Cases Of Nephropathy Research Articles

Serum Carboxy Methyl Lysine, Insulin Resistance and Sensitivity in Type 2 Diabetes Mellitus and Diabetic Nephropathy Cases; an Observational Study

Objective: Diabetes Mellitus (DM) and one of its types; type 2 diabetes mellitus (T2DM) is more prevalent from adolescent across the globe, invariable of heredity and age. Diet restriction shall cope up and help body metabolism to absorb the required nutrition and eliminate the junk out of body under healthy diet. Masking of insulin action on target cells leads to insulin resistance (IR) and decreased insulin sensitivity (IS) resulting in increased glycated products such, glycated hemoglobin, glycated albumin and other glycated macromolecules called Advanced Glycation End products. Along with AGE and diabetic profiling, BMI, insulin and lipid profiling may help elucidate the correlation between CML and glucose metabolism in diabetics and diabetic nephropathy cases. CML is formed by Glycoxidation and lipoxidation. Thereby, main objective of this study includes basic renal profiling was also performed to assess kidney functioning and finding its relation with CML. Results: Correlation of CML with important diabetic and metabolic syndrome parameters were performed, giving a supportive evidence for labeling CML as harmful molecule. CML positively correlated with HbA1c, TG and HOMA IR and negatively correlated with QUICKI in group 2 signifying increased damage to tissues due to collective action of glucose, lipid and insulin resistance. Monitoring plasma CML regularly during follow up along with HbA1c may help keep track on plasma glucose status and its deleterious effects on tissues thereby preventing erosion of tissue and vascular lining.

Crystals in renal allograft biopsies; a 5-year study with review of literature

Introduction: The kidney is exposed to a variety of crystalline substances which can cause tissue damage. There are limited studies on the frequency of crystal deposits in renal allograft biopsies especially from our part of the world. Objectives: The objective of this study was to find out the prevalence of crystal deposits among the allograft biopsies received at our centre over five years, and to identify its clinicopathological implications. Patients and Methods: We have retrospectively searched the records of renal biopsies reported during the period from 2014 to 2018, to identify allograft biopsies with crystal deposits. The histopathological findings including the density of deposits were noted and correlated with demographic and clinical profile in the light of available literature. Results: Of 1225 transplant biopsies received during the study period, 1.5% had crystal deposits reported on morphology. These biopsies were from 13 patients evaluated for graft dysfunction; 10 had oxalate crystals while three had the rare 2,8-dihydroxyadenine (DHA) crystals. Crystal density varied from 1 to 26/mm2 and all showed acute tubular injury. Around 39% of the biopsies with crystals, included in this study, were taken within a month of transplant and those cases with subsequent biopsies showed progressive interstitial fibrosis/tubular atrophy (IF/TA). All three cases of DHA nephropathy were first diagnosed only on allograft biopsies. Conclusion: In the process of graft dysfunction, interpretation of allograft biopsy should include a careful search for crystals including polarised microscopy as this might not only explain deterioration of renal function, but also clinch the diagnosis of native kidney disease. Though our study has limitations, it addresses a less discussed issue and further studies are required to reinforce the significance of crystal induced allograft injury.

Study of micro-albuminuria in diabetic nephropathy

The prevalence of diabetes mellitus is increasing worldwide. Recent studies showed that India has got large number of diabetic patients. Diabetic nephropathy (DN) develops in 30% to 40% of patients with type 1 diabetes mellitus and in 10% to 20% of patients with type 2 diabetes mellitus. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) worldwide. An early sign of impending nephropathy is microalbuminuria. A total number of 90 samples were analyzed to study the microalbumin levels in 30 diabetic nephropathy patients, 30 diabetic patients without nephropathy and 30 healthy controls. The mean and standard deviation were calculated for all the parameters. The significance between the groups were determined using Student - test for Equality of means. The results show increase in mean concentration of microalbumin in diabetic nephropathy cases when compared to controls and was statistically highly significant (p Keywords: Micro albumin, Diabetic nephropathy, proteinuria, End Stage Renal Disease

Comparison of FTIR spectrum with chemometric and machine learning classifying analysis for differentiating guan-mutong a nephrotoxic and carcinogenic traditional chinese medicine with chuan-mutong

