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El Labban M, Surani S. Immunoglobulin A glomerulonephropathy: A review. World J Clin Cases 2024; 12:1388-1394. [PMID: 38576821 PMCID: PMC10989439 DOI: 10.12998/wjcc.v12.i8.1388] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/27/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
In this editorial, we comment on the article by Meng et al published in the World Journal of Clinical Cases. We comprehensively review immunoglobulin A nephropathy (IgAN), including epidemiology, clinical presentation, diagnosis, and management. IgAN, also known as Berger's disease, is the most frequent type of primary glomerulonephritis (GN) globally. It is mostly found among the Asian population. The presentation can be variable, from microscopic hematuria to a rapidly progressive GN. Around 50% of patients present with single or recurring episodes of gross hematuria. An upper respiratory infection and tonsillitis often precede these episodes. Around 30% of patients present microscopic hematuria with or without proteinuria, usually detected on routine examination. The diagnosis relies on having a renal biopsy for pathology and immunofluorescence microscopy. We focus on risk stratification and management of IgAN. We provide a review of all the landmark studies to date. According to the 2021 KDIGO (kidney disease: Improving Global Outcomes) guidelines, patients with non-variant form IgAN are first treated conservatively for three to six months. This approach consists of adequate blood pressure control, reduction of proteinuria with renin-angiotensin system blockade, treatment of dyslipidemia, and lifestyle modifications (weight loss, exercise, smoking cessation, and dietary sodium restrictions). Following three to six months of conservative therapy, patients are further classified as high or low risk for disease progression. High-risk patients have proteinuria ≥ 1 g/d or < 1 g/d with significant microscopic hematuria and active inflammation on kidney biopsy. Some experts consider proteinuria ≥ 2 g/d to be very high risk. Patients with high and very high-risk profiles are treated with immunosuppressive therapy. A proteinuria level of < 1 g/d and stable/improved renal function indicates a good treatment response for patients on immunosuppressive therapy.
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Affiliation(s)
- Mohamad El Labban
- Department of Internal Medicine, Mayo Cliic Health System, Mankato, MN 56001, United States
| | - Salim Surani
- Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
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Gigante A, Pellicano C, De Marco O, Assanto E, Sorato G, Palladini A, Rosato E, Lai S, Muscaritoli M, Cianci R. Changes in renal microcirculation in patients with nephrotic and nephritic syndrome: The role of resistive index. Microvasc Res 2024; 152:104641. [PMID: 38072161 DOI: 10.1016/j.mvr.2023.104641] [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: 10/31/2023] [Revised: 12/03/2023] [Accepted: 12/03/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Renal Resistive Index (RRI) is an important and non-invasive parameter of renal damage and it is associated with abnormal microcirculation or to a parenchymal injury. The aim of our study was to compare the RRI in a cohort of patients with renal diseases categorized in three groups: nephrotic syndrome (NS), acute nephritic syndrome (ANS) and patients with urinary abnormalities (UA). METHODS Four hundred eighty-two patients with median age of 48 years (IQR 34-62) with indications for kidney disease were included in the study. Biochemical analyses, clinical assessment with detection of NS, ANS and UA and comorbidities were reported. Renal Doppler ultrasound with RRI was evaluated in all patients at the time of enrolment. RESULTS NS was present in 81 (16.8 %) patients while ANS in 81 (16.8 %) and UA in 228 (47.3 %) patients. Patients with ANS showed significant higher RRI compared to both patients with NS [0.71 (IQR 0.67-0.78) vs 0.68 (0.63-0.73), p < 0.001] and UA [0.71 (0.67-0.78) vs 0.65 (0.61-0.71), p < 0.001]; RRI was higher in NS patients than in patients with UA [0.68 (0.63-0.73) vs 0.65 (0.61-0.71), p < 0.001]. Patients with ANS had significantly lower median estimated glomerular filtration rate (eGFR) compared respectively to NS and UA patients [19.7 ml/min vs 54.8 ml/min and vs 72.3 ml/min, p < 0.001], while renal length was significantly higher in patients with NS compared to both patients with ANS and UA [111.88 mm vs 101.98 mm and vs 106.15, p < 0.001]. Patients with ANS had more frequently hematuria and RRI ≥ 0.70 (p < 0.001) compared to both patients with NS and patients with UA. The multiple regression analysis, weighted for age, showed that RRI inversely correlates with eGFR (β coefficient = -0.430, p < 0.001). CONCLUSIONS Higher and pathological RRI were found in ANS than NS and UA. Renal resistive index in ANS reflects changes in intrarenal perfusion and microvascular dysfunction related to disease characteristics.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Oriana De Marco
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Eleonora Assanto
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Georgia Sorato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alberto Palladini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Courville K, Milord R, Cerrud J, Bustamante N. Overcoming obstacles in Panama to starting a renal biopsy program in a rural area during the COVID-19 pandemic. J Nephrol 2022; 35:2387-9. [PMID: 35997937 DOI: 10.1007/s40620-022-01403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022]
