Form Of Nephritis Research Articles

A New Era for PET/CT: Applications in Non-Tumorous Renal Pathologies.

Non-tumorous kidney diseases include a variety of conditions affecting both the structure and function of the kidneys, thereby causing a range of health-related problems. Positron emission tomography/computed tomography (PET/CT) has emerged as a potential diagnostic tool, offering a multifaceted approach to evaluating non-tumorous kidney diseases. Its clinical significance extends beyond its conventional role in cancer imaging, enabling a comprehensive assessment of renal structure and function. This review explores the diverse applications of PET/CT imaging in the evaluation of non-cancerous kidney diseases. It examines PET/CT's role in assessing acute kidney injuries, including acute pyelonephritis and other forms of nephritis, as well as chronic conditions such as immune complex-mediated glomerulonephritis and chronic kidney disease. Additionally, the review delves into PET/CT's utility in evaluating complications in renal transplant recipients, identifying renal histiocytosis and detecting renal amyloidosis. The current review aims to promote further research and technological advancements to popularize PET/CT's clinical utility in diagnosing and treating non-tumorous kidney diseases.

Uncommon toxic epidermal necrolysis -like presentation of cutaneous lupus erythematosus: A series of 6 cases.

TEN like Lupus erythematosus is an uncommon life-threatening variant of Lupus erythematosus. It is usually associated with flares of systemic lupus erythematosus and also because of widespread skin erosions, it can cause acute skin failure. It is often confused with drug induced TEN, however the management of both the diseases is different and hence correct diagnosis becomes crucial. In this study we aimed to assess the clinical characteristics and outcome of TEN like LE in the Indian population. All patients satisfying ACR/EULAR 2019 criteria for SLE and clinically diagnosed with TEN like LE were retrospectively reviewed. A total of 6 patients were identified. All patients were female. Except 1 patient who presented de-novo, the others had pre-existing symptoms of connective tissue disease. Half of the patients had palmoplantar involvement. Mucosal involvement was only mild. Majority had systemic involvement in the form of nephritis followed by arthralgia, autoimmune hepatitis and autoimmune hemolytic anemia.

Extracellular mitochondrial components as new biomarkers for lupus nephritis.

Major reason for mortality among systemic lupus erythematosus patients is renal failure due to the deposition of immune complexes in the glomeruli. Being a chronic disease with multiple relapses and remissions across the lifespan, it's important to know the degree of nephritis for diagnosis as well as the long-term clinical management of the patients. Currently, renal biopsy is being used as the gold standard to diagnose and define the stages of the disease. However, renal biopsy being invasive only provides a localized picture of nephritis, and has the risk of bleeding. Additionally, it is also cost-intensive. Hence, a reliable, non-invasive biomarker is required for lupus nephritis. This study has evaluated extracellular mitochondrial components, including cell-free mitochondria, and cell-free mitochondrial DNA as probable biomarkers of the degree of nephritis. Both showed a significant correlation with proteinuria and protein-creatinine ratio. Our study substantiates their usage as clinical biomarkers of nephritis upon their validation in a larger cohort of lupus nephritis patients and other forms of nephritis. Although the current data suggest using cell-free mitochondria as a biomarker of lupus nephritis is better than the cell-free mitochondrial DNA.

The effect of blood levels of heparan sulfate, VCAM-1 and ICAM-1 in combination with clinical and morphological features of the course of glomerulonephritis on the probability of achieving remission

Objective: to analyze the effect of adhesion molecules (ICAM-1, VCAM-1) and blood heparan sulfate in combination with clinical and morphological signs on the likelihood of remission in glomerulonephritis. Material and methods: 80 patients with glomerulonephritis aged 35.7±10.9 years were included. Serum levels of ICAM-1, VCAM-1 and heparan sulfate were determined in all patients by quantitative enzyme immunoassay. Puncture nephrobiopsy was performed with verification of the form of nephritis and determination of signs of TIC, TIV, glomerulosclerosis. Results: It was shown that high values of heparan sulfate and uric acid in the blood reduce the likelihood of achieving remission in glomerulonephritis. Also, high values of heparan sulfate in the blood against the background of pronounced TIC or TIV were accompanied by a decrease in the probability of remission. An increase in the level of ICAM-1 in the blood, combined with an increase in age, the level of fibrinogen in the blood, as well as an increase in the phenomena of TIC, TIV and glomerulosclerosis, reduce the likelihood of achieving remission in glomerulonephritis. It was also shown that an increase in the level of VCAM-1 in the blood against the background of an increase in the patient’s age, hyperuricemia, an increase in the phenomena of TIV, TIC and glomerulosclerosis is accompanied by a decrease in the probability of achieving remission. We have compiled nomograms for assessing the prognosis of remission development. Conclusion: the assessment of the levels of heparan sulfate, ICAM-1 and VCAM-1 in the blood, together with a number of clinical and morphological signs, is an important tool for predicting the effectiveness of glomerulonephritis therapy.

