours, Tours, France
| | - Sébastien Eymieux
- Université de Tours, PRES Centre-Val de Loire, Tours, France.,Plateforme IBiSA de Microscopie Electronique, CHRU de Tours, Tours, France
| | - Marion Rabant
- Service d'anatomie pathologique, Hôpital Necker-enfants malades, Paris, France
| | - Jean-Michel Halimi
- Université de Tours, PRES Centre-Val de Loire, Tours, France.,Service de néphrologie, CHRU de Tours, Tours, France
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Garrouste C, Baudenon J, Gatault P, Pereira B, Etienne I, Thierry A, Szlavik N, Aniort J, Rabant M, Lambert C, Sayegh J, Oniszczuk J, Anglicheau D, Heng AE. No impact of disseminated intravascular coagulation in kidney donors on long-term kidney transplantation outcome: A multicenter propensity-matched study. Am J Transplant 2019; 19:448-456. [PMID: 29981217 DOI: 10.1111/ajt.15008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/14/2018] [Accepted: 06/24/2018] [Indexed: 01/25/2023]
Abstract
The diagnosis of disseminated intravascular coagulation (DIC) is often considered to be a contraindication to organ donation. The aim of this study was to evaluate the impact of DIC+ donors on kidney recipient (KR) evolution. We identified 169 KRs with DIC+ donation after brain death donors between January 1996 and December 2012 in 6 French transplant centers. Individuals were matched using propensity scores to 338 recipients with DIC- donors according to donor age and sex, whether expanded criteria for the donor existed, graft year, and transplantation center. After kidney transplantation, delayed graft function was observed in 28.1% of DIC+ KRs and in 22.8% of DIC- KRs (NS). Renal allograft survival at 1, 5, and 10 years was 94.5%, 89.3%, and 73.9% and 96.2%, 90.8%, and 81.3% in DIC+ KRs and DIC- KRs, respectively (NS). The median estimated glomerular filtration rate (eGFR) was similar between DIC+ and DIC- KRs at 3 months, 1 year, and 10 years: 45.9 vs 48.1 mL/min, 42.1 vs 43.1 mL/min, and 33.9 vs 38.1 mL/min, respectively. Delayed calcineurin inhibitor introduction or induction had no impact on delayed graft function rate or eGFR evolution at 10 years after transplantation in DIC+ KRs. Donor DIC did not seem to affect initial outcome, long-term graft function, or allograft survival.
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Affiliation(s)
- Cyril Garrouste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Baudenon
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Philippe Gatault
- Department of Nephrology and Clinical Immunology, CHRU de Tours, Tours, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Antoine Thierry
- Department of Nephrology Dialysis and Kidney Transplantation, CHU de Poitiers, Poitiers, France
| | - Nora Szlavik
- Pathology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Aniort
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marion Rabant
- Pathology Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Céline Lambert
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Johnny Sayegh
- Department of Nephrology Dialysis and Kidney Transplantation, CHU d' Angers, Angers, France
| | - Julie Oniszczuk
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Elisabeth Heng
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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Abstract
INTRODUCTION Hemolytic uremic syndrome (HUS) in Human Immunodeficiency Virus (HIV)-positive patients has become a rare cause of kidney injury since the era of highly active antiretroviral therapy (HAART). Plasma exchange and antiretroviral therapy were previously recommended but often failed to achieve remission. We report a case of HUS in a HIV-positive patient treated successfully with eculizumab. CASE SUMMARY A 52-year-old woman presented to hospital with acute renal failure, thrombocytopenia, anemia, and hypoxemia. She had been diagnosed with HIV infection in 1997. Kidney biopsy showed several fibrinous microthrombi in the glomerular capillaries, formation of thrombi in arterioles, moderate parietal and mesangial deposits of C3 and Immunoglobulin M, and intense glomerular and arterial deposits of Complement component 5b9 complement component. Serum HIV viral load was 227,848 copies/mL, and CD4 lymphocyte count was 120 cells/μL. A diagnosis of HIV-associated HUS was made. The patient had no confounding cause of HUS. Initiation of eculizumab and HAART resulted in complete hematological remission on day 32 and dialysis withdrawal on day 110. The patient has not relapsed during long-term follow-up (M17). CONCLUSION This observation suggests that eculizumab can achieve remission in HIV patients with HUS.
