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Marinaki S, Tsiakas S, Skalioti C, Lourida P, Argyraki A, Grigorakos K, Boletis I. A Patient with Cryoglobulinemic Membranoproliferative GN (MPGN) Who Survived COVID-19 Disease: Case Presentation and Current Data of COVID-19 Infection in Dialysis and Transplanted Patients in Greece. ACTA ACUST UNITED AC 2020; 56:medicina56070355. [PMID: 32708858 PMCID: PMC7404464 DOI: 10.3390/medicina56070355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/01/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
The evolving pandemic of Coronavirus Disease 2019 has posed a substantial health risk worldwide. However, there is a paucity of data regarding the clinical course and the therapeutic management of patients with chronic kidney disease and COVID-19 infection. To date, most evidence has come from renal transplantation, with about 45 patients reported thus far, and the current data from the ERA-EDTA (ERACODA) registry for transplanted patients and patients on Renal Replacement Therapy (RRT); as for those with glomerular diseases, data are lacking. Herein, we report the case of a 62-year-old patient with severe membranoproliferative glomerulonephritis who had been receiving a high burden of immunosuppression until four months before the COVID-19 infection. He developed severe disease with acute respiratory failure requiring mechanical ventilation. After treatment with hydroxychloroquine and azithromycin, despite his low chances, he gradually recovered and survived. To the best of our knowledge, this is one of the few reported patients with glomerulonephritis who had COVID-19 Besides our single case with glomerulonephritis early during the disease outbreak, the very low prevalence of COVID-19 infection in the country’s transplant recipients (0.038%) and dialysis patients (0.24%) reflects the impact of the rapid implementation of social distancing rules as well as of preventive measures for disease control in the hospitals and dialysis units in our country.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Azithromycin/therapeutic use
- Betacoronavirus
- COVID-19
- Ceftriaxone/therapeutic use
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/immunology
- Coronavirus Infections/therapy
- Creatinine/metabolism
- Cryoglobulinemia/complications
- Cryoglobulinemia/immunology
- Cyclophosphamide
- Enzyme Inhibitors/therapeutic use
- Glomerulonephritis, Membranoproliferative/complications
- Glomerulonephritis, Membranoproliferative/drug therapy
- Glomerulonephritis, Membranoproliferative/immunology
- Glomerulonephritis, Membranoproliferative/metabolism
- Glucocorticoids/therapeutic use
- Greece
- Humans
- Hydroxychloroquine/therapeutic use
- Immunocompromised Host
- Immunologic Factors/therapeutic use
- Kidney Failure, Chronic/therapy
- Kidney Transplantation
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lung/diagnostic imaging
- Male
- Methylprednisolone/therapeutic use
- Middle Aged
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/immunology
- Pneumonia, Viral/therapy
- Renal Dialysis
- Respiration, Artificial
- Respiratory Insufficiency/etiology
- Respiratory Insufficiency/therapy
- Reverse Transcriptase Polymerase Chain Reaction
- Rituximab/therapeutic use
- SARS-CoV-2
- Tomography, X-Ray Computed
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Affiliation(s)
- Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.M.); (S.T.); (I.B.)
| | - Stathis Tsiakas
- Clinic of Nephrology and Renal Transplantation, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.M.); (S.T.); (I.B.)
| | - Chrysanthi Skalioti
- Clinic of Nephrology and Renal Transplantation, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.M.); (S.T.); (I.B.)
- Correspondence:
| | - Panayiota Lourida
- Infectious Diseases Clinic A, Sotiria Chest Diseases Hospital, 11527 Athens, Greece; (P.L.); (A.A.)
| | - Aikaterini Argyraki
- Infectious Diseases Clinic A, Sotiria Chest Diseases Hospital, 11527 Athens, Greece; (P.L.); (A.A.)
| | | | - Ioannis Boletis
- Clinic of Nephrology and Renal Transplantation, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.M.); (S.T.); (I.B.)
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2
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Lee M, Suzuki H, Kato R, Fukao Y, Nakayama M, Kano T, Makita Y, Suzuki Y. Renal pathological analysis using galactose-deficient IgA1-specific monoclonal antibody is a strong tool for differentiation of primary IgA nephropathy from secondary IgA nephropathy. CEN Case Rep 2020; 10:17-22. [PMID: 32676896 PMCID: PMC7829275 DOI: 10.1007/s13730-020-00508-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
In several cases with IgA nephropathy (IgAN), differential diagnosis is difficult due to the complication with other systemic diseases which can induce secondary IgAN. Recently, we demonstrated that immunostaining with galactose-deficient IgA1-specific monoclonal antibody (KM55 mAb) specifically showed positive in primary IgAN cases. Here, we report four cases which we could make definitive diagnosis by immunohistological analysis using KM55 mAb. The underlying systemic diseases are rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), hepatitis C (HCV) and Crohn’s disease (CD). Renal pathological findings in the four cases revealed mesangial proliferative glomerulonephritis with IgA and C3 deposits. Immunostaining with KM55 mAb was positive for three cases complicated with RA, SLE and CD, respectively. Thus, these three cases were diagnosed as primary IgAN and treated with tonsillectomy and steroid pulse therapy. These three cases finally achieved clinical remission. On the other hand, the case with HCV showed negative for KM55. Finally, we diagnosed as HCV-related nephropathy and successfully treated by antiviral agents. These cases suggested KM55 mAb is a strong tool to differentiate primary IgAN from secondary IgAN.
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MESH Headings
- Adult
- Antibodies, Monoclonal/immunology
- Antiviral Agents/administration & dosage
- Antiviral Agents/therapeutic use
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Crohn Disease/complications
- Crohn Disease/diagnosis
- Diagnosis, Differential
- Female
- Galactose/deficiency
- Galactose/immunology
- Glomerulonephritis, IGA/diagnosis
- Glomerulonephritis, IGA/pathology
- Glomerulonephritis, Membranoproliferative/etiology
- Glomerulonephritis, Membranoproliferative/immunology
- Glomerulonephritis, Membranoproliferative/pathology
- Hepatitis C/complications
- Hepatitis C/diagnosis
- Humans
- Hydrocarbons, Fluorinated/immunology
- Immunoglobulin A/immunology
- Immunohistochemistry/methods
- Kidney/metabolism
- Kidney/pathology
- Kidney/ultrastructure
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Male
- Middle Aged
- Pulse Therapy, Drug/methods
- Remission Induction
- Steroids/administration & dosage
- Steroids/therapeutic use
- Tonsillectomy/methods
- Urea/analogs & derivatives
- Urea/immunology
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Affiliation(s)
- Mingfeng Lee
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Rina Kato
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yusuke Fukao
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Maiko Nakayama
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Toshiki Kano
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuko Makita
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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Garam N, Prohászka Z, Szilágyi Á, Aigner C, Schmidt A, Gaggl M, Sunder-Plassmann G, Bajcsi D, Brunner J, Dumfarth A, Cejka D, Flaschberger S, Flögelova H, Haris Á, Hartmann Á, Heilos A, Mueller T, Rusai K, Arbeiter K, Hofer J, Jakab D, Sinkó M, Szigeti E, Bereczki C, Janko V, Kelen K, Reusz GS, Szabó AJ, Klenk N, Kóbor K, Kojc N, Knechtelsdorfer M, Laganovic M, Lungu AC, Meglic A, Rus R, Kersnik-Levart T, Macioniene E, Miglinas M, Pawłowska A, Stompór T, Podracka L, Rudnicki M, Mayer G, Romana Rysava, Reiterova J, Saraga M, Tomáš Seeman, Zieg J, Sládková E, Szabó T, Capitanescu A, Stancu S, Tisljar M, Galesic K, Tislér A, Vainumäe I, Windpessl M, Zaoral T, Zlatanova G, Csuka D. C4 nephritic factor in patients with immune-complex-mediated membranoproliferative glomerulonephritis and C3-glomerulopathy. Orphanet J Rare Dis 2019; 14:247. [PMID: 31703608 PMCID: PMC6839100 DOI: 10.1186/s13023-019-1237-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/22/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Acquired or genetic abnormalities of the complement alternative pathway are the primary cause of C3glomerulopathy(C3G) but may occur in immune-complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) as well. Less is known about the presence and role of C4nephritic factor(C4NeF) which may stabilize the classical pathway C3-convertase. Our aim was to examine the presence of C4NeF and its connection with clinical features and with other pathogenic factors. RESULTS One hunfe IC-MPGN/C3G patients were enrolled in the study. C4NeF activity was determined by hemolytic assay utilizing sensitized sheep erythrocytes. Seventeen patients were positive for C4NeF with lower prevalence of renal impairment and lower C4d level, and higher C3 nephritic factor (C3NeF) prevalence at time of diagnosis compared to C4NeF negative patients. Patients positive for both C3NeF and C4NeF had the lowest C3 levels and highest terminal pathway activation. End-stage renal disease did not develop in any of the C4NeF positive patients during follow-up period. Positivity to other complement autoantibodies (anti-C1q, anti-C3) was also linked to the presence of nephritic factors. Unsupervised, data-driven cluster analysis identified a group of patients with high prevalence of multiple complement autoantibodies, including C4NeF. CONCLUSIONS In conclusion, C4NeF may be a possible cause of complement dysregulation in approximately 10-15% of IC-MPGN/C3G patients.
