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Navarro-Torres M, Wooden B, Santoriello D, Radhakrishnan J, Bomback AS. Podocytopathies. ADVANCES IN KIDNEY DISEASE AND HEALTH 2025; 32:2-11. [PMID: 40175026 DOI: 10.1053/j.akdh.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 09/25/2024] [Accepted: 10/08/2024] [Indexed: 04/04/2025]
Abstract
The podocyte is a critical component of the glomerular filtration barrier. Injury to these specialized cells results in podocytopathies. A kidney biopsy will reveal focal segmental glomerulosclerosis or minimal change disease. These diseases can have variable clinical presentations and biopsy features, which will help classify them into primary or secondary podocytopathies and further guide treatment. Contrary to secondary focal segmental glomerulosclerosis, primary focal segmental glomerulosclerosis and minimal change disease require immunosuppression since spontaneous remission is rare and complications related to nephrotic syndrome can be life-threatening. Podocytopathies secondary to genetic mutations rarely require immunosuppression, but this may be indicated in special populations. The purpose of this review is to discuss key points in diagnosis and treatment for patients with podocytopathies.
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Affiliation(s)
- Mariela Navarro-Torres
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Benjamin Wooden
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Dominick Santoriello
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
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Puspitasari M, Wardhani Y, Sattwika PD, Wijaya W. Patterns of kidney diseases diagnosed by kidney biopsy and the impact of the COVID-19 pandemic in Yogyakarta, Indonesia: A single-center study. World J Nephrol 2024; 13:100087. [PMID: 39723352 PMCID: PMC11572650 DOI: 10.5527/wjn.v13.i4.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/25/2024] [Accepted: 10/20/2024] [Indexed: 11/07/2024] Open
Abstract
BACKGROUND Glomerular diseases rank third among the causes of chronic kidney disease worldwide and in Indonesia, and its burden continues to increase, especially regarding the sociodemographic index. Kidney biopsy remains the gold standard for the diagnosis and classification of glomerular diseases. It is crucial for developing treatment plans, determining the degree of histologic changes, and identifying disease relapse. AIM To describe the patterns of biopsy-proven kidney diseases in adult patients. METHODS We retrospectively reviewed the demographic, histopathologic, clinical, and laboratory data of 75 adult patients with biopsy-proven kidney diseases at our institution recorded from 2017 to 2022. RESULTS Among the patients, 43 (57.3%) were females, and the mean age was 31.52 years ± 11.70 years. The most common histopathologies were lupus nephritis (LN) (33.3%), minimal change disease (MCD) (26.7%), and focal segmental glomerulosclerosis (10.7%). LN (41.7%) was frequently diagnosed in women and MCD (28.1%) in men. The most common cause of nephritic syndrome was LN (36.7%) and of nephrotic syndrome was MCD (40%). CONCLUSION Different kidney disease patterns were observed in different sexes, age categories, clinical syndromes, and biopsy dates relative to the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Metalia Puspitasari
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Yulia Wardhani
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Prenali Dwisthi Sattwika
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Clinical Epidemiology and Biostatistics Unit, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Radcliffe Department of Medicine, University of Oxford, Oxford OX39DU, Oxfordshire, United Kingdom
| | - Wynne Wijaya
- Department of Internal Medicine, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Oncology, University of Oxford, Oxford OX37DQ, Oxfordshire, United Kingdom
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Noda R, Ichikawa D, Shibagaki Y. Machine learning-based diagnostic prediction of minimal change disease: model development study. Sci Rep 2024; 14:23460. [PMID: 39379539 PMCID: PMC11461711 DOI: 10.1038/s41598-024-73898-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 09/23/2024] [Indexed: 10/10/2024] Open
Abstract
Minimal change disease (MCD) is a common cause of nephrotic syndrome. Due to its rapid progression, early detection is essential; however, definitive diagnosis requires invasive kidney biopsy. This study aims to develop non-invasive predictive models for diagnosing MCD by machine learning. We retrospectively collected data on demographic characteristics, blood tests, and urine tests from patients with nephrotic syndrome who underwent kidney biopsy. We applied four machine learning algorithms-TabPFN, LightGBM, Random Forest, and Artificial Neural Network-and logistic regression. We compared their performance using stratified 5-repeated 5-fold cross-validation for the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Variable importance was evaluated using the SHapley Additive exPlanations (SHAP) method. A total of 248 patients were included, with 82 cases (33%) were diagnosed with MCD. TabPFN demonstrated the best performance with an AUROC of 0.915 (95% CI 0.896-0.932) and an AUPRC of 0.840 (95% CI 0.807-0.872). The SHAP methods identified C3, total cholesterol, and urine red blood cells as key predictors for TabPFN, consistent with previous reports. Machine learning models could be valuable non-invasive diagnostic tools for MCD.
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Affiliation(s)
- Ryunosuke Noda
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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Yu L, Cheng S, Zhang M, Zhou T, Chen Y, Zhang Z, Yu Y. Successful treatment of peritoneal dialysis for two patients with refractory nephrotic syndrome and acute kidney injury: a case report. Front Med (Lausanne) 2023; 10:1263780. [PMID: 37920598 PMCID: PMC10618994 DOI: 10.3389/fmed.2023.1263780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Two patients with refractory nephrotic syndrome were treated with peritoneal dialysis (PD) for diuretic resistance, anasarca and acute kidney injury. Following PD, their fluid overload was promptly alleviated, accompanied by an increase in urine volume and an improvement in renal function. PD as an adjuvant approach enabled them to resume corticosteroids and immunosuppressive agents. Eventually, both patients could be withdrawn from PD and achieved remission of proteinuria.
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Affiliation(s)
| | | | | | | | | | | | - Yusheng Yu
- National Clinical Research Center for Kidney Disease, Jinling Hospital, Nanjing, China
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Zhang L, Cui L, Li C, Zhao X, Lai X, Li J, Lv T. Serum free fatty acid elevation is related to acute kidney injury in primary nephrotic syndrome. Ren Fail 2022; 44:1236-1242. [PMID: 35912916 PMCID: PMC9347463 DOI: 10.1080/0886022x.2022.2105232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of this research was to examine the clinical characteristics of acute kidney injury (AKI) in primary nephrotic syndrome (NS) and discuss the relationship between serum lipids and AKI. A total of 1028 patients diagnosed with primary NS with renal biopsy results were enrolled in this study. The patients were divided into AKI (n = 81) and non-AKI (n = 947) groups, and their characteristics were compared using a propensity score analysis for the best matching. Serum free fatty acid (FFA) was an independent predictor for AKI in the postmatch samples (p = 0.011). No significant difference in FFA levels was observed among AKI stages or different pathological types in the AKI and non-AKI groups. The AUC (area under the ROC curve) was 0.63 for FFA levels to distinguish AKI. In primary NS, elevated FFA levels tend to be related to a high risk of AKI. FFAs have diagnostic value and may serve as biomarkers for AKI in NS.
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Affiliation(s)
- Lili Zhang
- Department of Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Cui
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunmei Li
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiangzhong Zhao
- Medical Research Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoying Lai
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Li
- Department of Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Teng Lv
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Torigoe K, Ikemi Y, Yoshida Y, Sakamoto R, Yamashita A, Abe S, Muta K, Arai H, Mukae H, Nishino T. Acute Kidney Injury Caused by Renin-Angiotensin System Inhibitors During Minimal Change Disease Treatment. Cureus 2022; 14:e30346. [PMID: 36407214 PMCID: PMC9665908 DOI: 10.7759/cureus.30346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old Japanese man with nephrotic syndrome was admitted to our department for treatment. After his admission, he was administered prednisolone (PSL) at 40 mg/day, and a percutaneous renal biopsy was performed. However, on the first day of admission, his urinary protein decreased from 5.05 g/gCr to 1.85 g/gCr. On the fourth day of admission, his urinary protein further decreased to 0.38 g/gCr and the patient developed acute kidney injury (AKI). Renin-angiotensin system (RAS) inhibitors were suspected to be the cause of AKI; therefore, they were discontinued. After the renal function improved, the urinary protein worsened again to 5.49 g/gCr. Renal pathology suggested minimal change disease (MCD); therefore, PSL was continued. The patient's urinary protein subsequently improved and he had no renal function impairment. Minimal change disease can be complicated by AKI through intravascular volume depletion caused by high urinary protein and hypoalbuminemia. However, when MCD is complicated by RAS inhibitor-associated AKI, the urinary protein may notably decrease, and the patient may present with an atypical course of MCD-associated AKI.
