Leung N, Bridoux F, Batuman V, Chaidos A, Cockwell P, D'Agati VD, Dispenzieri A, Fervenza FC, Fermand JP, Gibbs S, Gillmore JD, Herrera GA, Jaccard A, Jevremovic D, Kastritis E, Kukreti V, Kyle RA, Lachmann HJ, Larsen CP, Ludwig H, Markowitz GS, Merlini G, Mollee P, Picken MM, Rajkumar VS, Royal V, Sanders PW, Sethi S, Venner CP, Voorhees PM, Wechalekar AD, Weiss BM, Nasr SH. The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol. 2019 Jan;15(1):45-59. [PubMed link]
The International Kidney and Monoclonal Gammopathy Research Group (IKMG) met in April 2017 to refine the definition of MGRS and to update the diagnostic criteria for MGRS-related diseases. Accordingly, in this Expert Consensus Document, the IKMG redefines MGRS as a clonal proliferative disorder that produces a nephrotoxic monoclonal immunoglobulin and does not meet previously defined haematological criteria for treatment of a specific malignancy.
Yazdani S, Callemeyn J, Gazut S, Lerut E, de Loor H, Wevers M, Heylen L, Saison C, Koenig A, Thaunat O, Thorrez L, Kuypers D, Sprangers B, Noël LH, Van Lommel L, Schuit F, Essig M, Gwinner W, Anglicheau D, Marquet P, Naesens M. Natural killer cell infiltration is discriminative for antibody-mediated rejection and predicts outcome after kidney transplantation. Kidney Int. 2019 Jan;95(1):188-198. [PubMed link]
The authors found increased NK cell infiltration in ABMR in comparison to TCMR and normal biopsies. NK cell infiltration was specifically associated with glomerulitis and peritubular capillaritis. These data suggest that NK cells play a central role in the pathophysiology of ABMR and graft failure after kidney transplantation.
Schinstock CA, Sapir-Pichhadze R, Naesens M, Batal I, Bagnasco S, Bow L, Campbell P, Clahsen-van Groningen MC, Cooper M, Cozzi E, Dadhania D, Diekmann F, Budde K, Lower F, Orandi BJ, Rowshani AT, Cornell L, Kraus E. Banff survey on antibody-mediated rejection clinical practices in kidney transplantation: Diagnostic misinterpretation has potential therapeutic implications. Am J Transplant. 2019 Jan;19(1):123-131. [PubMed link]
A survey of an international group of transplant nephrologists and pathologists reveals that the Banff antibody‐mediated rejection classification is vulnerable to misinterpretation, which may have patient management implications.
Mannon RB. The Banff schema for antibody-mediated rejection: Lost in translation? Am J Transplant. 2019 Jan;19(1):9-10. [PubMed link]
A comment on the previous paper.
Nankivell BJ, P'Ng CH, Chapman JR. Does tubulitis without interstitial inflammation represent borderline acute T cell mediated rejection? Am J Transplant. 2019 Jan;19(1):132-144. [PubMed link]
The authors find isolated tubulitis without interstitial inflammation is predominantly due to reversible, nonimmune tubular injury, rather than borderline acute T cell rejection. They suggest its removal from the borderline category, and reinstatement of i1 as the diagnostic threshold.
Divers J, Langefeld CD, Lyles DS, Ma L, Freedman BI. Protective association between JC polyoma viruria and kidney disease. Curr Opin Nephrol Hypertens. 2019 Jan;28(1):65-69. [PubMed link]
Urinary tract JC poliomavirus replication is common and associates with lower rates of nephropathy. This relationship is observed in diverse settings. Results support a host immune system that fails to eradicate nonnephropathic viruses and is also less likely to manifest renal parenchymal inflammation.
Brix SR, Noriega M, Tennstedt P, Vettorazzi E, Busch M, Nitschke M, Jabs WJ, Özcan F, Wendt R, Hausberg M, Sellin L, Panzer U, Huber TB, Waldherr R, Hopfer H, Stahl RAK, Wiech T. Development and validation of a renal risk score in ANCA-associated glomerulonephritis. Kidney Int. 2018 Dec;94(6):1177-1188. [PubMed link]
In a prospective training cohort of 115 patients, the percentage of normal glomeruli (without scarring, crescents, or necrosis within the tuft) was the strongest independent predictor of death-censored ESRD.
Kousios A, Duncan N, Charif R, Roufosse C. Smouldering Myeloma Presenting with Renal Histopathology of Monoclonal Gammopathy of Renal Significance: Adding to the Complexity. J Am Soc Nephrol. 2018 2018 Dec, 29 (12): 2901. [PubMed link]
Monoclonal gammopathy of renal significance (MGRS) caused by plasma cells is defined as <10% bone marrow plasma cells, <3 g/dl of M protein, and the presence of renal lesions without any other myelomadefining events. A intersting letter.
