MO308COULD THE PRESENCE OF ANCAS IN IGA NEPHROPATHY WITH CRESCENTS HAVE A CLINICAL IMPLICATION?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Zaira Castañeda Amado ◽  
Alejandra Gabaldon ◽  
María Teresa Sanz ◽  
Roxana Bury ◽  
Cinthia Baldallo ◽  
...  
Keyword(s):  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Kidney Biopsy ◽  
Clinical Presentation ◽  
Fibrinoid Necrosis ◽  
Oral Steroids ◽  
Common Clinical Presentation ◽  
The Mean ◽  
End Stage

Abstract Background and Aims IgA nephropathy (IgAN) is the most common glomerulonephritis. The presence of ANCAs in this pathology represents a rare coincidence. However, it is not clear if the presence of IgA or IgG ANCAs in these patients could have clinical significance. We aim to describe the presence of IgA and IgG ANCAs in patients diagnosed with IgAN with crescents, and its possible clinical implications. Method Retrospective study from 2013 to 2020, it included all patients diagnosed by kidney biopsy of IgAN with extracapillary proliferation. Outpatient follow-up time was up to 24 months. Demographics and clinicopathologic data, ANCAs subtype, characteristics of the biopsy and treatment at the time of diagnosis/follow up was recollected. Results From 2013 to 2020, 17 adults were diagnosed with IgAN and extracapillary proliferation. 5 patients presented ANCAs, 3 (17%) were IgA ANCAs and 2 (11%) were IgG ANCAs. At diagnosis, the median age was 48 years old (27-75 years, sd. 15), with 9 women (52%). At the time of diagnosis, the most common clinical presentation was hypertension (71%). The laboratory analysis showed that median hemoglobin was 11.7 mg/dl (8.4-14.9 mg/dL, sd. 1.5), median creatinine was 2.2 mg/dL (0.55-5.7 mg/dL, sd. 1.4) and median proteinuria was 3.5 g/mgCr (0.1-12 g/mgCr, sd. 3.5). 7 patients (41%) presented extracapillary proliferation less than 25%, 7 patients presented it between 25% and 50%, and 3 patients (17%) had it in more than 50%. 5 (30%) patients presented fibrinoid necrosis. 1 (6%) patient needed renal replacement therapy upon admission. In terms of treatment, all patients with ANCAs IgAN received endovenous steroids and cyclophosphamide. The mean follow-up time was 6 months. Oral steroids (59%) and mycophenolate (41%) were the most frequent treatments. At six months, the median creatinine was 1.9 mg/dL (0.4-7, sd. 1.78) and the median proteinuria was 1.45 g/gCr (0.12-5.9, sd. 1.84 g/gCr). 3 patients developed end-stage chronic kidney disease and requiring substitute renal therapy; 4 patients died. Statistical analysis did not show differences in clinical characteristics, demographics, kidney function, proteinuria, need for renal therapy replacement or mortality according to the presence or subtype of ANCA. ANCA negative patients presented less than 25% of extracapillary proliferation in renal biopsy (p = 0.04). ANCA positive patients presented more fibrinoid necrosis than ANCA negative patients (p=0.01). Conclusion Given the limited size of our sample, our results do not allow us to be conclusive, showing no significant differences between the ANCA subtypes. However, from the point of renal biopsy, it is observed that patients with negative ANCAs present less extracapillary proliferation; and that patients ANCA positive presented more fibrinoid necrosis.

scholarly journals Addition of eGFR and Age Improves the Prognostic Absolute Renal Risk-Model in 1,134 Norwegian Patients with IgA Nephropathy

2015 ◽  
Vol 41 (3) ◽  
pp. 210-219 ◽  
Author(s):  
Thomas Knoop ◽  
Ann Merethe Vågane ◽  
Bjørn Egil Vikse ◽  
Einar Svarstad ◽  
Bergrún Tinna Magnúsdóttir ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Prognostic Model ◽  
Risk Model ◽  
Area Under The Curve ◽  
Predicting Outcome ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
French Cohort

