Pub Date : 2024-02-20eCollection Date: 2024-01-01DOI: 10.1159/000537948
Rasheed Gbadegesin, Elena Martinelli, Yask Gupta, David J Friedman, Matthew G Sampson, Martin R Pollak, Simone Sanna-Cherchi
{"title":"<i>APOL1</i> Genotyping Is Incomplete without Testing for the Protective M1 Modifier p.N264K Variant.","authors":"Rasheed Gbadegesin, Elena Martinelli, Yask Gupta, David J Friedman, Matthew G Sampson, Martin R Pollak, Simone Sanna-Cherchi","doi":"10.1159/000537948","DOIUrl":"10.1159/000537948","url":null,"abstract":"","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"4 1","pages":"43-48"},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10942791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianling Tao, Sai Liu, M. Montez-Rath, Vivek Charu, Glenn M. Chertow
Introduction. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and its subtypes, granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic GPA (EGPA), frequently present with acute kidney injury and can often lead to kidney failure, even with successful induction therapy. Few contemporary, nationally representative studies have described hospital complications of AAV. Methods. Using data from the 2016–2020 National Inpatient Sample, a nationally representative database, we identified hospitalizations from adults with a new diagnosis of AAV (subtype or unspecified) and an inpatient kidney biopsy during the index hospitalization. We described baseline characteristics, associated inpatient procedures and complications, and compared lengths of stay and costs by geographic region, hospital characteristics, and AAV subtype. Results. We identified an average of 1329 cases of hospitalized AAV with a concurrent kidney biopsy per year over the 5-year period. More than 50% were not designated as having a specific subtype, likely owing to delays in documentation of histopathology. Kidney involvement was severe as the majority of patients developed acute kidney injury and the proportion of patients who required inpatient dialysis was approximately 24%. Approximately 20% of patients developed hypoxia. Inpatient plasmapheresis was delivered to 20.4% and 20.6% of patients with GPA and MPA, respectively. There were no clinically meaningful or statistically significant differences in adjusted length of stay or inpatient costs among AAV subtypes. Admission in the Midwest region was associated with shorter hospital stays and lower costs than that in the Northeast, South, or West regions of the US (adjusted p=0.007 and <0.001, respectively). Conclusion. AAV with acute kidney involvement remains a challenging, high-risk condition. Maintaining a high index of suspicion and a low threshold for kidney biopsy should help to ameliorate short- and longer-term complications (281 words)
{"title":"ANCA-associated vasculitis with active kidney involvement in the United States: 2016–2020","authors":"Jianling Tao, Sai Liu, M. Montez-Rath, Vivek Charu, Glenn M. Chertow","doi":"10.1159/000536168","DOIUrl":"https://doi.org/10.1159/000536168","url":null,"abstract":"Introduction. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and its subtypes, granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic GPA (EGPA), frequently present with acute kidney injury and can often lead to kidney failure, even with successful induction therapy. Few contemporary, nationally representative studies have described hospital complications of AAV. \u0000Methods. Using data from the 2016–2020 National Inpatient Sample, a nationally representative database, we identified hospitalizations from adults with a new diagnosis of AAV (subtype or unspecified) and an inpatient kidney biopsy during the index hospitalization. We described baseline characteristics, associated inpatient procedures and complications, and compared lengths of stay and costs by geographic region, hospital characteristics, and AAV subtype. \u0000Results. We identified an average of 1329 cases of hospitalized AAV with a concurrent kidney biopsy per year over the 5-year period. More than 50% were not designated as having a specific subtype, likely owing to delays in documentation of histopathology. Kidney involvement was severe as the majority of patients developed acute kidney injury and the proportion of patients who required inpatient dialysis was approximately 24%. Approximately 20% of patients developed hypoxia. Inpatient plasmapheresis was delivered to 20.4% and 20.6% of patients with GPA and MPA, respectively. There were no clinically meaningful or statistically significant differences in adjusted length of stay or inpatient costs among AAV subtypes. Admission in the Midwest region was associated with shorter hospital stays and lower costs than that in the Northeast, South, or West regions of the US (adjusted p=0.007 and <0.001, respectively). \u0000Conclusion. AAV with acute kidney involvement remains a challenging, high-risk condition. Maintaining a high index of suspicion and a low threshold for kidney biopsy should help to ameliorate short- and longer-term complications (281 words)\u0000\u0000","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139534163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salman B. Mahmood, Muhammad Aziz, Deepthi C. Malepati, Wade Lee-Smith, Justin Clark, Ann Brearley, Patrick H. Nachman