A non-interventional, prospective, multicenter study for evaluation of the use of the herbal medicinal product Canephron\xae N in the pediatric outpatient population in Russia

BackgroundA herbal medicinal product (HMP) with centaury, lovage, and rosemary as active ingredients (brand name: Canephron® N) has been widely used for treatment and prevention of urinary tract infections (UTIs) and other urinary system disorders. Non-clinical in vitro and in vivo data indicate its diuretic, spasmolytic, anti-inflammatory, antioxidative and analgesic effects. The purpose of this non-interventional, prospective, multicenter study was to collect data on the use of the HMP in the Russian pediatric outpatient population.ResultsIn total, 636 outpatients aged 1–17 years were enrolled. Of these, 634 received at least one dose of the HMP and were included in the safety set, which was used for analysis. 61 patients were 12–23 months, 227 were 2–5 years, 234 were 6–11 years and 112 were 12–17 years of age. The oral solution of the HMP was prescribed in 66.4%, and tablets (dragées) in 33.6% of the patients. For 48% of the patients the HMP was prescribed to treat an acute or chronic disease, 25% of the patients received it for prophylaxis, and 27% for both. More than half of the patients (53%) received the HMP as monotherapy.Main treatment indications were UTIs (34.1%) and pyelonephritis (30.0%). The proportion of UTIs was the highest within the youngest age group (51%), while the proportion of different cystitis forms increased in patients older than 2 years. Relevant proportions of different nephritis forms and urolithiasis were only observed in patients aged 12–17 years. Forms of cystitis were more frequent in female than in male patients (15% vs. 1%), while forms of nephritis, urolithiasis, and dysmetabolic nephropathy / crystalluria were more frequent in male patients.At the end of the observational period, 20% of the patients were reported as recovered from their disease, and 65% were reported to show improvements. For 91% of all patients with HMP monotherapy the investigators evaluated the effectiveness of the HMP as ‘good’ or ‘very good’. Nearly all patients (99%) evaluated the tolerability as ‘good‘or ‘very good‘. Five adverse drug reactions were observed.ConclusionsThe treatment of children aged 1–17 years with the HMP is safe and well tolerated. The study results support the use of the HMP for treatment and prophylaxis of urinary system diseases.

Proteinuria due to increased dose of deferasirox in a pediatric patient with thalassemia major: case report

Deferasirox is an iron chelator that used in B-thalassemia in worldwide. Nephrotoxicity is one of the common side effects of the deferasirox. Nephrotoxicity can be seen in the form of nephritis and tubulopathy. A 6-year-old male whose ferritin levels were above 3500 ng/mL is reported in this article. Deferasirox was increased from 30 mg/kg/day to 40 mg/kg/day because of the high levels of ferritin. In complete urinalysis of the patient after 3 weeks later +3 protein was detected, and spot urine protein/creatinine ratio was 2.5. In patient without symptoms and findings, deferasirox was discontinued. In his follow-ups, no proteinuria was detected in the complete urinalysis at the second week after the drug treatment was discontinued.