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Affiliation(s)
- Kenta Torigoe
- Nephrology, Nagasaki University Hospital, Nagasaki, JPN
| | - Yuta Ikemi
- Nephrology, Nagasaki University Hospital, Nagasaki, JPN
| | - Yuki Yoshida
- Nephrology, Nagasaki University Hospital, Nagasaki, JPN
| | | | | | - Shinichi Abe
- Nephrology, Nagasaki University Hospital, Nagasaki, JPN
| | - Kumiko Muta
- Nephrology, Nagasaki University Hospital, Nagasaki, JPN
| | - Hideyuki Arai
- Internal Medicine, Kusumoto Naika Clinic, Omura, JPN
| | - Hiroshi Mukae
- Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
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Chen T, Zhou Y, Zhu J, Chen X, Pan J. Prediction model of renal function recovery for primary membranous nephropathy with acute kidney injury. BMC Nephrol 2022; 23:247. [PMID: 35831820 PMCID: PMC9281044 DOI: 10.1186/s12882-022-02882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background and objectives The clinical and pathological impact factors for renal function recovery in acute kidney injury (AKI) on the progression of renal function in primary membranous nephropathy (PMN) with AKI patients have not yet been reported, we sought to investigate the factors that may influence renal function recovery and develop a nomogram model for predicting renal function recovery in PMN with AKI patients. Methods Two PMN with AKI cohorts from the Nephrology Department, the First Affiliated Hospital of Wenzhou Medical University during 2012–2018 and 2019–2020 were included, i.e., a derivation cohort during 2012–2018 and a validation cohort during 2019–2020. Clinical characteristics and renal pathological features were obtained. The outcome measurement was the recovery of renal function within 12 months. Lasso regression was used for clinical and pathological features selection. Prediction model was built and nomogram was plotted. Model evaluations including calibration curves were performed. Result Renal function recovery was found in 72 of 124 (58.1%) patients and 41 of 72 (56.9%) patients in the derivation and validation cohorts, respectively. The prognostic nomogram model included determinants of sex, age, the comorbidity of hypertensive nephropathy, the stage of glomerular basement membrane and diuretic treatment with a reasonable concordance index of 0.773 (95%CI,0.716–0.830) in the derivation cohort and 0.773 (95%CI, 0.693–0.853) in the validation cohort. Diuretic use was a significant impact factor with decrease of renal function recovery in PMN with AKI patients. Conclusion The predictive nomogram model provides useful prognostic tool for renal function recovery in PMN patients with AKI. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02882-9.
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Affiliation(s)
- Tianxin Chen
- Department of nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Zhou
- Department of nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianfen Zhu
- Department of endoscopy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinxin Chen
- Department of nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingye Pan
- Department of ICU, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, PR China. .,Key Laboratory of Intelligent Critical Care and Life Support Research of Zhejiang Province, Beijing, China.
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Hilmanto D, Mawardi F, Lestari AS, Widiasta A. Disease-Associated Systemic Complications in Childhood Nephrotic Syndrome: A Systematic Review. Int J Nephrol Renovasc Dis 2022; 15:53-62. [PMID: 35241925 PMCID: PMC8887965 DOI: 10.2147/ijnrd.s351053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Nephrotic syndrome (NS) is one of the most common childhood kidney diseases. During the active phase, the disease pathogenesis affects various biological functions linked to loss of proteins negatively, which can result in systemic complications. Complications of childhood NS are divided into two categories: disease-associated complications and drug-associated complications. However, complications in pediatric patients with NS, especially disease-associated complications are still limited. Although reported in the literature, information is not comprehensive and needs to be updated. This study aimed to systematically assess systemic complications in children with NS, especially disease-associated complications, to better understand how they impact outcomes. METHODS We conducted a systematic search of several databases: BioMed Central Pediatrics, PubMed, Google Scholar, the National Library of Medicine, Cochrane Library, CINAHL/EBSCO, British Medical Journal, Science Direct, Scopus, and Elsevier's ClinicalKey. We followed the PRISMA guidelines to plan, conduct, and report this review. We used the Joanna Briggs Institute's critical appraisal tools for assuring the quality of the journal articles that were chosen. RESULTS Eleven articles concerning complications in childhood NS were analyzed. Systemic disease-associated complications in covered were cardiovascular complications, infections, thyroid-hormone complication, kidney complications, and oral health complications. CONCLUSION NS is marked by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia, which can result in systemic disease-associated complications. Cardiovascular complications, infections, thyroid-hormone complications, kidney complications, and oral health complications are the main systemic complications in childhood NS. It is essential that health-care providers prevent these complications for proper maintenance of patients' health.
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Affiliation(s)
- Dany Hilmanto
- Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Fitriana Mawardi
- Community and Family Medicine Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, Indonesia
| | - Ayuningtyas S Lestari
- Nursing Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Yogyakarta, Indonesia
| | - Ahmedz Widiasta
- Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Effectiveness and safety of rehabilitation on minimal change nephrotic syndrome in remission for elderly patients with low activity of daily living: a case report. CEN Case Rep 2021; 11:196-202. [PMID: 34623618 DOI: 10.1007/s13730-021-00649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022] Open
Abstract
There are few reports on the rehabilitation of elderly patients with minimal change nephrotic syndrome (MCNS). The purpose of this case study was to evaluate the efficacy and safety of rehabilitation for an elderly patient with MCNS in remission. The patient was an 86-year-old woman. She was admitted to the hospital with a diagnosis of MCNS, and steroid treatment was initiated. She was weaned from dialysis 2 weeks later; however, her activities of daily living (ADL) decreased, and she developed disuse syndrome. After rehabilitation, the patient's ADL, maximum hand grip strength, and gait function improved. There was no recurrence of weight gain or increased proteinuria during rehabilitation, but the estimated glomerular filtration rate decreased. This case suggests that rehabilitation for elderly patients with MCNS in remission can be effective for physical and ADL functions without relapse of MCNS. The effect of exercise therapy on the relationship between exercise therapy and renal function needs to be further investigated by collecting more cases.
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Clinical features of acute kidney injury in patients with nephrotic syndrome and minimal change disease: a retrospective, cross-sectional study. Chin Med J (Engl) 2020; 134:206-211. [PMID: 33443939 PMCID: PMC7817344 DOI: 10.1097/cm9.0000000000001218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Minimal change nephropathy (MCD) is a common pathological type of nephrotic syndrome and is often associated with acute kidney injury (AKI). This study aimed to investigate the clinical characteristics and related factors of AKI in patients with MCD and nephrotic syndrome. Methods: Patients from Chinese People's Liberation Army General Hospital who were diagnosed with pathological renal MCD with clinical manifestations of nephrotic syndrome were included from January 1, 2013 to December 31, 2017. Patients diagnosed with membranous nephropathy (MN) by renal biopsy from January 1, 2013 to December 31, 2017 are included as a control population. We retrospectively analyzed the clinical and pathological characteristics of patients as well as the percentages and clinical characteristics of AKI in different age groups. We assessed the correlation of pathological characteristics with serum creatinine using multivariate linear regression analysis. Results: A total of 367 patients with MCD were included in the analysis, with a sex ratio of 1.46: 1 (male: female) and an age range of 6 to 77 years. Among all the patients, 109 developed AKI (29.7%), and of these patients, 85 were male (78.0%). In the 586 patients with MN, 27 (4.6%) patients developed AKI. The percentage of AKI in MCD patients was significantly higher than that in MN patients (χ2 = 41.063, P < 0.001). The percentage of AKI increased with age in the MCD patients. The percentage of AKI in patients aged 50 years or older was 52.9% (46/87), which was significantly higher than that [22.5% (63/280)] in patients under 50 years (χ2 = 6.347, P = 0.013). We observed statistically significant differences in age (43 [27, 59] years vs. 28 [20, 44] years, Z = 5.487, P < 0.001), male (78.0% vs. 51.4%, χ2 = 22.470, P < 0.001), serum albumin (19.9 ± 6.1 g/L vs. 21.5 ± 5.7 g/L, t = 2.376, P = 0.018), serum creatinine (129.5 [105.7, 171.1] μmol/L vs. 69.7 [57.7, 81.9] μmol/L, Z = 14.190, P < 0.001), serum urea (10.1 [6.2, 15.8] mmol/L vs. 4.7 [3.6, 6.4] mmol/L, Z = 10.545, P < 0.001), IgE (266.0 [86.7, 963.0] IU/ml vs. 142.0 [35.3, 516.5] IU/ml, Z = 2.742, P = 0.007), history of diabetes (6.4% vs. 1.2%, P = 0.009), and history of hypertension (23.9% vs. 5.1%, χ2 = 28.238, P < 0.001) between the AKI group and the non-AKI group. According to multivariate linear regression analysis, among the renal pathological features analyzed, renal tubular epithelial cell damage (β = 178.010, 95% CI: 147.888−208.132, P < 0.001) and renal interstitial edema (β = 28.833, 95% CI: 11.966−45.700, P = 0.001) correlated with serum creatinine values. Conclusions: The percentage of AKI in MCD patients is significantly higher than that in MN patients. Patients over 50 years old are more likely to develop AKI. Renal tubular epithelial cell injury and renal interstitial edema may be the main pathological lesions that are associated with elevated serum creatinine in patients with MCD.
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Heybeli C, Erickson SB, Fervenza FC, Hogan MC, Zand L, Leung N. Comparison of treatment options in adults with frequently relapsing or steroid-dependent minimal change disease. Nephrol Dial Transplant 2020; 36:1821-1827. [DOI: 10.1093/ndt/gfaa133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Studies comparing all treatment options for frequently-relapsing/steroid-dependent (FR/SD) minimal change disease (MCD) in adults are lacking.
Methods
Medical records of 76 adults with FR/SD MCD who were treated with corticosteroids as the first-line therapy were reviewed. Treatment options were compared for the time to relapse, change of therapy and progression (relapse on full-dose treatment).
Results
Second-line treatments included rituximab (RTX; n = 13), mycophenolate mofetil (MMF; n = 12), calcineurin inhibitors (CNI; n = 26) and cyclophosphamide (CTX; n = 16). During the second-line treatments, 48 (71.6%) patients relapsed at median 17 (range 2–100) months. The majority of relapses occurred during dose tapering or off drug. Twenty of 65 (30.8%) changed therapy after the first relapse. The median time to relapse after the second line was 66 versus 28 months in RTX versus non-RTX groups (P = 0.170). The median time to change of treatment was 66 and 44 months, respectively (P = 0.060). Last-line treatment options included RTX (n = 8), MMF (n = 4), CNI (n = 3) and CTX (n = 2). Seven (41.2%) patients had a relapse during the last-line treatment at median 39 (range 5–112) months. The median time to relapse was 48 versus 34 months in the RTX versus non-RTX groups (P = 0.727). One patient in the RTX group died presumably of heart failure. No major adverse event was observed. During the median follow-up of 81 (range 9–355) months, no patients developed end-stage renal disease.