Background: Predicting outcome in individual patients with IgA nephropathy (IgAN) is difficult but important. For this purpose, the absolute renal risk (ARR) model has been developed in a French cohort to calculate the risk of end-stage renal disease (ESRD) and death. ARR (0-3) is scored in individual IgAN patients based on the presence of proteinuria ≥1 g/24 h, hypertension, and severe histopathological lesions (1 point per risk factor). We have validated the ARR model in a Norwegian cohort of IgAN patients and tested whether adding data on initial estimated glomerular filtration rate (eGFR) and age improved prediction. Methods: IgAN patients diagnosed between 1988 and 2012 were identified in the Norwegian Kidney Biopsy Registry, and endpoints were identified by record linkage with the Norwegian Renal Registry (ESRD) and the Population Registry (deaths). Results: We identified 1,134 IgAN patients. The mean duration of follow-up was 10.2 years (range 0.0 to 25.7 years). Two hundred and fifty one patients developed ESRD and there were 69 pre-ESRD deaths. The ARR model significantly stratified the IgAN cohort according to risk of ESRD/death. The inclusion of eGFR and age significantly improved the ARR prognostic model; in the receiver operator characteristics (ROC) analysis, area under the curve (AUC) at 10-years of follow-up increased from 0.79 to 0.89, p < 0.001. Conclusions: ARR is a suitable prognostic model for stratifying IgAN patients according to the risk of ESRD or death. Including initial eGFR and age in the model substantially improved its accuracy in our nationwide cohort.

scholarly journals P0345THE EFFICACY OF THE CORTICOSTEROIDS COMBINED ORAL CYCLOPHOSPHAMIDE FOR IGA NEPHROPATHY WITH REAL INSUFFICIENCY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shiren Sun ◽  
Feng Ma ◽  
Xiaoxia Yang ◽  
Ming Bai
Keyword(s):  
Supportive Care ◽  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Cox Regression ◽  
Immunosuppressive Drugs ◽  
Oral Cyclophosphamide ◽  
Renal Survival ◽  
The Mean ◽  
Stage Renal Disease

Abstract Background and Aims IgA nephropathy (IgAN) is the most type of primary glomerulonephritis and one of the major causes of end-stage renal disease (ESRD). The KDIGO clinical practice guidelines for glomerulonephritis suggest not the use of immunosuppressive drugs in IgAN patients with estimated glomerular filtration rate (eGFR) ≤50 mL/min/1.73m2. However, VALIGA study showed that immunosuppressive drugs were more frequently used in IgAN patients with eGFR &lt; 30 mL/min/1.73m2 than in those with eGFR ≥ 30 ml/ min/1.73m2 (60% vs. 44 %; p = 0.004). The immunosuppressive drugs could be effective for IgAN with renal insufficiency in few studies, such as corticosteroids combined oral cyclophosphamide (CS + oral CTX). Therefore, in our present study, we evaluated the efficacy and treatment-related complications of the patients with eGFR from 15 ml/min/1.73m2 to 59 ml/min/1.73m2 who receive supportive care, or CS, or CS + oral CTX. Method 1602 renal biopsy–proven patients were reviewed between January 2008 and December 2016 in the Xijing Hospital. Patients were excluded from the study if they had secondary IgAN. The inclusion criteria were the primary IgAN with eGFR from 15 ml/min/1.73m2 to 59 ml/min/1.73m2 (n = 389). We extracted the patients with receive supportive care, or corticosteroids, or corticosteroids combined oral cyclophosphamide (n = 212). We further excluded patients: &lt; 8 glomeruli (n = 10), diabetes mellitus (n = 4), a follow-up less than 6 months (n = 22), and incomplete data (n = 7). The remaining 169 patients were included in the study (Figure 1). The data included baseline demographic at renal biopsy, renal biopsy, treatment, follow-up parameters and outcomes. The primary endpoint was the combined event of a ≥ 50% reduction in eGFR and/or ESRD. Univariate and multivariate Cox regression analyses were conducted to determine which variables were associated with renal survival. Variables were entered into a multivariate Cox regression model using an Enter method, which were derived from adjusted models: model 1 was adjusted for age, sex, MAP, proteinuria, and eGFR; model 2 was adjusted for the variables in model 1 plus RAS; model 3 was adjusted for the variables in model 1 plus M1, E1, S1, T1-2, and C1-2; model 4 was adjusted for the variables in model 3 plus RAS. Results In all patients, the mean age was 36.0 years, the median proteinuria at the time of the biopsy was 1.6 g/day, the mean MAP was 108.7 mmHg, and eGFR was 40.4 ml/min/per 1.73 m2, the mean follow-up period was 43.3 months, 75 (44.9%) patients had reached combined event. The cumulative 5-year and 10-year renal survival rate were 39.3% and 9.3%, respectively, in the no-IS group ; 56.5% and 25.1%, respectively, in the CS group and 63.4% and 27.1%, respectively, in the CS + CTX group (Figure 2). Both univariate and multivariate Cox analyses shown that CS did not reduce the risk of combined event, whereas CS + CTX significantly reduced the risk of combined event. CS + CTX (HR = 0.367, 95%CI 0.198-0.682, P = 0.002) was notably associated with the risk of combined event after adjusted for age, sex, MAP, proteinuria, eGFR, M1, E1, S1, T1-2, C1-2, and ARB. The two groups did not differ significantly in treatment-related complications. Conclusion CS + oral CTX is possibly more effective than supportive care, or CS for IgAN patients with eGFR from 15 ml/min/1.73m2 to 59 ml/min/1.73m2. Furthermore, randomized controlled trials further verified the findings of the present study.