Abstract
Due to the many implemented restrictions, the SARS-CoV-2 pandemic has rendered some tasks more difficult, for instance, the evaluation of outpatients. Panama's tertiary care hospital for kidney biopsy referral was transformed into a COVID-only hospital in order to assist the large number of COVID-19 patients. In order to face the impossibility of following patients with nephrotic or nephritic syndrome, a biopsy program was implemented in a southern province in Panama. Thirty kidney biopsies were carried out over a 1-year period. This experience shows that kidney biopsy programs, that are usually run only in large referral centers, can also be implemented in small nephrology centers, allowing to obtain accurate diagnoses and to guide correct treatment.
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Ong LT. Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol 2022; 11:139-145. [PMID: 36187464 PMCID: PMC9521512 DOI: 10.5527/wjn.v11.i5.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/23/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Acute post-streptococcal glomerulonephritis (APSGN) is the major cause of acute glomerulonephritis among children, especially in low- and middle-income countries. APSGN commonly occurs following pharyngitis due to the activation of antibodies and complements proteins against streptococcal antigens through the immune-complex-mediated mechanism. APSGN can be presented as acute nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis, or it may be subclinical. The management of APSGN is mainly supportive in nature with fluid restriction, anti-hypertensives, diuretics, and renal replacement therapy with dialysis, when necessary, as the disease is self-limiting. Congestive heart failure, pulmonary edema, and severe hypertension-induced encephalopathy might occur during the acute phase of APSGN due to hypervolemia. APSGN generally has a favorable prognosis with only a small percentage of patients with persistent urinary abnormalities, persistent hypertension, and chronic kidney disease after the acute episode of APSGN. Decreased complement levels, increased C-reactive protein, and hypoalbuminemia are associated with disease severity. Crescent formations on renal biopsy and renal insufficiency on presentation may be the predictors of disease severity and poor outcomes in APSGN in children.
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Affiliation(s)
- Leong Tung Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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Xiao H, Hildebrandt F. Whole exome sequencing identifies monogenic forms of nephritis in a previously unsolved cohort of children with steroid-resistant nephrotic syndrome and hematuria. Pediatr Nephrol 2022; 37:1567-1574. [PMID: 34762194 PMCID: PMC10043783 DOI: 10.1007/s00467-021-05312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/20/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alport syndrome (AS), atypical hemolytic-uremic syndrome (aHUS), and fibronectin-glomerulopathy (FG) are rare forms of glomerular diseases that manifest in a combination of proteinuria, hematuria, and hypertension, referred to as nephritic syndrome. Due to phenotypic overlays, steroid-resistant nephrotic syndrome (SRNS) and nephritic syndrome have been difficult to discern diagnostically. SRNS is more common than nephritic syndrome and is the second leading cause of childhood-onset CKD. Fourteen monogenic causes of AS, aHUS, and FG and 60 monogenic causes of SRNS have been identified. As whole exome sequencing (WES) allows for unequivocal molecular genetic diagnostics, we hypothesize to be able to identify causative mutations in genes known to cause nephritic syndrome in patient cohorts with a clinical diagnosis of SRNS. METHODS We identified patients with hematuria and steroid-resistant proteinuria in an international patient cohort that we had submitted to WES and who were unsolved for known monogenic causes of SRNS. These 70 patients from 65 individual families were subsequently analyzed for causative mutations in 14 AS, aHUS, or FG causing genes. WES data were compared to a control cohort of 76 patients from 75 families that were diagnosed with nephronophthisis-related ciliopathies (NPHP-RC) and to a control cohort of 83 individuals from 75 families with SRNS, but without hematuria. RESULTS We detected likely pathogenic genetic variants in 3 of 65 families (4.6%) in 2 of the 14 genes analyzed. CONCLUSIONS We confirmed that in cohorts of childhood-onset SRNS, patients with nephritic syndrome can be discerned by WES. The findings highlight the importance of clinical genetic testing for therapeutic and preventative measures in patients with proteinuria. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Hongbo Xiao
- Division of Nephrology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Friedhelm Hildebrandt
- Division of Nephrology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Abstract
BACKGROUND Nephritic syndrome (NiS) is a major indicator of serious renal diseases necessitating kidney biopsies for histopathological evaluations, but due to the lack of comprehensive reviews in the literature, the current understanding of the syndrome and its significance is limited.
