Glomerulonephritis Group Research Articles

#613 Is there a relationship between kidney stiffness identified by 2D shear wave elastography and the estimated glomerular filtration rate?

Abstract Background and Aims Ultrasound-based elastography has been utilized as an imaging method with high utility in the liver or thyroid, but it is not yet being implemented in evaluating the chronic kidney disease (CKD) because current research indicates a high level of heterogeneity between studies. We aimed to investigate if there is a connection between kidney stiffness measured with a new, specially designed elastography software for kidneys and estimated glomerular filtration rate (eGFR). Method In 2022 and 2023 we performed a cross-sectional study in 150 participants (50 healthy, 50 kidney-transplanted, 50 with chronic glomerulonephritis). The mean value of five different measurements for each kidney were correlated with biological and clinical parameters. To examine the variations amongst the three groups, one-way between-groups ANOVA was employed. Results The mean kidney stiffness for the healthy cohort was 31.9 ± 2.9 kiloPascal (kPa), for kidney transplanted (Ktx) patients 25.9 ± 6.9 kPa and for the chronic glomerulonephritis (GN) 23.8 ± 7.45 kPa. We discovered correlations between kidney stiffness and eGFR in all three groups: healthy r = 0.61, p < 0.0001, Ktx r = 0.56, p < 0.0001, GN r = 0.70, p < 0.0001. We also found a value of under 26 kPa for the detection of an eGFR under 60 mL/min/1.73 m2 with 94.3% sensitivity and 84% specificity (AUC = 0.905, p < 0.0001). The healthy group showed significant higher values than Ktx or GN groups, but without significant differences between the latter two. Conclusion Our findings demonstrate a correlation between renal function, with very good diagnostic accuracy, and these novel imaging techniques. A decrease in renal stiffness with the progression of CKD could prove to be an easy, reproducible approach to provide additional diagnostic information. However, given the limited number of participants, additional studies are required before they can be incorporated into standard clinical practice.

#1933 Urinary proteomics identifying the novel biomarker associated with crescentic glomerulonephritis

Abstract Background and Aims As a severe progressive acute renal injury, crescentic glomerulonephritis requires timely pathology diagnosis and treatment. New non-invasive biomarkers will be crucial when the renal biopsy is not available or unacceptable. Urinary proteomics, specifically data-independent acquisition (DIA) proteomics, might provide some potential indicators. Method Urine proteomics examination was on patients with crescentic glomerulonephritis(n = 15), chronic glomerulonephritis (n = 15), acute kidney injury (AKI) without glomerular crescentic(n = 10), and 15 healthy controls. The crescentic glomerulonephritis group is the patients with extensive glomerular crescents over 50%. We performed LC-MS/MS analysis to identify differentially expressed proteins (DEPs), Ingenuity Pathway Analysis (IPA), and the proteome map for significant pathways and crucial proteins among patients and controls. The signature proteins were validated using enzyme-linked immunosorbent assay (ELISA) analysis. Results A total of 55 population, males occupied 45.45%, with the average age being 53 ± 13 years old. A volcano plot among crescentic glomerulonephritis and control groups is in Fig. 1. IPA analysis showed that neutrophil degranulation and complement cascade were the top two pathways in crescentic glomerulonephritis but not in the healthy and nephritis groups. The activated neddylation pathway in patients with crescentic glomerulonephritis compared with AKI patients. After integrating the DEPs among three groups via the Venn plot, we observed eight DEPs significantly associated with the crescentic glomerulonephritis, among which Coagulation factor V (F5), Phospholipid transfer protein (PLTP), and Alcohol dehydrogenase 1C (ADH1C) were significant proteins. Biomarker analysis showed the area under the curve values for predicting crescentic glomerulonephritis were 0.867, 0.851, and 0.815, respectively (P < 0.001). Conclusion Urine proteomics holds promise in identifying the crescentic glomerulonephritis patient, thus providing a potential value as a noninvasive biomarker.

