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Background: India is a vast country with four geographical zones. Zonal heterogeneity amongst prevalent adult glomerular diseases is expected and has not been analysed in past studies.Methods: We conducted clinico-histological correlation of 290 kidney biopsies for adult glomerular diseases (GD) at tertiary teaching hospital in Eastern India between January 2013 and December 2015 and compared our data with biopsy data from other geographical zones in India to evaluate zonal variability (intra/inter) of adult glomerular diseases.Results: Males dominated all clinical syndromes except subnephrotic proteinuria (SbNP). IgA Nephropathy (IgAN, 41.1%) and Focal Segmental glomerulosclerosis (FSGS, 17.3%) were prevalent primary GD whereas Lupus nephritis (LN, 52.2%) and diabetic nephropathy (DN, 23.9%) were prevalent secondary GD. IgAN (44.4%) and LN (33.2%) dominated SbNP group whereas FSGS (30.2%) and Membranous nephropathy (MGN, 22.3%) dominated nephrotics. Mean eGFR (CKD-EPI) amongst EyRD and RPRF was 39.6±12.9 and 6.2±2.9 ml/min/1.73m2 respectively. In contrast, biopsies from East India showed MCD prevalence, followed by FSGS. Kidney biopsy data from West India showed MCD prevalence whereas Northern India and South India studies showed FSGS and MCD prevalence, but later data showed an IgAN emergence, as in our data.Conclusions: There is considerable heterogeneity in prevalent adult glomerular diseases in different geographical zones (inter and intra) in India. FSGS and MCD were the most prevalent in all zones. Our study showed IgAN prevalence in East Zone, similar to South India. Reason was, increased number of kidney biopsies in EyRD (eGFR 30-60 ml/min) and subnephrotic proteinuria.
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Adrenocorticotrophic hormone (ACTH) is a pituitary neuroimmunoendocrine polypeptide that belongs to the melanocortin system.Glomerular disease is common in children with kidney disease and may progress to renal insufficiency or even renal failure.The application of ACTH in the treatment of glomerular disease is a hot topic.Studies have shown that ACTH has a significant protective effect on podocytes,and plays a role in anti-urine protein and lipid-lowering.ACTH may play these roles through steroid and non-steroid mechanisms.This article reviews the types,mechanism and study progress of ACTH in the treatment of glomerular disease.
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Adrenocorticotrophic hormone(ACTH)is a pituitary neuroimmunoendocrine polypeptide that belongs to the melanocortin system.Glomerular disease is common in children with kidney disease and may progress to renal insufficiency or even renal failure.The application of ACTH in the treatment of glomerular disease is a hot topic.Studies have shown that ACTH has a significant protective effect on podocytes, and plays a role in anti-urine protein and lipid-lowering.ACTH may play these roles through steroid and non- steroid mechanisms.This article reviews the types, mechanism and study progress of ACTH in the treatment of glomerular disease.
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INTRODUCCIÓN: El sedimento de orina es una herramienta en la práctica clínica empleada desde hace muchos años para la evaluación de enfermedades renales. La detección de hematuria dismórfica es útil en el diagnóstico de enfermedades glomerulares. OBJETIVOS: Agrupar las hematurias dismórficas en los casos con presencia de acantocitos y los que no los presentan, y correlacionar estos dos grupos con los hallazgos histológicos de las biopsias renales. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y analítico. Se incluyeron los sedimentos de orina de 276 pacientes. Se analizaron dos grupos de hematuria dismórfica: D1 (presencia de acantocitos) y D2 (sin acantocitos), y se correlacionó con los hallazgos histológicos de la biopsia renal (glomerulopatías proliferativas y no proliferativas). Se analizaron los diferentes elementos formes de la orina (cilindros hemáticos, leucocitarios, céreos, granulosos, grasos), la creatinina plasmática y la proteinuria de 24 hs en los dos grupos de glomerulopatías. Posteriormente se realizó una regresión logística para evaluar las variables independientes entre los hallazgos del sedimento de orina, con los correspondientes