Bomback AS, Santoriello D, Avasare RS, Regunathan-Shenk R, Canetta PA, Ahn W, Radhakrishnan J, Marasa M, Rosenstiel PE, Herlitz LC, Markowitz GS, D'Agati VD, Appel GB. C3 glomerulonephritis and dense deposit disease share a similar disease course in a large United States cohort of patients with C3 glomerulopathy. Kidney Int. 2018 Apr;93(4):977-985. [PubMed link].
C3GN: 87 cases; dense deposit disease: 24 cases. Over an average of 72 months of follow-up, remission occurred in 38% of patients with C3GN and 25% of patients with dense deposit disease. Progression to late-stage CKD and ESRD was common, with no differences between C3GN (39%) and dense deposit disease (42%). The strongest predictors for progression were estimated glomerular filtration rate at diagnosis and tubular atrophy/interstitial fibrosis.
Šimunov B, Gunjača M, Čingel B, Škegro D, Knotek M. Safety of Outpatient Kidney Biopsies. Nephron. 2018 April;138(4):275-279. [PubMed link]
Seven hundred twenty-five biopsies performed in the outpatient setting; 592 transplant and 133 native biopsies. There were no major complications. A decline in Hb was observed in 72% of patients. In 10.1% patients there was >10% reduction in Hb level, with no evident bleeding, including by ultrasonography. In 2.5% of patients, macrohaematuria was present. No therapeutic interventions were required.
Colucci M, Corpetti G, Emma F, Vivarelli M. Immunology of idiopathic nephrotic syndrome. Pediatr Nephrol. 2018 Apr;33(4):573-584. [PubMed link]
Gutiérrez E, Praga M, Rivera F, Sevillano A, Yuste C, Goicoechea M, López-Gómez JM; all members of the Spanish Registry of Glomerulonephritis. Changes in the clinical presentation of immunoglobulin A nephropathy: data from the Spanish Registry of Glomerulonephritis. Nephrol Dial Transplant. 2018 Mar 1;33(3):472-477. [PubMed link]
The study was divided into five 4-year periods (1994-97, 1998-2001, 2002-05, 2006-09 and 2010-13); 2,961 biopsies. The prevalence of IgAN in Spain has remained stable over the years, patients are significantly older and present with significantly worse renal function in the last years.
Pakozdi A, Pyne D, Sheaff M, Rajakariar R. Utility of a repeat renal biopsy in lupus nephritis: a single centre experience. Nephrol Dial Transplant. 2018 Mar 1;33(3):507-513. [PubMed link]
Serial biopsies in 66 patients. Repeat renal biopsy is an important tool to guide management, in particular in those with initial class II or V who flare.
Fischer RSB, Vangala C, Truong L, Mandayam S, Chavarria D, Granera Llanes OM, Fonseca Laguna MU, Guerra Baez A, Garcia F, García-Trabanino R, Murray KO. Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy. Kidney Int. 2018 Mar;93(3):681-690. [PubMed link]
The authors report 11 patients who underwent renal biopsy that showed tubulointerstitial nephritis, with varying degrees of inflammation and chronicity. Interstitial cellular infiltrates mostly in the corticomedullary junction; neutrophilic accumulation in the tubular lumens; largely preserved glomeruli; few mild ischemic changes; and no immune deposits.
Bajema IM, Wilhelmus S, Alpers CE, Bruijn JA, Colvin RB, Cook HT, D'Agati VD, Ferrario F, Haas M, Jennette JC, Joh K, Nast CC, Noël LH, Rijnink EC, Roberts ISD, Seshan SV, Sethi S, Fogo AB. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018 Feb 16. [Epub ahead of print] [PubMed link]
The authors report detailed recommendations on issues for which they propose adjustments based on existing evidence and current consensus opinion.
Ponticelli C, Locatelli F. Corticosteroids in IgA Nephropathy. Am J Kidney Dis. 2018 Feb;71(2):160-162 [PubMed link]
The authors believe that patients with eGFRs > 30 mL/min/1.73 m2 and proteinuria with protein excretion > 1 g/d merit treatment with corticosteroids. To reduce the risk for side effects, they prefer to use the protocol based on pulse methylprednisolone and alternate-day prednisone.
Huerta A, Arjona E, Portoles J, Lopez-Sanchez P, Rabasco C, Espinosa M, Cavero T, Blasco M, Cao M, Manrique J, Cabello-Chavez V, Suñer M, Heras M, Fulladosa X, Belmar L, Sempere A, Peralta C, Castillo L, Arnau A, Praga M, Rodriguez de Cordoba S. A retrospective study of pregnancy-associated atypical hemolytic uremic syndrome. Kidney Int. 2017 Feb;93(2);450-459. [PubMed link]
Cases included: 22. Identification of inherited complement abnormalities explained nine of the cases. In thirteen of the cases, pregnancy complications were sufficient to trigger a thrombotic microangiopathy in the absence of genetic or acquired complement alterations. Ten patients received eculizumab with an excellent renal response in all, independent of carrying or not inherited complement abnormalities.