Interstitial nephritis in pigs

Interstitial nephritis as a form of renal diseases can be found frequently among pigs. Nevertheless, prevalence and aetiology need to be investigated in more detail as reports about detailed analysis are lacking. In the present study, a total of 169 kidneys of conventionally and organically raised pigs were randomly chosen at slaughter and classified according to the degree of inflammation and the participating inflammatory cells. Moreover, PCV2 as an infectious agent was analysed by immunohistochemistry and in-situ hybridisation. All of the investigated kidneys displayed mild interstitial lesions. Inflammatory cells included lymphocytes, macrophages, plasma cells, eosinophilic and neutrophilic granulocytes. Significant (p≤0.0001) differences concerning the grade of inflammation and inflammatory cell occurrence could be observed between kidneys of conventionally and organically raised pigs. In comparison to conventionally raised pigs organically raised pigs showed significant (p≤0.0001) more frequently a mild form of nephritis as well as a significant (p≤0.0001) more frequent occurrence of lymphocytes and macrophages. In contrast to that, conventionally raised pigs had a significant (p≤0.0001) higher occurrence rate of a mild to moderate form of nephritis as well as a significant (p≤0.0001) higher level in occurrence of lymphocytes, macrophages, plasma cells, and neutrophilic granulocytes when compared to organically raised pigs. PCV2 DNA was detected in the kidney of only one animal. Interstitial nephritis was found in conventionally and organically raised pigs and PCV2 was ruled out as a major pathogen for interstitial nephritis in slaughter pigs. Because of the high prevalence and unknown cause further investigations are necessary to delineate the clinic relevance of this alteration and its pathogenesis.

HLA Class II with Lupus Nephritis in Moroccan Patients

ABSTRACTLupus nephritis (LN) is a disease with a poor prognosis. The association between LN and the Human leukocyte antigen (HLA) genes has never been studied on a Moroccan population. The aim of this work was to evaluate the distribution of the HLA class II alleles in patients with LN and to determine susceptible and protective HLA alleles/haplotypes in LN. The association between these alleles, disease severity of LN, and age at onset were also investigated. Seventy-five patients with LN were compared with 169 healthy unrelated controls. HLA class II alleles typing was performed by polymerase chain reaction-sequence-specific primers (PCR-SSP). A significant increase of HLA-DRB1*15 allele frequency (p = 0.001) and a significant decrease of the HLA-DRB1*04 allele (p = 0.04) were observed in LN patients. The frequency of HLA-DRB1*15-DQB1*06 haplotype (p = 0.003) was increased in the patients while that of HLA-DRB1*04-DQB1*03 (p = 0.027) was decreased. A significant increase of HLA-DRB1*15 allele frequency (p = 0.0001) and HLA-DRB1*15-DQB1*06 haplotype (p = 0.002) was observed in patients with class IV LN. In the Moroccan population we demonstrated the positive association of HLA class II alleles and haplotypes with LN and with a severe form of nephritis. HLA-DRB1*15 allele does not determine the age of disease onset in LN.

T cell isolation from mouse kidneys.

The kidneys contain very few lymphocytes under homeostatic conditions. One kidney from a healthy mouse per average contains only 1-5 × 10(3) CD4(+) T cells. In immune-mediated kidney disease, γδ T cells, NKT cells, CD4(+) T cells, CD8(+) T cells, and regulatory T cells (Treg) infiltrate the kidney. Their numbers and subset composition of infiltrating T cells varies between the different forms of nephritis. For example, in glomerulonephritis CD4(+) T cells mediate renal injury, by local cytokine production, effector cell activation and/or by helping B cells to produce nephritogenic antibodies. A better understanding of the pathomechanisms of immune-mediated kidney diseases requires a method to isolate T cells from the kidney for ex vivo analysis. Here we describe an effective and specific isolation protocol for T cells from the murine kidney.

Detection of DNA-bound immunoglobulins in patients with lupus nephritis, using monoclonal anti-DNA antibody

In order to investigate the relationship between renal histopathology and the characteristics of circulating immune complexes (CICs) in patients with lupus nephritis (LN), we measured the sizes of CICs, DNA-bound immunoglobulins in patients with systemic lupus erythematosus (SLE) and different histopathological forms of nephritis. Sera were obtained from nine patients: four with diffuse proliferative LN (DPLN), four with membranous LN (MLN), and one with mesangial LN, who fulfilled the criteria of the American Rheumatism Association for SLE. The DNA-bound immunoglobulins were measured by ELISA, in which ELISA plates were coated with mouse monoclonal anti-DNA antibodies. The sizes of CICs were analysed by sucrose density gradient ultracentrifugation. Large (larger than 19S), intermediate (19-7S) and small (nearly 7S) sized DNA-bound immunoglobulins (high peaks of IgG and IgA, but low IgM peaks) were found in the patients with DPLN. By contrast, in patients with MLN, the sizes of ICs; DNA-bound IgG, IgA were in general slightly larger than 7S. In one patient with DPLN, at the onset, various sized DNA-bound IgG, IgA and IgM were found. After the methylprednisolone pulse therapy, CICs became smaller and gradually disappeared. We conclude that the characteristics of DNA-anti-DNA IgG, IgA complexes may determine the localization of ICs in the glomeruli and suggest that CICs play an important role in the pathogenesis of LN.