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Affiliation(s)
- Nóra Garam
- Research Laboratory, 3rd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Kútvölgyi St 4, Budapest, H-1125, Hungary
| | - Zoltán Prohászka
- Research Laboratory, 3rd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Kútvölgyi St 4, Budapest, H-1125, Hungary.
| | - Ágnes Szilágyi
- Research Laboratory, 3rd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Kútvölgyi St 4, Budapest, H-1125, Hungary
| | - Christof Aigner
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alice Schmidt
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Martina Gaggl
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Dóra Bajcsi
- 1st Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Jürgen Brunner
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Dumfarth
- Department of Medicine III: Nephrology, Transplant Medicine and Rheumatology, Geriatric Department, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | - Daniel Cejka
- Department of Medicine III: Nephrology, Transplant Medicine and Rheumatology, Geriatric Department, Ordensklinikum Linz - Elisabethinen, Linz, Austria
| | | | - Hana Flögelova
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Palacky University and Faculty Hospital in Olomouc, Moravia, Czech Republic
| | - Ágnes Haris
- Department of Nephrology, Szent Margit Hospital, Budapest, Hungary
| | - Ágnes Hartmann
- Department of Pediatrics, University of Pécs, Pécs, Hungary
| | - Andreas Heilos
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - Thomas Mueller
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - Krisztina Rusai
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - Klaus Arbeiter
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria
| | - Johannes Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Neurology of Senses and Language, Hospital of St John of God, Linz, Austria
- Research Institute for Developmental Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Dániel Jakab
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Mária Sinkó
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Erika Szigeti
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Csaba Bereczki
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | | | - Kata Kelen
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - György S Reusz
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Attila J Szabó
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Nóra Klenk
- FMC Center of Dialysis, Miskolc, Hungary
| | | | - Nika Kojc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Mario Laganovic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hopital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | | | - Anamarija Meglic
- Department of Pediatric Nephrology, Division of Pediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rina Rus
- Department of Pediatric Nephrology, Division of Pediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tanja Kersnik-Levart
- Department of Pediatric Nephrology, Division of Pediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ernesta Macioniene
- Nephrology Center, Santaros Klinikos, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Marius Miglinas
- Nephrology Center, Santaros Klinikos, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Anna Pawłowska
- Department of Nephrology, Hypertension and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Tomasz Stompór
- Department of Nephrology, Hypertension and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Michael Rudnicki
- Dept. of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Gert Mayer
- Dept. of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Romana Rysava
- Nephrology Clinic, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Reiterova
- Nephrology Clinic, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marijan Saraga
- Department of Pathology, University Hospital Split University of Split, School of Medicine, Split, Croatia
| | - Tomáš Seeman
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University Prague, University Hospital Motol, Prague, Czech Republic
| | - Jakub Zieg
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University Prague, University Hospital Motol, Prague, Czech Republic
| | - Eva Sládková
- Department of Pediatrics, Charles University in Prague, Faculty of Medicine in Pilsen, Prague, Czech Republic
| | - Tamás Szabó
- Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | | | - Simona Stancu
- Carol Davila Nephrology Hospital, Bucharest, Romania
| | - Miroslav Tisljar
- Department of Nephrology, Dubrava University Hospital, Zagreb, Croatia
| | - Kresimir Galesic
- Department of Nephrology, Dubrava University Hospital, Zagreb, Croatia
| | - András Tislér
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Inga Vainumäe
- Department of Pathology of Tartu University Hospital, Tartu, Estonia
| | - Martin Windpessl
- Internal Medicine IV, Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Tomas Zaoral
- Department of Pediatrics, University Hospital and Faculty of Medicine Ostrava, Ostrava, Czech Republic
| | - Galia Zlatanova
- University Children's Hospital Medical University, Sofia, Bulgaria
| | - Dorottya Csuka
- Research Laboratory, 3rd Department of Internal Medicine, and MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Kútvölgyi St 4, Budapest, H-1125, Hungary
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4
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Lu H, Cui Z, Zhou XJ, Jin QZ, Yu XJ, Wang SX, Wang Y, Zhou FD, Zhao MH. Plasma exchange and rituximab treatments in primary membranous nephropathy combined with crescentic glomerulonephritis: A case report. Medicine (Baltimore) 2019; 98:e15303. [PMID: 31045764 PMCID: PMC6504248 DOI: 10.1097/md.0000000000015303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Crescent formation is rare in primary membranous nephropathy (MN). Anti-phospholipase A2 receptor (PLA2R) antibodies are detectable in these patients. The mechanism and treatments are unknown. PATIENT CONCERNS A 72-year-old female patient who presented with nephrotic syndrome, hematuria, and rapidly progressive kidney dysfunction. DIAGNOSES Kidney biopsy was performed and the diagnosis was MN in combination with crescentic glomerulonephritis. Circulating anti-PLA2R IgG3 and IgG4 were detected of high level. INTERVENTIONS The patient received plasma exchange and rituximab besides corticosteroids. OUTCOMES The patient achieved complete remission of proteinuria and recovery of kidney function after the clearance of anti-PLA2R antibodies. LESSON This case suggests a pathogenic role of anti-PLA2R antibodies in the mechanism of crescent formation in MN, which may need intensive therapy to eliminate the antibodies quickly.
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MESH Headings
- Aged
- Female
- Glomerulonephritis, Membranoproliferative/blood
- Glomerulonephritis, Membranoproliferative/drug therapy
- Glomerulonephritis, Membranoproliferative/immunology
- Glomerulonephritis, Membranoproliferative/pathology
- Glomerulonephritis, Membranous/blood
- Glomerulonephritis, Membranous/drug therapy
- Glomerulonephritis, Membranous/immunology
- Glomerulonephritis, Membranous/pathology
- Hematuria/diagnosis
- Hematuria/etiology
- Humans
- Immunoglobulin G/blood
- Immunologic Factors/therapeutic use
- Kidney/pathology
- Kidney/physiopathology
- Nephrotic Syndrome/pathology
- Plasma Exchange/methods
- Proteinuria/pathology
- Receptors, Phospholipase A2/antagonists & inhibitors
- Receptors, Phospholipase A2/immunology
- Remission Induction
- Rituximab/administration & dosage
- Rituximab/therapeutic use
- Treatment Outcome
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Affiliation(s)
- Hui Lu
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Zhao Cui
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Xu-jie Zhou
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Qi-zhuang Jin
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Xiao-juan Yu
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Su-xia Wang
- Electron Microscopy Laboratory, Peking University First Hospital
| | - Yu Wang
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Fu-de Zhou
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital
- Institute of Nephrology, Peking University
- Key Laboratory of Renal Disease, Ministry of Health of China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
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5
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Zewde N, Morikis D. A computational model for the evaluation of complement system regulation under homeostasis, disease, and drug intervention. PLoS One 2018; 13:e0198644. [PMID: 29874282 PMCID: PMC5991421 DOI: 10.1371/journal.pone.0198644] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 03/21/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
The complement system is an intricate defense network that rapidly removes invading pathogens. Although many complement regulators are present to protect host cells under homeostasis, the impairment of Factor H (FH) regulatory mechanism has been associated with several autoimmune and inflammatory diseases. To understand the dynamics involved in the pivotal balance between activation and regulation, we have developed a comprehensive computational model of the alternative and classical pathways of the complement system. The model is composed of 290 ordinary differential equations with 142 kinetic parameters that describe the state of complement system under homeostasis and disorder through FH impairment. We have evaluated the state of the system by generating concentration-time profiles for the biomarkers C3, C3a-desArg, C5, C5a-desArg, Factor B (FB), Ba, Bb, and fC5b-9 that are influenced by complement dysregulation. We show that FH-mediated disorder induces substantial levels of complement activation compared to homeostasis, by generating reduced levels of C3 and FB, and to a lesser extent C5, and elevated levels of C3a-desArg, Ba, Bb, C5a-desArg, and fC5b-9. These trends are consistent with clinically observed biomarkers associated with complement-mediated diseases. Furthermore, we introduced therapy states by modeling known inhibitors of the complement system, a compstatin variant (C3 inhibitor) and eculizumab (C5 inhibitor). Compstatin demonstrates strong restorative effects for early-stage biomarkers, such as C3a-desArg, FB, Ba, and Bb, and milder restorative effects for late-stage biomarkers, such as C5a-desArg and fC5b-9, whereas eculizumab has strong restorative effects on late-stage biomarkers, and negligible effects on early-stage biomarkers. These results highlight the need for patient-tailored therapies that target early complement activation at the C3 level, or late-stage propagation of the terminal cascade at the C5 level, depending on the specific FH-mediated disease and the manifestations of a patient's genetic profile in complement regulatory function.
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Affiliation(s)
- Nehemiah Zewde
- Department of Bioengineering, University of California, Riverside, California, United States of America
| | - Dimitrios Morikis
- Department of Bioengineering, University of California, Riverside, California, United States of America
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6
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Ravindran A, Fervenza FC, Smith RJH, Sethi S. C3 glomerulopathy associated with monoclonal Ig is a distinct subtype. Kidney Int 2018; 94:178-186. [PMID: 29729982 DOI: 10.1016/j.kint.2018.01.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/18/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022]
Abstract
Monoclonal immunoglobulins (MIg) may play a causal role in C3 glomerulopathy (C3G) by impairing regulation of the alternative pathway of complement. Ninety-five patients with C3G were tested for MIg of which 36 were positive. Their mean age at diagnosis was 60 years and among patient 50 years and older, 65.1% had a MIg. At presentation, median serum creatinine and proteinuria were 1.9 mg/dL and 3.0 g/24 hours. Hematuria was present in 32 (88.9%) patients. Twelve (34.3%) patients had low C3 levels. C3 nephritic factor was detected in 45.8% patients; pathogenic variants in complement protein genes were rare. Hematologic evaluation revealed monoclonal gammopathy of renal significance in 26 patients, multiple myeloma in five, smoldering multiple myeloma in two, and chronic lymphocytic leukemia, lymphoma, or type I cryoglobulin each in one patient. After a median follow-up of 43.6 months, the median serum creatinine and proteinuria were 1.4 mg/dL and 0.8g/24 hours. Nine patients developed ESRD. Sixteen patients received MIg-targeted treatment, 17 patients received non-targeted treatment while three patients were managed conservatively. Of the 16 patients receiving MIg-targeted treatment, ten achieved complete/very good/partial hematologic response. Of these, seven achieved a complete/partial/stable renal response. Five patients receiving targeted treatment did not achieve hematologic response, none had a renal response. Patients receiving targeted treatment were more likely to have multiple myeloma/smoldering multiple myeloma. Patients receiving non-targeted treatment were more likely to have monoclonal gammopathy of renal significance. Thus, C3G with MIg is seen in older patients, C3 nephritic factor is the most common autoantibody detected, and MIg-targeted treatment may result in remission and stabilization of kidney function in a subset of these patients.