scholarly journals Clinical Spectrum and Outcome of Childhood IgA Nephropathy - A Single Centre Experience

2015 ◽  
Vol 7 (1) ◽  
pp. 97-100 ◽  
Author(s):  
Jubaida Rumana ◽  
Arpana Iyengar ◽  
Anil Vasudevan
Keyword(s):  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Clinical Presentation ◽  
Clinical Spectrum ◽  
Class Iii ◽  
Medical College ◽  
Childhood Iga Nephropathy ◽  
Time Of Presentation ◽  
Nephrotic Range Proteinuria

Background : IgA nephropathy (IgA N) is one of the most common primary glomerulonephritis worldwide. Although there is paucity of data on the clinical spectrum and outcome of childhood IgA nephropathy in India as well as South Asia.Objective : The aim of this retrospective study was to describe the clinical spectrum, histological findings, and outcome of the children with IgA nephropathy.Methods : This retrospective study was conducted at Peadiatric Nephrology Department of St Johns medical college Hospital, Bangalore India. Fifteen children with histopathologically proven diagnosis of IgA N between 2010 to 2013 were included for analysis. The baseline demographics, along with clinical data, laboratory and renal biopsy details at the time of presentation and during follow up were retrieved from patient case records. Renal biopsy was classified based on Hass classification. All patients with class III and IV received immunosuppressive therapy while the rest received ACE inhibitors or no specific therapy.Results : Among the 15 patients with IgA N, male to female ratio was 1:2 .The average age at presentation was 10 years (range 4½ years to 15 years) and the median follow up was 9 months (Inter Quartile range- 21 months). The most common clinical presentation was nephritic features with nephrotic range proteinuria (60%) followed by isolated gross hematuria (20%). The age at presentation was not associated with a specific clinical presentation. Ten patients had abnormal Estimated Glomerular Filtration Rate (eGFR) at the time of presentation. The renal biopsy revealed class III in 3 patients, class IV in 3 patients and class V in 3 patients. There was no correlation between histopathology and clinical presentation. Class I which was most common histopathology type (seen in 40% of biopsies) was associated with various clinical presentations. At the last follow up 53% and 27% children were in complete and partial remission respectively, also 20% children progressed to Chronic Kidney Disease (CKD).Conclusion : In this study of children with IgA N, the most common presentation was nephritic features with nephrotic range proteinuria and the most common histopathology feature was Class I. IgA N is associated with significant morbidity as 27 % of children at last follow up were in partial remission or 20 % progressed to CKD.Northern International Medical College Journal Vol.7(1) Jul 2015: 97-100