Conclusions
Relapse is frequent in MCD in adults. Patients treated with RTX may be less likely to require a change of therapy and more likely to come off immunosuppressive drugs.
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Affiliation(s)
- Cihan Heybeli
- Division of Nephrology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Stephen B Erickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Ladan Zand
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Caliskan Y, Caza T, Mosman A, Elawa U, Philipneri M, Martin K, Bastani B. A case of immune complex mediated tubulointerstitial disease and nephrotic syndrome: anti LRP-2 Nephropathy with diffuse podocyte effacement. J Nephrol 2020; 34:915-919. [PMID: 32472527 DOI: 10.1007/s40620-020-00762-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Abstract
Anti-LDL Receptor-Related Protein 2 (Anti-LRP2) nephropathy is a rare form of kidney disease that affects the older patients and is characterized with acute kidney injury (AKI) and progressive renal tubular injury associated with IgG immune complex deposits along the basement membrane of proximal tubules, and circulating autoantibodies to the proximal tubule brush border protein LRP2 (megalin). We present the case of a 79-year-old man who was hospitalized for worsening malaise, abdominal distention and bilateral lower extremity edema, diagnosed with AKI and had nephrotic range proteinuria. Percutaneous kidney biopsy revealed tubulointerstitial nephritis with IgG immune complex deposits along the basement membrane of proximal tubules and brush borders. Immunofluorescence staining for LRP2 (megalin) showed similar granular tubular basement membrane deposits along the proximal tubules and proximal tubule brush borders. Electron microscopy revealed global podocyte foot process effacement. The patient was started on oral prednisolone 1 mg/kg and rituximab at a dose of 375 mg/m2 once weekly for 4 weeks with gradual tapering of prednisone. This case with AKI and nephrotic syndrome highlights the significant morphologic overlap with minimal change disease and anti-LRP2 nephropathy, which is associated with autoantibodies to the tubular brush border protein LRP2/megalin.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA.
| | | | - Amy Mosman
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Usama Elawa
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Marie Philipneri
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Kevin Martin
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Bahar Bastani
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
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Oyama Y, Iwafuchi Y, Morioka T, Narita I. Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings. Case Rep Nephrol Dial 2020; 10:42-50. [PMID: 32399474 PMCID: PMC7204776 DOI: 10.1159/000507426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/22/2020] [Indexed: 01/04/2023] Open
Abstract
Oliguric acute kidney injury (AKI) with minimal change nephrotic syndrome (MCNS) has long been recognized. Several mechanisms such as hypovolemia due to hypoalbuminemia and the nephrosarca hypothesis have been proposed. However, the precise mechanism by which MCNS causes AKI has not been fully elucidated. Herein, we describe an elderly patient with AKI caused by MCNS who fully recovered after aggressive volume withdrawal by hemodialysis and administration of a glucocorticoid. A 75-year-old woman presented with diarrhea and oliguria, and laboratory examination revealed nephrotic syndrome (NS) and severe azotemia. Fluid administration had no effect on renal dysfunction, and hemodialysis was initiated. Her renal function improved upon aggressive fluid removal through hemodialysis. Renal pathological findings revealed minimal change disease with faint mesangial deposits of IgA. After administration of methylprednisolone pulse therapy followed by oral prednisolone, she achieved complete remission from NS. The clinical course of this case supports the nephrosarca hypothesis regarding the mechanism of AKI caused by MCNS. Furthermore, appropriate fluid management and kidney biopsy are also important in elderly patients with AKI caused by NS.
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Affiliation(s)
- Yuko Oyama
- Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, Japan
| | - Yoichi Iwafuchi
- Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, Japan
| | - Tetsuo Morioka
- Department of Internal Medicine, Kidney Center, Shinrakuen Hospital, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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14
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15
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Hamroun A, Frimat M, Beuscart JB, Buob D, Lionet A, Lebas C, Daroux M, Provôt F, Hazzan M, Boulanger É, Glowacki F. [Kidney disease care for the elderly]. Nephrol Ther 2019; 15:533-552. [PMID: 31711751 DOI: 10.1016/j.nephro.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In our aging population, kidney disease management needs to take into account the frailty of the elderly. Standardized geriatric assessments can be proposed to help clinicians apprehend this dimension in their daily practice. These tools allow to better identify frail patients and offer them more personalized and harmless treatments. This article aims to focus on the kidney diseases commonly observed in elderly patients and analyze their specific nephrogeriatric care modalities. It should be noticed that all known kidney diseases can be also observed in the elderly, most often with a quite similar clinical presentation. This review is thus focused on the diseases most frequently and most specifically observed in elderly patients (except for monoclonal gammopathy associated nephropathies, out of the scope of this work), as well as the peculiarities of old age nephrological care.
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Affiliation(s)
- Aghilès Hamroun
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Marie Frimat
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | | | - David Buob
- Service d'anatomopathologie, Centre de biologie-pathologie, CHRU de Lille, 59037 Lille, France
| | - Arnaud Lionet
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Céline Lebas
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Maïté Daroux
- Service de néphrologie, hôpital Duchenne, allée Jacques Monod, 62200 Boulogne-sur-Mer, France
| | - François Provôt
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Marc Hazzan
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Éric Boulanger
- Service de gériatrie, CHRU de Lille, 59037 Lille, France
| | - François Glowacki
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France.
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16
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Konigsfeld HP, Viana TG, Pereira SC, Santos TOCD, Kirsztajn GM, Tavares A, de Souza Durão Junior M. Acute kidney injury in hospitalized patients who underwent percutaneous kidney biopsy for histological diagnosis of their renal disease. BMC Nephrol 2019; 20:315. [PMID: 31409299 PMCID: PMC6693282 DOI: 10.1186/s12882-019-1514-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Performing a kidney biopsy is necessary to accurately diagnose diseases such as glomerulonephritis and tubulointerstitial nephritis, among other such conditions. These conditions predispose patients to chronic kidney disease, as well as acute kidney injury (AKI). Notably, most epidemiological studies describing AKI have not investigated this patient population. METHODS Included patients admitted to the nephrology ward of a tertiary hospital who underwent percutaneous kidney biopsy. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes criteria. RESULTS Of the 223 patients investigated, 140 (62.8%) showed AKI. Of these, 91 (65%), 19 (13.6%), and 30 (21.4%) presented with AKI classified as stages 1, 2, and 3, respectively. The primary indication for performing biopsy was nephrotic syndrome or nephrotic proteinuria (73 [52.1%] in the AKI vs. 51 [61.4%] in the non-AKI group, p = 0.048). Focal segmental glomerulosclerosis was the most prevalent primary disease (24 [17.1%] in the AKI vs. 15 [18.0%] in the non-AKI group, p = 0.150). Multivariate analysis of risk factors associated with AKI showed hemoglobin levels (odds ratio [OR] 0.805, 95% confidence interval [CI] 0.681-0.951, p = 0.011), serum high-density lipoprotein cholesterol levels (HDL-c, OR 0.970, 95% CI 0.949-0.992, p = 0.008), and baseline serum creatinine levels (OR 2.703, 95% CI 1.471-4.968, p = 0.001) were significantly associated with AKI. CONCLUSIONS We observed a high prevalence of AKI in hospitalized patients who underwent kidney biopsy to investigate their renal disease, particularly glomerulonephritis. Higher levels of hemoglobin and serum HDL-c were associated with a lower risk of AKI.
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Affiliation(s)
| | | | | | | | | | - Agostinho Tavares
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcelino de Souza Durão Junior
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil. .,Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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17
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Yamada Y, Inui K, Hara Y, Fuji K, Sonoda K, Hashimoto K, Kamijo Y. Verification of serum albumin elevating effect of cell-free and concentrated ascites reinfusion therapy for ascites patients: a retrospective controlled cohort study. Sci Rep 2019; 9:10195. [PMID: 31308465 PMCID: PMC6629637 DOI: 10.1038/s41598-019-46774-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cell-free and concentrated ascites reinfusion therapy (CART) is frequently used to treat refractory ascites in Japan. However, its efficacy remains unclear. This controlled cohort study verified the serum albumin elevating effect of CART by comparisons with simple paracentesis. Ascites patients receiving CART (N = 88) or paracentesis (N = 108) at our hospital were assessed for the primary outcome of change in serum albumin level within 3 days before and after treatment. A significantly larger volume of ascites was drained in the CART group. The change in serum albumin level was +0.08 ± 0.25 g/dL in the CART group and −0.10 ± 0.30 g/dL in the paracentesis group (P < 0.001). The CART – paracentesis difference was +0.26 g/dL (95%CI +0.18 to +0.33, P < 0.001) after adjusting for potential confounders by multivariate analysis. The adjusted difference increased with drainage volume. In the CART group, serum total protein, dietary intake, and urine volume were significantly increased, while hemoglobin and body weight was significantly decreased, versus paracentesis. More frequent adverse events, particularly fever, were recorded for CART, although the period until re-drainage was significantly longer. This study is the first demonstrating that CART can significantly increase serum albumin level as compared with simple paracentesis. CART represents a useful strategy to manage patients requiring ascites drainage.