Fundus hypertonicus malignus. Increased incidence in renal parenchymal diseases

Using photography of the fundus oculi the eyeground of 186 patients with histologically different forms of nephritis, 68 patients with essential hypertension and 10 patients with renovascular hypertension was investigated and evaluated. The fundal lesions were classified according to the grades recommended by WHO. Although in many individual cases the duration of the disease was short and the patients were young, the eyeground changes in renal hypertension were notably severe. Taking as basis comparable pressure rises, marked signs of fundus hypertonicus malignus were particularly frequent in primary and secondary hypertension with focal segmental sclerosis and membranoproliferative glomerulonephritis, whereas in essential hypertension non-malignant fundus hypertonicus predominated. The eyeground findings deteriorated further with impairment of renal function. Owing to the high incidence of severe fundal lesions in renal hypertension the eyeground of these patients should be examined and the hypertension treated accordingly even when the rise in blood pressure is relatively mild (less than 180/100 mm Hg).

Transforming growth factor-beta receptors in self-limited vs. chronic progressive nephritis in rats.

Increases in transforming growth factor-beta (TGF-beta) expression and extracellular matrix accumulation are transient in acute self-limited mesangial proliferative glomerulonephritis induced by a single injection of anti-thymocyte serum (ATS), while these increases persist following repeated injections that produce chronic progressive sclerosing glomerulonephritis with tubulointerstitial lesions. However, little is known about the expression of TGF-beta receptors (TbetaRs) in cells involved in the proliferative and sclerosing renal lesions. A study of protein and mRNA expression for type I (TbetaRI), type II (TbetaRII), and type III (TbetaRIII) TbetaR in both forms of nephritis was therefore carried out by immunohistochemistry and in situ hybridization. Inhibition of cell proliferation and stimulation of matrix production by TGF-beta1 were assessed in isolated glomeruli using [(3)H]thymidine incorporation and [(3)H]proline metabolic labelling, respectively. In acute self-limited nephritis, expression of TbetaRI, TbetaRII, and TbetaRIII increased in the glomerular and Bowman's capsular epithelial cells comprising the glomerular tuft adhesions to Bowman's capsules. However, TbetaRII expression was not prominent in proliferating mesangial cells. Glomeruli isolated from rats with acute self-limited nephritis at day 7, when mesangial cell proliferation was maximal, were partially resistant to the mitoinhibitory effects of TGF-beta1. In contrast, expression of all three TbetaRs was elevated in glomerular and tubulointerstitial lesions in chronic progressive nephritis, and glomeruli isolated from rats with chronic progressive nephritis 7 days after the second ATS injection were sensitive to TGF-beta1. These data suggest that distinct cellular responses to TGF-beta1 resulting from differential expression of TbetaR underlie the difference between acute self-limited mesangial proliferative and chronic progressive sclerosing ATS nephritis in the development of proliferative and sclerotic renal lesions.

SYSTEMIC HYPERTENSION IN PATIENTS WITH GLOMERULONEPHRITIS

Although systemic hypertension is very common in patients with glomerulonephritis there is a dispute if this alteration is consequence of the glomerulonephritis “per se” or is a consequence of the renal failure secondary to the glomerular lesion. With the aim to analyze the factors associated with systemic hypertension, 196 patients with different forms of nephritis were studied. The systemic arterial pressure was measured by standard sphygmomanometer, renal function was evaluated by the determination of the serum creatinine concentration or creatinine clearance. The diagnosis of the type of glomerulonephritis was made on the basis of an examination of kidney biopsy specimens. The prevalence of arterial hypertension among patients with glomerulonephritis was 62.7%. The hypertensive patients were older (hypertensive = 30.6 ± 12.8; normotensive = 25.4 ± 1.6 years; P = 0.03). The prevalence of arterial hypertension was lower in patients with minimal glomerular lesion (12.5%), though their ages were also lower (18.1 ± 3.6 and 29.1 ± 1.03 years; P = 0.03). Arterial hypertension did not correlate with the serum levels of creatinine and albumin; creatinine clearance and 24-h proteinuria. In conclusion: In the patients with glomerulonephritis, the presence of arterial hypertension was associated with a higher mean age whereas the intensity of proteinuria, the level of renal function or the type of glomerulonephritis was not different between the two groups.