scholarly journals Clinical efficacy and safety of full-dose versus half-dose corticosteroids plus leflunomide for IgA nephropathy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yebei Li ◽  
Yi Xiong ◽  
Tianlun Huang ◽  
Xin Liu ◽  
Gaosi Xu
Keyword(s):  
Iga Nephropathy ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Biopsy ◽  
Full Dose ◽  
Protein Excretion ◽  
Half Dose ◽  
Dose Corticosteroid ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background The results of leflunomide (LEF) in patients with IgA nephropathy (IgAN) were inconsistent. Methods A total of 149 kidney biopsy-confirmed IgAN patients with an estimated glomerular filtration rate (eGFR) ≥ 50 ml/min/1.73 m2 and protein excretion levels ≥0.75 g/d were enrolled, with 65 subjects receiving half-dose CS plus LEF (LEF group), and the 84 counterpart patients accepting full-dose corticosteroid (Full CS group). The primary outcomes included the complete remission (CR) rates and incidence of adverse events (AEs). The secondary outcomes were the overall remission (OR) rates and a combined event (eGFR reduced ≥30%, end-stage renal disease [ESRD], hemodialysis, peritoneal dialysis or kidney transplantation). Results During the 18 months of follow-up, the CR rates were 72 and 64% in the LEF and Full CS groups (P = 0.299), respectively. The proportion of patients with OR rates in the LEF group and Full CS group was 89% versus 75%, respectively (P = 0.027). Serious AEs were observed only in the Full CS group (P = 0.017). The incidences of total AEs (P = 0.036) and infections (P = 0.024) were lower in the LEF group than in the Full CS group. Conclusions LEF combined with half-dose CS is superior to full-dose CS in the treatment of IgAN.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Characteristics of patients with coexisting DNAJB9-associated fibrillary glomerulonephritis and IgA nephropathy

2020 ◽  
Author(s):  
Samar M Said ◽  
Alejandro Best Rocha ◽  
Anthony M Valeri ◽  
Mohamad Sandid ◽  
Anhisekh Sinha Ray ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Immunoglobulin A ◽  
Renal Survival ◽  
Hepatitis C Infection ◽  
Clinicopathologic Characteristics ◽  
Fibrillary Glomerulonephritis ◽  
Kaplan Meier ◽  
Dense Deposits ◽  
End Stage

Abstract Background Coexistence of fibrillary glomerulonephritis (FGN) and immunoglobulin A (IgA) nephropathy (IgAN) in the same kidney biopsy (FGN–IgAN) is rare, and the clinicopathologic characteristics and outcome of this dual glomerulopathy are unknown. Methods In this study, 20 patients with FGN–IgAN were studied and their characteristics were compared with 40 FGN and 40 IgAN control patients. Results Concurrent IgAN was present in 1.8% of 847 consecutive FGN cases and was the second most common concurrent glomerulopathy after diabetic nephropathy. FGN–IgAN patients were overwhelmingly White (94%) and contrary to FGN patients were predominantly (60%) males. Compared with IgAN patients, FGN–IgAN patients were older, had higher proteinuria, a higher incidence of renal insufficiency, and a lower incidence of microhematuria and gross hematuria at diagnosis. Six (30%) patients had malignancy, autoimmune disease or hepatitis C infection, but none had a secondary cause of IgAN or clinical features of Henoch–Schonlein purpura. Histologically, all cases exhibited smudgy glomerular staining for immunoglobulin G and DnaJ homolog subfamily B member 9 (DNAJB9) with corresponding fibrillary deposits and granular mesangial staining for IgA with corresponding mesangial granular electron-dense deposits. On follow-up (median 27 months), 10 of 18 (56%) FGN–IgAN patients progressed to end-stage kidney disease (ESKD), including 5 who subsequently died. Serum creatinine at diagnosis was a poor predictor of renal survival. The proportion of patients reaching ESKD or died was higher in FGN–IgAN than in IgAN. The median Kaplan–Meier ESKD-free survival time was 44 months for FGN–IgAN, which was shorter than IgAN (unable to compute, P = 0.013) and FGN (107 months, P = 0.048). Conclusions FGN–IgAN is very rare, with clinical presentation and demographics closer to FGN than IgAN. Prognosis is guarded with a median renal survival of 3.6 years. The diagnosis of this dual glomerulopathy requires careful evaluation of immunofluorescence findings, and electron microscopy or DNAJB9 immunohistochemistry.