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Affiliation(s)
- Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Keita Inui
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yuuta Hara
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kazuaki Fuji
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kosuke Sonoda
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
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18
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Lionaki S, Liapis G, Boletis JN. Pathogenesis and Management of Acute Kidney Injury in Patients with Nephrotic Syndrome Due to Primary Glomerulopathies. ACTA ACUST UNITED AC 2019; 55:medicina55070365. [PMID: 31336742 PMCID: PMC6681356 DOI: 10.3390/medicina55070365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
Acute kidney injury in the context of nephrotic syndrome is a serious and alarming clinical problem. Largely, acute kidney injury is a relatively frequent complication among patients with comorbidities while it has been independently associated with an increased risk of adverse outcomes, including death and chronic kidney disease. Nephrotic syndrome, without hematuria or with minimal hematuria, includes a list of certain glomerulopathies; minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy. In the light of primary nephrotic syndrome, pathophysiology of acute kidney injury is differentiated by the nature of the primary disease and the severity of the nephrotic state. This review aims to explore the clinical circumstances and pathogenetic mechanisms of acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies, focusing on newer perceptions regarding the pathogenesis and management of this complicated condition, for the prompt recognition and timely initiation of appropriate treatment in order to restore renal function to its baseline level. Prompt recognition of the precise cause of acute kidney injury is crucial for renal recovery. Clinical characteristics, laboratory and serological findings along with histopathological findings, if required, will reveal the implicated pathway leading to individualized approach and management.
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Affiliation(s)
- Sophia Lionaki
- Nephrology Department & Transplantation Unit, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece.
| | - George Liapis
- Department of Pathology, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - John N Boletis
- Nephrology Department & Transplantation Unit, Laiko Hospital, Faculty of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece
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19
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Mansur JB, Sandes-Freitas TV, Kirsztajn GM, Cristelli MP, Mata GF, de Paula MI, Grenzi PC, Martins SBS, Felipe CR, Tedesco-Silva H, Pestana JOM. Clinical features and outcomes of kidney transplant recipients with focal segmental glomerulosclerosis recurrence. Nephrology (Carlton) 2019; 24:1179-1188. [PMID: 30891898 DOI: 10.1111/nep.13589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
AIM Focal segmental glomerulosclerosis recurs in up to 30% and up to 80% of adult and pediatric kidney transplant recipients, respectively. There is no standard of care treatment. The purpose of this study was to evaluate clinical characteristics, treatments and outcomes of patients with focal segmental glomerulosclerosis recurrence (FSGSr). METHODS This was a retrospective single-center cohort study including FSGSr patients treated with plasmapheresis (PP) and combinations of high dose steroids, cyclosporine and rituximab. RESULTS Among 61 patients included in this analysis the median time to diagnosis was 19 days. The incidence of first biopsy-confirmed FSGSr was 18% reaching 52.4% with follow-up biopsies. During PP treatment 54% of the patients developed infectious complications. PP was discontinued in 37% of patients due to treatment failure (no remission or graft loss) and in 26% due to an adverse event. All patients who discontinued PP due to adverse event did not show clinical response or lost the allograft. The incidence of acute rejection was 34.4%. The incidences of partial and complete remissions were 16.4% and 27.8%, respectively. Overall 6-years patient and graft survivals were 90.7% and 64.5%, respectively. CONCLUSION This analysis confirms the low, variable and unpredictable rate of FSGSr remission, inconsistencies among available therapeutic options and its high rate of adverse events, and the negative impact on graft survival.
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Affiliation(s)
- Juliana B Mansur
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Gianna M Kirsztajn
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Marina P Cristelli
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Gustavo F Mata
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Mayara I de Paula
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Patricia C Grenzi
- Microbiology and Immunology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Suelen B S Martins
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Claudia R Felipe
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Hélio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - José O M Pestana
- Nephrology Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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20
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Tuğcu M, Kasapoğlu U, Şahin G, Apaydın S, Gümrükçü G. Evaluation of kidney biopsies in elderly patients. Int Urol Nephrol 2019; 51:869-874. [PMID: 30830658 DOI: 10.1007/s11255-019-02109-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The renal parenchymal disease spectrum in geriatric patients is similar to that in younger patients and can be controlled by appropriate treatment. We evaluated the clinicopathological features of kidney biopsies from geriatric patients. MATERIALS AND METHODS One hundred nine native kidney biopsies from older patients (> 65 years old) obtained from 2005 to 2014 were evaluated retrospectively. The specimens were inspected by the same pathologist in the same laboratory by light microscopy and immunofluorescence. RESULTS The mean age of the patients was 72.4 ± 7.8 years (range 65-90 years), and 51.3% were female. The most frequent indication for kidney biopsy was proteinuria at the nephrotic level (56.8%). The most frequent histopathological diagnoses were focal segmental glomerulosclerosis in primary glomerulonephritis and secondary amyloidosis in secondary glomerulonephritis. The rate of major complications due to kidney biopsy was < 1%. RESULT Kidney biopsy is an effective and safe method of evaluating renal parenchymal diseases in older patients.
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Affiliation(s)
- Murat Tuğcu
- Department of Nephrology, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak Mahallesi, Muhsin Yazıcıoğlu Cd No: 10, 34899, Istanbul, Turkey.
| | - Umut Kasapoğlu
- Department of Nephrology, Agrı Public Hospital, Agrı, Turkey
| | - Gülizar Şahin
- Department of Nephrology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Süheyla Apaydın
- Department of Nephrology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gülistan Gümrükçü
- Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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21
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Prasad BS, Kumar M, Dabas A, Mishra K. Profile of Acute Kidney Injury in Hospitalized Children with Idiopathic Nephrotic Syndrome. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1483-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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22
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Kim MY, Cho MH, Kim JH, Ahn YH, Choi HJ, Ha IS, Il Cheong H, Kang HG. Acute kidney injury in childhood-onset nephrotic syndrome: Incidence and risk factors in hospitalized patients. Kidney Res Clin Pract 2018; 37:347-355. [PMID: 30619690 PMCID: PMC6312784 DOI: 10.23876/j.krcp.18.0098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 02/01/2023] Open
Abstract
Background Nephrotic syndrome (NS) is the most common glomerulopathy in children. Acute kidney injury (AKI) is a common complication of NS, caused by severe intravascular volume depletion, acute tubular necrosis, interstitial nephritis, or progression of NS. However, the incidence and risk factors of childhood-onset NS in Korea are unclear. Therefore, we studied the incidence, causes, and risk factors of AKI in hospitalized Korean patients with childhood-onset NS. Methods We conducted a retrospective review of patients with childhood-onset NS who were admitted to our center from January 2015 to July 2017. Patients with decreased renal function or hereditary/secondary NS, as well as those admitted for management of other conditions unrelated to NS, were excluded. Results During the study period, 65 patients with idiopathic, childhood-onset NS were hospitalized 90 times for management of NS or its complications. Of these 90 cases, 29 met the Kidney Disease Improving Global Outcomes criteria for AKI (32.2%). They developed AKI in association with infection (n = 12), NS aggravation (n = 11), dehydration (n = 3), and intravenous methylprednisolone administration (n = 3). Age ≥ 9 years at admission and combined use of cyclosporine and renin-angiotensin system inhibitors were risk factors for AKI. Conclusion AKI occurred in one-third of the total hospitalizations related to childhood-onset NS, owing to infection, aggravation of NS, dehydration, and possibly high-dose methylprednisolone treatment. Age at admission and use of nephrotoxic agents were associated with AKI. As the AKI incidence is high, AKI should be considered during management of high-risk patients.
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Affiliation(s)
- Mi Young Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Myung Hyun Cho
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Ji Hyun Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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23
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Meyrier A, Niaudet P. Acute kidney injury complicating nephrotic syndrome of minimal change disease. Kidney Int 2018; 94:861-869. [PMID: 29980292 DOI: 10.1016/j.kint.2018.04.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/12/2018] [Accepted: 04/19/2018] [Indexed: 10/28/2022]
Abstract
Minimal change disease accounts for 70% to 90% of cases of nephrotic syndrome in children. It also causes nephrotic syndrome in adults, including patients older than age 60. Renal function is altered moderately in approximately 20% to 30% of patients because foot-process fusion impairs filtration of water and solutes. The glomerular filtration rate is reduced by approximately 20% to 30% and returns to baseline with remission of proteinuria. Over the past 50 years, a number of publications have reported cases of acute kidney injury occurring in approximately one-fifth to one-third of adult cases in the absence of prior or concomitant renal disease. Clinical attributes point to a male predominance, age >50, massive proteinuria, severe hypoalbuminemia, a background of hypertension and vascular lesions on kidney biopsy, along with ischemic tubular necrosis. Acute kidney injury may require dialysis for weeks or months until remission of proteinuria allows resolution of oliguria. In some cases, renal function does not recover. An effect of endothelin-1-induced vasoconstriction at the onset of proteinuria has been proposed to explain tubular cell ischemic necrosis. The main factors causing acute kidney injury in patients with minimal change disease are diuretic-induced hypovolemia and nephrotoxic agents. Acute kidney injury is uncommon in children in the absence of intercurrent complications. Infection, nephrotoxic medication, and steroid resistance represent the main risk factors. In all patients, the goal of supportive therapy is essentially to buy time until glucocorticoids obtain remission of proteinuria, which allows resolution of renal failure.