Chuan-Mutong (Clemetis spp.) is a precious medicinal herb in traditional Chinese medicine that possesses various therapeutic effects especially well known for its diuretic effect and widely used in Malaysia. However, there were several reported Chinese herb nephropathy cases due to the adulteration of Aristolochia spp. found in combinational herbal regimen. Guan-Mutong (Aristolochia manshuriensis), which looks similar in appearance and has similar therapeutic effects as Chuan-Mutong, has the possibility to substitute the Chuan-Mutong. Therefore, there is a necessity to differentiate the types of Mutong using analytical authentication methods. In this paper, a rapid and accurate method is proposed to discriminate Chuan-Mutong from Guan-Mutong by using tri-step fourier transform infrared spectroscopy (FT-IR) identification approaches. The method involves the deployment of FT-IR, second derivative infrared spectra (SD-IR), and two-dimensional correlation infrared spectra (2D-IR). In our approach, FT-IR spectra of Chuan-Mutong and Guan-Mutong were subjected to discrimination using principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and machine learning classifiers (ML). Chuan-Mutong and Guan-Mutong can be clearly classified or discriminated against each other by ML, PLS-DA and PCA. The sensitivity, accuracy and specificity of ML were >90%, while the sensitivity, accuracy and specificity of PLS-DA were 100%. It is hence demonstrated that the infrared spectroscopic identification approach using PCA, PLS-DA and ML can be effectively used to differentiate Chuan-Mutong and Guan-Mutong. PLS-DA and ML provide a simple, fast, and high accuracy prediction to differentiate Chuan-Mutong and Guan-Mutong.

Neural cell adhesion molecule 1 is a novel autoantigen in membranous lupus nephritis

Membranous lupus nephritis is a frequent cause of nephrotic syndrome in patients with systemic lupus erythematosus. It has been shown in phospholipase A2 receptor positive membranous nephropathy that known antibodies can be detected within sera, determination of the target autoantigen can have diagnostic significance, inform prognosis, and enable non-invasive monitoring of disease activity. Here we utilized mass spectrometry for antigen discovery in laser captured microdissected glomeruli from formalin-fixed paraffin embedded tissue and tissue protein G immunoprecipitation studies to interrogate immune complexes from frozen kidney biopsy tissue. We identified neural cell adhesion molecule 1 (NCAM1) to be a target antigen in some cases of membranous lupus nephritis and within rare cases of primary membranous nephropathy. The prevalence of NCAM1 association was 6.6% of cases of membranous lupus nephritis and in 2.0% of primary membranous nephropathy cases. NCAM1 was found to colocalize with IgG within glomerular immune deposits by confocal microscopy. Additionally, serum from patients with NCAM1-associated membranous nephropathy showed reactivity to NCAM1 recombinant protein on Western blotting and by indirect immunofluorescence assay, demonstrating the presence of circulating antibodies. Thus, we propose that NCAM1 is a target autoantigen in a subset of patients with membranous lupus nephritis. Future studies are needed to determine whether anti-NCAM1 antibody levels correlate with disease activity or response to therapy.

A Case of BK Polyomavirus-Associated Nephropathy of Native Kidneys in a 19-Year-Old Woman with a History of Orthotopic Cardiac Allotransplantation

A Case of BK Polyomavirus-Associated Nephropathy of Native Kidneys in a 19-Year-Old Woman with a History of Orthotopic Cardiac Allotransplantation

A Case of Secondary IgA Nephropathy and Response to Steroids

A Case of Secondary IgA Nephropathy and Response to Steroids

A Case of Oxalate Nephropathy in the Setting of Clostridium difficile Infection

A Case of Oxalate Nephropathy in the Setting of Clostridium difficile Infection

A Rare Case of Obstructive Nephropathy with Intratubular Tamm-Hors-fall Polyps Secondary to Acquired Hemophilia

A Rare Case of Obstructive Nephropathy with Intratubular Tamm-Hors-fall Polyps Secondary to Acquired Hemophilia

An Unusual Case of IgA Nephropathy Associated with Parvovirus B19

An Unusual Case of IgA Nephropathy Associated with Parvovirus B19

Two Cases of Oxalate Nephropathy: An Uncommon Disease, Often Missed

Two Cases of Oxalate Nephropathy: An Uncommon Disease, Often Missed

CHA2DS2-VASC SCORE AS A PREDICTOR FOR CONTRAST-INDUCED NEPHROPATHY IN PATIENT WITH ISCHEMIC HEART DISEASE TREATED WITH PERCUTANEOUS CORONARY INTERVENTION