Combined Heart-Liver and Domino Liver Transplantation in Familial Amyloidosis

2021 ◽  
pp. 000313482110234
Author(s):  
Angela Sickels ◽  
Keyur B. Shah ◽  
Brianna Ruch ◽  
Adrian Cotterell ◽  
Inna Tchoukina ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Total Artificial Heart ◽  
Donor Pool ◽  
Cardiac Rejection ◽  
Recipient Age ◽  
Hospital Stays ◽  
The Mean ◽  
Domino Liver Transplantation ◽  
End Stage

Background Combined heart-liver transplantation (CHLT) is the only curative option for patients with concomitant pathology affecting the heart and liver. In some cases, the native livers of familial amyloidosis (FA) patients may be suitable for domino transplantation into other recipients. Methods Retrospective analysis (2013 to 2019) of all CHLT at our center was performed. Continuous data were presented as mean with standard deviation and discrete variables as percentages. Results Familial amyloidosis was the indication for CHLT in 5 out of 6 patients. The mean recipient age was 55 ± 5.62 years. Two patients were bridged with total artificial heart. The mean model for end-stage liver disease score at transplant was 17.17 ± 3.7. Two explanted livers were used for transplantation in a domino fashion. The median intensive care and hospital stays were 5.5 and 19 days, respectively. Complications included renal failure (1), groin abscess (1), pulmonary embolism (1), and cardiac rejection (1). Patient and graft survival for both organs was 100% at a median follow-up of 59 (range 20-76) months. Discussion Combined heart-liver transplantation for FA achieves excellent outcomes. The possible use of livers explanted from patients with FA for domino liver transplantation can contribute to the liver donor pool.

MO403ACUTE KIDNEY INJURY IN ELDERLY: EPIDEMIOLOGICAL, CLINICAL AND ETIOLOGICAL FEATURES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mouna Malki abidi ◽  
Rajaa Aoudia ◽  
Soumaya Chargui ◽  
Imen Gorsane ◽  
Mouna Jerbi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Injury ◽  
The Elderly ◽  
Major Interest ◽  
The Mean ◽  
Renal Aging ◽  
End Stage ◽  
Iatrogenic Origin

Abstract Background and Aims Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly. Method We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017. Results We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l. AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF. Conclusion AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.