Introduction: More frequent and severe lupus nephritis (LN) has been reported in men compared to women but data are limited and inconsistent. We conducted a meta-analysis of the literature to compare the histopathologic findings and outcomes between men and women with biopsy-proven LN. Methods: A systematic search of MEDLINE, Embase, Cochrane, and Web of Science databases was conducted through February 2021. Clinical information was extracted and synthesized from 25 studies that met inclusion criteria (1210 men and 6635 women). Pooled odds ratios (OR) with corresponding 95% confidence intervals (CI) were generated via meta-analysis, and meta-regression was performed to assess the impact of several covariates, both using random-effects models. Results: Twenty studies reported kidney histopathology, eleven reported kidney outcomes and eight reported mortality rates. Men had greater odds of class IV ± V LN (OR 1.26, 95% CI 1.01-1.56), and the composite of end-stage kidney disease, persistent eGFR <15 mL/min or doubling of serum creatinine (OR 2.20, 95% CI 1.59-3.06), and lower odds of complete remission (OR 0.52, 95% CI 0.39-0.68). Mortality was not statistically significantly different between sexes (OR 1.50, 95% CI 0.92-2.46). Meta-regression did not reveal statistically significant study-level relationships between sex differences in any of the covariates that could account for the greater odds of worse kidney outcome in males. Conclusion: Our analysis confirms the association between male sex and increased severity of LN as well as worse kidney outcomes. Larger prospective studies are needed to validate this association and inform treatment strategies adapted to this population.
导言：与女性相比，男性狼疮肾炎（LN）的发病率更高，病情更严重，但相关数据有限且不一致。我们对文献进行了荟萃分析，比较了经活检证实的狼疮肾炎患者中男性和女性的组织病理学结果和预后：截至 2021 年 2 月，我们对 MEDLINE、Embase、Cochrane 和 Web of Science 数据库进行了系统检索。从符合纳入标准的 25 项研究（男性 1210 例，女性 6635 例）中提取并综合了临床信息。通过荟萃分析得出汇总的几率比（OR）及相应的95%置信区间（CI），并使用随机效应模型进行荟萃回归以评估几个协变量的影响：20项研究报告了肾脏组织病理学，11项报告了肾脏结果，8项报告了死亡率。男性出现 IV ± V 级 LN 的几率更高（OR 1.26，95% CI 1.01-1.56），出现终末期肾病、eGFR 持续<15 mL/min 或血清肌酐翻倍的复合几率更高（OR 2.20，95% CI 1.59-3.06），完全缓解的几率更低（OR 0.52，95% CI 0.39-0.68）。性别间的死亡率无明显统计学差异（OR 1.50，95% CI 0.92-2.46）。元回归没有发现任何协变量的性别差异与研究水平之间存在统计学意义上的显著关系，而这些协变量可能是导致男性肾脏预后更差几率更大的原因：我们的分析证实了男性性别与 LN 严重程度增加以及肾脏预后恶化之间的关系。需要进行更大规模的前瞻性研究来验证这种关联，并为适合这一人群的治疗策略提供依据。
{"title":"Evaluating sex differences in the characteristics and outcomes of lupus nephritis: a systematic review and meta-analysis","authors":"Salman B. Mahmood, Muhammad Aziz, Deepthi C. Malepati, Wade Lee-Smith, Justin Clark, Ann Brearley, Patrick H. Nachman","doi":"10.1159/000535981","DOIUrl":"https://doi.org/10.1159/000535981","url":null,"abstract":"Introduction: More frequent and severe lupus nephritis (LN) has been reported in men compared to women but data are limited and inconsistent. We conducted a meta-analysis of the literature to compare the histopathologic findings and outcomes between men and women with biopsy-proven LN.\u0000Methods: A systematic search of MEDLINE, Embase, Cochrane, and Web of Science databases was conducted through February 2021. Clinical information was extracted and synthesized from 25 studies that met inclusion criteria (1210 men and 6635 women). Pooled odds ratios (OR) with corresponding 95% confidence intervals (CI) were generated via meta-analysis, and meta-regression was performed to assess the impact of several covariates, both using random-effects models.\u0000Results: Twenty studies reported kidney histopathology, eleven reported kidney outcomes and eight reported mortality rates. Men had greater odds of class IV ± V LN (OR 1.26, 95% CI 1.01-1.56), and the composite of end-stage kidney disease, persistent eGFR <15 mL/min or doubling of serum creatinine (OR 2.20, 95% CI 1.59-3.06), and lower odds of complete remission (OR 0.52, 95% CI 0.39-0.68). Mortality was not statistically significantly different between sexes (OR 1.50, 95% CI 0.92-2.46). Meta-regression did not reveal statistically significant study-level relationships between sex differences in any of the covariates that could account for the greater odds of worse kidney outcome in males.\u0000Conclusion: Our analysis confirms the association between male sex and increased severity of LN as well as worse kidney outcomes. Larger prospective studies are needed to validate this association and inform treatment strategies adapted to this population.