Brodsky S, Eikelboom J, Hebert LA. Anticoagulant-Related Nephropathy. J Am Soc Nephrol. 2018 Dec;29(12):2787-2793. [PubMed link]
Anticoagulant-related nephropathy (ARN) is a newly recognized form of AKI in which overanticoagulation causes profuse glomerular hemorrhage, which manifests on renal biopsy as numerous renal tubules filled with red cells and red cell casts. The glomeruli show changes, but they are not sufficient to account for the glomerular hemorrhage. A review.
Höcker B, Tabatabai J, Schneble L, Oh J, Thiel F, Pape L, Rusai K, Topaloglu R, Kranz B, Klaus G, Printza N, Yavascan O, Fichtner A, Krupka K, Bruckner T, Waldherr R, Pawlita M, Schnitzler P, Hirsch HH, Tönshoff B. JC polyomavirus replication and associated disease in pediatric renal transplantation: an international CERTAIN Registry study. Pediatr Nephrol. 2018 Dec;33(12):2343-2352. [PubMed link]
In pediatric renal transplant recipients JC polyomavirus replication is common (24.5%), with strong immunosuppression being a significant risk factor, but associated nephropathy is rare.
McRae M, Bouchard-Boivin F, Béland S, Noël R, Côté I, Lapointe I, Lesage J, Latulippe E, Riopel J, Santoriello D, Husain SA, Désy O, Houde I, Batal I, De Serres SA. Impact of the Current Versus the Previous Diagnostic Threshold on the Outcome of Patients With Borderline Changes Suspicious for T Cell-mediated Rejection Diagnosed on Indication Biopsies. Transplantation. 2018 Dec;102(12):2120-2125. [PubMed link]
Since the borderline changes suspicious for acute T cell-mediated rejection (BL) category was broadened, there has been a debate regarding the right threshold for tubulitis and interstitial inflammation scores. The authors compared those patients with biopsy with scores of t1i0 (BLt1i0) to those with higher scores (BL≥t1i1). Patients with BLt1i0 have a different prognosis to that of BL≥t1i1 patients, which brings into question the current diagnostic thresholds.
Bomback AS. An Update on Therapies for Proliferative Lupus Nephritis: How Certain Can We Be About the Evidence? Am J Kidney Dis. 2018 Nov;72(5):758-760. [PubMed link]
The treatment of glomerular diseases has often been considered more art than science. When asked to explain their treatment rationale, the experts at managing glomerular diseases often fall back on some version of, “This patient reminds me of that other patient who responded to this specific therapy.” A very interesting comment on the next article.
Tunnicliffe DJ, Palmer SC. Immunosuppressive Treatment for Proliferative Lupus Nephritis: Summary of a Cochrane Review. Am J Kidney Dis. 2018 Nov;72(5):756-757. [PubMed link]
MMF provides equivalent disease remission and probably avoids drug-related toxicity compared to intravenous cyclophosphamide, supporting the use of MMF in addition to corticosteroids as first-line induction therapy for proliferative lupus nephritis. The safety and effectiveness of biologics is uncertain.
Roufosse C, Simmonds N, Clahsen-van Groningen M, Haas M, Henriksen KJ, Horsfield C, Loupy A, Mengel M, Perkowska-Ptasińska A, Rabant M, Racusen LC, Solez K, Becker JU. A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology. Transplantation. 2018 Nov;102(11):1795-1814. [PubMed link]
This review shall provide an illustrated reference guide of the Banff Classification of Kidney Allograft Pathology based on all publications including the 2017 update.
Meyrier A, Niaudet P. Acute kidney injury complicating nephrotic syndrome of minimal change disease. Kidney Int. 2018 Nov;94(5):861-869, [PubMed link]
Renal function is altered moderately in approximately 20% to 30% of patients because foot-process fusion impairs filtration of water and solutes. 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. 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.
Nino-Murcia A, Pinto Ramirez JL, Nino-Torres L. Organ Transplantation in Colombia. Transplantation. 2018 Nov;102(11):1779-1782. [PubMed link]
A review of historical and current aspects of transplantation in Colombia.
Bath NM, Wang X, Bledsoe JR, Thijssen M, Ahearn A, Movahedi B, Bozorgzadeh A, Martins PN. The Use of Smartphone for Liver Graft Biopsy Assessment at the Time of Procurement. Transplantation. 2018 Nov;102(11):e459-e460. [PuibMed link]
In this brief report, the authors describe as telepathology via smartphone provides a reliable, simple, and inexpensive method to review instantly donor liver biopsies.
Xu PC, Chen T, Gao S, Hu SY, Wei L, Yan TK. Clinical and pathologic characteristics of pauci-immune anti-myeloperoxidase antibody associated glomerulonephritis with nephrotic range proteinuria. Ren Fail. 2018 Nov;40(1):554-560. [PubMed link]
Pauci-immune ANCA GN with nephrotic proteinuria do not have more severe hypoalbuminemia, hypercoagulability or hyperlipidemia than patients without nephrotic proteinuria. Non-selective proteinuria might be the reason. However, pauci-immune ANCA GN with nephrotic proteinuria have poorer renal prognosis despite of good sensitivity to therapy of proteinuria.