odds ratio (OR) e intervalos de confianza (IC 95%). RESULTADOS: Se contó con 172 muestras provenientes de mujeres (62.3%) y 104 de hombres (37,7%). La presencia de acantocitos (D1) en las enfermedades glomerulares proliferativas (GP) fue 17 veces más frecuente comparada con las no proliferativas (GNP) OR 17.7 IC 95% (9.6-32.5) p 0.001. La presencia de cilindros hemáticos es ocho veces más frecuente en las GP OR 8 IC 95% (3.1-20.9). Los pacientes con hematuria no acantocitica (D2) es 5 veces más frecuente en una GNP OR 5.2 IC (2.4-11.3) p 0,001. La presencia de cilindros grasos fue más frecuente en los pacientes con GNP a diferencia de los cilindros leucocitarios, cuya frecuencia fue mayor en la GP. CONCLUSIONES: La presencia de hematuria dismórfica no acantocitica (D2) se correlacionó en la histología renal con la presencia de glomerulopatías no proliferativas (GNP) en forma significativa, a diferencia de la hematuria acantocitica y cilindros hemáticos que se observaron en glomerulopatías proliferativas, por lo tanto se considera una herramienta útil para poder diferenciar clínicamente estos dos grupos, sin remplazar la biopsia renal para el diagnóstico preciso y el pronóstico
INTRODUCTION: The analysis of urine sediment is a tool that has been used for many years in clinical practice to evaluate kidney diseases. Detecting dysmorphic red blood cells (RBC's) in urine is useful for the diagnosis of glomerular diseases. OBJECTIVES: To divide the cases of glomerular hematuria into two groups, depending on the presence or absence of acanthocytes, and to compare this factor with the histological findings of renal biopsies. METHODS: In this observational, retrospective, analytical study, urine sediments of 276 patients were included. Two groups of subjects with glomerular hematuria were analyzed: D1 (presence of acanthocytes) and D2 (absence of acanthocytes). The results were compared with the renal biopsy histological findings, i.e. proliferative glomerulonephritis and non-proliferative glomerulonephritis, considered separately. The formed elements of the urine (red blood cell, white blood cell, waxy, granular and fatty casts), plasma creatinine concentration and 24-hour urinary protein were tested in the two groups. A logistic regression analysis was later performed to assess the independent variables among urine sediment findings, with the corresponding odds ratio (OR) and confidence intervals (CI 95%). RESULTS: The samples were collected from 172 women (62.3 %) and 104 men (37.7 %). The presence of acanthocytes (D1) was 17 times more frequent in proliferative glomerulonephritis (PGN) than in non-proliferative glomerulonephritis (NPGN) [OR 17.7, CI 95% (9.6-32.5), p 0.001]. The presence of red blood cell casts was 8 times more frequent in PGN [OR 8, CI 95% (3.1-20.9)]. Cases of hematuria with no acanthocytes (D2) were 5 times more frequent in NPGN [OR 5.2, CI (2.4-11.3), p 0.001]. Fatty casts appeared more frequently in patients with NPGN, whereas white blood cell casts were more common in PGN cases. CONCLUSIONS: Renal histological findings revealed a significant correlation between glomerular hematuria without acanthocytes (D2) and non-proliferative glomerulonephritis (NPGN), while the presence of acanthocytes and red blood cell casts was associated with proliferative glomerulonephritis (PGN). The existence of acanthocytes in urine constitutes a useful tool to make a clinical distinction between these two conditions, but it does not replace renal biopsy to establish an accurate diagnosis and prognosis
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Humans , Acanthocytes , Hematuria , Urine , Glomerulonephritis, Membranous/diagnosisABSTRACT
Rituximab ( RTX) is a monoclonal antibody to the CD 20 antigen on B-cells that was initially designed and approved for the treatment of non-Hodgkin′s B-cell lymphoma and has emerged as a potent immunosuppressant for many immune -mediated disea-ses.Given its efficacy , tolerability and safety profile in comparison to more conventional treatment regimens , RTX is rapidly emerging as a critical therapeutic modality for glomerular disease .The paper reviews the role of RTX in the treatment of ANCA-associated vascul-itis, lupus nephritis , mixed cryoglobulinemia , membranous nephropathy , minimal change disease , and focal segmental glomeruloscle-rosis.