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"60 51","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139385525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The etiology of chronic kidney disease (CKD) is varied and complex, with diabetes mellitus and hypertension responsible for the 2/3 of cases and rare conditions, including inherited genetic diseases such as autosomal dominant polycystic kidney disease (ADPKD) and glomerulonephritis (GN), comprising 1/3. We previously reported a 54% increase in clinical studies in CKD in the last 10 years. Summary CT.gov was searched for 39 conditions determined to be rare renal diseases posted between 01-Jan-2003 and 31-Dec-2022. Of 876 records returned, 50 were excluded. 826 in the analysis were divided into 2 time periods: P1(2003-2012) and P2 (2013-2022) and analyzed by study type, phase, primary indication, primary endpoint, population and funding. Studies increased 123% in P2 with the greatest rise in observational studies (283%). Interventional studies increased 93%, with the greatest rise in early phases (205%). The most frequent indications were lupus nephritis (22%), ADPKD (16%) and IgA nephropathy (IGAN) (15%); all increased 77-166% in P2. Proteinuria, measured by 24-hour urine protein (24hUP) excretion or urine protein-creatinine ratio (UPCR), was the most frequent primary endpoint in both periods. Most studies were in adult-only populations (P1 60%; P2 68%); however, there was a 78% increase in studies with pediatric populations in P2. Most studies were non-industry funded (P1 64%; P2 57%); however, the number of industry funded studies increased by 225% in P2. Key Messages Our data provides evidence of a marked rise in clinical research in rare renal diseases in the last 10 years, particularly in GN and ADPKD. Proteinuria correlates with outcomes in GN, which explains the high percentage of studies with this as a primary endpoint. Rare renal diseases disproportionately affect children and the rise in the number of studies with pediatric populations is encouraging. The rise in observational studies signals an increased focus on understanding the natural course and pathophysiology of disease, which may lead to new potential therapeutic targets and future interventional studies.
{"title":"Advancing Treatments for Rare Renal Diseases: New Hopes and Opportunities to Address a High Unmet Need.","authors":"Davide Garrisi, Andrew Bevan, Carmichael Angeles","doi":"10.1159/000535955","DOIUrl":"https://doi.org/10.1159/000535955","url":null,"abstract":"Background The etiology of chronic kidney disease (CKD) is varied and complex, with diabetes mellitus and hypertension responsible for the 2/3 of cases and rare conditions, including inherited genetic diseases such as autosomal dominant polycystic kidney disease (ADPKD) and glomerulonephritis (GN), comprising 1/3. We previously reported a 54% increase in clinical studies in CKD in the last 10 years. Summary CT.gov was searched for 39 conditions determined to be rare renal diseases posted between 01-Jan-2003 and 31-Dec-2022. Of 876 records returned, 50 were excluded. 826 in the analysis were divided into 2 time periods: P1(2003-2012) and P2 (2013-2022) and analyzed by study type, phase, primary indication, primary endpoint, population and funding. Studies increased 123% in P2 with the greatest rise in observational studies (283%). Interventional studies increased 93%, with the greatest rise in early phases (205%). The most frequent indications were lupus nephritis (22%), ADPKD (16%) and IgA nephropathy (IGAN) (15%); all increased 77-166% in P2. Proteinuria, measured by 24-hour urine protein (24hUP) excretion or urine protein-creatinine ratio (UPCR), was the most frequent primary endpoint in both periods. Most studies were in adult-only populations (P1 60%; P2 68%); however, there was a 78% increase in studies with pediatric populations in P2. Most studies were non-industry funded (P1 64%; P2 57%); however, the number of industry funded studies increased by 225% in P2. Key Messages Our data provides evidence of a marked rise in clinical research in rare renal diseases in the last 10 years, particularly in GN and ADPKD. Proteinuria correlates with outcomes in GN, which explains the high percentage of studies with this as a primary endpoint. Rare renal diseases disproportionately affect children and the rise in the number of studies with pediatric populations is encouraging. The rise in observational studies signals an increased focus on understanding the natural course and pathophysiology of disease, which may lead to new potential therapeutic targets and future interventional studies.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"580 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139160417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debbie S. Gipson, Chia-shi Wang, Eloise Salmon, Rasheed Gbadegesin, Abhijit Naik, Simone Sanna-Cherchi, Alessia Fornoni, Matthias Kretzler, Sandra Merscher, Paul Hoover, Kelley Kidwell, Moin Saleem, Leonardo Riella, Lawrence Holzman, Annette Jackson, Opeyemi Olabisi, Paolo Cravedi, Benjamin Solomon Freedman, Jonathan Himmelfarb, Marina Vivarelli, Jennifer Harder, Jon Klein, George Burke, Michelle Rheault, Cathie Spino, Hailey E. Desmond, Howard Trachtman