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Affiliation(s)
- Aishwarya Ravindran
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, Departments of Internal Medicine and Pediatrics, Division of Nephrology, Carver College of Medicine, Iowa City, Iowa, USA
| | - Sanjeev Sethi
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
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Ramirez GA, De Luca G, Dell'Antonio G, Baldissera E, Suma GV, Tresoldi M, Dagna L. C3-glomerulopathy and MGUS: the skin beyond the kidney. QJM 2018; 111:187-188. [PMID: 29272460 DOI: 10.1093/qjmed/hcx254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- G A Ramirez
- Università Vita-Salute San Raffaele, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Scientific Institute, Milan, Italy
| | - G De Luca
- Università Vita-Salute San Raffaele, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Scientific Institute, Milan, Italy
- Unit of General Medicine and Advanced Care, Scientific Institute, Milan, Italy
| | - G Dell'Antonio
- Unit of Pathology, IRCCS San Raffaele Hospital & Scientific Institute, Milan, Italy
| | - E Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Scientific Institute, Milan, Italy
| | - G V Suma
- Università Vita-Salute San Raffaele, Milan, Italy
- Unit of General Medicine and Advanced Care, Scientific Institute, Milan, Italy
| | - M Tresoldi
- Unit of General Medicine and Advanced Care, Scientific Institute, Milan, Italy
| | - L Dagna
- Università Vita-Salute San Raffaele, Milan, Italy
- Unit of General Medicine and Advanced Care, Scientific Institute, Milan, Italy
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8
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AlHermi B, Al Mosawi Z, Mohammed D. Renal manifestations in hypocomplementic urticarial vasculitis syndrome: Is it a distinct pathology? Saudi J Kidney Dis Transpl 2017; 28:929-933. [PMID: 28748901] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Hypocomplementic urticarial vasculitis syndrome (HUVS) is an autoimmune disease characterized by recurrent urticaria, arthritis, and glomerulonephritis (GN). Anti-C1q antibody is the marker of HUVS together with low levels of classical pathway complements which are C2, C3, C4, and C1q. We report a case of a 6-year-old boy who presented with episodes of rashes, injected conjunctiva, abdominal pain, and arthritis, diagnosed as HUVS. He had low C3, low CH50, normal C4, and positive C1q antibody. His urinalysis showed intermittent microscopic hematuria only. One year later, his laboratories showed persistent low C3 and positive Anti-ds DNA. The urinalysis showed hematuria, pyuria, and nephrotic-range proteinuria. Urine protein to creatinine ratio was 101.8 h mg/mmol. Kidney biopsy showed mesangioproliferative GN consistent with the diagnosis of HUVS. The patient was treated initially with prednisolone then azathioprine was added to the regimen. He showed good response with the disappearance of hematuria and proteinuria. Nine months later, he had no skin rashes with normal urinalysis and normal anti-ds DNA antibody. We report a case with HUVS and GN with positive anti-dsDNA antibody that revealed good response to combination of immunosuppressive therapy.
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Affiliation(s)
- Badriya AlHermi
- Department of Pediatrics, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Zakiya Al Mosawi
- Department of Pediatrics, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Deena Mohammed
- Department of Pediatrics, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
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Conti G, De Vivo D, Vitale A, Fede C, Santoro D. Dense deposit disease in a child with febrile sore throat. Saudi J Kidney Dis Transpl 2017; 28:925-928. [PMID: 28748900] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Dense deposit disease or membranoproliferative glomerulonephritis type II is a rare glomerulopathy characterized on renal biopsy by deposition of abnormal electron-dense material in the glomerular basement membrane. The pathophysiologic basis is uncontrolled systemic activation of the alternate pathway of the complement cascade. C3 nephritic factor, an autoantibody directed against the C3 convertase of the alternate pathway, plays a key role. In some patients, complement gene mutations have been identified. We report the case of a child who had persistent microscopic hematuria, proteinuria, and hypocomplementemia C3 for over 2 months. Renal biopsy confirmed the diagnosis of dense deposit disease.
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Affiliation(s)
- Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, University Hospital Gaetano Martino, Messina, Italy
| | - Dominique De Vivo
- Pediatric Nephrology and Rheumatology Unit, University Hospital Gaetano Martino, Messina, Italy
| | - Agata Vitale
- Pediatric Nephrology and Rheumatology Unit, University Hospital Gaetano Martino, Messina, Italy
| | - Carmelo Fede
- Pediatric Nephrology and Rheumatology Unit, University Hospital Gaetano Martino, Messina, Italy
| | - Domenico Santoro
- Nephrology and Dialysis Unit, University Hospital Gaetano Martino, Messina, Italy
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10
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Affiliation(s)
- Shivani Shah
- Johns Hopkins University, Baltimore, Maryland, USA.
| | | | - Lois Arend
- Johns Hopkins University, Baltimore, Maryland, USA
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Hernández-Jaras J, Espí-Reig J, Alis R, García-Martínez AM, Rodríguez-Ortega D, Roca-Argente L, Moll-Guillen JL. Immune Complex Membranoproliferative Glomerulonephritis Associated with Transjugular Intrahepatic Portosystemic Shunts in Alcoholic Cirrhosis: Two Case Reports. Med Princ Pract 2017; 26:286-288. [PMID: 28226323 PMCID: PMC5588412 DOI: 10.1159/000464365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/23/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report on 2 patients with alcoholic cirrhosis who were treated with transjugular intrahepatic portosystemic shunt (TIPS) placement. CLINICAL PRESENTATION AND INTERVENTION The 2 patients had a history of alcoholic cirrhosis, and TIPS surgery was performed on them. In both cases, 4 months after TIPS placement, proteinuria was observed along with histological alterations characteristic of immune complex membranoproliferative glomerulonephritis (MPGN). CONCLUSION The TIPS in one patient was successful without immediate complications, while the other patient was referred for a combined liver-kidney transplant. In both cases, immune complex MPGN might have developed after TIPS placement probably due to a reduced immune complex clearance.
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Affiliation(s)
- Julio Hernández-Jaras
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- *Julio Hernández-Jaras, MD, PhD, Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Avda. de Fernando Abril Martorell 106, ES-46026 Valencia (Spain), E-Mail
| | - Jordi Espí-Reig
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Alis
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Lourdes Roca-Argente
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Motwani SS, Herlitz L, Monga D, Jhaveri KD, Lam AQ. Paraprotein-Related Kidney Disease: Glomerular Diseases Associated with Paraproteinemias. Clin J Am Soc Nephrol 2016; 11:2260-2272. [PMID: 27526706 PMCID: PMC5142064 DOI: 10.2215/cjn.02980316] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Paraproteins are monoclonal Igs that accumulate in blood as a result of abnormal excess production. These circulating proteins cause a diversity of kidney disorders that are increasingly being comanaged by nephrologists. In this review, we discuss paraprotein-related diseases that affect the glomerulus. We provide a broad overview of diseases characterized by nonorganized deposits, such as monoclonal Ig deposition disease (MIDD), proliferative GN with monoclonal Ig deposits (PGNMID), and C3 glomerulopathy, as well as those characterized by organized deposits, such as amyloidosis, immunotactoid glomerulopathy, fibrillary GN, and cryoglobulinemic GN, and rarer disorders, such as monoclonal crystalline glomerulopathies, paraprotein-related thrombotic microangiopathies, and membranous-like glomerulopathy with masked IgGκ deposits. This review will provide the nephrologist with an up to date understanding of these entities and highlight the areas of deficit in evidence and future lines of research.
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Affiliation(s)
- Shveta S. Motwani
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Adult Survivorship Program, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Leal Herlitz
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Divya Monga
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Kenar D. Jhaveri
- Division of Kidney Diseases and Hypertension, Hofstra Northwell School of Medicine, Northwell Health, Great Neck, New York
| | - Albert Q. Lam
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Adult Survivorship Program, Dana Farber Cancer Institute, Boston, Massachusetts
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Koda R, Nagahori K, Kitazawa A, Imanishi Y, Yoshino A, Kawamoto S, Ueda Y, Takeda T. Myeloperoxidase Antineutrophil Cytoplasmic Antibody (MPO-ANCA) Associated Crescentic and Necrotizing Glomerulonephritis (GN) with Membranoproliferative GN Features. Intern Med 2016; 55:2043-8. [PMID: 27477412 DOI: 10.2169/internalmedicine.55.6426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man presented with a fever, non-productive cough, and edema formation. A laboratory analysis showed an elevated creatinine level (2.5 mg/dL), a high titer of myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA) (99 U/mL), positive reaction for antinuclear antibody (×320), hematuria, and massive proteinuria (3.33 g/day). A renal biopsy revealed crescentic and necrotizing glomerulonephritis (GN) with membranoproliferative GN features [double contour appearance of the glomerular basement membrane, granular deposition of immunoglobulin (Ig) G, IgM, and C3 along the capillary wall, subendothelial and subepithelial deposits with mesangial interposition]. A potential relationship between MPO-ANCA associated GN and membranoproliferative GN is discussed.
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Affiliation(s)
- Ryo Koda
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Japan
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Imtiaz S, Dhrolia MF, Nasir K, Salman B, Ahmad A. Type of immune and complement deposits and response of immunosuppressive treatment on Membranoproliferative Glomerulonephritis -- a single centre experience. J PAK MED ASSOC 2015; 65:995-1000. [PMID: 26338748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To see the response of steroid and cyclophosphamide if membranoproliferative glomerulonephritis is classified by pattern of immune and complement deposits. METHODS The retrospective study was conducted at The Kidney Centre, Karachi, and comprised patients treated for membranoproliferative glomerulonephritis between 1996 and 2013. Records of patients who were not treated with immunosuppressive medications were excluded. Patients were classified according to the types of immune deposits; one group had patients with only Complement factor 3 deposits, and the other with Complement factor 3 and immunoglobulin deposits. The effect of steroid alone and steroid with cyclophosphamide was observed on two histological patterns, according to the severity of kidney dysfunction and degree of interstitial fibrosis. SPSS 17 was used for statistical analysis. RESULTS Of the 54 patients, 31(57%) were males and 23(42%) were females, with an overall mean age of 30.26±15.41 years. Group with Complement factor 3deposits had 17(31%) patients, while that with Complement factor 3 and immunoglobulin had 37(68%). Both groups were similar in terms of clinical and laboratory parameters (p>0.05). Both groups showed better response when treated with steroid and cyclophosphamide: 8/9(88.9%) vs. 3/8(37.5%) in Complement factor 3 only; and 10/15(66.7%) vs. 12/22(54.5%) in Complement factor 3 with immunoglobulin. Increasing severity of interstitial fibrosis (p=0.014) and presence of renal dysfunction (p=0.001) hampered the response. After adjusting the confounders, the odds ratio of response was 4.654(95%confidence interval: 0.957-22.63) in patients who received the treatment with steroid and cyclophosphamide compared to steroid alone. CONCLUSIONS Steroids and cyclophosphamide together have a beneficial role if treatment is initiated early in the course of the disease.