Recurrence of Glomerulonephritis After Kidney Transplantation - Experience of One Center from 2020 to 2023

Glomerulonephritis (GN) after kidney transplantation is a common problem. Many of them are recurrences of the primary disease in the transplanted kidney. The course and prognosis of individual types of glomerulonephritis (GN) are very different and their appearance may worsen the graft survival. World statistics show significant discrepancies regarding the incidence of GN recurrence depending on the adopted protocol (protocolar biopsy or due to symptoms). We analyzed the transplanted kidney biopsy results that are performed only in symptomatic patients. A group of 125 patients transplanted and treated in one medical center were observed. In this group, in 32 patients, the primary kidney disease was GN, confirmed by kidney biopsy before transplantation. Twenty three kidney biopsies were performed; in 8, cases the primary disease was GN. The indication for biopsy were hematuria and/or proteinuria and/or graft failure. We diagnosed 5 cases of GN, including 4 cases of GN recurrence (12.5% in whole GN group, 50% in symptomatic GN group). In the relapse group, there was 1 case of IgA nephropathy (the earliest recurrence 1 month after transplantation), 1 case of focal segmental glomerulosclerosis, 1 case of membranous nephropathy, and 1 case of lupus nephritis (the latest recurrence 1 year and 4 months after transplantation). Our observation showed a high percentage of GN recurrences in symptomatic patients. This indicates the need to specify data regarding the diagnosis of recurrence depending on the adopted research method (protocolar or due to symptoms biopsy) to know which patients should be treated.

Patterns of Dickkopf-3 Serum and Urine Levels at Different Stages of Chronic Kidney Disease.

Dickkopf 3 (Dkk3) is a WNT/β-catenin signaling pathway regulator secreted by tubular epithelial cells upon the influence of different stressors. Recently Dkk3 was described as a biomarker of tubular cell injury and a tool that may estimate the risk of chronic kidney disease (CKD) progression. The data about Dkk3 concentrations at particular stages of CKD are lacking. The aim of this study was to measure serum and urine Dkk3 levels in patients with different 'renal status' and evaluate its role as a biomarker of renal damage. One hundred individuals, aged between 24 and 85 years (mean 53.1 ± 17.1), were enrolled in the study. Five groups of 20 subjects each were recruited based on their kidney function. Serum and urine Dkk3 levels were measured by ELISA. The highest median urinary Dkk3 normalized to urinary creatinine was found in patients with established CKD (7051 pg/mg). It was two times higher in renal transplant patients (5705 pg/mg) than in healthy individuals (2654 pg/mg) and the glomerulonephritis group (2470 pg/mg). Urinary Dkk3 was associated with serum creatinine in participants with established CKD and following transplantation. Our results confirm the potential role of Dkk3 as a biomarker of an ongoing renal injury.

#4624 VISCOELASTICITY MEASUREMENT- A NEW ULTRASOUND-BASED ELASTOGRAPHY METHOD IN THE ASSESSMENT OF THE KIDNEY

Abstract Background and Aims Viscoelasticity is the result of the tissue's combined viscous and elastic response to stress. This characteristic can reveal details about the function of the kidney and is essential for comprehending how it responds to deformation. Hologic Aixplorer Mach 30 ultrasound system comes with new and improved software that indirectly assesses the viscosity of the renal tissue by measuring tissue shear wave dispersion. Method Over the course of 2022 we performed a cross-sectional study by including 50 healthy participants, 50 kidney-transplanted patients, and 40 patients with chronic glomerulonephritis (before being referred for renal biopsy). Viscosity plane-wave ultrasound (Vi PLUS) measurements were performed on each participant, and the mean value of five distinct evaluations for each kidney was correlated with their demographic, biological, and clinical parameters. Results The mean viscosity value for the healthy group was 2.44 ± 0.57 Pascal.second (Pa.s), correlated with age (r = -0.4251, p = 0.0021), estimated glomerular filtration rate (eGFR) (r = 0.4057, p = 0.0038) but it did not correlate with C reactive protein (CRP), the mean value for Vi PLUS in the kidney-transplanted group was 2.82± 0.59 Pa.s, correlated with eGFR (r = 0.3335, p = 0.0180), but not with age or CRP, and the mean value for the patients with chronic glomerulonephritis group was 2.39 ± 0.73 Pa.s, did not correlate with age, but correlated with eGFR (r = 0.3637, p < 0.0211) and CRP (r = -0.3695, P = 0.0189) and we also found for a cut-off value of <2.8 Pa.s for detecting the presence of tubulointerstitial fibrosis with an AUC of 0.792, p < 0.001 with 94% sensitivity, and 60% specificity. Results of one-way ANOVA (p = 0.001), used to test the differences in the variables among the three groups, showed statistically significant higher values for the viscoelasticity in renal transplant patients compared to the other two groups, but no differences between the healthy and chronic glomerulonephritis groups. Conclusion Our results show that this novel ultrasound technique correlates with renal function and inflammation (in chronic glomerulonephritis patients) and it is also capable of discriminating between patients with and without tubulointerstitial fibrosis, but further research is needed for it to be implemented into routine clinical practice.