Since it was first described more than 50 years ago, recurrence of FSGS in kidney allografts has frustrated the transplant community. This rare condition is associated with considerable morbidity, and it is the most common cause of graft loss in patients with CKD stage 5 due to FSGS. However, the problem remains insufficiently studied. It is an ultra-orphan disease and incidence rates at individual centers are often very low and unpredictable. The published literature contains conflicting reports in basic epidemiologic data. Progress in defining the mechanisms of disease and advancing therapeutic options has been limited. The treatment options that are currently available are limited and largely ineffective. The range in time to recurrence and variability in responsiveness to treatment suggest that recurrence is not a single entity, but rather multiple phenotypes resulting from diverse pathogenetic mechanisms grouped under a larger umbrella. There is an urgent need for innovative basic science and translational research to [1] better understand FSGS recurrence from a mechanistic perspective; [2] improve risk stratification to predict this outcome; and [3] develop effective therapies. In this conference report, we describe the work of investigators whose state-of-the-art research paves the way for innovative approaches to diagnosis and treatment of the problem and provides hope that we can achieve these objectives for affected patients.
{"title":"FSGS Recurrence Collaboration: Report of a symposium","authors":"Debbie S. Gipson, Chia-shi Wang, Eloise Salmon, Rasheed Gbadegesin, Abhijit Naik, Simone Sanna-Cherchi, Alessia Fornoni, Matthias Kretzler, Sandra Merscher, Paul Hoover, Kelley Kidwell, Moin Saleem, Leonardo Riella, Lawrence Holzman, Annette Jackson, Opeyemi Olabisi, Paolo Cravedi, Benjamin Solomon Freedman, Jonathan Himmelfarb, Marina Vivarelli, Jennifer Harder, Jon Klein, George Burke, Michelle Rheault, Cathie Spino, Hailey E. Desmond, Howard Trachtman","doi":"10.1159/000535138","DOIUrl":"https://doi.org/10.1159/000535138","url":null,"abstract":"Since it was first described more than 50 years ago, recurrence of FSGS in kidney allografts has frustrated the transplant community. This rare condition is associated with considerable morbidity, and it is the most common cause of graft loss in patients with CKD stage 5 due to FSGS. However, the problem remains insufficiently studied. It is an ultra-orphan disease and incidence rates at individual centers are often very low and unpredictable. The published literature contains conflicting reports in basic epidemiologic data. Progress in defining the mechanisms of disease and advancing therapeutic options has been limited. The treatment options that are currently available are limited and largely ineffective. The range in time to recurrence and variability in responsiveness to treatment suggest that recurrence is not a single entity, but rather multiple phenotypes resulting from diverse pathogenetic mechanisms grouped under a larger umbrella. There is an urgent need for innovative basic science and translational research to [1] better understand FSGS recurrence from a mechanistic perspective; [2] improve risk stratification to predict this outcome; and [3] develop effective therapies. In this conference report, we describe the work of investigators whose state-of-the-art research paves the way for innovative approaches to diagnosis and treatment of the problem and provides hope that we can achieve these objectives for affected patients.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"9 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134956846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Levinsohn, Shen Li, Eunji Ha, Katalin Susztak
Background: Kidney diseases pose a significant global health burden, there is an urgent need to deepen our understanding of their underlying mechanisms. Summary: This review focuses on new innovative approaches that merge Genome-Wide Association Studies (GWAS) and single-cell omics (including transcriptomics) in kidney disease research. We begin by detailing how GWAS have identified numerous genetic risk factors, offering valuable insight into disease susceptibility. Then, we explore the application of scRNA-seq, highlighting its ability to unravel how genetic variants influence cellular phenotypes. Through a synthesis of recent studies, we illuminate the synergy between these two powerful methodologies, demonstrating their potential in elucidating the complex etiology of kidney diseases. Moreover, we discuss how this integrative approach could pave the way for precise diagnostics and personalized treatments. Key Message: This review underscores the transformative potential of combining GWAS and scRNA-seq in the journey towards a deeper understanding of kidney diseases.