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Glomerular disease remains an important cause of renal disease in children. We retrospectively assessed the clinical features and histopathological diagnoses in kidney biopsy specimens in children (n=27). The medical records and histopathological diagnoses between 2003 and 2006 were reviewed. In each patient, clinical presentation, age at onset of disease, gender, presence of nephrotic range proteinuria, hematuria, hypertension and histopathological diagnoses were evaluated. SLE nephritis (n= 8) and membranoproliferative glomerulonephritis (MPGN) (n=8) were the most frequent glomerular diseases and nephrotic syndrome (n=21) was the frequent clinical manifestation.
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BACKGROUND: Steroid-induced osteoporosis(SIO) is one of the serious complications of long- term steroid therapy, especially in growing children. Recently bisphosphonates have been used to treat or prevent SIO in adult, which is rare in children with glomerular diseases. We studied the effect of pamidronate on SIO using dual energy X-ray absorptiometry and biochemical markers of bone turnover. METHODS: Forty four children receiving moderate-to-high doses of steroids were enrolled. They had no history of bone, liver, or endocrine disease. Patients were stratified by their baseline bone mineral density(BMD) findings. All patients received corticosteroids for 3 month and oral calcium supplementation(500 mg/day) daily. Among them, 28 patients were treated with placebo and 16 were treated with pamidronate(125 mg) for 3 months. Blood chemistry and bone mineral density(BMD) were measured at baseline, and 3months. In addition, parathyroid hormone(PTH), serum osteocalcin, and urinary dipyridinoline levels were evaluated. RESULTS:In overall population, the mean lumbar spine BMD decreased from 0.754+/-0.211 (g/cm2) to 0.728+/-0.208(g/cm2) in the placebo group(P0.05). CONCLUSION:Pamidronate appears to be effective in preventing SIO in children with glomerular diseases requiring long-term steroids therapy. Further careful observation and follow-up might be needed for children receiving bisphosphonates such as pamidronate.
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Adult , Child , Humans , Absorptiometry, Photon , Adrenal Cortex Hormones , Biomarkers , Calcium , Chemistry , Diphosphonates , Endocrine System Diseases , Follow-Up Studies , Liver , Osteocalcin , Spine , SteroidsABSTRACT
PURPOSE: To know the body handling properties and anti-proteinuric effect of cyclosporine A(CsA) in children with renal diseases, 34 patients with nephrotic syndrome or glomerular diseases were included to treatment trials and evaluated. METHODS: Microemulsion formula CsA, 5 mg/kg/day was administered orally in two divided doses for 9.3+/-4.6 months. Pharmacokinetic studies of CsA were done twice at beginning and closing of 12 months' CsA therapy. RESULTS: The steady state CsA pharmacokinetic parameters of 34 patients were as follows; Tmax:1.64+/-0.84 hr, Cmax:788+/-354 ng/dL, C12:58.7+/-33.2 ng/mL, Cavg:246+/-96 ng/mL, AUC:2,949+/-1,156 ng hr/mL, Vd:4.03+/-0.45 L/kg, CL:9.69+/-2.27 L/hr, T1/2:5.31+/-2.37 hr. C2 was the best to predict the CsA AUC(R=0.896, P<0.001). Body surface area based dosage(mg/m2/d) correlates best with AUC. Intra-individual CsA pharmacokinetic changes were not found after 12 months' therapy. Anti-proteinuric effect of CsA was considerable; 88.9% of primary nephrotic syndrome and 62.5% of secondary glomerular diseases was responsive to CsA thearpy. There was no serious complication and CsA treatment was well tolerated by the pediatric patients. CONCLUSION: CsA therapy for difficult renal diseases with proteinuria was effective and safe. For better AUC prediction of CsA, body surface area based dosage(mg/m2/d) and C2 monitoring are recommended in children with renal diseases.
Subject(s)
Child , Humans , Area Under Curve , Body Surface Area , Cyclosporine , Nephrotic Syndrome , Pharmacokinetics , ProteinuriaABSTRACT
0.05).The levels of serum anti-MPO antibody in patients with lupus nephritis(LN)and purpuric glomerulonephritis had significantly increased(P