Comparison of outcomes of chronic kidney disease based on etiology: a prospective cohort study from KNOW-CKD

The causes of chronic kidney disease (CKD) affects its outcomes. However, the relative risks for adverse outcomes according to specific causes of CKD is not well established. In a prospective cohort study from KNOW-CKD, a cohort was analyzed using overlap propensity score weighting methods. Patients were grouped into four categories according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), or polycystic kidney disease (PKD). From a total of 2070 patients, the hazard ratio of kidney failure, the composite of cardiovascular disease (CVD) and mortality, and the slope of the estimated glomerular filtration rate (eGFR) decline according to the cause of CKD were compared between causative groups in a pairwise manner. There were 565 cases of kidney failure and 259 cases of composite CVD and death over 6.0 years of follow-up. Patients with PKD had a significantly increased risk for kidney failure compared to those with GN [Hazard ratio (HR) 1.82], HTN (HR 2.23), and DN (HR 1.73). For the composite outcome of CVD and death, the DN group had increased risks compared to the GN (HR 2.07), and HTN (HR 1.73) groups but not to the PKD group. The adjusted annual eGFR change for the DN and PKD groups were − 3.07 and − 3.37 mL/min/1.73 m2 per year, respectively, and all of these values were significantly different than those of the GN and HTN groups (− 2.16 and − 1.42 mL/min/1.73 m2 per year, respectively). In summary, the risk of kidney disease progression was relatively higher in patients with PKD compared to other causes of CKD. However, the composite of CVD and death was relatively higher in patients with DN-related CKD than in those with GN- and HTN-related CKD.

The Long-Term Survival Outcome in Older Patients with Different Pathological Types of Chronic Kidney Disease

Introduction: Chronic kidney diseases (CKDs) are prevalent in older people, and renal pathological manifestations are important for diagnosis, treatment, and prognosis. However, the long-term survival outcome and risk factors for older CKD patients with different pathological types are not fully understood and need to be further investigated. Methods: Medical data were recorded and all-cause mortality was followed up in patients who underwent renal biopsy diagnosed in Guangdong Provincial People’s Hospital from 2005 to 2015. Kaplan-Meier analysis was used to identify the incidence of survival outcomes. Multivariate Cox regression models and nomograms were applied to analyze pathological types and other factors for overall survival outcomes. Results: 368 cases were included and the median follow-up was 85 (46.5, 111) months. Overall mortality was 35.6%. The highest mortality was in the mesangioproliferative glomerulonephritis (MPGN) group (88.9%), followed by amyloidosis (AMY) group (84.6%), and the lowest mortality was in the minimal change disease (MCD) group (21.9%). Moreover, multivariate Cox regression model showed that survival times of MPGN {hazard ratio (HR) = 8.215 (95% confidence interval [CI]: 2.735–24.674), p < 0.001} and AMY (HR = 6.130 [95% CI: 2.219–16.94], p < 0.001) were significantly shorter than MCD. In addition, age, lower baseline estimated glomerular filtration rate (eGFR), history of chronic obstructive pulmonary disease (COPD) and cerebrovascular accidents (CVA)/transient ischemic attack (TIA), MPGN, and AMY were independent risk factors for the mortality of older patients with CKD. Conclusion: The long-term survival outcome of older CKD patients showed differences among different pathological types, and MPGN, AMY, age, baseline eGFR, CVA/TIA, and COPD were independent predictors for mortality.