AIM To collect all the evidence retrievable from the literature on the diagnoses made on the renal biopsies performed for NiS as the indication to the procedure.
METHODS A literature search was conducted to find studies reporting final diagnoses on renal biopsies in NiS patients. Data were pooled and analyzed with stratifications on age and regions. Meta-analyzes were performed using Stata v.9.
RESULTS Overall, 26414 NiS patients from the total number of 96738 kidney biopsy diagnoses reported by 47 studies from 23 countries from all continents (except sub-Saharan Africa) were found and analyzed. NiS was the indication for renal biopsy in 21% of the patient populations across the reviewed studies. Immunoglobulin A (IgA) nephropathy was the single most frequent diagnosis in these patients (approximately 38%) followed by lupus nephritis (approximately 8%) and Henoch Schönlein purpura (approximately 7%). IgA nephropathy was the most frequent diagnosis reported for the NiS patients from the East Asia, comprising half of all the cases, and least prevalent in South Asia. Considering the age subgroups, adult (vs pediatric or elderly) patients were by far the most likely age group to be diagnosed with the IgA nephropathy. A myriad of such regional and age disparities have been found and reported.
CONCLUSION As the indication for renal biopsy, NiS represents a very distinctive epidemiology of final renal disease diagnoses compared to the other major syndromes.
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Affiliation(s)
- Saeed Taheri
- Department of Medicine, New Lahijan Scientific Foundation, Lahijan 44158-13166, Iran
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Thomé GG, Bianchini T, Bringhenti RN, Schaefer PG, Barros EJG, Veronese FV. The spectrum of biopsy-proven glomerular diseases in a tertiary Hospital in Southern Brazil. BMC Nephrol 2021; 22:414. [PMID: 34903188 PMCID: PMC8667371 DOI: 10.1186/s12882-021-02603-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/05/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background The prevalence and distribution of glomerular diseases differ among countries, and the indication to perform a kidney biopsy varies among centres. In this study, we assessed the prevalence of primary and secondary glomerulopathies based on histological diagnoses, and the correlation between glomerulopathies and demographic and clinical data was evaluated. Methods In this study, 1051 kidney biopsies were retrospectively reviewed between 2000 and 2018. Patient demographic, clinical and laboratory data were assessed. The prevalence of primary glomerulonephritis (PG) and secondary glomerulopathies (SG), as well as tubulointerstitial diseases (TIDs), hereditary nephropathies (HNs) and other diagnoses, were determined. The frequency of primary and secondary glomerulopathies was evaluated by age group, and the temporal variation in frequencies across three time periods (2000-2005, 2006-2011, and 2012-2018) was reported. Results The prevalence of SG predominated (52.4%), followed by PG (29.6%), other diagnoses (10.7%), TID (6.6%) and HN (1.1%). Among the primary forms of glomerular disease, focal segmental glomerulosclerosis (FSGS) was the most common (37.3%), followed by IgA nephropathy (IgAN, 24.4%), membranous nephropathy (MN, 18.6%) and minimal change disease (MCD, 8.4%). Lupus nephritis (LN, 41.1%) was most common in patients with SG, followed by diabetic kidney disease (DKD, 17.8%), systemic vasculitis (SV, 10.2%) and secondary FSGS (2nd FSGS, 10%). Nephrotic syndrome was the most common clinical presentation in patients with PG and also in patients with DRD and 2nd FSGS, whereas in patients with IgAN and SV, nephritic syndrome was the main presentation. For the age group between 18 and 50 years, LN, FSGS and IgAN predominated; for patients aged between 51 and 65 years, the proportion of DKD and 2nd FSGS increased, and SV was more common in patients > 65 years. The temporal variation in PG across the three time periods showed a statistically significant increase in IgAN (p = 0.001) and a reduction in FSGS over time (p < 0.001). In SG, there was a reduction in LN (p = 0.027) and an increase in DKD (p < 0.001) over time, with a tendency for 2nd FSGS to decrease over time (p = 0.053). Conclusions In the studied kidney biopsy registry, FSGS and IgAN were the most prevalent diagnoses in patients with PG, and LN and DKD were the most prevalent in patients with SG. Nephrotic syndrome was the major indication for biopsy. When comparing the temporal variation in glomerulopathies, there was a reduction in FSGS and an increase in IgAN in patients with PGs over time, and for patients with SGs, there was a reduction in LN with an increase in cases of DKD over time.
