scholarly journals Combined Urinary Excretion of IgG and α2-Macroglobulina Very Simple Marker to Assess Disease Severity, Outcome Prediction and Responsiveness to Steroids and Cyclophosphamide in Patients with Chronic Glomerulonephritis and Nephrotic Syndrome

2021 ◽  
Vol 7 (2) ◽  
pp. 1-8
Author(s):  
Claudio Bazzi ◽  
Keyword(s):  
Nephrotic Syndrome ◽  
Urinary Excretion ◽  
Disease Severity ◽  
Outcome Prediction ◽  
Molecular Biomarkers ◽  
Chronic Glomerulonephritis ◽  
Treatment Responsiveness

In Glomerulonephritis (GN) with Nephrotic Syndrome (NS) proteinuric and molecular biomarkers don’t reach 100% of outcome prediction and treatment responsiveness.

scholarly journals May be Urinary Excretion of α2-macroglobulin (MW 720 kDa) a Proteinuric Marker of Podocytopathy? Insight from Analysis of 204 Patients with Glomerulonephritis (GN) and Nephrotic Syndrome, 177 with Functional Outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 01-06
Author(s):  
Claudio Bazzi
Keyword(s):  
Nephrotic Syndrome ◽  
Clinical Practice ◽  
Urinary Excretion ◽  
Functional Outcome ◽  
Clinical Significance ◽  
Α2 Macroglobulin ◽  
Progression Risk ◽  
Treatment Responsiveness

Background: In IgAN with cellular crescents (CIgAN) urinary excretion of α2-macroglobulin (α2m/C, MW 720 kDa) may be a marker of podocytes damage induced by crescents. The purpose of the study was the evaluation of the clinical significance of α2m/C excretion in 177 patients with glomerulonephritis (GN), nephrotic syndrome (NS) and functional outcome. Methods: In all 177 patients α2m/C excretion was measured; the patients were divided in 2 groups: α2mC=0 (n. 72) and α2m/C >0 (n. 105); for each group were assessed the outcomes considered in combination: Remission & persistent nephrotic syndrome (PNS) with long lasting NRF designed “Remission & NRF”; ESRD & eGFR < 50% & PNS with CRF designed “Progression and progression risk”. Results: In 72 patients with α2m/C=0 “Remission & NRF” was 78% and “Progression & progression risk” was 22%; in 105 patients with α2m/C>0 “remission & NRF” was 52% and “Progression & progression risk” was 48%. “Remission & NRF” in each GN type with α2m/C=0 was: 100% in MCD and LN; 82%, 79%, 67% in FSGS, IMN, MPGN; in α2m/C>0 “Progression and progression risk” was 0%, 38%, 46%, 54%, 56%, 85% in MCD, LN, IMN, MPGN, FSGS, CIgAN with cellular crescents, respectively. Conclusion: Urinary excretion of α2m is a very simple marker available in all clinical practice laboratories, marker of damage of podocytes at least in CIgAN and LN with crescents and marker of GFB damage in different GN types and useful to predict outcome and treatment responsiveness.

CORTICOSTEROIDS AND ANTIDIURETIC SUBSTANCE IN NEPHROTIC CHILDREN

PEDIATRICS ◽  
1953 ◽  
Vol 12 (3) ◽  
pp. 233-252
Author(s):  
ENRIQUE GALÁN ◽  
MANUEL PÉREZ-STABLE ◽  
ORLANDO GARCÍA FAEZ ◽  
EMILIO UNANUE ◽  
OTTO GARCÍA ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Urinary Excretion ◽  
Ascitic Fluid ◽  
Renal Hemodynamics ◽  
Tubular Function ◽  
Urinary Flow ◽  
Adrenal Steroids ◽  
Functional Disturbance ◽  
Urinary Steroids ◽  
Nephrotic Children