Clinical and pathological features of anti-glomerular basement membrane disease associated with membranous nephropathy: an observational study

To investigate the clinical manifestations, pathological features, pathogenesis, treatment, and prognosis of anti-glomerular basement membrane (anti-GBM) disease with membranous nephropathy (MN). Seven patients with anti-GBM disease and concurrent MN were enrolled in this study. Control subjects included 13 patients with anti-GBM glomerulonephritis (GN) and 6 with anti-GBM disease and concurrent anti-neutrophil cytoplasmic antibodies-associated disease (anti-GBM + ANCA). Laboratory tests and pathological information were analyzed before immunosuppressive therapy or plasmapheresis administration. Prognosis was assessed in continuous follow-up. In the anti-GBM + MN group, 28.57% of patients exhibited acute kidney disease, lower than that in the anti-GBM GN group (84.62%, p = .022). None of the anti-GBM + MN or + ANCA patients exhibited hemoptysis, but 15.4% of anti-GBM GN patients did, with no significant difference (p = .720). Only 14.3% of anti-GBM + MN patients had crescentic GN. The proportion of necrosis averaged 29.0% in the anti-GBM + MN group. Survival curve analysis revealed that renal outcomes in the anti-GBM + MN group were better than those in the anti-GBM GN group (p = .019). Patients with both anti-GBM disease and MN showed atypical anti-GBM GN. They had a lower proportion of glomerular crescents and a better renal function prognosis than patients with classical anti-GBM GN. To improve renal recovery, early identification and treatment of anti-GBM disease associated with MN is needed.

Role of fluid-phase complement system regulation in the development of hepatitis C virus-associated glomerulonephritis.

ObjectivesIt is not known why only some hepatitis C virus (HCV) infected patients develop glomerulonephritis (GN). Therefore, we investigated the role of soluble complement regulators in the development of HCV associated GN.MethodsPatients with HCV associated GN who were admitted to our nephrology unit between July 2016 and July 2018 were recruited to the study (group 1). Two other age and sex matched groups were studied as control groups: patients with HCV without GN (group 2) and healthy HCV negative volunteers (group 3). There were 26 participants in each of the three groups at the end of the recruitment period. An assay of serum fluid-phase complement regulators was performed using enzyme linked immunosorbent assay technique. Three complement single nucleotide polymorphisms (SNPs) were analyzed using real time polymerase chain reaction (Taqman; thermo fisher scientific): rs2230199 and rs1047286 for complement 3 (C3) and rs800292 for complement factor H (CFH).ResultsSerum levels of complement 4 binding protein (C4BP) were significantly lower in group 1 (median 70 ng/ml) than in groups 2 (median 88.8 ng/ml) and 3 (median 82.8 ng/ml) with p value of 0.007. The minor allele (allele A) of rs800292 for CFH was significantly higher in group 2 and group 3 (G 54% and A 46%) than in group 1 (G 73% and A 27%), p = 0.04.ConclusionsLow C4BP levels are associated with GN in HCV infected patients. In addition, rs800292 SNP in CFH protects against GN in patients with HCV.

Epidemiology and clinicopathological characteristics of native kidney disease in children in Flanders, Belgium.

The Flemish Collaborative Glomerulonephritis Group (FCGG) registry is a population-based kidney biopsy registry that has been including all native kidney biopsies performed in children in Flanders (Belgium), since 2017. From 2017 to 2020, 148 pediatric (< 18years) native kidney biopsies were included. Each biopsy received a histopathological and final nephrological diagnosis, and concordance between both was assessed. Disease chronicity, summarized by the Mayo Clinic Chronicity Score, was determined on 122 biopsies with > 5 glomeruli. Kidney biopsy rate was high (29.0 biopsies per million children per year), median age was 10.0years (IQR 5.8-14.7), and boys predominated (56.1% males). A total of 140 biopsies (94.6%) showed a representative pathology result. Glomerular disease was most prevalent, with IgA nephropathy/IgA vasculitis (43 biopsies, 29.1%) and minimal change disease (MCD) (29 biopsies, 19.6%) being the overall most frequent diagnoses. In general, diagnostic concordance was high (80.7%). In Alport syndrome and focal segmental glomerulosclerosis (FSGS), concordance was lower, as the nephrological diagnosis was often determined by results of genetic analysis. Nephrotic syndrome was the most frequent indication for kidney biopsy (31.8%) and was mainly caused by MCD and FSGS. The degree of disease chronicity on kidney biopsies was generally low, although 27.3% of biopsies with a diagnosis of FSGS showed moderate-to-severe chronic damage. The presented epidemiological findings validate data from previous European registry studies and may inspire kidney biopsy registries worldwide to implement novel features such as clinicopathological concordance and chronicity grading. A higher resolution version of the Graphical abstract is available as Supplementary information.