scholarly journals P0181PERSISTENT C3 HYPOCOMPLEMENTEMIA AND MODERATE TUBULOINTERSTITIAL SCARRING AS EARLY PREDICTORS OF END-STAGE RENAL DISEASE IN LUPUS NEPHRITIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Giovanni Maria Rossi ◽  
Francesco Peyronel ◽  
Marco Delsante ◽  
Avi Z Rosenberg ◽  
Paride Fenaroli ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Regression Models ◽  
Kidney Biopsy ◽  
Cox Regression ◽  
Activity Index ◽  
Renal Recovery ◽  
Early Predictors ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims The prognosis of lupus nephritis (LN) has become progressively more favorable thanks to the introduction of cyclophosphamide and mycophenolate as the mainstay of induction of remission treatment regimens. However, 10-15% of patients still progress to end-stage renal disease (ESRD). Early predictors of ESRD, i.e. in the first six months between kidney biopsy and the completion of induction, are currently limited to few histological and clinical features: ≥ 25% interstitial fibrosis and tubular atrophy (IFTA), fibrinoid necrosis, fibrous crescents, and thrombotic microangiopathy (TMA) [Rijnink EC et al CJASN 2017; Song D Arthritis Res Ther 2013]; lack of decrease in proteinuria &lt; 0.5 g/24-h at 3 and 6 months from kidney biopsy [Tamirou F Ann Rheum Dis 2016], baseline GFR ≤ 90 ml/min/1.73 m2, lack of decrease in urinary protein-to-creatinine ratio (UPCR) &lt; 1 and anti-dsDNA positivity at the end of induction [Dall’Era M Lupus Sci Med 2015]. In this study we sought to identify further clinical and histological predictors of ESRD in LN. Methods Adult patients diagnosed with LN between 1995 and 2018 in two centers (NIAMS, Bethesda, Maryland, USA, and Nefrologia, AOU di Parma, Italy) were retrospectively identified. Patients with available serum C3 and C4 levels at the time of biopsy and 6 months thereafter, and a follow-up of at least 6 months, were included. Baseline and follow-up data (until March 2019) including age, sex, ethnicity, clinical, histological and laboratory findings were collected. Histology slides were reviewed by an experienced renal pathologist and biopsies re-scored using the ISN/RPS classification and NIH activity and chronicity indices. Distinct histological features were assessed individually (e.g. TMA). Persistent C3 hypocomplementemia was defined as decreased serum C3 levels at the time of biopsy and after 6 months (i.e. after the completion of induction), with concurrent normal serum C4 levels at 6 months. Early renal recovery was defined as either an increase in eGFR above 60 in those with a baseline eGFR &lt; 60 ml/min/1.73 m2, or a 50% decrease in proteinuria in those with a baseline eGFR ≥ 60 ml/min/1.73 m2 and ≥ 0.5 g/24-h or g/g UPCR at the time of biopsy. Variables were tested for their predictive power of death-censored ESRD in univariate and multivariate Cox regression models. Results 74 patients (NIAMS n = 36; Parma n = 38) met our criteria. Median follow-up duration was 64 months (range 6-230). On univariate analysis, the following parameters predicted ESRD: Hispanic ethnicity; age at biopsy; persistent C3 hypocomplementemia; normalization of both C3 and C4; renal recovery after induction; NIH activity index; presence of TMA; ≥ 25% IFTA. Multivariate Cox regression models for ESRD were created considering statistically significant variables (p &lt; 0.05). In a model including Hispanic ethnicity, age at biopsy, and persistent C3 hypocomplementemia, the latter predicted ESRD with an HR of 5.22 (95% CI [1.33, 20.58] p = 0.018) when adjusting for renal recovery after induction. Upon including histological features in the model, persistent C3 hypocomplementemia, TMA, and the NIH activity index lost significance, while ≥ 25% IFTA predicted ESRD with an HR of 27.26 (95% CI [2.12, 350.54], p = 0.011). Conclusion In patients with LN, ≥ 25% IFTA at baseline biopsy is a predictor of ESRD, allowing for early risk stratification with the potential of informing treatment strategies. Where percent IFTA is unavailable or its assessment unreliable (e.g. inadequate biopsy specimen for tubulointerstitial assessment), persistent C3 hypocomplementemia represents a reliable and reproducible early predictor of ESRD, irrespective of early renal recovery after induction.

Clinical Outcomes of Total Ankle Arthroplasty With Total Talar Prosthesis

2019 ◽  
Vol 40 (8) ◽  
pp. 948-954
Author(s):  
Noriyuki Kanzaki ◽  
Nobuaki Chinzei ◽  
Tetsuya Yamamoto ◽  
Takahiro Yamashita ◽  
Kazuyuki Ibaraki ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
The Mean ◽  
End Stage ◽  
Medial Malleolus Fracture

Background: Total ankle arthroplasty (TAA) has been developed to treat patients with end-stage ankle osteoarthritis (OA). However, there is often difficulty in treating complicated pathologies such as ankle OA with subtalar joint OA and severe talar collapse. Therefore, this study aimed to explore the short-term results and complications of TAA with total talar prosthesis, known as combined TAA, as the new techniques to treat such complicated pathology. Methods: We examined postoperative results including ankle range of motion, Japanese Society for Surgery of the Foot (JSSF) scale, and complications. There were 22 patients (15 women), with mean follow-up of 34.9 (range, 24–53 months), and the mean age was 72 (range, 62–80) years. The main indications for combined TAA included osteoarthritis (18 patients), rheumatoid arthritis (3 patients), and talar osteonecrosis with osteoarthritis (one patient). Results: The mean range of motion improved from 4.0 to 14.4 degrees in dorsiflexion and from 23.8 to 32.0 degrees in plantarflexion. The JSSF scale improved from 50.5 to 91.5 points. Prolonged wound healing occurred in 3 patients, and medial malleolus fracture occurred in 4 patients. Conclusion: Combined TAA was a reliable procedure for the treatment of not only ankle OA following avascular necrosis of talus but also of degeneration of both ankle and subtalar joints. Level of Evidence: Level IV, case series.

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