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Affiliation(s)
- Alain Meyrier
- Service de Néphrologie, Hôpital Georges Pompidou, Université Paris-Descartes, Paris, France.
| | - Patrick Niaudet
- Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, Université Paris-Descartes, Paris, France
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24
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Kim JS, Kim KJ, Choi EY. Minimal change disease related to rifampicin presenting with acute renal failure during treatment for latent tuberculosis infection: A case report. Medicine (Baltimore) 2018; 97:e10556. [PMID: 29851774 PMCID: PMC6392561 DOI: 10.1097/md.0000000000010556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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 The standard drugs used to treat tuberculosis are rifampicin and isoniazid. These agents are usually safe and inexpensive for short-term use in treatment of latent tuberculosis infection, but sometimes cause adverse renal effects, including minimal change disease (MCD). PATIENT CONCERNS Here, we report a 51-year-old woman with latent tuberculosis infection who developed nephrotic syndrome during treatment with rifampicin and isoniazid for 25 days. DIAGNOSES Renal biopsy findings were compatible with MCD, and she had no relevant medical history and was not taking other medications. A diagnosis of anti-tuberculosis drug- induced MCD was made. This is the first report of acute renal failure due to rifampicin and/or isoniazid-induced MCD. INTERVENTIONS After cessation of rifampicin and isoniazid, however, acute renal failure progressed and she was treated with temporary dialysis and oral prednisolone. OUTCOMES The patient achieved complete remission after cessation of rifampicin and isoniazid with steroid therapy. LESSONS This case demonstrates that rifampicin and/or isoniazid can cause nephrotic syndrome with acute renal failure during the first months of continuous latent tuberculosis therapy. Therefore, renal function and proteinuria should be monitored carefully in all patients taking rifampicin and isoniazid, especially during the first few months of therapy.
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Affiliation(s)
- Jee-Seon Kim
- Department of Internal Medicine, Yeungnam University Medical Center
| | - Kyong-Ju Kim
- Department of Pathology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Eun-Young Choi
- Department of Internal Medicine, Yeungnam University Medical Center
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25
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Abstract
Nephrotic syndrome (NS) is one of the commonest kidney diseases seen in childhood and is characterized by a relapsing remitting course. Various complications have been reported in children with NS, including infections, thromboembolism, hypovolemia, and acute kidney injury (AKI). There is often a modest decrease in renal function in patients with active proteinuria due to decreased glomerular permeability that improves when they go into remission. However, more pronounced AKI in NS is multifactorial in origin. It is most often secondary to hypovolemia, nephrotoxic medications, and infections, although other reasons may also be seen. Recent years have seen an increase in the incidence of AKI in NS. There is limited data on the correlation between AKI in pediatric NS and long-term outcomes. A better understanding of this increasingly common condition will help improve patient outcomes.
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Affiliation(s)
- Shina Menon
- Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, United States
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26
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Fujigaki Y, Tamura Y, Nagura M, Arai S, Ota T, Shibata S, Kondo F, Yamaguchi Y, Uchida S. Unique proximal tubular cell injury and the development of acute kidney injury in adult patients with minimal change nephrotic syndrome. BMC Nephrol 2017; 18:339. [PMID: 29179690 PMCID: PMC5704628 DOI: 10.1186/s12882-017-0756-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/14/2017] [Indexed: 12/13/2022] Open
Abstract
Background Adult patients with minimal change nephrotic syndrome (MCNS) are often associated with acute kidney injury (AKI). To assess the mechanisms of AKI, we examined whether tubular cell injuries unique to MCNS patients exist. Methods We performed a retrospective analysis of clinical data and tubular cell changes using the immunohistochemical expression of vimentin as a marker of tubular injury and dedifferentiation at kidney biopsy in 37 adult MCNS patients. AKI was defined by the criteria of the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI. Results Thirteen patients (35.1%) were designated with AKI at kidney biopsy. No significant differences in age, history of hypertension, chronic kidney disease, diuretics use, proteinuria, and serum albumin were noted between the AKI and non-AKI groups. Urinary N-acetyl-β-D-glucosaminidase (uNAG) and urinary alpha1-microglobulin (uA1MG) as markers of tubular injury were increased in both groups, but the levels were significantly increased in the AKI group compared with the non-AKI group. The incidence of vimentin-positive tubules was comparable between AKI (84.6%) and non-AKI (58.3%) groups, but vimentin-positive tubular area per interstitial area was significantly increased in the AKI group (19.8%) compared with the non-AKI group (6.8%) (p = 0.011). Vimentin-positive injured tubules with tubular simplification (loss of brush-border of the proximal tubule/dilated tubule with flattening of tubular epithelium) were observed in the vicinity of glomeruli in both groups, suggesting that the proximal convoluted tubules were specifically injured. Two patients exhibited relatively severe tubular injuries with vimentin positivity and required dialysis within 2 weeks after kidney biopsy. The percentage of the vimentin-positive tubular area was positively correlated with uNAG but not with uA1MG in the non-AKI group. Conclusions Proximal tubular injuries with increased uNAG exist in MCNS patients without renal dysfunction and were more severe in the AKI group than they were in the non-AKI group. The unique tubular injuries probably due to massive proteinuria might be a predisposing factor for the development of severe AKI in adult MCNS patients.
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Affiliation(s)
- Yoshihide Fujigaki
- Department of Internal Medicine and Central Laboratory, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
| | - Yoshifuru Tamura
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Michito Nagura
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Shigeyuki Arai
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Tatsuru Ota
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Shigeru Shibata
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yutaka Yamaguchi
- Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Shunya Uchida
- Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
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Yaseen A, Tresa V, Lanewala AA, Hashmi S, Ali I, Khatri S, Mubarak M. Acute kidney injury in idiopathic nephrotic syndrome of childhood is a major risk factor for the development of chronic kidney disease. Ren Fail 2017; 39:323-327. [PMID: 28093933 PMCID: PMC6014292 DOI: 10.1080/0886022x.2016.1277743] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/04/2016] [Accepted: 12/26/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is an important complication of idiopathic nephrotic syndrome (INS) and is associated with adverse outcomes, especially the development of chronic kidney disease (CKD). We aimed to determine the clinical profile of children with INS who developed AKI and its short-term outcome. MATERIAL AND METHODS This prospective study was conducted from March 2014 to October 2015. A total of 119 children of INS (age: 2-18 years) fulfilling the pediatric RIFLE criteria for the diagnosis of AKI were enrolled and followed up for 3 months to determine the outcome. Factors predisposing to CKD were studied. RESULTS The mean age at presentation was 8.8 ± 3.59 years and males were 74 (62.2%). At presentation, 61 (51.3%) children were in Risk category, 43 (36.1%) in Injury category, and 15 (12.6%) in Failure category. Most of them (41.2%) had steroid-resistant nephrotic syndrome (SRNS) and focal segmental glomerulosclerosis (FSGS) on histopathology (33.6%). Infections were the major predisposing factor for AKI in 67 (56.3%) cases. Drug toxicity was the next common, found in 52 (43.7%) children. A total of 65 (54.6%) children recovered from AKI, while 54 (45.4%) did not. CKD developed in 49 (41.2%) non-recovered cases and 5 (4.2%) children succumbed to acute illness. SRNS, cyclosporine use, FSGS on histology, and drug toxicity were significant factors associated with the development of CKD. CONCLUSION AKI associated with INS is a reversible condition in most cases but it can progress to CKD, especially among those who have SRNS, FSGS, and drug toxicity.
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Affiliation(s)
- Afshan Yaseen
- Department of Pediatric Nephrology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Vina Tresa
- Department of Pediatric Nephrology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Ali Asghar Lanewala
- Department of Pediatric Nephrology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Seema Hashmi
- Department of Pediatric Nephrology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Irshad Ali
- Department of Pediatric Nephrology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Sabeeta Khatri
- Department of Pediatric Nephrology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Muhammed Mubarak
- Department of Pediatric Nephrology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Inoue-Torii A, Kitamura S, Wada J, Tsuji K, Makino H. The level of urinary semaphorin3A is associated with disease activity in patients with minimal change nephrotic syndrome. Int J Nephrol Renovasc Dis 2017; 10:167-174. [PMID: 28790860 PMCID: PMC5489052 DOI: 10.2147/ijnrd.s132980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Semaphorin3A is a secreted protein known to be involved in organogenesis, immune responses and cancer. In the kidney, semaphorin3A is expressed in the glomerular podocytes, distal tubules and collecting tubules, and believed to play a role in the regulation of the kidney development and function. We examined the serum and urinary semaphorin3A levels in 72 patients with renal disease and 5 healthy volunteers. The patients had been diagnosed with thin basement membrane disease (n=4), minimal change nephrotic syndrome (MCNS; n=22), IgA nephritis (n=21), membranous nephropathy (n=16) and focal segmental glomerular sclerosis (n=9). The level of urinary semaphorin3A in MCNS patients tended to be relatively high among all disease groups. We also investigated the urinary semaphorin3A level in 7 patients with MCNS from disease onset to remission during the drug therapy. MCNS patients in pre-remission states had higher urinary semaphorin3A levels than those in post-remission states receiving immunosuppressive therapies. These results suggested that the urinary semaphorin3A level correlates with the MCNS activity. Semaphorin3A has the potential as a biomarker for MCNS to clarify the reactivity for therapy and may be useful in examining other glomerular diseases with proteinuria as well.
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Affiliation(s)
- Akiko Inoue-Torii
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Kitamura
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Tsuji
- Center for Systems Biology, Program in Membrane Biology, Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Hirofumi Makino
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Ashikaga E, Uda S, Kamata K, Shikida Y, Inoue T, Kuno Y, Yao A, Nakamura M, Kai K. Single low-dose rituximab for the treatment of steroid-resistant nephrotic syndrome with acute kidney injury. CEN Case Rep 2017; 5:56-60. [PMID: 28509183 DOI: 10.1007/s13730-015-0199-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/30/2015] [Indexed: 11/29/2022] Open
Abstract
The efficacy of rituximab for kidney disease, such as frequent relapsing nephrotic syndrome, has been reported recently. Herein, we report a case of a patient with acute kidney injury that was steroid-resistant nephrotic syndrome who responded to a single administration of low-dose rituximab. An 86-year-old Japanese woman with hypertension presented with severe peripheral edema within several days after onset. Due to the patient's age, renal biopsy was not performed, nephrotic syndrome was diagnosed and prednisolone was administered at 40 mg/day on the day after admission. However, anuria developed and hemodialysis was inevitably initiated on the 5th hospital day. The renal function did not recover, and the general condition gradually became aggravated. On the 50th hospital day, 100 mg rituximab was administered, which led to immediate depletion of CD20-positive cells. The urine volume gradually increased from 2-3 weeks after the rituximab administration, and the renal function recovered slightly. After 5 weeks, it became possible to wean the patient from dialysis, which had been applied for 3 months. Rituximab might be an option for the treatment of acute kidney injury due to steroid-resistant nephrotic syndrome.