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Affiliation(s)
- Salman Imtiaz
- The Kidney Centre Postgraduate Training Institute, Karachi
| | | | - Kiran Nasir
- The Kidney Centre Postgraduate Training Institute, Karachi
| | - Beena Salman
- The Kidney Centre Postgraduate Training Institute, Karachi
| | - Aasim Ahmad
- The Kidney Centre Postgraduate Training Institute, Karachi
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15
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Sakai H, Endoh M, Yano N, Kashem A, Nomoto Y. Activation of IgA-specific switch T cells in patients with IgA nephropathy. Contrib Nephrol 2015; 104:92-8. [PMID: 8100756 DOI: 10.1159/000422401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- H Sakai
- Department of Internal Medicine, School of Medicine, Tokai University, Isehara City, Japan
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MESH Headings
- Aleutian Mink Disease/immunology
- Animals
- Antibodies, Viral/immunology
- Antigens, Bacterial/immunology
- Dextrans/immunology
- Dextrans/toxicity
- Dinitrophenols/immunology
- Disease Models, Animal
- Glomerulonephritis, IGA/immunology
- Glomerulonephritis, Membranoproliferative/etiology
- Glomerulonephritis, Membranoproliferative/immunology
- Immune Complex Diseases/etiology
- Immune Complex Diseases/immunology
- Immunization, Passive
- Immunoglobulin A/toxicity
- Mice
- Mice, Inbred BALB C
- Mice, Mutant Strains
- Mink
- Parainfluenza Virus 1, Human/immunology
- Rats
- Rats, Inbred Lew
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Affiliation(s)
- A Fornasieri
- Department of Nephrology, San Carlo Borromeo Hospital, Milan, Italy
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17
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Abstract
'Membranoproliferative' describes glomerular injury characterized by capillary wall thickening and mesangial expansion owing to increased matrix deposition and hypercellularity. The presence of immune deposits is indicative of membranoproliferative glomerulonephritis (MPGN). Historically, MPGN was further classified into three types according to the appearance and site of the electron-dense deposits seen by electron microscopy, but it is now recognized that many cases show only deposition of the complement component C3, owing to abnormal control of the alternative pathway of complement activation-these cases are now classified as C3 glomerulopathies. Not all cases of C3 glomerulopathy, however, show an MPGN pattern. C3 glomerulopathies include dense deposit disease, which shows dense osmiophilic deposits, and C3 glomerulonephritis, which shows isolated deposits. In many cases, the genetic mutations or autoantibodies responsible for C3 deposition have been identified. Some patients in whom complement control is abnormal will accumulate small amounts of immunoglobulin in their glomeruli and so, in everyday practice, the morphological diagnosis of 'glomerulonephritis with dominant C3' is useful for identifying patients who require investigation of the complement pathway. The recognition that many cases of MPGN are C3 glomerulopathies and that the underlying cause can often be identified in immunoglobulin-associated cases means that the diagnosis of idiopathic MPGN is now very uncommon.
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Affiliation(s)
- H Terence Cook
- Centre for Complement and Inflammation Research, Department of Medicine, Imperial College, London W12 0NN, UK
| | - Matthew C Pickering
- Centre for Complement and Inflammation Research, Department of Medicine, Imperial College, London W12 0NN, UK
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18
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Bhargava A, Ortega LM, Nayer A, Burguera V, Jasnosz K. Necrotizing crescentic glomerulonephritis in a patient with positive serologies for lupus and antineutrophil cytoplasmic antibodies. Nefrologia 2014; 34:678-681. [PMID: 25259824 DOI: 10.3265/nefrologia.pre2014.apr.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2014] [Indexed: 06/03/2023] Open
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19
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Kaneko Y, Narita I. [Nephritis and nephrotic syndrome]. Nihon Jinzo Gakkai Shi 2013; 55:35-41. [PMID: 23461208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Affiliation(s)
- Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA.
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21
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Zhang Y, Meyer NC, Wang K, Nishimura C, Frees K, Jones M, Katz LM, Sethi S, Smith RJ. Causes of alternative pathway dysregulation in dense deposit disease. Clin J Am Soc Nephrol 2012; 7:265-74. [PMID: 22223606 PMCID: PMC3280037 DOI: 10.2215/cjn.07900811] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 10/21/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES This study was designed to investigate the causes of alternative pathway dysregulation in a cohort of patients with dense deposit disease (DDD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Thirty-two patients with biopsy-proven DDD underwent screening for C3 nephritic factors (C3Nefs), factor H autoantibodies (FHAAs), factor B autoantibodies (FBAAs), and genetic variants in CFH. C3Nefs were detected by: ELISA, C3 convertase surface assay (C3CSA), C3CSA with properdin (C3CSAP), two-dimensional immunoelectrophoresis (2DIEP), and immunofixation electrophoresis (IFE). FHAAs and FBAAs were detected by ELISA, and CFH variants were identified by Sanger sequencing. RESULTS Twenty-five patients (78%) were positive for C3Nefs. Three C3Nef-positive patients were also positive for FBAAs and one of these patients additionally carried two novel missense variants in CFH. Of the seven C3Nef-negative patients, one patient was positive for FHAAs and two patients carried CFH variants that may be causally related to their DDD phenotype. C3CASP was the most sensitive C3Nef-detection assay. C3CASP and IFE are complementary because C3CSAP measures the stabilizing properties of C3Nefs, whereas IFE measures their expected consequence-breakdown of C3b. CONCLUSIONS A test panel that includes C3CSAP, IFE, FHAAs, FBAAs, and genetic testing for CFH variants will identify a probable cause for alternative pathway dysregulation in approximately 90% of DDD patients. Dysregulation is most frequently due to C3Nefs, although some patients test positive for FHAAs, FBAAs, and CFH mutations. Defining the pathophysiology of DDD should facilitate the development of mechanism-directed therapies.
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Affiliation(s)
- Yuzhou Zhang
- Departments of Otolaryngology–Head & Neck Surgery and
| | | | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | | | - Kathy Frees
- Departments of Otolaryngology–Head & Neck Surgery and
| | - Michael Jones
- Departments of Otolaryngology–Head & Neck Surgery and
| | - Louis M. Katz
- Mississippi Valley Regional Blood Center, Davenport, Iowa; and
| | - Sanjeev Sethi
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Richard J.H. Smith
- Departments of Otolaryngology–Head & Neck Surgery and
- Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Jiang JY, Huang XD, Wang Y, Deng AP, Zhou JH. [FTY720 attenuates rat anti-Thy-1 mesangial proliferative glomerulonephritis by inhibition of transforming growth factor β1-connective tissue growth factor pathway]. Zhonghua Bing Li Xue Za Zhi 2012; 41:107-111. [PMID: 22455887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate whether FTY720 inhibits rat mesangial proliferation and extracellular matrix expansion through suppression of transforming growth factor β1-connective tissue growth factor (TGFβ1-CTGF) pathway, and to explore experimental evidence for its effect on mesangial proliferative glomerulonephritis. METHODS A rat model of anti-Thy-1 mesangial proliferative glomerulonephritis was established and FTY720 intervention was performed. Periphery blood lymphocyte count, urine protein excretion, glomerular mesangial proliferation, protein and gene expression of TGFβ1 and CTGF and extracellular matrix protein including fibronectin, laminin and collagen IV in isolated glomeruli were documented at 1, 3 and 7 days after injection of anti-Thy-1 antibody. RESULTS The model group developed proteinuria at 1, 3 and 7 days after injection of anti-Thy-1 antibody, which were significantly higher [(27.9 ± 7.3), (63.5 ± 18.8) and (52.4 ± 15.4)mg/d, respectively] than those in the control group [(8.4 ± 2.4), (8.4 ± 2.1) and (10.4 ± 3.2) mg/d; respectively, P < 0.01]. FTY720 intervention group showed significantly decreased proteinuria at 3 and 7 days after injection [(31.4 ± 7.0), (25.5 ± 7.7) mg/d, respectively] than model group (P < 0.01), although higher than the control group (P < 0.01). After intervention for 3 and 7 days, FTY720 significantly down-regulated both TGFβ1 and CTGF gene and protein expression in cultured glomeruli, and suppressed the production of glomerular extracellular matrix protein secretion, leading to attenuated mesangial cell proliferation and extracellular matrix expansion in rat anti-Thy-1 mesangial proliferative glomerulonephritis. CONCLUSION FTY720 significantly attenuates mesangial proliferation and extracellular matrix expansion through inhibition of TGFβ1-CTGF pathway in rat, and thus ameliorates the development of anti-Thy-1 mesangial proliferative glomerulonephritis.
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Affiliation(s)
- Jing-yu Jiang
- Department of Pharmacy, the Central Hospital of Wuhan, Wuhan 430014, China.
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Morales JM, Kamar N, Rostaing L. Hepatitis C and renal disease: epidemiology, diagnosis, pathogenesis and therapy. Contrib Nephrol 2012; 176:10-23. [PMID: 22310777 DOI: 10.1159/000333772] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
There is an increased evidence for the association between hepatitis C virus (HCV) infection and kidney diseases. Recent epidemiological studies strongly suggest that HCV infection is a risk factor for proteinuria and/or impaired renal function. Type I membranoproliferative glomerulonephritis (MPGN) associated with type II cryoglobulinemia is the most frequent renal disease, and non-cryoglobulinemic MPGN and membranous glomerulonephritis are less frequently associated with active HCV infection. The pathogenesis of these lesions are related to the deposition of immune complexes in the glomeruli, and recently it has been described that toll-like receptor 3 could have a pathogenic role establishing a link between viral infection and glomerulonephritis. Patients with HCV-related glomerulopathies should be treated with angiotensin-converting enzyme inhibitors in association or not with angiotensin receptor blockers, as well as with anti-HCV therapy. The latter relies on a combined antiviral therapy of standard or pegylated interferon-α and ribavirin. We recommend the treatment of patients for at least 48 weeks, and the continuation of antiviral therapy, even in the absence of a decrease in HCV RNA concentration of 2-log at week 12. Ribavirin doses should be adapted according to creatinine clearance in order to avoid its main side effect, i.e. hemolytic anemia. Combined antiviral therapy and immunosuppression (cyclophosphamide or rituximab with steroids) may be the treatment of choice for patients with severe renal disease, i.e. nephrotic syndrome and/or progressive renal failure, or diseases that are refractory to anti-HCV therapy alone.