The role of tubular reabsorption in the pathogenesis of nephrotic edema led the authors to study the participation of antidiuretic hormone and adrenal steroids in regard to changes in renal hemodynamics and tubular function during different clinical events that may induce an increase or a decrease of urinary flow in nephrotic children. Formaldehydogenic steroids in urine, plasma and ascitic fluid and serum antidiuretic substance were simultaneously studied with clearance tests, electrolyte excretion and plasma constituents through 10 different periods of observations. From previous and present studies on renal function it was found that changes in renal hemodynamics and tubular transport mechanisms are responsible for variations in urinary flow leading to accumulation or disappearance of edema in the nephrotic syndrome. An increase in urinary flow was seen to occur with no change in the GFR but with a marked decrease in the U/P inulin and potassium ratio. Serum antidiuretic substance appeared to correlate closely with antidiuresis. Injection of nephrotic sera into peritoneal cavity of rats was followed by an antidiuretic effect similar to that produced by pitressin and posterior pituitary hormone. Antidiuretic factor seemed to be present in the globulin fraction of plasma proteins. No such effect was seen with intraperitoneal injections of plasma albumin, protein-free filtrate and ascitic fluid. An increase in titer of antidiuretic substance was observed during initial doses of ACTH and the reverse at the onset of diuretic response. Urinary excretion of formaldehydogenic steroids depended partly on diuresis in nephrotic children; this was not so in control cases. The influence of tubular function was suggested by the relationship found between urinary excretion of steroids and the V/Cin and V/Cth ratio and between clearance of steroids and diuresis. The influence of renal functional disturbance prevented a correct evaluation of adrenal activity by estimation of urinary steroids in nephrotic children. During the edematous-oliguric stage of nephrosis and in the absence of any stimulating or depressing effect upon the elaboration of adrenal steroids their urinary excretion was not significantly different from that seen in control cases. Formaldehydogenic steroids did not seem to have a direct role in producing variations of urine flow in nephrotic children. Increase and decrease in diuresis occurred simultaneously with an increase and a decrease in urinary and plasma steroids and vice versa. Formaldehydogenic material was found in variable amounts in the ascitic fluid suggesting an appreciable retention in the increased extracellular fluid during the oliguricedematous stage of the nephrotic syndrome. This material appears to be mostly true adrenal steroids. Potassium excretion was related to urinary steroids in nephrotic children but not in control cases. Potassium clearance was related to glomerular filtration in both control and nephrotic children. At the present time it remains a matter of some speculation of the role that steroids present in extracellular fluids may play in the physiologic and morphologic changes known to occur in the course of the nephrotic syndrome and experimentally reproduced by injection of DOCA to animals.

scholarly journals ASSOTIATIONS OF PECULIARITIES OF HLA-PHENOTYPE AND THE SENSIBILITY TO THE CORTICOSTEROID TREATMENT IN PATIENTS WITH CHRONIC GLOMERULONEPHRITIS WITH NEPHROTIC SYNDROME

2017 ◽  
pp. 37-44
Author(s):  
M. Kolesnyk ◽  
G. Drannik ◽  
V. Driyanska ◽  
O. Petrina ◽  
M. Velychko
Keyword(s):  
Nephrotic Syndrome ◽  
Hla Antigens ◽  
Corticosteroid Treatment ◽  
Steroid Resistance ◽  
Control Group ◽  
Chronic Glomerulonephritis ◽  
Healthy Donors ◽  
Steroid Sensitive ◽  
Steroid Sensitivity ◽  
Hla Phenotype

The purpose of study was determination of HLA -antigens I and II classes as predictors of ineffectiveness of initial steroid therapy, and according prognozonegative markers of chronic glomerulonephritis with nephrotic syndrome. Methods. In 59 chronic glomerulonephritis with nephrotic syndrome patients (steroid sensitive n=33 (1 gr.) and steroid resistant’s n= 26 (2 gr.)) and 350 healthy donors( control group) studied HLA antigens I and II classes of the special anti- HLA-antigens panel (20 antigens of locus A, 31 – of locus B and 9- of locus DR). Result. In patients with chronic glomerulonephritis, nephrotic syndrome with hormone sensitivity relative risk is high at the presents of A28 (RR=8,5, r р <0,001), it made attributive risk (=0,37). In comparison with a control group, RR>2 for antigens  A11  (RR=2,23), A23 (RR=4,28),  A24 (RR=3,3),  A29 (RR=10,78) that A30 (RR=11,23); attributive risk more than 0,1 for the antigen A11 (=0,16) ; A24 (=0,13), other did not differ from control. Subzero connection is exposed for the antigens of A2 (р<0,001), А9 (р=0,007). In locus antigen B14 (RR=5,65, р =0,001) are exposed, B44 (RR=48,25, р =0,004), B51(RR=12,32, р =0,006) and attributive risk of development of disease (according =0,24, 0,12 ; 0,14); and antigens B38 and B41 (RR=11,57, р=0,05). The steroid sensitivity was associated with the antigens B5 (p=0,033), B12 (p=0,005) and B35 (p=0,021). In locus DR made etiologic faction antigens DR4 (RR=7,0 and =0,24) DRw52 (RR=7,0 and =0,25). Conclusions. For patients with chronic glomerulonephritis with a nephrotic syndrome antigens of HLA-B14,B38, B51, DRw52 are associated with steroid sensitivity. The attributive risk of steroid resistance is high for split A19+31+32, antigens B8, B55.