Transplant or dialysis: What's the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data.

PurposeThe incidence of end-stage renal disease (ESRD) caused by renal cell carcinoma (RCC) is increasing with the high prevalence of RCC as well as those with treatment-related renal function impairment. Worries about tumor recurrence after transplant-related immunosuppression hinder the recommendation of kidney transplantation for RCC-induced ESRD patients. However, no direct analysis has been performed to identify whether kidney transplantation can offer better survival than maintaining dialysis.Materials and methodsThis retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes were compared, including the patient and graft survival of candidates and recipients with RCC-induced ESRD etiology as well as other primary diseases.ResultsPatients with RCC-induced ESRD were older; more likely to be male, White, and obese; and more likely to have a history of diabetes and dialysis. They also had higher creatinine levels, more delayed graft function, more primary non-function, and higher Kidney Donor Profile Index score donors, compared with the glomerulonephritis (GN) group. While waiting, RCC candidates suffered the worst outcomes of all groups, a 44% (adjusted hazard ratio [aHR], 1.44 [1.27–1.62]) higher risk of removal than GN patients. After transplantation, RCC recipients demonstrated comparable patient survival and better graft survival (p=0.21 and p=0.13, respectively). Compared with still-waiting RCC patients, the RCC recipients who received kidney transplants had significantly better outcomes (13.6 [9.3–17.8] vs. 61 [52–68.4] %), decreasing the death or deteriorating risk by 84% (aHR, 0.16 [0.13–0.20]).ConclusionsPatients with RCC-induced ESRD can dramatically benefit from kidney transplantation. Hence, these patients should not be limited to transplantation by strict strategies or a delayed waiting time out of their malignancy history.

Angiotensin II Type 1 Receptor Antibodies Are Higher in Lupus Nephritis and Vasculitis than Other Glomerulonephritis Patients

Angiotensin II type 1 receptor (AT1R) antibodies are considered non-HLA (human leukocyte antigen) antibodies connected with humoral rejection after kidney transplantation. The role of AT1R antibodies in the pathogenesis of glomerular diseases and systemic vasculitis is unknown. We assessed the level of AT1R antibodies in 136 patients with different types of glomerulonephritis and systemic vasculitis and we observed kidney function and proteinuria, serum albumin and total protein levels for 2 years. The mean levels of AT1R antibodies were the following: 6.00 ± 1.31 U/ml in patients with membranous nephropathy (n = 18), 5.67 ± 1.31 U/ml with focal and segmental glomerulosclerosis (n = 25), 6.26 ± 2.25 U/ml with lupus nephropathy (n = 17), 10.60 ± 6.72 U/ml with IgA nephropathy (n = 14), 6.69 ± 2.52 U/ml with mesangial proliferative (non IgA) glomerulonephritis (n = 6), 6.63 ± 1.38 U/ml with systemic vasculitis (n = 56), including c-ANCA (anti-neutrophil cytoplasmic antibodies) vasculitis: 11.22 ± 10.78 U/ml (n = 40) and p-ANCA vasculitis: 12.65 ± 14.59 U/ml (n = 16). The mean AT1R antibodies level was higher in patients with lupus nephropathy and systemic vasculitis compared to glomerulonephritis groups. An inverse statistically significant correlation between AT1R antibodies and serum albumin (r = − 0.51) in membranous nephropathy group was also found. Prospective analysis of creatinine levels indicated an increase of creatinine levels during time among patients with higher AT1R antibodies levels in p-ANCA vasculitis. Lupus nephropathy and systemic vasculitis patients may have high levels of AT1R antibodies. AT1R antibodies may be associated with the severity of membranous nephropathy and the course of p-ANCA vasculitis, although influence of concomitant factors is difficult to exclude.