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Bataille S, Kaplanski G, Boucraut J, Halfon P, Camus C, Daniel L, Burtey S, Berland Y, Dussol B. Membranoproliferative glomerulonephritis and mixed cryoglobulinemia after hepatitis C virus infection secondary to glomerular NS3 viral antigen deposits. Am J Nephrol 2012; 35:134-40. [PMID: 22248563 DOI: 10.1159/000335375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 10/27/2011] [Accepted: 11/27/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND We report on 3 cases of membranoproliferative glomerulonephritis associated with mixed cryoglobulin in patients with hepatitis C virus (HCV) antibodies but a negative blood viral load. These cases explore the pathogenesis of the renal disease. METHODS We searched for occult HCV infection in peripheral blood mononuclear cells, cryoprecipitate, bone marrow cells, and glomeruli using ultrasensitive PCR assays and immunohistochemistry. We also looked for infraclinical B cell lymphoma by computed tomodensitometry, bone marrow aspiration and biopsy, and lymphocyte typing. RESULTS By PCR assays, we did not evidence occult hepatitis C infection in peripheral blood mononuclear cells, bone marrow cells, or cryoprecipitates. In the only patient with available kidney specimen, we evidenced HCV-NS3 antigen in glomeruli. HCV-associated lymphoma was excluded, but mild polyclonal B lymphocytosis was present in the 3 patients. Remission occurred spontaneously in 1 patient, and in another patient it occurred after rituximab treatment. The third patient was lost to follow-up. CONCLUSIONS In patients with hepatitis C-negative viral load, membranoproliferative glomerulonephritis could be induced by the persistence of HCV antigen in the kidney but not in hematopoietic cells. Nonlymphomatous B cell proliferation may also be induced by chronic viral stimulation.
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Affiliation(s)
- Stanislas Bataille
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France.
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25
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Sovetkina NV, Riabova TS, Ar'ev AL, Ovsiannikova NA. [Influence of immunoglobulins on clinical laboratory picture and morphological changes in patients with mesangial-proliferative glomerulonephritis: age aspects]. Adv Gerontol 2012; 25:63-67. [PMID: 22708446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article presents data of 77 mesangial proliferative glomerulonephritis (MezPGN) patients, aged 20 to 71 years. The effect of deposits of immunoglobulins in the kidney tissue to the index of blood pressure and laboratory parameters of disease activity in MezPGN patients regardless of age is shown. The data demonstrate that the presence of IgM deposits in kidney tissue is unfavorable prognostic sign of MezPGN flow.
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Komatsuda A, Nara M, Ohtani H, Nimura T, Sawada K, Wakui H. Proliferative glomerulonephritis with monoclonal immunoglobulin light chain deposits: a rare entity mimicking immune-complex glomerulonephritis. Intern Med 2012. [PMID: 23207123 DOI: 10.2169/internalmedicine.51.8513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 39-year-old man developed proteinuria, hematuria, and renal insufficiency. A renal biopsy revealed the presence of mesangial proliferative glomerulonephritis with monoclonal λ-light chain deposits without evidence of immunoglobulin G (IgG), immunoglobulin A (IgA) or immunoglobulin M (IgM) deposits. Electron microscopy revealed granular electron-dense deposits resembling immune-complex deposits. No monoclonal proteins were detected in the serum or urine. The patient was treated with an angiotensin II receptor antagonist, and his condition was almost stable during the 1-year follow-up. This case shares common pathological characteristics with the newly described entity referred to as "proliferative glomerulonephritis with monoclonal IgG deposits" in which, glomerular deposits are composed entirely of monoclonal IgG. Therefore, we term the unusual form of glomerulonephritis observed in the present case "proliferative glomerulonephritis with monoclonal immunoglobulin light chain deposits."
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Affiliation(s)
- Atsushi Komatsuda
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan.
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27
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Otani N, Morishita Y, Oh I, Saito O, Takemoto F, Muto S, Kusano E. Successful treatment of a mesangial proliferative glomerulonephritis with interstitial nephritis associated with Castleman's disease by an anti-interleukin-6 receptor antibody (tocilizumab). Intern Med 2012; 51:1375-8. [PMID: 22687845 DOI: 10.2169/internalmedicine.51.6555] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of mesangial proliferative glomerulonephritis with interstitial nephritis associated with multicentric Castleman's disease (MCD) successfully treated with an anti-interleukin-6 receptor antibody (tocilizumab). This mesangial proliferative glomerulonephritis with interstitial nephritis was resistant to methylprednisolone treatment; however, it was markedly improved with tocilizumab, which was administered intravenously at a dose of 8 mg/kg every 2 weeks. These results suggest that tocilizumab is effective for the treatment of mesangial proliferative glomerulonephritis with interstitial nephritis associated with MCD.
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MESH Headings
- Antibodies, Monoclonal, Humanized/therapeutic use
- Castleman Disease/complications
- Castleman Disease/therapy
- Glomerulonephritis, Membranoproliferative/etiology
- Glomerulonephritis, Membranoproliferative/immunology
- Glomerulonephritis, Membranoproliferative/pathology
- Glomerulonephritis, Membranoproliferative/therapy
- Humans
- Interleukin-6/blood
- Male
- Methylprednisolone/therapeutic use
- Middle Aged
- Nephritis, Interstitial/etiology
- Nephritis, Interstitial/immunology
- Nephritis, Interstitial/pathology
- Nephritis, Interstitial/therapy
- Receptors, Interleukin-6/antagonists & inhibitors
- Treatment Outcome
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Affiliation(s)
- Naoko Otani
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
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28
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Chen Q, Müller D, Rudolph B, Hartmann A, Kuwertz-Bröking E, Wu K, Kirschfink M, Skerka C, Zipfel PF. Combined C3b and factor B autoantibodies and MPGN type II. N Engl J Med 2011; 365:2340-2. [PMID: 22168663 DOI: 10.1056/nejmc1107484] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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29
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Yoshio T, Okamoto H, Onishi S, Minota S. Antiribosomal-P protein antibodies are associated with proliferative glomerulonephritis more strongly than with membranous glomerulonephritis in Japanese patients with systemic lupus erythematosus. Mod Rheumatol 2011; 22:488-90. [PMID: 22042098 DOI: 10.1007/s10165-011-0549-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 10/12/2011] [Indexed: 11/28/2022]
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30
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Wan YG, Sun W, Zhen YJ, Che XY, Pu HP, Wang Y, Li M, Ruan JG, Yan QJ. Multi-glycoside of Tripterygium wilfordii Hook. f. reduces proteinuria through improving podocyte slit diaphragm dysfunction in anti-Thy1.1 glomerulonephritis. J Ethnopharmacol 2011; 136:322-333. [PMID: 21570456 DOI: 10.1016/j.jep.2011.04.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 05/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Multi-glycoside of Tripterygium wilfordii Hook. f. (GTW) has been proved clinically effective in reducing proteinuria in chronic kidney disease in China. However, the mechanisms involved are still unclear. In this study we examined the effects of GTW at the different dosages on proteinuria and podocyte slit diaphragm (SD) dysfunction in anti-Thy1.1 glomerulonephritis (GN). MATERIALS AND METHODS Rats with anti-Thy1.1 GN were divided into 2 groups, a GTW group and a vehicle group, and sacrificed at 30 min, on day 7, and on day 14 in Experiments 1, 2 and 3, respectively. The administration of GTW at the moderate and high doses was started 3 days before or at the same time of antibody injection till sacrifice. Proteinuria was determined in Experiments 1, 2, and 3. After sacrifice, the staining intensity of SD-associated key functional molecules including nephrin and podocin, podocyte structure, mesangial change, macrophage infiltration, and blood biochemical parameters were examined, respectively. Protein and mRNA expressions of nephrin and podocin in glomeruli were also investigated. Besides, liver histological characteristics were analyzed. RESULTS In Experiment 1, GTW pretreatment at the medium dose (75 mg/kg body weight) caused no influence on the induction of anti-Thy1.1 GN and the basal nephrin expression. In Experiment 2, the high dosage (100mg/kg body weight) of GTW ameliorated proteinuria, the distribution of nephrin and podocin, mesangial proliferation, and the activated macrophage accumulation, as compared with vehicle group (P<0.05). Additionally, it increased mRNA and protein expressions of nephrin and podocin in glomeruli on day 7, but had no influence on podocyte structure. In Experiment 3, the medium dosage (75 mg/kg body weight) of GTW improved proteinuria, the partial matrix expansion, and the distribution of nephrin and podocin on day 14, as compared with anti-Thy1.1 GN rats (P<0.05). GTW at the high or moderate dose did not affect hepatic function on day 7 and on day 14. CONCLUSIONS Podocyte SD dysfunction, such as the disordered distribution and down-regulation of nephrin and podocin expression, is critically involved in the pathogenesis of anti-Thy1.1 GN induced by mAb 1-22-3. The restoration of the distribution and expression of nephrin and podocin by GTW could be an important mechanism by which GTW ameliorates proteinuria and podocyte SD dysfunction.
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Affiliation(s)
- Yi-Gang Wan
- Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Abstract
Dense deposit disease (DDD) is an orphan disease that primarily affects children and young adults without sexual predilection. Studies of its pathophysiology have shown conclusively that it is caused by fluid-phase dysregulation of the alternative pathway of complement, however the role played by genetics and autoantibodies like C3 nephritic factors must be more thoroughly defined if we are to make an impact in the clinical management of this disease. There are currently no mechanism-directed therapies to offer affected patients, half of whom progress to end stage renal failure disease within 10 years of diagnosis. Transplant recipients face the dim prospect of disease recurrence in their allografts, half of which ultimately fail. More detailed genetic and complement studies of DDD patients may make it possible to identify protective factors prognostic for naïve kidney and transplant survival, or conversely risk factors associated with progression to renal failure and allograft loss. The pathophysiology of DDD suggests that a number of different treatments warrant consideration. As advances are made in these areas, there will be a need to increase healthcare provider awareness of DDD by making resources available to clinicians to optimize care for DDD patients.