{"title":"Combing Genome-Wide Association Studies and Single-Cell Analysis to Elucidate the Mechanisms of Kidney Disease: Proceedings of the Henry Shavelle Professorhip","authors":"Jonathan Levinsohn, Shen Li, Eunji Ha, Katalin Susztak","doi":"10.1159/000534678","DOIUrl":"https://doi.org/10.1159/000534678","url":null,"abstract":"Background: Kidney diseases pose a significant global health burden, there is an urgent need to deepen our understanding of their underlying mechanisms. Summary: This review focuses on new innovative approaches that merge Genome-Wide Association Studies (GWAS) and single-cell omics (including transcriptomics) in kidney disease research. We begin by detailing how GWAS have identified numerous genetic risk factors, offering valuable insight into disease susceptibility. Then, we explore the application of scRNA-seq, highlighting its ability to unravel how genetic variants influence cellular phenotypes. Through a synthesis of recent studies, we illuminate the synergy between these two powerful methodologies, demonstrating their potential in elucidating the complex etiology of kidney diseases. Moreover, we discuss how this integrative approach could pave the way for precise diagnostics and personalized treatments. Key Message: This review underscores the transformative potential of combining GWAS and scRNA-seq in the journey towards a deeper understanding of kidney diseases.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"17 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas McDonnell, John Hartemink, Omar Ragy, Kathrine Parker, Meshaal Shukkur, Jecko Thachil, Durga Kanigicherla
Introduction Thromboembolic events (TEEs) are a serious and potentially fatal complication of nephrotic syndrome (NS). Despite this there is a lack of evidence examining the benefits of prophylactic anticoagulation (PAC) in NS. It was our objective to review the risk factors, rates of TEEs and patterns of PAC in patients with primary NS, with the aim to provide a pragmatic approach to PAC in primary NS. Methods This is a retrospective longitudinal cohort study of adult patients with primary NS. Included were: biopsy proven Minimal Change Disease and Focal Segmental Glomerulosclerosis (described as a combined podocytopathy cohort) plus Membranous Nephropathy (MN) over an 8-year period from a single centre. Anticoagulation practice, TEEs and longer-term outcomes were recorded. Results 54 patients with MN and 48 with podocytopathies were included. Baseline demographics and severity of NS was comparable. Those with MN were more likely to develop TEE 12(22%) vs 4(8%) (p=0.027) though this difference was predominantly seen at index diagnosis. Only 2 patients developed TEEs during active incident nephrotic syndrome. Rates of PAC were similar comparing MN (53%) and podocytopathies (58%). Those with a serum albumin < 20 g/L and HAS BLED score <3 were most likely to receive PAC (22/30, 73% in MN vs 21/30, 70% in iNS). Warfarin was the most common agent used in MN cohort 18/26 (69%) vs prophylactic dose low molecular weight heparin in the podocytopathy cohort 12/28 (43%). Discussion/Conclusion PAC practices applied in this cohort of patients were pragmatic and effective, with low TEE rates during active nephrotic syndrome.