Clinicopathological characteristics and disease chronicity in native kidney biopsies in Flanders.

The Flemish Collaborative Glomerulonephritis Group (FCGG) registry provides complete population data on kidney disease epidemiology in the region of Flanders (Belgium), as it captures all native kidney biopsies performed in its population of 6.5 million inhabitants. From 2017 until 2019, 2054 adult kidney biopsies were included from 26 nephrology centers (one biopsy per patient). Data on nephrotic and nephritic syndrome were available in 1992 and 2026 biopsies, respectively. In a subgroup of 898 biopsies containing ≥10 glomeruli from 2018 to 2019, disease chronicity was graded using the Mayo Clinic Chronicity Score (MCCS). The association between clinical variables and MCCS was determined using simple and multiple linear regression models. Nephrotic syndrome (present in 378 patients, 19.0%) was most frequently caused by minimal change disease in younger patients (18-44 years), membranous nephropathy in older patients (45-74 years) and amyloidosis in the elderly (>75 years). Nephritic syndrome (present in 421 patients, 20.8%) was most frequently caused by immunoglobulin A nephropathy (IgAN) in younger patients (18-64 years) and ANCA-associated vasculitis (AAV) in older patients (>64 years). AAV and IgAN were the most frequent underlying diagnoses in biopsies in which crescents were identified. In multivariable analysis, acute and chronic kidney disease and diagnoses of diabetic kidney disease, nephrosclerosis and hyperoxaluria/hypercalcemic nephropathy were associated with the highest MCCS increases. The FCGG registry validates data from previous Western European registries and provides a snapshot of disease chronicity in the whole biopsied Flemish population.

A case report: 19-year-old male diagnosed with C1q nephropathy requiring renal replacement therapy

C1q nephropathy is a rare glomerular disease. Clinical presentation is diverse and ranges from asymptomatic hematuria or proteinuria to symptoms and signs of nephrotic/nephritic syndrome. On light microscopy, it can be classified into two subtypes: minimal change disease (MCD)/focal segmental glomerulosclerosis (FSGS) group and immune complex mediated proliferative glomerulonephritis group. A case of a 19-year-old male patient presenting nausea and decreased appetite will be reported. The labs showed severe nephrotic syndrome and a progressive kidney injury over a few months that were never diagnosed. The immune workup came back negative. The patient mentioned that he was taking protein shakes a few months earlier for bettering his physical fitness. A renal biopsy was done and showed a major reduction in renal mass and C1q nephropathy. He received steroids without any improvement. He was started on hemodialysis afterward then got transplanted 8 months later. In front of this rapid deterioration, FSGS might be the underlying etiology rather than MCD. Further studies are warranted to establish a connection between protein supplements, and progression of kidney disease.

Analysis of Various Types of Glomerulonephritis with Crescents at a Single Center

Background The importance of crescent formation in glomerulonephritis has increased. However, detailed analysis of crescentic glomerulonephritis in Asia is scarce. In addition, advances in serological diagnostic techniques (antineutrophil cytoplasmic and antiglomerular basement membrane autoantibodies) and early diagnosis have reduced the number of cases meeting the strict definition of crescentic glomerulonephritis (>50% of glomeruli are crescentic). Therefore, we analyzed the clinicopathological features and renal prognosis of glomerulonephritis cases that exhibited at least one crescentic lesion. Methods We retrospectively evaluated 265 adult patients diagnosed with glomerulonephritis with at least one crescent formation based on the results of renal biopsy. We divided the patients into two groups based on the four types of glomerulonephritis, namely, the immune-complex (type II: IgA nephropathy, IgA vasculitis with nephritis, and lupus nephritis) and pauci-immune (type III: microscopic polyangiitis) groups. Factors affecting renal prognosis (end-stage renal failure requiring renal replacement therapy) were examined in a multivariate analysis using the Cox proportional hazards model. Kaplan–Meier curves and log-rank test were used to analyze and compare time from entry to renal death. Results Renal prognosis differed significantly between the immune-complex and pauci-immune groups. Among the four types of glomerulonephritis, IgA nephropathy was the most prevalent. Multivariate analysis showed that renal function at renal biopsy and the ratio of global sclerosis independently predicted renal prognosis, but the type of glomerulonephritis was not a factor. Conclusions Renal dysfunction at renal biopsy and the ratio of global sclerosis predicted renal prognosis, because it reflects the degree of irreversible renal damage. We also suspect that the formation of at least one crescentic lesion led to the development of these predictive factors, regardless of the type of glomerular disease and degree of crescent formation.