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Affiliation(s)
- Richard J H Smith
- Department of Internal Medicine, Division of Nephrology, Carver College of Medicine, University of Iowa, 21151 PFP, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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32
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Krmar RT, Holtbäck U, Linné T, Berg UB, Celsi G, Söderberg MP, Wernerson A, Szakos A, Larsson S, Skattum L, Bárány P. Acute renal failure in dense deposit disease: complete recovery after combination therapy with immunosuppressant and plasma exchange. Clin Nephrol 2011; 75 Suppl 1:4-10. [PMID: 21269585] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
We describe the clinical course of a female adolescent who was followed because of isolated microhematuria and hypocomplementemia before admission to hospital with a sudden onset of acute renal failure. At presentation, she exhibited complement consumption through the complement alternative pathway (AP) while other serologic tests were negative. Renal biopsy revealed dense deposit disease (DDD) with a crescentic pattern. Intravenous methylprednisolone, followed by plasma exchange (PE), and intravenous cyclophosphamide pulses were started shortly after admission. C3NeF and anti-factor H antibody tests were negative. Serum factor H and I levels were normal as well as factor H activity. Screening for mutation in the factor H gene revealed the H402 allele variant. Clinical remission, defined as normalization in renal function and in the activity levels of the complement AP, was noted at one month post-presentation and throughout the follow-up. A repeat renal biopsy showed the disappearance of crescent formation, whereas electron microscopy revealed no regression in dense transformation of the lamina densa. In summary, our patient was successfully treated with immunosuppressant and PE. The absence of known factors associated with DDD suggests that, in this particular case, other regulatory mechanisms of complement AP might have been involved in the disease process.
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Affiliation(s)
- R T Krmar
- Karolinska Institute, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden.
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33
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Manganelli R, Iannaccone S, Ferbo U, De Simone W. [Diagnostic pathway of an unusual case of nephrotic syndrome: immunotactoid glomerulopathy]. G Ital Nefrol 2010; 27:668-673. [PMID: 21132650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Immunotactoid glomerulopathy is a clinicopathological entity characterized by extracellular deposition of microtubular substructures, which are negative for the usual staining that identifies amyloid within the mesangium and capillary walls of renal glomeruli. Despite ongoing debate in the nephrological community, it is kept distinct from fibrillary glomerulonephritis on the basis of the size and arrangement of the microtubules and microfibrils. It is clinically characterized by the presence of glomerular proteinuria in the nephrotic range, microscopic hematuria and hypertension, and is often associated with hypocomplementemia, monoclonal gammopathy, and lymphoprolipherative disorders. A 47-year-old woman was referred to our unit for evaluation of proteinuria associated with nephrotic syndrome. Laboratory findings revealed a serum M component and hypocomplementemia. Renal biopsy yielded three fragments for optical microscopy, immunofluorescence, and electron microscopy; Congo red staining was used. Renal histology showed a morphological pattern of membranoproliferative glomerulonephritis. Immunofluorescence showed IgG deposits with monoclonal kappa light chain restriction as well as C3 and C1q deposits. Electron microscopy revealed the presence within the mesangium of microtubules measuring >35 nm that were focally parallel oriented. The final diagnosis was nephrotic syndrome caused by immunotactoid glomerulopathy. The clinical diagnosis of immunotactoid glomerulopathy is based on pathological, clinical and hematological features and requires the exclusion of other diseases that are associated with organized glomerular deposits. We discuss the diagnostic options offered by the clinical and morphological elements of this case; the use of electron microscopy is emphasized, especially when a renal syndrome is associated with paraproteinemia.
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Affiliation(s)
- Rocco Manganelli
- Struttura Complessa di Nefrologia e Dialisi, AORN A.G. Moscati, Avellino, Italy.
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34
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Halim MA, Al-Otaibi T, Al-Waheeb S, Tawab KA, El Kholy O, Nair P, Said T, Narayanan Nampoory MR. Late acute antibody mediated rejection after nine years of renal transplantation. Saudi J Kidney Dis Transpl 2010; 21:1111-1114. [PMID: 21060182] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Acute antibody mediated rejection (AMR) is rarely reported as a long-term com-plication of renal transplantation, and it can present on top of another chronic pathology affecting the graft. A 45-year-old gentleman with chronic kidney disease due to unknown etiology received renal transplantation from his sister with 4 HLA mismatches. He received antithymocte globulin induction therapy and was maintained on steroids, azathioprine (AZA) and cyclosporine A (CsA). Up to eight years post-transplantation he was clinically and biochemically stable. He lost follow-up for about one year, and then presented with nephritic nephrotic syndrome and rise of serum creatinine (SCr.) to 210 μmol/L. Graft biopsy revealed picture suggestive of acute AMR on top of de novo membranoprolipherative glomerulonephritis (MPGN) with focal crescent formation, diffuse immune complex deposition and peritubular capillaries C4d positivity. Anti-HLA donor specific antibodies were highly positive for B and T cells class I and class II. The patient was treated with intravenous immunoglobulin, plasma exchange and anti-CD20 (rituximab). AZA was changed to mycophenolate mofetil and CsA to tacrolimus. He had partial response, but SCr. continued at 220 μmol/L.
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Affiliation(s)
- Medhat Abdel Halim
- Hamed Alessa Organ Transplantation Center, Mubarak Al-Kabeer Hospital, Kuwait.
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35
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Upadhaya BK, Sharma A, Khaira A, Dinda AK, Agarwal SK, Tiwari SC. Transient IgA nephropathy with acute kidney injury in a patient with dengue fever. Saudi J Kidney Dis Transpl 2010; 21:521-525. [PMID: 20427882] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Dengue virus infection can clinically manifest as dengue fever, dengue shock syndrome and dengue hemorrhagic fever. Acute kidney injury as a result of dengue virus infection can occur due to various reasons including hypotension, rhabdomyolysis, sepsis and rarely immune complex mediated glomerular injury. However, glomerulonephritis associated with IgA Nephropathy in dengue virus infection has not been reported previously. We report a case of 15-year-old boy who was admitted with dengue fever and dialysis dependant acute kidney injury. Urine examination showed microscopic glomerular hematuria and proteinuria. Kidney biopsy showed mesangial proliferation with mesangial IgA dominant immune complex deposits and acute tubular necrosis. A repeated kidney biopsy 6 weeks after clinical recovery showed reversal of glomerular changes as well as resolution of mesangial IgA deposits.
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36
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Ikezumi Y, Suzuki T, Karasawa T, Hasegawa H, Kawachi H, Nikolic-Paterson DJ, Uchiyama M. Contrasting effects of steroids and mizoribine on macrophage activation and glomerular lesions in rat thy-1 mesangial proliferative glomerulonephritis. Am J Nephrol 2010; 31:273-82. [PMID: 20110667 DOI: 10.1159/000279163] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [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: 09/24/2009] [Accepted: 11/27/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Macrophages with a pro-inflammatory (M1) phenotype mediate renal injury in proliferative forms of glomerulonephritis, while alternatively activated (M2) macrophages are thought to be anti-inflammatory and promote repair. Glucocorticoids, the mainstay therapy for proliferative glomerulonephritis, can induce alternative macrophage activation in vitro, but it is unknown whether this occurs in vivo and if this is required for glucocorticoid responsiveness. In addition, clinical studies have suggested that the ability of mizoribine (MZR) to suppress steroid-resistant proliferative glomerulonephritis may operate via inhibiting pro-inflammatory macrophage activation. METHODS This study examined prednisolone (PSL) and/or MZR treatment of rat Thy-1 disease - a model in which macrophages promote mesangial proliferative glomerulonephritis. RESULTS PSL treatment of Thy-1 nephritis induced an M2-like macrophage phenotype, but failed to modify mesangial hypercellularity and actually exacerbated global glomerulosclerosis. In contrast, MZR treatment reduced hypercellularity and glomerulosclerosis and suppressing both M1 and M2 markers of macrophage activation, with a selective reduction in CD169+ macrophages. Combined PSL/MZR treatment suppressed glomerular lesions and prevented steroid induction of an M2-like macrophage phenotype. In vitro, MZR prevented steroid induction of an M2 macrophage phenotype. CONCLUSIONS Glucocorticoid induced alternative macrophage activation failed to ameliorate rat mesangial proliferative glomerulonephritis, whereas MZR suppression of this disease model was attributed, in part, to inhibition of M1-like pro-inflammatory macrophage activation.
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Affiliation(s)
- Yohei Ikezumi
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Japan.
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37
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Nasr SH, Satoskar A, Markowitz GS, Valeri AM, Appel GB, Stokes MB, Nadasdy T, D'Agati VD. Proliferative glomerulonephritis with monoclonal IgG deposits. J Am Soc Nephrol 2009; 20:2055-64. [PMID: 19470674 PMCID: PMC2736767 DOI: 10.1681/asn.2009010110] [Citation(s) in RCA: 270] [Impact Index Per Article: 18.0] [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: 01/27/2009] [Accepted: 03/10/2009] [Indexed: 01/19/2023] Open
Abstract
Dysproteinemias that result in monoclonal glomerular deposits of IgG are relatively uncommon. Here, we report the largest series of proliferative glomerulonephritis with monoclonal IgG deposits, a form of renal involvement by monoclonal gammopathy that mimics immune-complex glomerulonephritis. We retrospectively identified 37 patients, most of whom were white (81%), female (62%), or older than 50 yr (65%). At presentation, 49% had nephrotic syndrome, 68% had renal insufficiency, and 77% had hematuria. In 30% of the patients, we identified a monoclonal serum protein with the same heavy- and light-chain isotypes as the glomerular deposits (mostly IgG1 or IgG2), but only one patient had myeloma. Histologic patterns were predominantly membranoproliferative (57%) or endocapillary proliferative (35%) with membranous features. Electron microscopy revealed granular, nonorganized deposits, and immunofluorescence demonstrated glomerular deposits that stained for a single light-chain isotype and a single heavy-chain subtype, most commonly IgG3kappa (53%). During an average of 30.3 mo of follow-up for 32 patients with available data, 38% had complete or partial recovery, 38% had persistent renal dysfunction, and 22% progressed to ESRD. Correlates of ESRD on univariate analysis were higher creatinine at biopsy, percentage of glomerulosclerosis, and degree of interstitial fibrosis but not immunomodulatory treatment or presence of a monoclonal spike. On multivariate analysis, higher percentage of glomerulosclerosis was the only independent predictor of ESRD. Only one patient lacking a monoclonal spike at presentation subsequently developed a monoclonal spike and no patient with a monoclonal spike at presentation subsequently developed a hematologic malignancy. We conclude that proliferative glomerulonephritis with monoclonal IgG deposits does not seem to be a precursor of myeloma in the vast majority of patients.