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Affiliation(s)
- Gustavo Gomes Thomé
- Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. .,Division of Nephrology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, 2350, Ramiro Barcelos St, Porto Alegre, RS, Brazil.
| | - Talissa Bianchini
- Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Nephrology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, 2350, Ramiro Barcelos St, Porto Alegre, RS, Brazil
| | - Rafael Nazario Bringhenti
- Division of Pathology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Pedro Guilherme Schaefer
- Division of Pathology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Elvino José Guardão Barros
- Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Nephrology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, 2350, Ramiro Barcelos St, Porto Alegre, RS, Brazil
| | - Francisco Veríssimo Veronese
- Graduate Program in Medicine: Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Nephrology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, 2350, Ramiro Barcelos St, Porto Alegre, RS, Brazil
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Shi SS, Yang XZ, Zhang XY, Guo HD, Wang WF, Zhang L, Wu P, Zhang W, Wen WB, Huo XL, Zhang YQ. Horseshoe kidney with PLA2R-positive membranous nephropathy. BMC Nephrol 2021; 22:277. [PMID: 34376183 PMCID: PMC8353813 DOI: 10.1186/s12882-021-02488-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background Horseshoe kidney (HSK) is a common congenital defect of the urinary system. The most common complications are urinary tract infection, urinary stones, and hydronephrosis. HSK can be combined with glomerular diseases, but the diagnosis rate of renal biopsy is low due to structural abnormalities. There are only a few reports on HSK with glomerular disease. Here, we have reported a case of PLA2R-positive membranous nephropathy occurring in a patient with HSK. Case presentation After admission to the hospital due to oedema of both the lower extremities, the patient was diagnosed with nephrotic syndrome due to abnormal 24-h urine protein (7540 mg) and blood albumin (25 g/L) levels. Abdominal ultrasonography revealed HSK. The patient’s brother had a history of end-stage renal disease due to nephrotic syndrome. Therefore, the patient was diagnosed with PLA2R-positive stage II membranous nephropathy through renal biopsy under abdominal ultrasonography guidance. He was administered adequate prednisone and cyclophosphamide, and after 6 months of treatment, urinary protein excretion levels significantly decreased. Conclusion The risk and difficulty of renal biopsy in patients with HSK are increased due to structural abnormalities; however, renal biopsy can be accomplished through precise positioning with abdominal ultrasonography. In the literature, 20 cases of HSK with glomerular disease have been reported thus far. Because of the small number of cases, estimating the incidence rate of glomerular diseases in HSK is impossible, and the correlation between HSK and renal pathology cannot be stated. Further studies should be conducted and cases should be accumulated to elucidate this phenomenon.
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Affiliation(s)
- Shuai-Shuai Shi
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Xian-Zu Yang
- Graduate School of Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Xiao-Ye Zhang
- Graduate School of Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Hui-Dan Guo
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Wen-Feng Wang
- Department of Jin Yu Renal pathology center, Taiyuan, 030000, Shanxi, China
| | - Li Zhang
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Peng Wu
- Department of Imaging, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Wei Zhang
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Wen-Bin Wen
- Department of Nephrology, Heji Hospital of Changzhi Medical College, Changzhi, 046011, Shanxi, China
| | - Xiao-Lei Huo
- Department of Histology and Embryology, Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Yi-Qiang Zhang
- Department of Biochemistry, Changzhi Medical College, Shanxi, Changzhi, 046000, People's Republic of China.