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Affiliation(s)
- Eijin Ashikaga
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Susumu Uda
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan.
| | - Kazuhisa Kamata
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan.,Tanaka Medical Clinic, Kawasaki, Japan
| | - Yasuto Shikida
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Takashi Inoue
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Yoshihiro Kuno
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Atsushi Yao
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Mari Nakamura
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Keiko Kai
- Division of Nephrology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan
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Komukai D, Hasegawa T, Kaneshima N, Takayasu M, Sato Y, Hirose M, Yoshimura A. Influence of acute kidney injury on the time to complete remission in adult minimal change nephrotic syndrome: a single-centre study. Nephrology (Carlton) 2017; 21:887-92. [PMID: 26603689 DOI: 10.1111/nep.12678] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/17/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Abstract
AIM Acute kidney injury (AKI) is a common complication of minimal change nephrotic syndrome (MCNS), particularly in adults. We evaluated the prevalence of AKI at the onset of adult MCNS and analyzed the influence of AKI on the duration of achieving complete remission (CR). METHODS A retrospective, single-centre, dynamic cohort study was conducted with biopsy-proven, first-onset, adult MCNS patients treated with corticosteroids. Fifty-three consecutive patients diagnosed with MCNS from January 2000 to April 2014 were enrolled. Age, gender, daily urinary protein excretion, and serum creatinine levels were measured. To evaluate AKI during induction, we used the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI and judged AKI stage according to the fluctuations in serum creatinine levels during the first 4 weeks of starting corticosteroid therapy. RESULTS Twenty patients (37.7%) met the AKI criteria and all 53 patients achieved CR within 1 year. Kaplan-Meier analysis showed that the median time to CR was significantly longer in patients with AKI than in patients without AKI. Cox proportional hazard analysis showed that the hazard ratio (HR) associated with the presence of AKI for achieving CR within 4 weeks was 0.36 after adjustment for age, gender, serum albumin, daily urinary protein excretion, hypertension, administration of 25% albumin, and methylprednisolone pulse therapy. A graded association was also observed between AKI stage and HR for achieving CR. CONCLUSIONS The prevalence of AKI is high in adult patients with MCNS during induction therapy. AKI is an independent factor that delays the time to CR.
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Affiliation(s)
- Daisuke Komukai
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Takeshi Hasegawa
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Nobuharu Kaneshima
- Division of Nephrology, Department of Internal Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Mamiko Takayasu
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yoshinori Sato
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Makoto Hirose
- Department of Medicine, Fujiyoshida Municipal Medical Center, Yamanashi, Japan
| | - Ashio Yoshimura
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
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Maas RJ, Deegens JK, Beukhof JR, Reichert LJ, Ten Dam MA, Beutler JJ, van den Wall Bake AWL, Rensma PL, Konings CJ, Geerse DA, Feith GW, Van Kuijk WH, Wetzels JF. The Clinical Course of Minimal Change Nephrotic Syndrome With Onset in Adulthood or Late Adolescence: A Case Series. Am J Kidney Dis 2017; 69:637-646. [PMID: 28089478 DOI: 10.1053/j.ajkd.2016.10.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/24/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Few studies have examined the treatment and outcome of adult-onset minimal change nephrotic syndrome (MCNS). We retrospectively studied 125 patients who had MCNS with onset in either adulthood or late adolescence. Presenting characteristics, duration of initial treatment and response to treatment, relapse patterns, complications, and long-term outcome were studied. STUDY DESIGN Case series. SETTING & PARTICIPANTS Patients with new-onset nephrotic syndrome 16 years or older and a histologic diagnosis of MCNS in 1985 to 2011 were identified from pathology records of 10 participating centers. OUTCOMES Partial and complete remission, treatment resistance, relapse, complications, renal survival. RESULTS Corticosteroids were given as initial treatment in 105 (84%) patients. After 16 weeks of corticosteroid treatment, 92 (88%) of these patients had reached remission. Median time to remission was 4 (IQR, 2-7) weeks. 7 (6%) patients initially received cyclophosphamide with or without corticosteroids, and all attained remission after a median of 4 (IQR, 3-11) weeks. 13 (10%) patients reached remission without immunosuppressive treatment. One or more relapses were observed in 57 (54%) patients who received initial corticosteroid treatment. Second-line cyclophosphamide resulted in stable remission in 57% of patients with relapsing MCNS. Acute kidney injury was observed in 50 (40%) patients. Recovery of kidney function occurred almost without exception. Arterial or venous thrombosis occurred in 11 (9%) patients. At the last follow-up, 113 (90%) patients were in remission and had preserved kidney function. 3 patients with steroid-resistant MCNS progressed to end-stage renal disease, which was associated with focal segmental glomerulosclerosis lesions on repeat biopsy. LIMITATIONS Retrospective design, variable treatment protocols. CONCLUSIONS The large majority of patients who had MCNS with onset in adulthood or late adolescence were treated with corticosteroids and reached remission, but many had relapses. Cyclophosphamide resulted in stable remission in many patients with relapses. Significant morbidity was observed due to acute kidney injury and other complications. Progression to end-stage renal disease occurred in a few patients and was explained by focal segmental glomerulosclerosis.
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Affiliation(s)
- Rutger J Maas
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jeroen K Deegens
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johan R Beukhof
- Department of Nephrology, Isala Klinieken, Zwolle, the Netherlands
| | | | - Marc A Ten Dam
- Department of Nephrology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Jaap J Beutler
- Department of Nephrology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands
| | | | - Pieter L Rensma
- Department of Nephrology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands
| | | | - Daniel A Geerse
- Department of Nephrology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Geert W Feith
- Department of Nephrology, Gelderse Vallei, Ede, the Netherlands
| | - Willi H Van Kuijk
- Department of Nephrology, Viecuri Medisch Centrum, Venlo, the Netherlands
| | - Jack F Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
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Beyar-Katz O, Davila EK, Zuckerman T, Fineman R, Haddad N, Okasha D, Henig I, Leiba R, Rowe JM, Ofran Y. Adult Nephrotic Syndrome after Hematopoietic Stem Cell Transplantation: Renal Pathology is the Best Predictor of Response to Therapy. Biol Blood Marrow Transplant 2015; 22:975-981. [PMID: 26740372 DOI: 10.1016/j.bbmt.2015.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/16/2015] [Indexed: 01/28/2023]
Abstract
Nephrotic syndrome (NS) after allogeneic hematopoietic stem cell transplantation (HSCT) is a rare phenomenon usually associated with graft-versus-host disease (GVHD). This systematic review of post-HSCT NS cases reported in the literature aimed to identify risk factors and unique features of the disease in this clinical setting. One hundred sixteen cases of post-HSCT NS published in the English literature between 1988 and 2015 were revealed and analyzed. The median onset of NS was 20.5 months (range, 3 to 174) post-HSCT. NS development was associated with acute or chronic GVHD in 87.2% of cases. Membranous nephropathy (MGN) was the most frequent pathology (65.5%), followed by minimal change disease (MCD) (19%). Complete remission of the NS was achieved in 63.5% of patients (59.1% of MGN cases and 81.3% of MCD cases; P = .15). Patients presenting with MCD recovered at a median of 1.75 months (range, 1 to 12) and with MGN a median of 7 months (range, 1 to 53) (P = .001). NS was treated with corticosteroids alone in 16.8% of patients and with a combination of corticosteroids and other immunosuppressive agents in 73.5% of patients. Univariate analysis failed to identify a single predictive factor of response to therapy. In conclusion, post-HSCT NS usually develops concomitant to GVHD and is associated with high rates of response to therapy. Although most patients were treated with a combination of immunosuppressive drugs, single-agent therapy with steroids may be sufficient in some cases.
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Affiliation(s)
- Ofrat Beyar-Katz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | | | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Riva Fineman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Nuhad Haddad
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Doaa Okasha
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Israel Henig
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ronit Leiba
- Department of Statistics, Rambam Health Care Campus, Haifa, Israel
| | - Jacob M Rowe
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yishai Ofran
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
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Sumnu A, Gursu M, Ozturk S. Primary glomerular diseases in the elderly. World J Nephrol 2015; 4:263-270. [PMID: 25949940 PMCID: PMC4419136 DOI: 10.5527/wjn.v4.i2.263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 12/22/2014] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Primary glomerular diseases in the elderly population are a frustrating topic due to difficulties in both the diagnosis and decision making about treatment. The most frequent type of primary glomerular disease in elderly is membranous nephropathy; while its counterpart in younger population is IgA nephropathy. The most frequent cause of nephrotic syndrome in the elderly is also membranous nephropathy. Pauci-immune crescentic glomerulonephritis (GN) rate increases both in elderly and very elderly population. Pauci-immune crescentic GNs should be regarded as urgencies in elderly patients as in their younger counterparts due to potential for causing end-stage renal disease in case of delayed diagnosis and treatment, and also causing mortality due to alveolar hemorrhage in patients with pulmonary involvement. Renal biopsy is the inevitable diagnostic method in the elderly as in all other age groups. Renal biopsy prevents unnecessary treatments and provides prognostic data. So advanced age should not be the sole contraindication for renal biopsy. The course of primary glomerular diseases may differ in the elderly population. Acute kidney injury is more frequent in the course and renal functions may be worse at presentation. These patients are more prone to be hypertensive. The decision about adding immune suppressive therapies to conservative methods should be made considering many factors like co-morbidities, drug side effects and potential drug interactions, risk of infection, patient preference, life expectancy and renal functions at the time of diagnosis.