Urinary Excretion of Apolipoproteins Bound to HDL-Like Particles in Rat Nephrotic Syndrome and Their Relation to Plasma HDL

Nephron ◽  
1990 ◽  
Vol 56 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Eleazar Shafrir ◽  
Emile Levy ◽  
Richard Deckelbaum
Keyword(s):  
Nephrotic Syndrome ◽  
Urinary Excretion

Approach to the Patient with Glomerular Disease

2018 ◽  
Author(s):  
Richard J. Glassock ◽  
An S De Vriese ◽  
Fernando C. Fervenza
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Rapidly Progressive Glomerulonephritis ◽  
Chronic Glomerulonephritis ◽  
Glomerular Diseases ◽  
Diagnosis And Prognosis ◽  
Protein Excretion ◽  
Clinical Syndromes ◽  
Organ Systems ◽  
Therapeutic Decision Making

Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making. This review contains 4 figures, 6 tables and 92 references Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement

scholarly journals Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian Adults: A 13-Year Retrospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Perditer Okyere ◽  
Isaac Okyere ◽  
Richard Kobina Dadzie Ephraim ◽  
Joseph Attakorah ◽  
Charlotte Osafo ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Disease ◽  
Teaching Hospital ◽  
Clinical Characteristics ◽  
Treatment Options ◽  
Renal Diseases ◽  
Chronic Glomerulonephritis ◽  
Randomized Sampling ◽  
Leg Edema ◽  
Stage Renal Disease

Background. Renal diseases over the years have become one of the leading causes of morbidity and mortality worldwide. In this study, we assessed the spectrum and clinical characteristics of Ghanaians with renal diseases at the nephrology unit of Komfo Anokye Teaching Hospital (KATH), Kumasi. Methods. This was a retrospective hospital-based study conducted at Komfo Anokye Teaching Hospital (KATH) from the years 2005 to 2017. A non-randomized sampling approach was used to include 1426 participants who were diagnosed with AKI, CKD, ESRD, and nephrotic syndrome at the nephrology unit of KATH during the years under review. All the 1426 patients were eligible for the study. Demographic characteristics as well as clinical data such as the kind of renal disease presentation, causes of the renal disease, and the treatment options were also obtained from their records. Results. Overall, 1009 of the total participants had CKD (70.76%), 295 participants had ESRD (20.69%), 72 participants had AKI (5.05%), and 50 participants had nephrotic syndrome (3.51%). Furthermore, 69 (23.4%) participants with ESRD were on dialysis whiles 6 (8.3) and 17 (1.7) participants with only AKI and CKD superimposed AKI, respectively, were on dialysis. 226 (76.6%) participants with ESRD were on conservative therapy. Hypertension emerged as the major cause of renal disease presentation (53.93%) with bilateral leg edema (13.46%) being the major complaint. There was a significant association between CKD and age (p≤0.001). Nephrotic syndrome also showed a significant association with age (p≤0.001). Conclusion. This study revealed that patients at the nephrology unit of KATH, Ghana, are mainly adults between ages 46–55. The clinical pattern of renal diseases is dominated by CKD and ESRD. We conclude that hypertension, chronic glomerulonephritis, diabetic nephropathy, and sepsis are the most common causes of renal diseases. The commonest clinical presentations are bilateral leg edema, palpitations, headache, breathlessness, dizziness, and vomiting. Early diagnosis and management of these conditions may prevent or delay the progress to end-stage renal disease.

A SEVERITY SCORING SYSTEM FOR OUTCOME PREDICTION IN CATS WITH PANCREATITIS

2017 ◽  
Vol 43 (04) ◽  
pp. 269-275
Author(s):  
Bi-Ling Su ◽  
Shu-Yu Wang ◽  
Pin-Chen Liu
Keyword(s):  
Disease Severity ◽  
Scoring System ◽  
Outcome Prediction ◽  
Clinical Signs ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Laboratory Findings ◽  
Severity Scoring ◽  
Imaging Results ◽  
The Mean

In order to develop a clinically applicable severity scoring system in cats with pancreatitis, 41 cats diagnosed with pancreatitis and hospitalized between 2011 and 2013 with their complete medical history were selected for analysis. Clinical signs, physical examination findings, laboratory findings, diagnostic imaging results, complications and concurrent diseases were analyzed to evaluate potential prognostic factors and further establish the severity scoring system. The mortality of cats selected in this study due to pancreatitis was 48.8%. Abnormalities in hemoglobin, albumin, blood urea nitrogen, total bilirubin, phosphorous and blood pressure were significantly associated with disease severity and prognosis and were selected for constructing the system. The abnormal range for each variable was further partitioned into quartiles, which were recorded into categorical variables. The weighting factors were calculated from the odds ratios (OR) between each of the quartiles and the normal range category. The area under curve (AUC) of the six continuous variables system at presentation and after rehydration of the cats was 0.873 and 0.976, respectively. The scores of 41 cats after rehydration ranged from 7 to 36 points. The mean score was [Formula: see text], the median 17 points and the mode 32 points. The optimal cut-off point for outcome prediction was 17.5 with a sensitivity of 95.2% and specificity of 95.5%. The mortality was 95% with a [Formula: see text], whereas 4.8 % had a [Formula: see text]. The severity scoring system provides a reliable and clinically applicable method to predict disease severity in cats with pancreatitis.

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