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Trutin I, Oletić L, Galešić Ljubanović D, Turudić D, Milošević D. A CHILD WITH DENSE DEPOSIT DISEASE AND DECREASED CLASSIC COMPLEMENT PATHWAY ACTIVITY. Acta Clin Croat 2021; 60:141-145. [PMID: 34588735 PMCID: PMC8305348 DOI: 10.20471/acc.2021.60.01.21] [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: 03/24/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
We report a rare case of nephritic syndrome underlying dense deposit disease (DDD) with alternative complement pathway dysfunction explained with both C3 nephritic factor (C3NeF) antibodies and DDD associated polymorphism of factor H. An 8-year-old boy presented with macroscopic hematuria, hypertension and periorbital edema followed by persistently low C3 during the 8-week follow-up. Positive C3 staining on immunofluorescence microscopy, supported by dense deposits within the glomerular basement membrane on electron microscopy, confirmed the diagnosis of DDD. Preliminary tests for complement activation showed decreased classic pathway and deficient alternative complement pathway, as well as slightly positive C3NeF, supporting the diagnosis of DDD. Genetic analysis revealed a polymorphism of the complement factor H gene with an increased risk of developing DDD. Supportive therapy led to satisfactory recovery of renal function and normalization of C3. Given the poor prognosis of the disease, proper approach to such specific glomerulopathy is important to avoid or at least slow down progression to end-stage renal disease.
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Affiliation(s)
| | - Lea Oletić
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Renal Pathology and Electron Microscopy, Department of Pathology, Dubrava University Hospital, ZagrebCroatia; 3University of Zagreb, School of Medicine, Zagreb, Croatia; 4Zagreb University Hospital Centre, Zagreb, Croatia
| | - Danica Galešić Ljubanović
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Renal Pathology and Electron Microscopy, Department of Pathology, Dubrava University Hospital, ZagrebCroatia; 3University of Zagreb, School of Medicine, Zagreb, Croatia; 4Zagreb University Hospital Centre, Zagreb, Croatia
| | - Daniel Turudić
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Renal Pathology and Electron Microscopy, Department of Pathology, Dubrava University Hospital, ZagrebCroatia; 3University of Zagreb, School of Medicine, Zagreb, Croatia; 4Zagreb University Hospital Centre, Zagreb, Croatia
| | - Danko Milošević
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Division of Renal Pathology and Electron Microscopy, Department of Pathology, Dubrava University Hospital, ZagrebCroatia; 3University of Zagreb, School of Medicine, Zagreb, Croatia; 4Zagreb University Hospital Centre, Zagreb, Croatia
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Viggiano D, Nigro M, Sessa F, Vignolini G, Campi R, Serni S, Pollastro RM, Vallone G, Gigliotti G, Capasso G. The number of nephrons in different glomerular diseases. PeerJ 2019; 7:e7640. [PMID: 31534861 PMCID: PMC6731770 DOI: 10.7717/peerj.7640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/07/2019] [Indexed: 11/27/2022] Open
Abstract
Background The total number of nephrons has been measured mainly from post-mortem studies and only in selected populations. Data from living subjects are scanty, and direct comparisons among different glomerular diseases are lacking. The present work exploits modern methodology to estimate the total nephron number in glomerulopathies with prevalent proteinuria/nephrotic syndrome versus glomerulopathies with nephritic syndrome (IgA nephropathy (IgAN), lupus nephritis), thus extending previous observations about the number and function of glomeruli in different physiological and pathological states. Methods This is a retrospective study based on one hundred and seven patients who have undergone renal biopsy. The glomerular density has been estimated from the biopsy specimens and the total cortical volume has been obtained from ultrasound recordings. Stereological methods have been applied to calculate the total number of nephrons and their volume. The correlation between clinical parameters and quantitative morphological data have studied using the Pearson correlation coefficient (r). Results The total number of nephrons inversely correlated with the systolic blood pressure (r = −0.4, p < 0.05). In proteinuric diseases, such as focal segmental glomerulo-sclerosis (FSGS), membranous nephropathy (MN) and diabetes, the change in estimated GFR (eGFR) directly correlated with the total number of non-sclerotic glomeruli (NSG) (r = 0.62, p < 0.01), whereas in nephritic syndrome no significant correlation was observed. The alterations in eGFR occurring in nephritic syndromes such as IgAN cannot be explained on the basis of the number of NSG. Discussion The fusion of the podocyte foot-processes that typically occurs in purely proteinuric diseases does not modify the glomerular filtration rate: therefore in these situations, the change in eGFR depends mainly on the number of available glomeruli. On the other side, the eGFR decrease occurring in nephritic syndromes, such as IgAN, cannot be explained simply on the basis of the number of NSG and likely depends on the substantial involvement of the mesangial axis. Future studies should verify whether these changes are reversible with appropriate therapy, thus reversing eGFR decrease.