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Affiliation(s)
- Samih H Nasr
- Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
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38
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Araya C, Diaz L, Wasserfall C, Atkinson M, Mu W, Johnson R, Garin E. T regulatory cell function in idiopathic minimal lesion nephrotic syndrome. Pediatr Nephrol 2009; 24:1691-8. [PMID: 19495805 PMCID: PMC2785122 DOI: 10.1007/s00467-009-1214-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 02/10/2009] [Accepted: 03/03/2009] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to test the hypothesis that, in idiopathic minimal lesion nephrotic syndrome (IMLNS), the T regulatory (T reg) cell suppressor mechanism is deficient, thereby enhancing cytokine release by T effector cells. Twenty-one patients with IMLNS, eight healthy controls and two patients with nephrotic syndrome and membranoproliferative glomerulonephritis were studied. The percentage of T reg cells was similar in the healthy controls and in patients with IMLNS in relapse or in remission. Thymidine incorporation in autologous T effector cells, as well as expression of the regulatory cytokine interleukin (IL)-10, was significantly reduced in patients in relapse when compared with patients in remission and healthy subjects. IL-2 expression was also reduced in patients in relapse but did not achieve statistical significance. In a different set of experiments, T cells, from subjects with IMLNS in remission, when stimulated with antiCD3-antiCD28 antibodies, secreted increased levels of cytokines. No such increase in cytokines was observed when cells from healthy controls were stimulated with same mitogen. The impaired T reg cell function observed in these patients may have pathogenic and therapeutic implications, because it could explain the persistence of the proposed pathogenic cytokines observed in the patients with IMLNS.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/pharmacokinetics
- Cell Count
- Cell Proliferation/drug effects
- Cells, Cultured
- Child
- Child, Preschool
- Female
- Flow Cytometry
- Glomerulonephritis, Membranoproliferative/drug therapy
- Glomerulonephritis, Membranoproliferative/immunology
- Glomerulonephritis, Membranoproliferative/pathology
- Glucocorticoids/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- Interleukin-10/metabolism
- Male
- Middle Aged
- Nephrosis, Lipoid/drug therapy
- Nephrosis, Lipoid/immunology
- Nephrosis, Lipoid/pathology
- Recurrence
- Remission Induction
- Suppressor Factors, Immunologic/immunology
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/pathology
- T-Lymphocytes, Regulatory/physiology
- Young Adult
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Affiliation(s)
- Carlos Araya
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Leila Diaz
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Clive Wasserfall
- Department of Pathology, University of Florida, Gainesville, FL, USA
| | - Mark Atkinson
- Department of Pathology, University of Florida, Gainesville, FL, USA
| | - Wei Mu
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Richard Johnson
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Eduardo Garin
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
- Division of Pediatric Nephrology, PO Box 100296, 1600 SW Archer Road, Gainesville, FL 32610-0296, USA
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39
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Abstract
The predominance of renal involvement in autoimmune diseases can most likely be assigned to the specialised function of the kidneys filtrating over 120 ml plasma per minute. Complement activation by autoantibodies directed against planted antigens or antigens already present in renal tissue in the subendothelial and mesangial regions provoke an inflammatory response ultimately resulting in renal damage. New data also suggest complement involvement in the pathogenesis of renal disease caused by subepithelial immune complex deposition. On the other hand complement itself can also be a target of an autoimmune responses causing renal damage as seen in SLE. The results on intervention of complement activation in clinical practise are awaited.
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Affiliation(s)
- M A Seelen
- Renal Transplantation Unit, Department of Internal Medicine, University Medical Center, Groningen, The Netherlands
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40
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Defendenti C, Spina MF, Castiglione A, Atzeni F, Miadonna A, Saudelli M, Guercilena G, Sarzi-Puttini P. [Alveolar hemorrhage in pulmonary-renal syndrome anti-SCL/70 and anti-MPO-ANCA positive]. Recenti Prog Med 2009; 100:361-364. [PMID: 19725477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We describe a case of pulmonary-renal syndrome on autoimmune basis, with alveolar hemorrhage and worsening renal failure. The patient was positive for anti-MPO and anti-SCL/70. Immunosuppressive therapy was effective to treat the pulmonary condition, but chronic renal failure emerged. The clinical condition did not improve after plasmapheresis, thus chronic dialysis was required.
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MESH Headings
- Adult
- Antibodies, Antineutrophil Cytoplasmic/blood
- Antibodies, Antinuclear/blood
- Biomarkers/blood
- DNA Topoisomerases, Type I
- Female
- Glomerulonephritis, Membranoproliferative/blood
- Glomerulonephritis, Membranoproliferative/complications
- Glomerulonephritis, Membranoproliferative/immunology
- Glomerulonephritis, Membranoproliferative/pathology
- Glomerulonephritis, Membranoproliferative/therapy
- Hemorrhage/immunology
- Hemorrhage/therapy
- Humans
- Immunologic Factors/blood
- Immunosuppressive Agents/therapeutic use
- Lung Diseases/blood
- Lung Diseases/complications
- Lung Diseases/immunology
- Lung Diseases/pathology
- Lung Diseases/therapy
- Lung Diseases, Interstitial/immunology
- Nuclear Proteins/blood
- Plasmapheresis
- Pulmonary Alveoli/pathology
- Renal Dialysis/methods
- Scleroderma, Systemic/complications
- Syndrome
- Treatment Outcome
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41
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Licht C, Fremeaux-Bacchi V. Hereditary and acquired complement dysregulation in membranoproliferative glomerulonephritis. Thromb Haemost 2009; 101:271-278. [PMID: 19190809] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Membranoproliferative glomerulonephritis (MPGN) is a chronic progressive renal disease that is diagnosed on the basis of renal histological features. Several MPGN subtypes have been defined by the localization and composition of glomerular deposits (electron dense, Ig and C3). MPGN II or dense deposit disease (DDD) which is defined by the occurrence of electron dense deposits within the lamina densa of the glomerular basement membrane (GBM) is strongly associated with dysregulation of the alternative complement pathway (AP). However, C3 Nephritic Factor (C3NeF), an autoantibody against the alternative C3 convertase C3bBb, and mutations in regulatory proteins of the AP have also been identified in other subtypes of MPGN and even in glomerulonephritis with mesangial C3 deposits. Clinically, MPGN is characterized by proteinuria (up to nephrotic range) and hypertension, frequent progression to end-stage kidney disease and disease recurrence after renal transplantation. The age of onset varies from childhood to adulthood. In the following we will review our current knowledge of pathogenesis of MPGN and will present a novel classification system of the disease based on pathogenesis rather than on morphology. A better understanding of the pathogenesis of MPGN is crucial for the development of novel, specific treatment strategies.
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Affiliation(s)
- Christoph Licht
- The Hospital for Sick Children, Division of Nephrology, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8.
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42
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Zipfel PF, Smith RJH, Skerka C. Factor I and factor H deficiency in renal diseases: similar defects in the fluid phase have a different outcome at the surface of the glomerular basement membrane. Nephrol Dial Transplant 2009; 24:385-7. [PMID: 19056782 PMCID: PMC2727304 DOI: 10.1093/ndt/gfn652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 10/30/2008] [Indexed: 01/08/2023] Open
Affiliation(s)
- Peter F Zipfel
- Department of Infection Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Beutenbergstr. 11a, D-07745 Jena, Germany.
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43
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Komatsuda A, Masai R, Ohtani H, Togashi M, Maki N, Sawada KI, Wakui H. Monoclonal immunoglobulin deposition disease associated with membranous features. Nephrol Dial Transplant 2008; 23:3888-94. [PMID: 18596130 DOI: 10.1093/ndt/gfn363] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Very few cases of non-organized and non-Randall-type monoclonal immunoglobulin deposition disease (MIDD) associated with membranous features have been reported. Information on clinicopathological features and prognosis in this entity is limited. METHODS We reviewed 5443 renal biopsies processed at our department, and identified three patients with MIDD associated with membranous features. We evaluated clinicopathological features and outcomes in these patients. RESULTS All patients had proteinuria, and one patient developed nephrotic syndrome. Renal insufficiency was not observed. Cryoglobulin or monoclonal protein in serum and urine was not detected. A renal biopsy showed thickening of the glomerular capillary walls and spike formation. Tubulointerstitial and vascular alterations were mild or absent. Immunofluorescence studies revealed granular IgG3-kappa deposits in two patients and IgG1-kappa deposits in one patient, along the glomerular capillary walls. Immunofluorescence studies using antibodies specific for gamma-heavy chain Fab containing C(H)1 domain, C(H)2 domain and C(H)3 domain did not show any apparent deletion. On confocal microscopy, glomerular colocalization of light and heavy chains was observed. Electron microscopy showed predominant subepithelial granular deposits without distinct ultrastructural organization. All patients were treated with steroids, and good effects were observed. A follow-up renal biopsy performed in one patient showed histological improvements. No patient developed myeloma or other haematological malignancy during the course of follow-up (mean 44 months). CONCLUSIONS MIDD associated with membranous features is an extremely rare but distinctive entity. Our study suggests glomerular deposition of a nondeleted whole immunoglobulin molecule. Patients with this entity appear to respond well to steroid therapy.
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Affiliation(s)
- Atsushi Komatsuda
- Third Department of Internal Medicine, Akita University School of Medicine, Akita City, Akita 010-8543, Japan.