How end-stage renal disease (ESRD)-Medicare developed

Uremia is a chemical, toxic, potentially fatal condition. In a variable pattern, uremia ultimately kills almost every cell in the body. Uremia is produced by hundreds of diseases, both kidney and systemic (eg, diabetes). These kinds of uremic conditions range from the acute and catastrophic to the slowly and moderately progressive. Humans and medicine have struggled at least since Hippocrates to understand, prevent and treat uremia and thereby prolong the useful lives of the young and the aging. Accelerated by the spectacle of premature uremic deaths from crush syndrome, shock, and forms of nephritis during major wars and disasters, medicine fused clinical and basic science with industrial technology and came up with two effective treatments. Dialysis in several modes and kidney transplantation became feasible but proved complex and expensive. How people, struggling to survive, were able to use a representative form of government to treat all kidney patients, forms a human story: A “people” story. Since it culminated within a single medical generation, it is possible to tell the story as a participant and eye-witness. This is how the medical, social and national organization of substitution therapy for uremia evolved. Since it is legislatively called end-stage renal disease, we titled the entitlement, “How ESRD-Medicare Developed.”

Chemokine Amplification in Mesangial Cells

Mesangial cells are specialized cells of the renal glomerulus that share some properties of vascular smooth muscle cells and macrophages. They are implicated in the pathogenesis of many forms of nephritis. The murine CXC-chemokines macrophage inflammatory protein-2 (MIP-2) and KC induce migration of mouse mesangial cells. Mesangial cells also exhibit a unique chemokine feedback mechanism. Treatment with nanomolar concentrations of MIP-2 or KC markedly up-regulates monocyte chemoattractant protein-1 and RANTES expression in mesangial cells. Autoinduction of MIP-2 and KC mRNA was also noted. Low levels of MIP-1alpha, MIP-1beta, and IFN-gamma-inducible protein-10 were induced following treatment with higher doses of MIP-2 or KC. These effects are specific to mesangial cells, as MIP-2 or KC treatment of renal cortical epithelial cells or peritoneal macrophages failed to induce chemokine production. This cascade of chemokine interactions may contribute to renal infiltration and leukocyte activation. The abilities of MIP-2 or KC to stimulate their own synthesis may also contribute to the maintenance and chronic course of glomerular inflammation. The mesangial cell receptor for MIP-2 and/or KC is unknown but is not CXC-chemokine receptor-2.

Renal involvement in systemic lupus erythematosus. A study of 180 patients from a single center.

Charts of 180 patients (147 women, 33 men) with systemic lupus erythematosus (SLE) complicated by renal involvement were retrospectively analyzed from a series of 436 patients. Mean age at renal disease onset was 27 years. Thirty-six percent of the patients had renal involvement after diagnosis of lupus, for 30.7% of that group it was more than 5 years later. Renal involvement occurred more frequently in young male patients of non-French non-white origin. Patients with renal involvement suffered more commonly from malar rash, psychosis, myocarditis, pericarditis, lymphadenopathy, and hypertension. Anemia, low serum complement, and raised anti-dsDNA antibodies were more frequent. According to the 1982 World Health Organization classification, histologic examination of initial renal biopsy specimen in 158 patients showed normal kidney in 1.5% of cases, mesangial in 22%, focal proliferative in 22%, diffuse proliferative in 27%, membranous in 20%, chronic sclerosing glomerulonephritis in 1%, and other forms of nephritis in 6.5%. Distribution of initial glomerulonephritis patterns was similar whether renal involvement occurred before or after the diagnosis of lupus. Transformation from 1 histologic pattern to another was observed in more than half of the analyzable patients (those who underwent at least 2 renal biopsies). Nephritis evolved toward end-stage renal disease in 14 patients despite the combined use of steroids and cyclophosphamide in 12. Initial elevated serum creatinine levels, initial hypertension, non-French non-white origin, and proliferative lesions on the initial renal biopsy were indicators of poor renal outcome. Twenty-four patients died after a mean follow-up of 109 months from SLE diagnosis. Among our 436 patients, the 10-year survival rate was not significantly affected by the presence or absence of renal involvement at diagnosis (89% and 92%, respectively).