Background: CHA2DS2-VASC risk score (CVRS) is useful in predicting the occurrence of contrast induced nephropathy (CIN) among patients with Ischemic heart disease undergoing percutaneous coronary Intervention. CIN was defined an absolute increase in serum creatinine levels by ≥0.3 mg/dL from baseline, or a relative increase in serum creatinine by ≥50% from baseline, within 48 h after PCI, according to Acute kidney Injury Network (AKIN) definition. Objective: To evaluate CHA2DS2-VASC score as a predictor of contrast induced nephropathy (CIN) in patient with ischemic heart disease undergoing percutaneous coronary intervention (PCI). Patients and Methods: A total of 200 consecutive patients presenting to Cardiology Department, Almogama Alteby Hospital at Tanta city ,during the period from January 2019 to January 2020, diagnosed as IHD and underwent PCI, They were divided into two groups: Group I: Those who developed CIN 48h after PCI (28%) and Group II: Those who did not (72%). CHA2DS2-VASc score (age, sex, diabetes, hypertension, heart failure on admission, previous ischemic event, vascular event) was calculated for each patient. Serum creatinine level and estimated Glomerular Filtration Rate (eGFR) were estimated for all patient before and 48h after PCI. Results: CIN was reported in 56 patients (28%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. The average CVRS in the CIN group was significantly higher than that in non-CIN group. CHADSVASC score cut off value was higher than 3 and the area under the ROC curve was equal to 0.906 which indicating that it is excellent predictor for contrast induced nephropathy cases. The sensitivity, Specificity, positive predictive value and negative predictive values of CHADSVASC score were 80.36, 89.58, 51.5, and 96.0 respectively. Conclusion: The CVRS can be used as a simple pre-procedural predictor of CIN among patients with IHD undergoing PCI.

CHA2DS2-VASC SCORE AS A PREDICTOR FOR CONTRAST-INDUCED NEPHROPATHY IN PATIENT WITH ISCHEMIC HEART DISEASE TREATED WITH PERCUTANEOUS CORONARY INTERVENTION

Background: CHA2DS2-VASC risk score (CVRS) is useful in predicting the occurrence of contrast induced nephropathy (CIN) among patients with Ischemic heart disease undergoing percutaneous coronary Intervention. CIN was defined an absolute increase in serum creatinine levels by ≥0.3 mg/dL from baseline, or a relative increase in serum creatinine by ≥50% from baseline, within 48 h after PCI, according to Acute kidney Injury Network (AKIN) definition. Objective: To evaluate CHA2DS2-VASC score as a predictor of contrast induced nephropathy (CIN) in patient with ischemic heart disease undergoing percutaneous coronary intervention (PCI). Patients and Methods: A total of 200 consecutive patients presenting to Cardiology Department, Almogama Alteby Hospital at Tanta city ,during the period from January 2019 to January 2020, diagnosed as IHD and underwent PCI, They were divided into two groups: Group I: Those who developed CIN 48h after PCI (28%) and Group II: Those who did not (72%). CHA2DS2-VASc score (age, sex, diabetes, hypertension, heart failure on admission, previous ischemic event, vascular event) was calculated for each patient. Serum creatinine level and estimated Glomerular Filtration Rate (eGFR) were estimated for all patient before and 48h after PCI. Results: CIN was reported in 56 patients (28%). Patients with CIN had a higher frequency of hypertension, diabetes mellitus, and had a lower left ventricular ejection fraction and baseline estimated glomerular filtration rate. The average CVRS in the CIN group was significantly higher than that in non-CIN group. CHADSVASC score cut off value was higher than 3 and the area under the ROC curve was equal to 0.906 which indicating that it is excellent predictor for contrast induced nephropathy cases. The sensitivity, Specificity, positive predictive value and negative predictive values of CHADSVASC score were 80.36, 89.58, 51.5, and 96.0 respectively. Conclusion: The CVRS can be used as a simple pre-procedural predictor of CIN among patients with IHD undergoing PCI.

Patient characteristics according to rehabilitation and employment status in Korean hemodialysis patients.

BackgroundWhile the final goal of renal replacement therapy is to achieve normal social adaptation and employment, many studies to date have focused on the analysis of complications and causes of death. In contrast, the analysis of dialysis patients with normal job employment and exhibiting a good medical status can be important for clinical treatment policy. This study assessed various clinical parameters according to rehabilitation and employment status to elucidate characteristics correlated with better rehabilitation status among hemodialysis patients.MethodsA total of 29,865 hemodialysis patients who were registered with rehabilitation status information in the Korean Society of Nephrology end-stage renal disease registration program from January 2017 to April 2019 were included and divided into five groups according to their rehabilitation status.ResultsAbout half (47%) of enrolled patients belonged to the “independent but without a job” group and 21% of patients belonged to the “employed with a full-time job” group. Analysis revealed significantly younger mean age, longer mean hemodialysis duration, a higher proportion of male sex, and a lower proportion of diabetic nephropathy cases in the full-time job group than in the other hemodialysis patient groups. Also, hemoglobin, albumin, and phosphorus levels were higher but the urea reduction ratio was lower in the full-time job group.ConclusionA better rehabilitation and employment state of hemodialysis patients was associated with younger age, male sex, and underlying chronic glomerulonephritis. Patients with full-time jobs generally have better laboratory data but lower dialysis efficacy.