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44
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Wang H, Jiang XM, Xu JH, Xu J, Tong JX, Wang YW. The profile of gene expression and role of nuclear factor kappa B on glomerular injury in rats with Thy-1 nephritis. Clin Exp Immunol 2008; 152:559-67. [PMID: 18422731 PMCID: PMC2453208 DOI: 10.1111/j.1365-2249.2008.03654.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2008] [Indexed: 12/19/2022] Open
Abstract
Mesangioproliferative glomerulonephritis (MsPGN) is a disease of high incidence in humans. Rats with Thy-1 nephritis (Thy-1 N) are used as an animal model for studying MsPGN. Although several studies have demonstrated that many pathological factors could cause the injury of glomerular mesangial cells (GMCs) in Thy-1 N, changes of profile and the molecular mechanism of the disease (i.e. the role of transcription factors) at intervals remain unclear. The purpose of this study was to identify the changes in gene expression profile and to observe the role of nuclear factor kappa B (NF-kappaB) on the pathological change of renal tissue in Thy-1 N rats. Our results showed that the pathological changes of GMCs in Thy-1 N included three phases: apoptosis (40 min), necrosis (24 h) and proliferation (7 days). Concomitantly, at 40 min and on day 7, the up-regulation of 341 genes and 250 genes were observed, while 392 genes and 119 genes were down-regulated in Thy-1 N. Expression of interleukin (IL)-1beta, IL-6, proliferating cell nuclear antigen, alpha-smooth muscle actin, collagen type IV and excretion of urinary protein was increased in rats with Thy-1 N and decreased in pyrrolidine dithiocarbamate-treated rats with Thy-1 N. These data indicated that the significant changes in the gene profile were coupled with the pathological changes of Thy-1 N, and activation of NF-kappaB may contribute to the pathogenesis of GMCs apoptosis, proliferation, extracelluar matrix accumulation and proteinuria in Thy-1 N.
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Affiliation(s)
- H Wang
- Department of Microbiology and Immunology, Nanjing Medical University, Nanjing, Jiangsu, China
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45
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Laurinavicius A, Gruodyte E, Priluckiene J, Razukeviciene L, Supranaviciene L, Salkus G. [Potential causes of antigenemia in the patients with an immune complex-mediated membranoproliferative glomerulonephritis in Lithuania]. MEDICINA (KAUNAS, LITHUANIA) 2008; 39 Suppl 1:28-32. [PMID: 12761417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
UNLABELLED The pathogenesis of an immune complex-mediated membranoproliferative glomerulonephritis (IMPGN) involves persistent deposition of circulating immune complexes in the glomeruli caused by persistent antigenemia. We have previously reported relatively high incidence of IMPGN in Lithuania. The objective of our study was to evaluate potential causes of persistent antigenemia in the patients with IMPGN. MATERIAL AND METHODS Forty-five patients with IMPGN diagnosed on renal biopsy during 2000-2002 were retrospectively evaluated for the presence of persistent bacterial or viral infections, autoimmune diseases and other associated medical conditions. Patients with established diagnosis of systemic lupus erythematosus (SLE) before the biopsy were not included in the study. RESULTS A great majority (20; 44%) of the patients were found to have persistent bacterial infections of various localization. Four patients (9%) were infected with hepatitis B virus (HBV). Three (7%) patients were eventually diagnosed with SLE and another 3 (7%) had other associated pathology. In the remaining 15 (33%) patients, IMPGN remained idiopathic. Testing for hepatitis C virus (HCV) antibody was performed in 36 patients (12 of them with idiopathic IMPGN) and was negative in all patients. Testing for HCV RNA was not performed. Patients with bacterial infections were significantly younger compared to the group of idiopathic IMPGN (36.5+/-19.1 and 53.8+/-16.4, respectively, p=0.01). We conclude that persistent bacterial infection was a major potential source of antigenemia in our patients with IMPGN, particularly in the younger patients, while HBV and HCV infection was rarely detected.
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Affiliation(s)
- Arvydas Laurinavicius
- Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, State Center of Pathology, Vilnius, Lithuania.
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46
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Pickering MC, Cook HT. Translational mini-review series on complement factor H: renal diseases associated with complement factor H: novel insights from humans and animals. Clin Exp Immunol 2008; 151:210-30. [PMID: 18190458 PMCID: PMC2276951 DOI: 10.1111/j.1365-2249.2007.03574.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2007] [Indexed: 01/28/2023] Open
Abstract
Factor H is the major regulatory protein of the alternative pathway of complement activation. Abnormalities in factor H have been associated with renal disease, namely glomerulonephritis with C3 deposition including membranoproliferative glomerulonephritis (MPGN) and the atypical haemolytic uraemic syndrome (aHUS). Furthermore, a common factor H polymorphism has been identified as a risk factor for the development of age-related macular degeneration. These associations suggest that alternative pathway dysregulation is a common feature in the pathogenesis of these conditions. However, with respect to factor H-associated renal disease, it is now clear that distinct molecular defects in the protein underlie the pathogenesis of glomerulonephritis and HUS. In this paper we review the associations between human factor H dysfunction and renal disease and explore how observations in both spontaneous and engineered animal models of factor H dysfunction have contributed to our understanding of the pathogenesis of factor H-related renal disease.
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Affiliation(s)
- M C Pickering
- Molecular Genetics and Rheumatology Section, Faculty of Medicine, Imperial College, Hammersmith Campus, London, UK.
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47
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Rose KL, Paixao-Cavalcante D, Fish J, Manderson AP, Malik TH, Bygrave AE, Lin T, Sacks SH, Walport MJ, Cook HT, Botto M, Pickering MC. Factor I is required for the development of membranoproliferative glomerulonephritis in factor H-deficient mice. J Clin Invest 2008; 118:608-18. [PMID: 18202746 PMCID: PMC2200299 DOI: 10.1172/jci32525] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 11/28/2007] [Indexed: 12/17/2022] Open
Abstract
The inflammatory kidney disease membranoproliferative glomerulonephritis type II (MPGN2) is associated with dysregulation of the alternative pathway of complement activation. MPGN2 is characterized by the presence of complement C3 along the glomerular basement membrane (GBM). Spontaneous activation of C3 through the alternative pathway is regulated by 2 plasma proteins, factor H and factor I. Deficiency of either of these regulators results in uncontrolled C3 activation, although the breakdown of activated C3 is dependent on factor I. Deficiency of factor H, but not factor I, is associated with MPGN2 in humans, pigs, and mice. To explain this discordance, mice with single or combined deficiencies of these factors were studied. MPGN2 did not develop in mice with combined factor H and I deficiency or in mice deficient in factor I alone. However, administration of a source of factor I to mice with combined factor H and factor I deficiency triggered both activated C3 fragments in plasma and GBM C3 deposition. Mouse renal transplant studies demonstrated that C3 deposited along the GBM was derived from plasma. Together, these findings provide what we believe to be the first evidence that factor I-mediated generation of activated C3 fragments in the circulation is a critical determinant for the development of MPGN2 associated with factor H deficiency.
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Affiliation(s)
- Kirsten L Rose
- Molecular Genetics and Rheumatology Section, Faculty of Medicine, Imperial College, Hammersmith Campus, London, United Kingdom
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48
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Watorek E, Boratyńska M, Hałoń A, Klinger M. Anti-Fya antibodies as the cause of an unfortunate post-transplant course in renal transplant recipient. Ann Transplant 2008; 13:48-52. [PMID: 18344944] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 02/22/2008] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Duffy glycoprotein, belonging to blood group alloantigens, is also recognized as chemokine-binding protein, therefore the role of Duffy antigen in chemokine distribution has been postulated. Duffy positive phenotype prevalent among Caucasians is associated with antigen expression on erythrocytes and endothelium of several organs including kidney. The role of anti-Duffy antibodies significant in transfusiology may be also important in kidney transplantation. CASE REPORT The case of renal transplant recipient with Fy (a-b+) phenotype, possessing anti Fya antibodies, with unfortunate post-transplant course complicated with acute cellular and antibody-mediated graft rejections, with the presence of crescentic glomerular lesions, kidney graft insufficiency and recurrent urinary tract infections is presented. The role of anti-Duffy antibodies in acute antibody-mediated rejection is discussed. CONCLUSIONS Fy(a )antibodies present in renal recipient with Fy(a-b+) phenotype may be the reason for unfavorable transplantation outcome resulting from reaction against Duffy antigen up-regulated on graft tissue during ischemia reperfusion injury and acute rejection episode. In renal transplant recipients with antibody-mediated rejection without antidonor specific antibodies, incompatibility in blood group antigens other than AB0 system could be considered.
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Affiliation(s)
- Ewa Watorek
- Departament of Nephrology and Transplantation Medicine Wrocław Medical University, Wrocław, Poland.
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49
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de Córdoba SR, de Jorge EG. Translational mini-review series on complement factor H: genetics and disease associations of human complement factor H. Clin Exp Immunol 2008; 151:1-13. [PMID: 18081690 PMCID: PMC2276932 DOI: 10.1111/j.1365-2249.2007.03552.x] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.9] [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] [Accepted: 10/16/2007] [Indexed: 12/13/2022] Open
Abstract
Factor H is an abundant plasma glycoprotein that plays a critical role in the regulation of the complement system in plasma and in the protection of host cells and tissues from damage by complement activation. Several recent studies have described the association of genetic variations of the complement factor H gene (CFH) with atypical haemolytic uraemic syndrome (aHUS), age-related macular degeneration (AMD) and membranoproliferative glomerulonephritis (MPGN). This review summarizes our current knowledge of CFH genetics and examines the CFH genotype-phenotype correlations that are helping to understand the molecular basis underlying these renal and ocular pathologies.
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Affiliation(s)
- S Rodríguez de Córdoba
- Centro de Investigaciones Biológicas and Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.
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50
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Barlow PN, Hageman GS, Lea SM. Complement factor H: using atomic resolution structure to illuminate disease mechanisms. Adv Exp Med Biol 2008; 632:117-142. [PMID: 19025119 PMCID: PMC4863441] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Complement Factor H has recently come to the fore with variant forms implicated in a range of serious disease states. This review aims to bring together recent data concerning the structure and biological activity of this molecule to highlight the way in which a molecular understanding of function may open novel therapeutic possibilities. In particular we examine the evidence for and against the hypothesis that sequence variations in factor H may predispose to disease if they perturb its ability to recognise and respond appropriately to polyanionic carbohydrates on host surfaces that require protection from complement-mediated damage.
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Affiliation(s)
- Paul N. Barlow
- Schools of Chemistry and Biological Sciences, Joseph Black Chemistry Building, University of Edinburgh, Edinburgh EH9 2PB, UK
| | - Gregory S. Hageman
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Susan M. Lea
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
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