Knoop T, Vikse BE, Mwakimonga A, Leh S, Bjørneklett R. Long-term outcome in 145 patients with assumed benign immunoglobulin A nephropathy. Nephrol Dial Transplant. 2017 Nov 1;32(11):1841-1850. [PubMed link]
The authors found that 18.6% of patients with assumed benign IgAN had progressive disease after a median duration of 22 years and that these patients could not be predicted at the time of biopsy.
Turner-Stokes T, Wilson HR, Morreale M, Nunes A, Cairns T, Cook HT, Pusey CD, Tarzi RM, Lightstone L. Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy. Kidney Int. 2017 Nov;92(5):1223-1231. [PubMed link]
ANCAs appear to influence the histological pattern of lupus nephritis and are associated with worse baseline renal function and more active lupus serology. There was no significant difference in outcome between groups when matched for severity of disease and treatment using propensity scoring.
Jotwani V, Atta MG, Estrella MM. Kidney Disease in HIV: Moving beyond HIV-Associated Nephropathy. J Am Soc Nephrol. 2017 Nov;28(11):3142-3154. [PubMed link]
The authors review the growing knowledge regarding the APOL1 renal risk variants in the context of HIV infection, antiretroviral therapy-related nephrotoxicity, and developments in kidney transplantation among HIV-positive individuals.
McAdoo SP, Tanna A, Hrušková Z, Holm L, Weiner M, Arulkumaran N, Kang A, Satrapová V, Levy J, Ohlsson S, Tesar V, Segelmark M, Pusey CD. Patients double-seropositive for ANCA and anti-GBM antibodies have varied renal survival, frequency of relapse, and outcomes compared to single-seropositive patients. Kidney Int. 2017 Sep;92(3):693-702. [PubMed link].
No single-positive anti-GBM patients experienced disease relapse, whereas approximately half of surviving patients with AAV and double-positive patients had recurrent disease during a median follow-up of 4.8 years. Thus, double-positive patients have a truly hybrid disease phenotype, requiring aggressive early treatment for anti-GBM disease.
Beck LH Jr. PLA2R and THSD7A: Disparate Paths to the Same Disease? J Am Soc Nephrol. 2017 Sep;28(9):2579-2589. [PubMed link]
Oruc M, Durak H, Yalin SF, Seyahi N, Altıparmak MR, Trabulus S. A Rare Presentation of Immunoglobulin A Nephropathy: Acute Kidney Injury. Nephron. 2017;137(1):8-14. [PubMed link]
A total of 15 patients of 123 patients (12.2%) with primary IgAN admitted with AKI. On histology, cellular/fibrocellular crescents were present in 6 patients. In most cases (53.3%), pathologic abnormalities associated with acute tubular injury/necrosis were defined. Red blood cell casts in tubules were present in 6 cases (40%). In all cases, interstitial mixed inflammatory cell infiltration was observed.
Hilhorst M, van Paassen P, van Rie H, Bijnens N, Heerings-Rewinkel P, van Breda Vriesman P, Cohen Tervaert JW; Limburg Renal Registry. Complement in ANCA-associated glomerulonephritis. Nephrol Dial Transplant. 2017 Aug 1;32(8):1302-1313. [PubMed link]
C3c was found in 78 of 187 renal biopsies (41.7%). C4d was found positive in 70.8%, and properdin in 38.7%. In the majority of patients no immune complex deposits were found in their renal biopsies. The authors hypothesize that local immune complexes are quickly degraded and that complement activation occurs predominantly via alternative pathway.
Malvar A, Pirruccio P, Alberton V, Lococo B, Recalde C, Fazini B, Nagaraja H, Indrakanti D, Rovin BH. Histologic versus clinical remission in proliferative lupus nephritis. Nephrol Dial Transplant. 2017 Aug 1;32(8):1338-1344. [PubMed link]
One-third of patients who achieved a complete clinical response after induction had persistently high histologic activity, and 62% of patients who had complete histologic remission on rebiopsy were still clinically active. The kidney accrues chronic damage rapidly and despite clinical response in LN.