IgA nephropathy in a patient receiving infliximab for generalized pustular psoriasis

BackgroundIgA nephropathy is the most common glomerulonephritis. Secondary IgA nephropathy complicated with systemic diseases, including psoriasis, is also often reported. Generalized pustular psoriasis is a form of psoriasis characterized by sterile pustules on reddened skin and fever. Infliximab, one of the first-line therapies for severe psoriasis, has also been reported to cause systemic vasculitis and IgA nephropathy. We herein report a case of IgA nephropathy activated during infliximab treatment for generalized pustular psoriasis.Case presentationA 28-year-old woman presented with episodic gross hematuria, increasing proteinuria, and renal dysfunction. She had been receiving anti-TNFα therapy with infliximab because of generalized pustular psoriasis for 3 years, but her skin symptoms worsened following withdrawal during pregnancy. After delivery, her skin symptoms improved with the resumption of infliximab, but clinical signs suggested glomerulonephritis, and renal biopsy showed active IgA nephropathy. Infliximab was discontinued, and the combination of corticosteroids, tonsillectomy, and secukinumab, an IL-17A inhibitor, improved both the skin symptoms and the glomerulonephritis.ConclusionsIn our case, the activity of IgA nephropathy was exacerbated by anti-TNFα therapy but was improved by the combination of corticosteroids, tonsillectomy, and an IL-17A inhibitor against the original disease. Autoimmune diseases may underlie the development of secondary IgA nephropathy associated with anti-TNFα therapy, and so further studies are needed to better understand the association between molecular-targeted drugs and IgA nephropathy.

NELL1 is a target antigen in malignancy-associated membranous nephropathy

Patients with membranous nephropathy have an increased risk of malignancy compared to the general population, but the target antigen for malignancy-associated membranous nephropathy is unknown. To explore this, we utilized mass spectrometry for antigen discovery in malignancy-associated membranous nephropathy examining immune complexes eluted from frozen kidney biopsy tissue using protein G bead immunoglobulin capture. Antigen discovery was performed comparing cases of membranous nephropathy of unknown and known type. Mass spectrophotometric analysis revealed that nerve epidermal growth factor-like 1 (NELL1) immune complexes were uniquely present within the biopsy tissue in membranous nephropathy. Additional NELL1-positive cases were subsequently identified by immunofluorescence. In a consecutive series, 3.8% of PLA2R- and THSD7A-negative cases were NELL1-positive. These NELL1-positive cases had segmental to incomplete IgG capillary loop staining (93.4%) and dominant or co-dominant IgG1-subclass staining (95.5%). The mean age of patients with NELL1-positive membranous nephropathy was 66.8 years, with a slight male predominance (58.2%) and 33% had concurrent malignancy. Compared with PLA2R- and THSD7A-positive cases of membranous nephropathy, there was a greater proportion of cases with malignancies in the NELL1-associated group. Thus, NELL1-associated membranous nephropathy has a unique histopathology characterized by incomplete capillary loop staining, IgG1-predominance, and is more often associated with malignancy than other known types of membranous nephropathy.

Lack of association between diabetic nephropathy and human leukocyte antigen type 2 (HLA II-DQ1) in patients with type 2 diabetes mellitus in west of Iran

Introduction: Diabetic nephropathy (diabetic kidney disease) is one of the microvascular complications of diabetes mellitus. The human leukocyte antigen (HLA) is a group of genes that is related to autoimmune diseases, infections and inflammation. Studies regarding the association of type 2diabetes and HLA-II are negligible. Objectives: The aim of this study is to determinate association between diabetic nephropathy and HLA II-DQ1 in diabetes type 2 patients. Patients and Methods: In this study, 120 diabetes type 2 patients were divided into two groups of diabetic nephropathy (case group) and without diabetic nephropathy (control group). Blood samples were taken and DNA was isolated. Asymmetric polymerase chain reaction (PCR) was used to amplify the HLA II-DQ1 exon 2 and exon 3. PCR products were hybridized and labeled with probes on the chip. Determination of HLAII-DQ1 gene typing was conducted by scanning hybrid products and analyzed with PerkinElmer ScanArray software. Results: The results of chi-square test showed no significant difference between expression levels of HLA in the two groups (P<0.05). Conclusion: There was no significant difference between expression levels of HLA in two groups of patients. Various factors such as demographic characteristics, lifestyle, geographic region, and race are the factors influencing the relationship between diabetic nephropathy and DQ1-HLA II. Since this study is conducted in one region and one race and with limited population, it is suggested that future studies should be considered and the association between the mentioned variables with HLA should be considered.