血栓栓塞事件(tee)是肾病综合征(NS)的一种严重且可能致命的并发症。尽管如此，仍缺乏证据证明预防性抗凝(PAC)对NS的益处。我们的目的是回顾原发性NS患者的危险因素、tee的发生率和PAC的模式，旨在为原发性NS患者的PAC提供实用的方法。方法:回顾性纵向队列研究，研究对象为原发性NS的成年患者。包括:活检证实的最小改变疾病和局灶节段性肾小球硬化(被描述为联合足细胞病队列)加上膜性肾病(MN)，来自单一中心，时间超过8年。记录抗凝实践、tee和长期预后。结果54例MN患者，48例足细胞病变患者。基线人口统计学和NS严重程度具有可比性。MN患者更有可能发展为TEE 12(22%) vs 4(8%) (p=0.027)，尽管这种差异主要见于指数诊断。只有2例患者在活动性偶发肾病综合征期间发生tee。PAC的发生率与MN(53%)和足细胞病变(58%)相似。血清白蛋白阳性者;20 g/L和HAS BLED评分为lt;3的患者最有可能接受PAC (MN为22/ 30,73%，iNS为21/ 30,70%)。在MN队列18/26(69%)中，华法林是最常用的药物，而在足细胞病变队列12/28(43%)中，预防剂量低分子量肝素是最常用的药物。讨论/结论在该队列患者中应用PAC实践是实用和有效的，活动性肾病综合征期间TEE发生率低。
{"title":"Longitudinal Analysis of Prophylactic Anticoagulation in Primary Nephrotic Syndrome: Low Incidence of Thromboembolic Complications","authors":"Thomas McDonnell, John Hartemink, Omar Ragy, Kathrine Parker, Meshaal Shukkur, Jecko Thachil, Durga Kanigicherla","doi":"10.1159/000534652","DOIUrl":"https://doi.org/10.1159/000534652","url":null,"abstract":"Introduction Thromboembolic events (TEEs) are a serious and potentially fatal complication of nephrotic syndrome (NS). Despite this there is a lack of evidence examining the benefits of prophylactic anticoagulation (PAC) in NS. It was our objective to review the risk factors, rates of TEEs and patterns of PAC in patients with primary NS, with the aim to provide a pragmatic approach to PAC in primary NS. Methods This is a retrospective longitudinal cohort study of adult patients with primary NS. Included were: biopsy proven Minimal Change Disease and Focal Segmental Glomerulosclerosis (described as a combined podocytopathy cohort) plus Membranous Nephropathy (MN) over an 8-year period from a single centre. Anticoagulation practice, TEEs and longer-term outcomes were recorded. Results 54 patients with MN and 48 with podocytopathies were included. Baseline demographics and severity of NS was comparable. Those with MN were more likely to develop TEE 12(22%) vs 4(8%) (p=0.027) though this difference was predominantly seen at index diagnosis. Only 2 patients developed TEEs during active incident nephrotic syndrome. Rates of PAC were similar comparing MN (53%) and podocytopathies (58%). Those with a serum albumin < 20 g/L and HAS BLED score <3 were most likely to receive PAC (22/30, 73% in MN vs 21/30, 70% in iNS). Warfarin was the most common agent used in MN cohort 18/26 (69%) vs prophylactic dose low molecular weight heparin in the podocytopathy cohort 12/28 (43%). Discussion/Conclusion PAC practices applied in this cohort of patients were pragmatic and effective, with low TEE rates during active nephrotic syndrome.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew B Palmer, Virginie Royal, J. Charles Jennette, Abigail R. Smith, Qian Liu, Josephine M. Ambruzs, Nicole K. Andeen, Vivette D. D’Agati, Agnes B. Fogo, Joseph Gaut, Rasheed A. Gbadegesin, Larry A. Greenbaum, Jean Hou, Margaret E Helmuth, Richard A. Lafayette, Helen Liapis, Bruce Robinson, Michael B. Stokes, Katherine Twombley, Hong Yin, Cynthia C. Nast
Introduction: CureGN is an observational cohort study of patients with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), or IgA nephropathy (IgAN). We developed a conventional, consensus-based scoring system to document pathologic features for application across multiple pathologists and herein describe the protocol, reproducibility and correlation with clinical parameters at biopsy. Methods: Definitions were established for glomerular, tubular, interstitial and vascular lesions evaluated semi-quantitatively using digitized light microscopy slides and electron micrographs, and reported immunofluorescence. Cases with curated pathology materials as of April 2019 were scored by a randomly assigned pathologist, with at least 10% of cases scored by a second pathologist. Scoring reproducibility was assessed using Gwet’s AC1 statistic and correlations with clinical variables were performed. Results: Of 800 scored biopsies (143 MCD, 185 FSGS, 206 MN, 266 IgA), 94 were scored twice (11.8%). Of 60 pathology features, 46 (76.7%) demonstrated excellent (AC1>0.8), and 12 (20.0%) had good (AC1 0.6-0.8) reproducibility. Mesangial hypercellularity scored as absent, focal or diffuse had moderate reproducibility (AC1=0.58), but good reproducibility (ACI=0.71) when scored as absent or focal vs diffuse. The percent glomeruli scored as no lesions had fair reproducibility (AC1=0.34). Strongest correlations between pathologic features and clinical characteristics at biopsy included interstitial inflammation, interstitial fibrosis and tubular atrophy with eGFR, foot process effacement with UPCR, and active crescents with hematuria. Conclusions: Most scored pathology features showed excellent reproducibility, demonstrating consistency for these features across multiple pathologists. Correlations between certain pathologic features and expected clinical characteristics show the value of this approach for future studies on clinicopathologic correlations and biomarker discovery.
