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.
De Rosa M, Azzato F, Toblli JE, De Rosa G, Fuentes F, Nagaraja HN, Nash R, Rovin BH. A prospective observational cohort study highlights kidney biopsy findings of lupus nephritis patients in remission who flare following withdrawal of maintenance therapy. Kidney Int. 2018 Oct;94(4):788-794. [PubMed link]
Forty-four patients were enrolled, and 36 completed the study. LN flares occurred in 11 patients, and ten of these had residual histologic activity on the second biopsy. The activity index and duration of systemic lupus erythematosus at the second biopsy were independent predictors of flare. A predictive equation based on these variables discriminated between flare and no flare with a sensitivity of 100%, specificity of 88%, and a misclassification rate of 8.3%. A study conducted at the University of Buenos Aires Hospital (Argentina).
Pelletier JH, Kumar KR, Engen R, Bensimhon A, Varner JD, Rheault MN, Srivastava T, Straatmann C, Silva C, Davis TK, Wenderfer SE, Gibson K, Selewski D, Barcia J, Weng P, Licht C, Jawa N, Kallash M, Foreman JW, Wigfall DR, Chua AN, Chambers E, Hornik CP, Brewer ED, Nagaraj SK, Greenbaum LA, Gbadegesin RA. Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings. Pediatr Nephrol. 2018 Oct;33(10):1773-1780. [PubMed link]
Patients with minimal change disease (MCD) on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. (OR; 95% CI 5.6; 1.3-23.7). Very interesting result: more recurrence if the initial biopsy showed minimal change disease! Wow! As a question on the sidelines: can ECM lead to ERCT? Or were these FSGS cases in which segmental lesions were not evident in the initial biopsy?
Chen D, Hu W. Lupus podocytopathy: a distinct entity of lupus nephritis. J Nephrol. 2018 Oct;31(5):629-634. [PubMed link]
Lupus podocytopathy usually presents with typical nephrotic syndrome and sensitive to glucocorticoid treatment, but the relapse rate could reach up to 90% on maintenance treatment with glucocorticoid alone. Glucocorticoid plus other immunosuppressive agents could significantly decrease the relapse rate. A review.
Picken MM. The Interpretation of Congophilia in Tissue Biopsies: Caution Required. Am J Kidney Dis. 2018 Sep;72(3):315-317. [PubMed link]
Although Congo red stain remains at the forefront of testing in the diagnosis of amyloidosis, its interpretation may be challenging in certain instances involving genuine cases of amyloidosis that show weak congophilia, as well as rare cases of FGN that may be also weakly congophilic.
Alexander MP, Dasari S, Vrana JA, Riopel J, Valeri AM, Markowitz GS, Hever A, Bijol V, Larsen CP, Cornell LD, Fidler ME, Said SM, Sethi S, Herrera Hernandez LP, Grande JP, Erickson SB, Fervenza FC, Leung N, Kurtin PJ, Nasr SH. Congophilic Fibrillary Glomerulonephritis: A Case Series. Am J Kidney Dis. 2018 Sep;72(3):325-336. [PubMed link]
The congophilic properties of organized fibrillary deposits should not be solely relied on in differentiating fibrillary GN from renal amyloidosis. Mass spectrometry and DNAJB9 immunohistochemistry can be useful in making this distinction.
Xing G, Gillespie R, Bedri B, Quan A, Zhang P, Zhou XJ. Proliferative glomerulonephritis with monoclonal IgG deposits in children and young adults. Pediatr Nephrol. 2018 Sep;33(9):1531-1538. [PubMed link]
The authors descrive 5 cases with an age range of 10-19 years old. All five cases showed a membranoproliferative pattern with abundant mesangial and subendothelial monoclonal IgG3 deposits (3 κ and 2 λ light chain, respectively). Despite various immunosuppressive treatments, the disease appears slowly progressive.
Seifert ME, Yanik MV, Feig DI, Hauptfeld-Dolejsek V, Mroczek-Musulman EC, Kelly DR, Rosenblum F, Mannon RB. Subclinical inflammation phenotypes and long-term outcomes after pediatric kidney transplantation. Am J Transplant. 2018 Sep;18(9):2189-2199. [PubMed link]
The authors found that subclinical inflammation phenotypes were prevalent in pediatric kidney recipients without clinical dysfunction and were associated with increased acute rejection and allograft failure.