Renal Pathology and Cytogenetic Examination in Multiple Myeloma Patients with Renal Impairment--Retrospective Analysis

To explore the renal pathology and cytogenetic features in the multiple myeloma (MM) patients with renal impairment. The clinical data of newly diagnosed MM patients with renal impairment in our hospital from January 2009 to January 2019 were analyzed retrospectively, and the relationship between FISH results and results of renal pathological exanimation was analyzed statistically by using SPSS 20.0. A total of 20 patients underwent renal biopsy, included 12 males and 8 females. FISH result showed that out of 20 patients, 7 cases presented interstitial nephritis, among which 3 cases were negative for FISH, and in the remaining cases the rate of IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection was 42.86%, 28.57%, 28.57%, 28.57% and 14.29% respectively, the detection positive rate was statistically significantly lower as compared with total probe positive rate (P＜0.01). There were 6 cases of cast nephropathy, among which IgH rearrangement, the rate of 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion detection was 66.67%, 50%, 66.67%, 50% and 0% respectively. Compared with the total probe positive rate, there was no statistical significance (P＞0.05). There were 4 cases of acute tubular necrosis, among which the detection rates of IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion, and P53 deletion was 100%, 50%, 50%, 25% and 25%, respectively. Compared with the total probe positive rate, there was no statistical significance (P＞0.05). There were one case of amyloidosis, and one case of tubular nephropathy with amyloidosis, the detection with 5 probes were all positive. One case of light chain deposition disease was positive for RB1 gene deletion + D13S319 gene deletion. FISH in the MM patients with different renal pathological changes is characterized by heterogeneity, which can be used to predict the risk of renal damage and speculate possible renal pathological types to guide prognosis.

Histopathological review of renal pelvic tumours of Balkan nephropathy cases from Southern Serbia

Background Urothelial tumour frequently associates with atrophied kidney pelvis in Balkan endemic nephropathy but histopathology illustration lacks both definition and immune profile for differential diagnosis from renal cell carcinoma. Methods Histology sections of anonymized archived renal tumours and associated kidney of eight local Balkan nephropathy patients were stained by haematoxylin and eosin, and immune profiles revealed by automated clinical immunohistochemistry, to refine carcinoma diagnosis and illustration. Results Two low-grade and four high-grade papillary carcinomas were diagnosed. Two cases of high-grade urothelial carcinomas with solid architecture, invasive features and aggressive biological behaviour are also described with illustrated immune profiles. Conclusion Refined pelvic tumour histopathology can now facilitate comparison across endemic areas within the Balkans and beyond. Notably, immune profiles of the present tumours correspond to those of contemporary urothelial cancers studied in Slovakia, where Balkan-like nephropathies have not been recognised. Some etiological considerations can be discussed.

Etiologies, Clinical Features, and Outcome of Oxalate Nephropathy

BackgroundOxalate nephropathy is a potentially underestimated cause of kidney failure characterized by massive deposition of calcium oxalate crystals in the renal parenchyma. The prevalence and modes of presentation of this entity are ill-defined.MethodsHere we report on the largest consecutive series of cases of adult oxalate nephropathy diagnosed on native kidney biopsies from January 2010 to December 2018 in the UCLouvain Kidney Disease Network.ResultsWe screened 2265 native kidney biopsies and identified 22 cases (1%) of oxalate nephropathy. Patients had a mean age at diagnosis of 61 years (±20) and presented either with acute on chronic kidney disease (CKD) (62%) or with acute kidney injury (AKI) (38%). Mean serum creatinine at biopsy was 8.0 ± 4.5 mg/dl. Kidney biopsies showed abundant calcium oxalate crystal deposits, associated with acute interstitial nephritis and tubular necrosis, and variable degrees of interstitial fibrosis and tubular atrophy. Chronic pancreatitis and gastric bypass were the most common causes of oxalate nephropathy (48%). During a mean follow-up of 29 months, half of the patients (52%) progressed to kidney failure, all within the month following diagnosis. Higher serum creatinine level at presentation and interstitial fibrosis and tubular atrophy score were associated with progression to kidney failure.ConclusionOxalate nephropathy is the cause of kidney disease in 1% of consecutive native kidney biopsies and typically presents as acute on CKD or AKI. The prognosis of the disease is poor, with a high rate of kidney failure within the first month after the diagnosis.