Recurrent primary disease and de novo nephritis following renal transplantation

Recurrent or de novo diseases account for only 5% of graft failure in children, but have much to teach us about mechanisms. In children, almost the only metabolic disease with recurrence is type I hyperoxaluria, in which the poor long-term results of isolated renal transplantation make combined liver and renal transplantation, or even prophylactic liver transplantation before renal failure the preferable alternatives. While many forms of nephritis may show histological recurrence in allografts, it is notable that in many patients this is accompanied by no clinical manifestations or only mild disease: this is particularly so in mesangiocapillary glomerulonephritis (MCGN) type II. IgA-associated nephropathy and Henoch-Schönlein purpura. However focal segmental glomerulosclerosis and MCGN type I recur with sufficient frequency and severity to deter the use of living donors unless there is no alternative. The same is true of haemolytic-uraemic syndromes. As many as 10% of paediatric grafts may show de novo membranous nephropathy, but in the majority this is mild or not clinically evident. In contrast, the rare anti-glomerular basement membrane nephritis affecting some patients with Alport's syndrome usually results in graft failure, but occurs in only a minority of recipients with the syndrome. For all types of disease in allografts, risk factors for recurrence are poorly worked out, and attempts at treatment generally ineffective.

Antiglomerular basement membrane antibody: Antibody specificity in different forms of glomerulonephritis

Components were solubilized from human glomerular basement membrane by digestion with collagenase and pepsin or by extraction with guanidine-HCl either directly or after previous digestion with the enzyme. The diverse preparations were used as antigens in the enzyme-linked immunosorbent assay (ELISA) of antibody titers in sera from patients with Goodpasture syndrome and patients with other forms of glomerulonephritis, that is, systemic lupus erythematosus, periarteritis nodosa, and IgA-related nephropathy. Patients with Goodpasture syndrome had high titers of IgG antibodies reacting most strongly with collagenase digests. The antigen(s) was only partly solubilized by guanidine-HCl extraction, was destroyed by pepsin digestion as well as reduction, and partly destroyed by trypsin digestion. The antigen(s) is most likely noncollagenous protein. Antibodies from patients with other forms of nephritis were directed primarily against antigens in guanidine-HCl extracts, while the antigen(s) was not solubilized by collagenase digestion. Pepsin digestion destroyed the antigen(s). The antibodies were of a different class, that is, the patients with systemic lupus erythematosus had IgG and IgA as well as IgM antibodies; the patients with periarteritis nodosa had IgM or IgG and IgA antibodies, while the patients with IgA-related nephritis had the highest recorded titers of IgA but also had IgG as well as IgM antibodies. None of the patients had antibodies directed against triple helical collagen. The antibody response in anti-GBM antibody-related nephritis, then, is different both with respect to antigen and antibody class and depends on the underlying disease syndrome.

Further studies on "limey-disease" of Tasmanian mutton birds (Puffinus tenuirostris).

“Limey-disease” of mutton birds has been shown to be a form of nephritis probably associated with infection of the ureters and collecting ducts by a coccidium. The parasite has been identified as an Eimeria sp., but does not appear to be identical with other avian, renal coccidia.

The effect of corticosteroid therapy on the state of the cardiovascular system in children with nephritis

Cardiovascular disorders are one of the main syndromes in the clinical picture of glomerulonephritis in both adults and children. In recent years, due to the use of corticosteroid hormones, nephritis in children proceeds more favorably [1, 6]. The effect of steroid therapy on the development of cardiovascular pathology in patients with nephritis has not been studied. R.E. Mazo, based on observations of the dynamics of ECG and BCG in children with lingering forms of nephritis treated with small doses of prednisolone, suggests that this treatment has a beneficial effect on the course of cardiovascular syndrome. Further study of this issue is necessary, especially in connection with the change in the method of nephritis treatment in the direction of increasing the dose of hormones and lengthening the course of treatment [6].