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Affiliation(s)
- Davide Viggiano
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Michelangelo Nigro
- UOC of Nephrology and dialysis, Eboli Hospital "Maria SS Addolorata", Eboli, Italy
| | - Francesco Sessa
- Department of Urologic Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urologic Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urologic Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urologic Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rosa Maria Pollastro
- Department of Translational Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gianfranco Vallone
- Department of Radiology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Gigliotti
- UOC of Nephrology and dialysis, Eboli Hospital "Maria SS Addolorata", Eboli, Italy
| | - Giovambattista Capasso
- Department of Translational Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Biogem, Ariano Irpino, Italy
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Yadav S, Garg D, Vaswani ND, Kaushik JS, Rohilla S. Concurrent Acute Glomerulonephritis and Retropharyngeal Abscess in 10 Year Boy: A Case Report. J Clin Diagn Res 2017; 11:SD13-SD14. [PMID: 28892995 PMCID: PMC5583899 DOI: 10.7860/jcdr/2017/26421.10299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/05/2017] [Indexed: 11/24/2022]
Abstract
Postinfectious Glomerulonephritis (PIGN) usually follows 1-2 weeks after respiratory tract infection and 4-6 weeks after skin infection. Acute Glomerulonephritis (AGN) is uncommon with simultaneous severe throat infections. We describe a 10-year-old boy who was presented with high grade fever, dysphagia and tender swelling over left side of neck. Examination also revealed enlarged multiple cervical lymph nodes on the same side of neck. Magnetic Resonance Imaging (MRI) of soft tissue of neck revealed evidence of retropharyngeal abscess. The next day, he subsequently developed haematuria and oliguria with borderline raised blood pressure. His corresponding blood urea and serum antistreptolysin O (ASO) levels were raised with low C3 levels. He had a remarkable improvement on injectable broad spectrum antibiotics with complete resolution of fever and neck symptoms. At eight weeks follow up, complete resolution of microscopic haematuria with normal C3 levels was observed. The present case highlights a 10-year-old young boy with retropharyngeal abscess presenting with clinical and laboratory evidence of Poststreptococcal Glomerulonephritis (PSGN).
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Affiliation(s)
- Sudha Yadav
- Resident, Department of Pediatrics, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Deepali Garg
- Resident, Department of Pediatrics, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Narain Das Vaswani
- Professor, Department of Pediatrics, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Jaya Shankar Kaushik
- Associate Professor, Department of Pediatrics, Pt B D Sharma PGIMS, Rohtak, Haryana, India
| | - Seema Rohilla
- Professor, Department of Radiodiagnosis, Pt B D Sharma PGIMS, Rohtak, Haryana, India
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Abstract
Immune-mediated damage to glomerular structures is largely responsible for the pathology associated with the majority of glomerular diseases. Therefore, a detailed understanding of the basic immune mechanisms responsible for glomerular damage is needed to inform the design of novel intervention strategies. Glomerular injury of immune origin is complex and involves both inflammatory and non-inflammatory processes driven by elements of the innate and adaptive immune system. This review summarizes the basic immune mechanisms that cause glomerular injury leading to the nephritic and nephrotic syndromes. A major focus of the review is to highlight the mechanisms by which antibodies cause glomerular injury through their interactions with glomerular cells, complement proteins, phagocytes bearing complement and Fcγ receptors, and dendritic cells expressing the neonatal receptor for IgG, FcRn.