Identification of Candida Species among Renal Transplanted Recipient, In Khartoum, Sudan 2021

Background: Kidney transplantation represents the optimal therapeutic tool for patients affected by end-stage renal disease (ESRD), Candidiasis is a major challenge among renal transplant recipients (RTRs) worldwide and is associated with high morbidity and mortality rates. Fluconazole is the most commonly used agent for Candida infections Aim: to identify Candida spp from renal transplanted patients. Method: cross sectional study were done, 51 Urine sample was collected on sterile urine container then cultured on Sabouraud dextrose agar, incubated at 35 °C and observed daily for 7 days. When the growth of yeast colonies was observed, the Gram stain method was done to verify the absence of bacterial contamination. The yeasts were identified via germ tube test and chromogenic media to differentiate between candida spp. Results: out of 51 patients; female were more than male wit mean age group 45 years for both male and female.The cause of ESRD was; 19 (37.3%) had DM, 12(23.5%) had hypertension, 10(19.6%) had Glomerulonephritis and 3(5.9%) had kidney stone candida species among study group as follow; c.albicans isolated from 28 (54.9%) pt., c.glabrata isolated from 11 (21.6%) pt., c.tropicalis isolated from 6 (11.8%) pt., c.krusie isolated from 3 (5.9%) of pt. and 3(5.9%) had mixed infection. C.albicans, tropicalis and C.krusie had been distributed more among DM groups and less among kidney stone groups, on the other hand C.glabrata more isolated among Glomerulonephritis groups. There was no association between candida species and ESRD. Conclusion: There was no relation between candida spp and cause of ERDS.

Association between Opisthorchis viverrini Infection and Glomerular Disease in Thailand

Introduction: Opisthorchis viverrini (OV) is a major cause of infection in Southeast Asia. Previous studies in mouse models have shown that OV infection can contribute to immune-complex glomerulonephritis (GN). However, OV infection in human kidney tissue has never been demonstrated. Herein, we evaluated the association of OV infection with biopsy-proven glomerular disease. Methods: This study was performed in adult patients who underwent kidney biopsy between July 2016 and February 2017. All kidney tissue samples were processed using the standard techniques for renal pathological diagnoses and immunohistochemistry techniques to detect OV antigen. Pre-implanted donor kidney tissue samples were used as controls. The participants were also assessed for OV infection by serum OV immunoglobulin G antibody (Ab) levels and/or presence of OV eggs in stool. Results: Forty-three renal tissue samples from glomerular disease patients and 50 from transplant donors were included in the study. Mean age in the GN group was 41.7 ± 15.9 years, estimated glomerular filtration rate (eGFR) was 70.65 ± 36.61 mL/min/1.73 m², and median proteinuria was 3.17 (1.70–4.95) g/day. Lupus nephritis (LN) was the most common diagnosis (32.6%), followed by IgA nephropathy (23.3%), IgM nephropathy (18.6%), and primary membranous nephropathy (MN; 7%). The OV antigen was observed in kidney tissue from patients with IgA nephropathy, LN, primary MN, focal segmental glomerulosclerosis, and IgM nephropathy. By contrast, no OV antigen was detected in tissue samples from the control group. The presence of OV antigens was observed in glomerular endothelial cells, mesangial cells, tubular cells, and peritubular capillaries. The odds ratio of positive serum OV Ab to predict the presence of OV antigen in kidney tissues was 4.47 (p = 0.057), and there was a negative correlation between levels of serum OV Ab and eGFR (r = −0.31, p = 0.04). Discussion/Conclusion: This is the first study to demonstrate the presence of OV antigen in human kidney tissue, which indicates that OV infection may be associated with biopsy-proven glomerular diseases.