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Affiliation(s)
- Marine Freist
- Service de Néphrologie, Pôle REUNNIRH, CHU Clermont-Ferrand, Clermont-Ferrand
| | - Cyril Garrouste
- Service de Néphrologie, Pôle REUNNIRH, CHU Clermont-Ferrand, Clermont-Ferrand
- Centre de Référence des Microangiopathies Thrombotiques, Paris
| | - Nora Szlavik
- Service d’anatomopathologie, CHU Clermont-Ferrand, Clermont-Ferrand
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques, Paris
- Service d’Hématologie, Hôpital Saint-Antoine, CHU Paris Est, AP-HP
- Université Pierre et Marie Curie UPMC, Paris
| | - Alexandre Lautrette
- Centre de Référence des Microangiopathies Thrombotiques, Paris
- Service de Réanimation, Pôle REUNNIRH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Elisabeth Heng
- Service de Néphrologie, Pôle REUNNIRH, CHU Clermont-Ferrand, Clermont-Ferrand
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Schreiber HA, Hulseberg PD, Lee J, Prechl J, Barta P, Szlavik N, Harding JS, Fabry Z, Sandor M. Dendritic cells in chronic mycobacterial granulomas restrict local anti-bacterial T cell response in a murine model. PLoS One 2010; 5:e11453. [PMID: 20625513 PMCID: PMC2897891 DOI: 10.1371/journal.pone.0011453] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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: 02/21/2010] [Accepted: 06/04/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mycobacterium-induced granulomas are the interface between bacteria and host immune response. During acute infection dendritic cells (DCs) are critical for mycobacterial dissemination and activation of protective T cells. However, their role during chronic infection in the granuloma is poorly understood. METHODOLOGY/PRINCIPAL FINDINGS We report that an inflammatory subset of murine DCs are present in granulomas induced by Mycobacteria bovis strain Bacillus Calmette-guerin (BCG), and both their location in granulomas and costimulatory molecule expression changes throughout infection. By flow cytometric analysis, we found that CD11c(+) cells in chronic granulomas had lower expression of MHCII and co-stimulatory molecules CD40, CD80 and CD86, and higher expression of inhibitory molecules PD-L1 and PD-L2 compared to CD11c(+) cells from acute granulomas. As a consequence of their phenotype, CD11c(+) cells from chronic lesions were unable to support the reactivation of newly-recruited, antigen 85B-specific CD4(+)IFNgamma(+) T cells or induce an IFNgamma response from naïve T cells in vivo and ex vivo. The mechanism of this inhibition involves the PD-1:PD-L signaling pathway, as ex vivo blockade of PD-L1 and PD-L2 restored the ability of isolated CD11c(+) cells from chronic lesions to stimulate a protective IFNgamma T cell response. CONCLUSIONS/SIGNIFICANCE Our data suggest that DCs in chronic lesions may facilitate latent infection by down-regulating protective T cell responses, ultimately acting as a shield that promotes mycobacterium survival. This DC shield may explain why mycobacteria are adapted for long-term survival in granulomatous lesions.
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Affiliation(s)
- Heidi A. Schreiber
- Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
- Cellular and Molecular Pathology Training Program, University of Wisconsin, Madison, Wisconsin, United States of America
- * E-mail:
| | - Paul D. Hulseberg
- Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
- Cellular and Molecular Pathology Training Program, University of Wisconsin, Madison, Wisconsin, United States of America
| | - JangEun Lee
- Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Jozsef Prechl
- Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Peter Barta
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Nora Szlavik
- Sejtdiagnosztika Kft, Hospital Bajcsy Zsilinszky, Budapest, Hungary
| | - Jeffrey S. Harding
- Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
- Cellular and Molecular Pathology Training Program, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
- Cellular and Molecular Pathology Training Program, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Matyas Sandor
- Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
- Cellular and Molecular Pathology Training Program, University of Wisconsin, Madison, Wisconsin, United States of America
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