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Jin B, Zeng C, Ge Y, Le W, Xie H, Chen H, Liang S, Xu F, Jiang S, Liu Z. The spectrum of biopsy-proven kidney diseases in elderly Chinese patients. Nephrol Dial Transplant 2014; 29:2251-9. [PMID: 25034755 DOI: 10.1093/ndt/gfu239] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Studies on biopsy-proven renal disease in the elderly (age ≥65 years) are extremely limited in China. The aim of this study was to examine the spectrum of renal diseases and their clinical presentations in elderly patients undergoing renal biopsy. METHODS All native renal biopsies (n = 851) performed in patients aged ≥65 years from January 2003 to December 2012 were retrospectively analyzed. The results were compared with a control group of 28 574 patients aged 18-64 years undergoing renal biopsy over the same period. RESULTS These 851 patients included 549 males and 302 females. Primary glomerular diseases (53.94%) occurred more frequently than secondary glomerular diseases (36.49%). The clinical manifestations were nephrotic syndrome (NS) in 29.49% of the patients, chronic renal failure in 24.68%, proteinuria and hematuria in 13.28%, proteinuria in 10.93%, acute kidney injury (AKI) in 10.81% and AKI and NS in 8.93%. Membranous nephropathy (MN) was the most frequent diagnosis (28.79%), followed by diabetic nephropathy (DN, 9.75%), IgA nephropathy (IgAN, 9.64%) and vasculitis (6.82%). When compared with the control group, the results showed that MN (P < 0.0001), DN (P < 0.0001), vasculitis (P < 0.0001) and amyloidosis (P < 0.0001) occurred more frequently and IgAN (P < 0.0001), lupus nephritis (P < 0.0001) and minimal change disease (P < 0.0001) occurred less frequently in the elderly. CONCLUSION This study is the first and largest renal biopsy series to analyze patients aged ≥65 years in China, and the results obtained from this study may increase the knowledge of renal diseases in elderly patients.
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Affiliation(s)
- Bo Jin
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Yongchun Ge
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Weibo Le
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Honglang Xie
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Hao Chen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Song Jiang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P.R. China
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Carron PL, Padilla M, Maurizi Balzan J. Nephrotic syndrome and acute renal failure during pegylated liposomal doxorubicin treatment. Hemodial Int 2014; 18:846-7. [PMID: 25040096 DOI: 10.1111/hdi.12196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Pierre-Louis Carron
- Néphrologie, Dialyse et Transplantation Centre Hospitalier Universitaire, CS 10217, 38043, Grenoble, France
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Heras M, Saiz A, Fernández-Reyes MJ, Guerrero MT, Rodríguez MA. [Membranous nephropathy after cholecystitis surgery complicated with severe acute renal failure]. Rev Esp Geriatr Gerontol 2014; 49:302-3. [PMID: 24997543 DOI: 10.1016/j.regg.2014.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Manuel Heras
- Servicio de Nefrología, Hospital General de Segovia, Segovia, España.
| | - Ana Saiz
- Servicio de Anatomía Patológica, Hospital Ramón y Cajal, Madrid, España
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Chu F, Chen G, Liu Y. Pathological patterns of primary nephrotic syndrome in Central China: a retrospective study of 627 cases. Ren Fail 2014; 36:514-9. [PMID: 24564431 DOI: 10.3109/0886022x.2014.882736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The pathological patterns underlying PNS in adult are poorly studied in Central China. METHODS This is a retrospective analysis of the clinical and pathologic data involving 627 adult patients with PNS who have been finished the renal biopsies from January 2009 to September 2012 in XiangYa 2nd Hospital of Central South University. Patients enrolled in our study were all from Central China. RESULTS There were 379 males and 248 females, formed the ratio of 1.53:1. There existed three main sorts of pathological patterns underlying PNS: membranous nephropathy (MN) 26.63%, minimal change disease (MCD) 23.60%, IgA nephropathy (IgAN) 23.39%. Among all biopsies, the proportion of FSGS underlying PNS increased from 5.8% during the period from 2009 to 2010 to 14.7% during the period from 2011 to 2012. The most common complication of PNS was infectious diseases, and MCD underlying PNS ran a higher risk of encountering acute renal injury. IgAN had the highest incidence of hematuresis. The common pathological patterns of PNS differed in age-brackets: IgAN and MCD were the main pathological lesions in patients aged from 16 to 30 years; MN mostly occurs in patients over 30. MCD was the dominating pathological lesions underlying IgAN which expressed as PNS. CONCLUSIONS (1) MN was the most frequent pathological pattern underlying PNS, the proportion of FSGS underlying PNS increased during the last 2 years. (2) The common pathological patterns of PNS differed in age-brackets and pathological patterns correlated to the complications or comorbidities of PNS to some extent.
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Affiliation(s)
- Fenfen Chu
- Department of Nephrology, Second Xiangya Hospital, Renal Research Institute of Central South University , Hunan , People's Republic of China
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Rheault MN, Wei CC, Hains DS, Wang W, Kerlin BA, Smoyer WE. Increasing frequency of acute kidney injury amongst children hospitalized with nephrotic syndrome. Pediatr Nephrol 2014; 29:139-47. [PMID: 24037143 PMCID: PMC6556228 DOI: 10.1007/s00467-013-2607-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nephrotic syndrome (NS) is among the most common kidney diseases seen in children. The major complications of NS include infection, acute kidney injury (AKI), and thromboembolism (TE). The objective of this study was to analyze long-term trends in the epidemiology of major complications of pediatric NS. METHODS We used the Healthcare Cost and Utilization Project Kids' Inpatient Database for the years 2000-2009 to perform an analysis of U.S. hospitalizations of children diagnosed with NS with or without infection, AKI or TE. RESULTS The frequency of NS hospitalizations complicated by AKI increased by 158 % between 2000 and 2009 (p < 0.001). The frequency of NS hospitalizations with infection and TE remained stable overall. Pneumonia was the most common infectious complication while peritonitis decreased by 50 % (p < 0.001). Importantly, development of any of these major complications of NS resulted in ∼2-3-fold increases in both hospital charges and length of stay. CONCLUSIONS It is concerning that the frequency of AKI in children hospitalized with NS has more than doubled in the past decade. Strategies to prevent or initiate earlier treatments for complications of NS could have a major impact on both morbidity and health care expenses.
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Affiliation(s)
| | - Chang-Ching Wei
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - David S. Hains
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
| | - Wei Wang
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
| | - Bryce A. Kerlin
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
| | - William E. Smoyer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43205, USA
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Bande U, Moger V, Kamath V, Mallikarjunaswamy, Chandrashekar. Acute kidney injury in a patient with membranous nephropathy - a case report. J Clin Diagn Res 2013; 7:2290-1. [PMID: 24298505 PMCID: PMC3843471 DOI: 10.7860/jcdr/2013/6610.3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 08/19/2013] [Indexed: 11/24/2022]
Abstract
Acute Kidney Injury (AKI) is one of the most challenging problems faced by clinicians in the tropics owing to its fast-changing burden. Acute Kidney Injury is an important complication of membranous nephropathy. Causes are varied and include hypovolumia, crescentic conversion of preexisting nephropathy, renal vein thrombosis, NSAID'S, vasculitis, and sepsis. In this case report we discuss the case of membranous nephropathy in a young adult complicated by AKI. This report highlights the importance of early renal biopsy in patients with post GE AKI not improving on hemodialysis. Here we also discuss the potential differentials to be considered in a case of membranous nephropathy with AKI.
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Affiliation(s)
- Uday Bande
- Associate Professor, Department of Gen Medicine, KIMSHubli, Karnataka, India
| | - Venkatesh Moger
- Associate Professor, Department of Nephrology, KIMSHubli, Karnataka, India
| | - Vasantha Kamath
- Director, Professor, Department of Medicine, KIMSHubli, Karnataka, India
| | | | - Chandrashekar
- Post graduate, Department of Medicine, KIMSHubli, Karnataka, India
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40
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Kanazawa H, Kotoda A, Akimoto T, Shinozaki T, Inoue M, Sugimoto H, Kusano E. Serial Tc-99m MAG3 renography evaluating the recovery of acute kidney injury associated with minimal change nephrotic syndrome. Intern Med 2013; 52:987-91. [PMID: 23648719 DOI: 10.2169/internalmedicine.52.9204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute kidney injury (AKI) is a well-recognized complication of minimal change nephrotic syndrome (MCNS). Previous reports support the concept that AKI associated with MCNS is reversible; however, information regarding the hemodynamic basis of AKI in MCNS is insufficient. We herein describe a case of AKI in a man with MCNS. In this case, monitoring the longitudinal changes in renal perfusion using serial Tc-99m-MAG3 renal scanning was beneficial for evaluating the pathophysiological background associated with the development of AKI. The potential impact of serial renal scanning in MCNS patients with AKI will also be discussed.