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Affiliation(s)
- Bonny L Dickinson
- Department of Biomedical Science, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, United States.
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Jenssen GR, Hovland E, Bangstad H, Nygård K, Vold L, Bjerre A. The incidence and aetiology of acute kidney injury in children in Norway between 1999 and 2008. Acta Paediatr 2014; 103:1192-7. [PMID: 25039408 PMCID: PMC4480659 DOI: 10.1111/apa.12742] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/18/2014] [Accepted: 07/08/2014] [Indexed: 11/26/2022]
Abstract
Aim Primary acute kidney injury (AKI) is a direct cause of hospitalisation in children, but can also result from other conditions. There is limited information on the epidemiology of this condition. Our aim was to describe the national incidence rate and aetiology of acute kidney injury in children under the age of 16 in Norway from 1999 to 2008. Methods We carried out a retrospective study of medical records provided by all 18 of the paediatric hospital departments that specialise in treating paediatric patients with AKI. Results We identified 315 cases of AKI (53% male), with an estimated average annual incidence rate of 3.3 cases per 100 000 children and a median annual occurrence of 33 cases. Most cases (43%) were in children under five. We identified 53 aetiologies and classified these into 30 aetiological groups: 24% of the cases were prerenal (n = 75), 74% were intrinsic/renal (n = 234) and 2% were postrenal (n = 5). Nephritic syndromes was the major cause (44%) of AKI, followed by haemolytic-uraemic syndrome (HUS) (15%). Conclusion Nephritic syndromes and HUS are the most common aetiologies of AKI in Norway. Although our results could indicate a low incidence of paediatric AKI in Norway, the lack of other national studies makes comparisons difficult.
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Affiliation(s)
- Gaute Reier Jenssen
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Eirik Hovland
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | | | - Karin Nygård
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
| | - Line Vold
- Department of Infectious Disease Epidemiology Norwegian Institute of Public Health (Nasjonalt Folkehelseinstitutt) Oslo Norway
| | - Anna Bjerre
- Department of Pediatrics Oslo University Hospital Oslo Norway
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Bruschi M, Candiano G, Santucci L, Ghiggeri GM. Oxidized albumin. The long way of a protein of uncertain function. Biochim Biophys Acta Gen Subj 2013; 1830:5473-9. [PMID: 23618696 DOI: 10.1016/j.bbagen.2013.04.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 03/11/2013] [Revised: 04/11/2013] [Accepted: 04/15/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Proteins are extremely reactive to oxidants and should represent a potential target of instable reactive oxygen. This may represent a problem for plasma proteins since they may be directly modified in vivo in a compartment where antioxidant enzymatic systems are scarcely represented. On the other hand, it is possible that some plasma components have evolved over time to guarantee protection, in which case they can be considered as anti-oxidants. SCOPE OF REVIEW To present and discuss main studies which addressed the role of albumin in plasma antioxidant activity mainly utilizing in vitro models of oxidation. To present some advances on structural features of oxidized albumin deriving from studies carried out on in vitro models as well as albumin purified in vivo from patients affected by clinical conditions characterized by oxidative stress. MAJOR CONCLUSIONS There are different interaction with HOCl and chloramines. In the former case, HOCl produces an extensive alteration of (238)Trp and (162)Tyr, (425)Tyr, (47)Tyr, while thiol groups are only partially involved. Chloramines are extremely reactive with the unique free SH group of albumin ((34)Cys) with the formation of sulfenic and sulfinic acid as intermediates and sulfonic acid as end-product. Oxidized albumin has a modified electrical charge for the addition of an acidic residue and presents α-helix and random coil reorganization with subtle changes in domain orientation. GENERAL SIGNIFICANCE Albumin, is the major antioxidants in plasma with a concentration (0.8mM) higher than other antioxidants by an exponential factor. Functional and protective roles in the presence of oxidative stress must be defined. This article is part of a Special Issue entitled Serum Albumin.
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Affiliation(s)
- Maurizio Bruschi
- Laboratory on Pathophysiology of Uremia, Istituto Giannina Gaslini, Genoa, Italy
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