Epidemiology of native kidney disease in Flanders: results from the FCGG kidney biopsy registry.

ABSTRACTBackgroundThe Flemish Collaborative Glomerulonephritis Group (FCGG) registry is the first population-based native kidney biopsy registry in Flanders, Belgium. In this first analysis, we report on patient demographics, frequency distribution and incidence rate of biopsied kidney disease in adults in Flanders.MethodsFrom January 2017 to December 2019, a total of 2054 adult first native kidney biopsies were included. A ‘double diagnostic coding’ strategy was used, in which every biopsy sample received a histopathological and final clinical diagnosis. Frequency distribution and incidence rate of both diagnoses were reported and compared with other European registries.ResultsThe median age at biopsy was 61.1 years (interquartile range, 46.1–71.7); male patients were more prevalent (62.1%) and biopsy incidence rate was 129.3 per million persons per year. Immunoglobulin A nephropathy was the most frequently diagnosed kidney disease (355 biopsies, 17.3% of total) with a similar frequency as in previously published European registries. The frequency of tubulointerstitial nephritis (220 biopsies, 10.7%) and diabetic kidney disease (154 biopsies, 7.5%) was remarkably higher, which may be attributed to changes in disease incidence as well as biopsy practices. Discordances between histopathological and final clinical diagnoses were noted and indicate areas for improvement in diagnostic coding systems.ConclusionsThe FCGG registry, with its ‘double diagnostic coding’ strategy, provides useful population-based epidemiological data on a large Western European population and allows subgroup selection for future research.

NR3C1 gene polymorphisms in adult patients with nephrotic syndrome

Introduction: Glucocorticoids therapy is a selective treatment strategy for cases with nephrotic syndrome (NS). Objectives: Due to the lack of positive response of all patients to therapy and the dependency of biological effects of glucocorticoids on its receptors (GR), here, the association of the NR3C1 gene (N363S, BclI, GR-9β, and ER22/23EK) polymorphisms with the response to glucocorticoids was investigated in patients with NS. Patients and Methods: In this study, 55 patients with primary NS including 29 steroid-responder (SS) and 26 steroid-resistant (SR) and also 30 healthy individuals were recruited. The polymorphisms of NR3C1 gene were studied by PCR and sequencing of the amplified fragments and the results were compared between the groups. Results: A3669 SNP was observed in 8.7% (n=2) of patients with SRNS and 6.3% (n=2) of responders (P=0.560). In 40.7% of steroid-responsive patients (n=11) and 21.4% of patients with SRNS (n=6), BclI polymorphism was detected that was not statistically significant (P=0.098). The N363S and ER22/23EK polymorphisms were not detected in the studied groups. No significant differences were observed between the frequency of the studied polymorphisms between the different subtypes of NS; focal and segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MGN), and control group. Conclusion: The NR3C1 gene N363S, BclI, GR-9β, and ER22/23EK polymorphisms do not affect the steroid responsiveness and the pathogenesis of NS in Azari adult patients with primary NS. Other polymorphisms within NR3C1 gene need to be explored in large cohorts.

Possible new role for angiotensin-converting enzyme inhibitors in treating glomerulonephritis

Serum transforming growth factor-beta (TGF-beta1) production was estimated for 10 patients with essential hypertension, 12 patients with glomerulonephritis (5 hypertensive and 7 normotensive) and 10 healthy controls. The glomerulonephritis group received angiotensin-converting enzyme inhibitor captopril 25-75 mg/day for 4 weeks. Blood urea, serum creatinine, 24-hour urinary protein and serum TGF-beta1 were then re-estimated. Urea and creatinine were significantly higher in the hypertension and glomerulonephritis groups than in the controls and also higher in the glomerulonephritis group than the hypertension group. TGF-beta1 was significantly higher in the glomerulonephritis groups than in the control and hypertension groups. TGF-beta1 and 24-hour urinary protein were significantly reduced in the glomerulonephritis group.