{"title":"CureGN Pathology Classification and Core Scoring Criteria, Reproducibility, and Clinicopathologic Correlations","authors":"Matthew B Palmer, Virginie Royal, J. Charles Jennette, Abigail R. Smith, Qian Liu, Josephine M. Ambruzs, Nicole K. Andeen, Vivette D. D’Agati, Agnes B. Fogo, Joseph Gaut, Rasheed A. Gbadegesin, Larry A. Greenbaum, Jean Hou, Margaret E Helmuth, Richard A. Lafayette, Helen Liapis, Bruce Robinson, Michael B. Stokes, Katherine Twombley, Hong Yin, Cynthia C. Nast","doi":"10.1159/000534755","DOIUrl":"https://doi.org/10.1159/000534755","url":null,"abstract":"Introduction: CureGN is an observational cohort study of patients with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), or IgA nephropathy (IgAN). We developed a conventional, consensus-based scoring system to document pathologic features for application across multiple pathologists and herein describe the protocol, reproducibility and correlation with clinical parameters at biopsy. Methods: Definitions were established for glomerular, tubular, interstitial and vascular lesions evaluated semi-quantitatively using digitized light microscopy slides and electron micrographs, and reported immunofluorescence. Cases with curated pathology materials as of April 2019 were scored by a randomly assigned pathologist, with at least 10% of cases scored by a second pathologist. Scoring reproducibility was assessed using Gwet’s AC1 statistic and correlations with clinical variables were performed. Results: Of 800 scored biopsies (143 MCD, 185 FSGS, 206 MN, 266 IgA), 94 were scored twice (11.8%). Of 60 pathology features, 46 (76.7%) demonstrated excellent (AC1>0.8), and 12 (20.0%) had good (AC1 0.6-0.8) reproducibility. Mesangial hypercellularity scored as absent, focal or diffuse had moderate reproducibility (AC1=0.58), but good reproducibility (ACI=0.71) when scored as absent or focal vs diffuse. The percent glomeruli scored as no lesions had fair reproducibility (AC1=0.34). Strongest correlations between pathologic features and clinical characteristics at biopsy included interstitial inflammation, interstitial fibrosis and tubular atrophy with eGFR, foot process effacement with UPCR, and active crescents with hematuria. Conclusions: Most scored pathology features showed excellent reproducibility, demonstrating consistency for these features across multiple pathologists. Correlations between certain pathologic features and expected clinical characteristics show the value of this approach for future studies on clinicopathologic correlations and biomarker discovery.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"55 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136377123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Introduction: Anti-glomerular basement membrane (anti-GBM) disease is a rare organ-specific autoimmune disease. The overall and renal outcomes of patients have mostly been reported in small-sized cohorts. We aimed to study the clinical profile, overall and renal survival of anti-glomerular basement membrane disease patients at our center. Methods: We conducted a retrospective analysis of the data regarding the clinical profile and renal survival of patients diagnosed with anti-GBM disease from October 2019 and March 2022, having a minimum follow-up of 12 months. Results: There were 15 patients in the study, with the mean age of presentation being 51.6±13.7 years. The median duration of symptoms onset to nephrologist opinion was 15 (10-23) days. The extrarenal manifestations were seen in the respiratory, otorhinolaryngological, and neurological systems. The mean serum anti-GBM titers were 154.5 (14.9-263.5) U/ml. Serum anti-GBM titers were present in 13/15(86.6%) patients, and 12/13 (92.3%) patients had above the reference range. ANCA levels were assessed in 12/15 (80%) patients, and 9/12 (75%) had higher levels. Renal biopsy was available in 14 patients with more than 50% crescents. Along with crescents, necrotizing lesions, rupture of the Bowman’s capsule, and granulomatous lesions were also seen. Among the initial therapy, steroid pulse was given in 13 (86.6%) patients, whereas membrane plasmapheresis was given in 8 (53.3%) patients. Inj. Cyclophosphamide and Inj. Rituximab were given in 8 (53.3%) and 4 (26.6%) patients, respectively. No difference was seen in clinical characteristics, renal biopsy features, treatment received, and outcomes with ANCA positivity except for age, where patients who were ANCA positive were older compared to patients who were ANCA negative. One-year renal and patient survival was seen in 4 (26.6%) and 6 (40%) patients, respectively. Conclusion: Most patients of anti-GBM disease have active sediments, raised creatinine, and non-specific symptomatology. There is poor renal and patient outcome as most patients present with advanced renal failure.