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Affiliation(s)
- Hidenori Kanazawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
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41
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Tavares MB, Chagas de Almeida MDC, Martins RTC, de Sousa ACGP, Martinelli R, dos-Santos WLC. Acute tubular necrosis and renal failure in patients with glomerular disease. Ren Fail 2012; 34:1252-7. [PMID: 23002699 PMCID: PMC3496189 DOI: 10.3109/0886022x.2012.723582] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Renal failure is common in patients with glomerular disease. Although renal failure may result from the glomerular lesion itself, it is also observed in patients with minimal glomerular alterations. Degenerative changes and necrosis of the tubular epithelium are common findings in kidney biopsies from these patients. The aim of this work is to examine the association between acute tubular necrosis (ATN) and renal failure in patients with glomerulopathy and to estimate the relationship between the degree of ATN and renal failure in these patients. Data on age, sex, presence of nephrotic syndrome, and renal failure were recorded for 149 patients, who underwent a renal biopsy for the diagnosis of glomerulopathy. The biopsies were reviewed, and ATN, when present, was classified as one of four grades depending on its intensity. The mean age of the patients was 21 ± 16 years. Eighty patients (54%) were male, 43 (42%) had renal failure, 104 (72%) had nephrotic syndrome, and 66 (45%) had minimal change disease or focal segmental glomerulosclerosis. ATN was present in 115 (77%) patients. The frequency of renal failure was directly correlated with the intensity of ATN [odds ratio (OR) of 26.0 for patients with grade 2 lesions and OR of 45.5 for patients with grade 3 lesions]. ATN is a common finding in the biopsies of patients with glomerulopathy. The severity of ATN is directly associated with the frequency of renal failure in these patients.
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Affiliation(s)
- Maria Brandão Tavares
- Fundação Oswaldo Cruz, Centro de Pesquisa Gonçalo Moniz, Rua Waldemar Falcão, Candeal, Salvador, BA, Brazil
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Abstract
OBJECTIVE This study aims to investigate the epidemiology, clinical and histological features, and prognosis of acute kidney injury (AKI) according to RIFLE classification in adult patients with idiopathic nephrotic syndrome. METHODS In this retrospective study, 277 patients with idiopathic nephrotic syndrome were reviewed from June 2005 to June 2009. RESULTS Fifty-one (18%) patients entered RIFLE class Risk (AKI-R); 24 (9%) patients entered RIFLE class Injury (AKI-I); and 20 (7%) patients entered RIFLE class Failure (AKI-F). Logistic regression analysis showed that severe hypoalbuminemia, increase in age, and being male were risk factors of AKI. Cumulative recovery rates in 3 months for groups AKI-R, AKI-I, and AKI-F were 95%, 100%, and 94%, respectively (p = 0.21). The mean time to recovery for groups AKI-R, AKI-I, and AKI-F was 20 ± 3, 25 ± 4, and 30 ± 5 days, respectively. Cumulative complete remission rates in 3 months for groups AKI-R, AKI-I, and AKI-F were 92%, 86%, and 65%, respectively (p = 0.002). The mean time to remission for groups AKI-R, AKI-I, and AKI-F was 28 ± 3, 39 ± 6, and 62 ± 8 days, respectively. CONCLUSION AKI is not uncommon in adult idiopathic nephrotic syndrome. More severe AKI was associated with longer time of nephrotic syndrome complete remission. Renal function can recover completely in most of the patients.
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Affiliation(s)
- Tianxin Chen
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, PR China.
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Rodamilans MF, Barros LL, Carneiro MM, dos Santos WLC, Rocha PN. Challenges in clinical-pathologic correlations: acute tubular necrosis in a patient with collapsing focal and segmental glomerulosclerosis mimicking rapidly progressive glomerulonephritis. Ren Fail 2011; 32:1005-8. [PMID: 20722570 DOI: 10.3109/0886022x.2010.501931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Herein, we report a case of acute kidney injury (AKI) due to diarrhea-induced acute tubular necrosis (ATN) in a patient with nephrotic syndrome secondary to biopsy-proven collapsing focal and segmental glomerulosclerosis (FSGS). The clinical picture mimicked rapidly progressive glomerulonephritis (RPGN) and motivated pulse therapy with methylprednisolone and cyclophosphamide. The case presentation is followed by a brief overview of the epidemiology of AKI in nephrotic syndrome as well as a discussion of its risk factors and potential mechanisms involved.
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Affiliation(s)
- Mariana Freire Rodamilans
- Departamento de Medicina, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Cohen LJ, Rennke HG, Laubach JP, Humphreys BD. The spectrum of kidney involvement in lymphoma: a case report and review of the literature. Am J Kidney Dis 2010; 56:1191-6. [PMID: 20843590 PMCID: PMC3222147 DOI: 10.1053/j.ajkd.2010.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/01/2010] [Indexed: 11/11/2022]
Abstract
Kidney involvement is an under-recognized complication of both Hodgkin and non-Hodgkin lymphoma. The diversity of lymphoma-related renal manifestations makes diagnosis difficult. Although abrupt worsening of kidney function may be the first sign of malignant disease, renal effects can be subtle or even silent. The causes of renal involvement similarly are varied. We discuss a case of non-Hodgkin lymphoma and associated kidney failure from several distinct malignancy-related mechanisms and review the spectrum of lymphoma-related kidney involvement.
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Affiliation(s)
- Lisa J Cohen
- Nephrology Division, Brigham and Women's Hospital, Boston, MA, USA.
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Abstract
OBJECTIVES To summarize the clinical presentation, histological features, treatment, and outcome of minimal change nephropathy (MCN) in patients with systemic lupus erythematosus (SLE). METHODS We performed a systematic review of cases of MCN in SLE patients reported in the English literature from January 1985 to May 2009 by a Medline search. RESULTS The estimated prevalence of MCN in biopsy-proven lupus nephritis is 2.3% in childhood and 1.1% in adults. There are 13 individual cases (12 women, one man) of SLE-related MCN reported in the literature. The mean age of nephritis onset was 32.7 years. In six (46%) patients, MCN was the initial manifestation of SLE. All patients presented with nephrotic syndrome and two (15%) had active urinary sediments. Renal function was impaired in eight (62%) patients and six (46%) patients had active lupus serology. All patients responded promptly to high-dose glucocorticoids but four (31%) had relapse of proteinuria during their course of SLE. None of the patients developed thromboembolic or infective complications. CONCLUSIONS MCN is an uncommon histological class of lupus nephritis. Typically, patients present with heavy proteinuria, and transient renal dysfunction is common. The prognosis of MCN in SLE appears to be good because of its rapid response to glucocorticoids. Relapses of proteinuria may be reduced by the use of maintenance immunosuppression. Alkylating agents, calcineurin inhibitors, mycophenolate mofetil, and rituximab can be considered in glucocorticoid-dependent or refractory cases of SLE-related MCN.
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Affiliation(s)
- C C Mok
- Department of Medicine, Tuen Mun Hospital and Centre for Assessment and Treatment of Rheumatic Diseases, Pok Oi Hospital, Hong Kong, China.
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46
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Nonoguchi H, Kohda Y, Fukutomi R, Nakayama Y, Naruse M, Kitamura K, Inoue T, Nakanishi T, Tomita K. A Case with Acute Renal Failure and Subsequent Nephrotic Syndrome. Ren Fail 2009; 31:162-6. [DOI: 10.1080/08860220802595955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Nguyen MT, Maynard SE, Kimmel PL. Misapplications of commonly used kidney equations: renal physiology in practice. Clin J Am Soc Nephrol 2009; 4:528-34. [PMID: 19261813 DOI: 10.2215/cjn.05731108] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Equations for estimating GFR, quantifying urinary protein excretion, and assessing renal sodium handling are widely used in routine nephrology and general medical and surgical practice. If these equations are applied in circumstances inconsistent with the clinical situations for or extrapolated beyond the limits in which they were validated, clinicians can come to erroneous conclusions, which could be detrimental for patient care. This review uses clinical vignettes to demonstrate some of the common pitfalls that clinicians may encounter in the use of these equations and considers the physiologic principles underlying their use. Equations for assessing aspects of renal function should only be used in specific clinical situations, if the underlying assumptions regarding their calculations and values are satisfied.
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Affiliation(s)
- Mai T Nguyen
- Department of Medicine, Division of Renal Diseases and Hypertension, George Washington University Medical Center, Washington, DC 20037, USA
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49
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Affiliation(s)
- Abiodun A Omoloja
- Nephrology Department, The Children's Medical Center, Dayton, Ohio, USA
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50
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Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, D'Agati V, Appel G. Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol 2007; 2:445-53. [PMID: 17699450 DOI: 10.2215/cjn.03531006] [Citation(s) in RCA: 260] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Minimal-change disease (MCD) counts for 10 to 15% of cases of primary nephrotic syndrome in adults. Few series have examined this disease in adults. A retrospective review was performed of 95 adults who had MCD and were seen at a single referral center. Examined were presenting features, response to daily versus alternate-day steroids, response to second-line agents, relapse patterns, complications of the disease and therapy, presence of acute renal failure (ARF), and outcome data. Sixty-five patients received daily and 23 received alternate-day steroids initially. There were no differences in remissions, time to remission, relapse rate, or time to relapse between daily- and alternate-day-treated patients. More than one quarter of patients were steroid resistant. At least one relapse occurred in 73% of patients; 28% were frequently relapsing. A significant proportion of frequently relapsing patients became steroid dependent. Second-line agents were used for steroid dependence, steroid resistance, or frequent relapses. No single agent proved superior. There were more remissions with second-line agents in steroid-dependent patients compared with steroid-resistant patients, and remissions were more likely to be complete in steroid-dependent patients. ARF occurred in 24 patients; they tended to be older and hypertensive with lower serum albumin and more proteinuria than those without ARF. At follow up, patients with an episode of ARF had higher serum creatinine than those without ARF. Four patients progressed to ESRD. These patients were less likely to have responded to steroids and more likely to have FSGS on repeat renal biopsy. In this referral MCD population, response to daily and alternate-day steroids is similar. Second-line agents give greater response in patients who are steroid dependent. ARF occurs in a significant number of adult MCD patients and may leave residual renal dysfunction. Few patients progress to ESRD.
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Affiliation(s)
- Meryl Waldman
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
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