{"title":"Clinical profile and renal survival of anti-glomerular basement membrane disease patients– A retrospective case-series from Northern India","authors":"Asheesh Kumar, Samriti Gupta, Kush Dev Singh Jarial, Sukhwinder Sangha, Ashish Chauhan, Vikas Sharma, Rajeev Sandal, Dheeraj Sharma","doi":"10.1159/000534498","DOIUrl":"https://doi.org/10.1159/000534498","url":null,"abstract":"Abstract: Introduction: Anti-glomerular basement membrane (anti-GBM) disease is a rare organ-specific autoimmune disease. The overall and renal outcomes of patients have mostly been reported in small-sized cohorts. We aimed to study the clinical profile, overall and renal survival of anti-glomerular basement membrane disease patients at our center. Methods: We conducted a retrospective analysis of the data regarding the clinical profile and renal survival of patients diagnosed with anti-GBM disease from October 2019 and March 2022, having a minimum follow-up of 12 months. Results: There were 15 patients in the study, with the mean age of presentation being 51.6±13.7 years. The median duration of symptoms onset to nephrologist opinion was 15 (10-23) days. The extrarenal manifestations were seen in the respiratory, otorhinolaryngological, and neurological systems. The mean serum anti-GBM titers were 154.5 (14.9-263.5) U/ml. Serum anti-GBM titers were present in 13/15(86.6%) patients, and 12/13 (92.3%) patients had above the reference range. ANCA levels were assessed in 12/15 (80%) patients, and 9/12 (75%) had higher levels. Renal biopsy was available in 14 patients with more than 50% crescents. Along with crescents, necrotizing lesions, rupture of the Bowman’s capsule, and granulomatous lesions were also seen. Among the initial therapy, steroid pulse was given in 13 (86.6%) patients, whereas membrane plasmapheresis was given in 8 (53.3%) patients. Inj. Cyclophosphamide and Inj. Rituximab were given in 8 (53.3%) and 4 (26.6%) patients, respectively. No difference was seen in clinical characteristics, renal biopsy features, treatment received, and outcomes with ANCA positivity except for age, where patients who were ANCA positive were older compared to patients who were ANCA negative. One-year renal and patient survival was seen in 4 (26.6%) and 6 (40%) patients, respectively. Conclusion: Most patients of anti-GBM disease have active sediments, raised creatinine, and non-specific symptomatology. There is poor renal and patient outcome as most patients present with advanced renal failure.","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-10eCollection Date: 2023-01-01DOI: 10.1159/000534536
Laurel J Damashek, Sharon G Adler, Joshua M Tarnoff, Tobias B Huber
{"title":"The International Society of Glomerular Disease: Building the Future of Glomerular Medicine.","authors":"Laurel J Damashek, Sharon G Adler, Joshua M Tarnoff, Tobias B Huber","doi":"10.1159/000534536","DOIUrl":"https://doi.org/10.1159/000534536","url":null,"abstract":"","PeriodicalId":73177,"journal":{"name":"Glomerular diseases","volume":"3 1","pages":"230-232"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10616665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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