Serum Bilirubin Is Correlated With the Progression of IgA Vasculitis With Nephritis

Background: Bilirubin has been identified as an endogenous antioxidant and cellular protectant. The present study was performed to clarify the potential influence of serum bilirubin on IgA vasculitis with nephritis (IgAV-N).Methods: One hundred and eighty-nine IgAV-N patients over 14 years old were enrolled. The patients were divided into two groups by the optimum cut-off value calculated by ROC curve. The composite endpoints were defined as a 60% decline in estimate glomerular filtration rate (e-GFR), end-stage renal disease (ESRD) and/or death. Kaplan-Meier (K-M) analysis and multivariate Cox analysis were carried out to determine the predictors for renal outcomes. In order to eliminate the influence of different baseline data, a 1:2 propensity score (PS) match was performed to make the results comparable and convictive.Results: The baseline data suggested that patients in low serum bilirubin group had significantly higher levels of systolic blood pressure, proteinuria, serum creatinine and crescent formation ratio and lower levels of serum albumin and hemoglobin. Renal survival analysis indicated that lower serum bilirubin levels were significantly correlated with a poorer prognosis. Multivariate Cox analysis demonstrated that the higher level of serum bilirubin was an independent protective factor for renal survival (HR, 0.172; 95% CI, 0.030–0.991; P = 0.049). After PS matching, the baseline characters of two groups had no statistical differences. Similar outcomes were demonstrated in K-M curve and the multivariate Cox analysis.Conclusion: Elevated bilirubin levels might be related to the favorable renal outcomes.

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A multicenter, prospective, observational study to determine association of mesangial C1q deposition with renal outcomes in IgA nephropathy

Scientific Reports ◽

10.1038/s41598-021-84715-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Li Tan ◽

Yi Tang ◽

Gaiqin Pei ◽

Zhengxia Zhong ◽

Jiaxing Tan ◽

...

Keyword(s):

Risk Factors ◽

Iga Nephropathy ◽

Cox Regression ◽

Renal Outcome ◽

Matched Cohort ◽

Negative Group ◽

Renal Survival ◽

Cox Regression Analysis ◽

Renal Outcomes

AbstractIt was reported that histopathologic lesions are risk factors for the progression of IgA Nephropathy (IgAN). The aim of this study was to investigate the relationships between mesangial deposition of C1q and renal outcomes in IgAN. 1071 patients with primary IgAN diagnosed by renal biopsy were enrolled in multiple study centers form January 2013 to January 2017. Patients were divided into two groups: C1q-positive and C1q-negative. Using a 1: 4 propensity score matching (PSM) method identifying age, gender, and treatment modality to minimize confounding factors, 580 matched (out of 926) C1q-negative patients were compared with 145 C1q-positive patients to evaluate severity of baseline clinicopathological features and renal outcome. Kaplan–Meier and Cox proportional hazards analyses were performed to determine whether mesangial C1q deposition is associated with renal outcomes in IgAN. During the follow-up period (41.89 ± 22.85 months), 54 (9.31%) patients in the C1q negative group and 23 (15.86%) patients in C1q positive group reached the endpoint (50% decline of eGFR and/or ESRD or death) respectively (p = 0.01) in the matched cohort. Significantly more patients in C1q negative group achieved complete or partial remission during the follow up period (P = 0.003) both before and after PSM. Three, 5 and 7-year renal survival rates in C1q-positive patients were significantly lower than C1q-negative patients in either unmatched cohort or matched cohort (all p < 0.05). Furthermore, multivariate Cox regression analysis showed that independent risk factors influencing renal survival included Scr, urinary protein, T1-T2 lesion and C1q deposition. Mesangial C1q deposition is a predictor of poor renal survival in IgA nephropathy.Trial registration TCTR, TCTR20140515001. Registered May 15, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074.

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The role of VEGF rs699947 polymorphism in End-Stage Renal Disease: A preliminary study

10.51271/kmj-0005 ◽

2021 ◽

pp. 19-23

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Protective Factor ◽

Public Health Problem ◽

Turkish Population ◽

Control Group ◽

Case Group ◽

Important Public Health Problem ◽

Stage Renal Disease ◽

End Stage

Aim: End-Stage Renal Disease (ESRD) is an important public health problem worldwide with an increasing incidence and prevalence. There are many environmental and genetic factors which contribute to the development of ESRD. Vascular endothelial growth factor (VEGF) has been suggested to play an important role in renal pathophysiology. The aim of this study was to determine the probable relation between ESRD and VEGF gene rs699947 polymorphism in Turkish population. Material and Method: Genotyping of rs699947 was carried out in 50 ESRD patients on dialysis treatment and 30 healthy controls, using a Kompetitive Allelic-Specific PCR (KASP) method following DNA isolation. Demographic and clinical characteristics of the patients were recorded. Results: The prevalance of rs699947 AA genotype was found to be higher in the control group, but it was not statistically significant (p>0.05) . Conclusion: Although statistically insignificant, the frequency of AA genotype was higher in the control group compared to the case group, therefore we concluded that AA genotype may be a protective factor for ESRD in Turkish population. However, this conclusion needs to be further verified by future studies performed in larger study groups.

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Identification of patients with autosomal dominant polycystic kidney disease at highest risk for end-stage renal disease.

Journal of the American Society of Nephrology ◽

10.1681/asn.v8101560 ◽

1997 ◽

Vol 8 (10) ◽

pp. 1560-1567 ◽

Cited By ~ 1

Author(s):

A M Johnson ◽

P A Gabow

Keyword(s):

Kidney Disease ◽

Risk Ratio ◽

End Stage Renal Disease ◽

Autosomal Dominant ◽

Renal Survival ◽

Polycystic Kidney ◽

Autosomal Dominant Polycystic Kidney ◽

Stage Renal Disease ◽

End Stage ◽

Risk Ratios

To identify those potential factors that, early in the course of disease, mark a population of patients with autosomal dominant polycystic kidney disease (ADPKD) who have worse renal survival, survival analysis and risk ratio calculation for 1215 ADPKD patients were performed. Survival times were calculated as time to dialysis, transplantation, or death. Risk ratios were calculated using the Cox proportional hazards model. Three hundred eighty-eight patients entered end-stage renal disease and 205 patients died. ADPKD2 subjects had longer renal survival than ADPKD1 subjects (median survival, 68 versus 53 yr; P < 0.0005; risk ratio, 2.5). Women had significantly better renal survival than men (56 versus 52 yr; P < 0.0001; risk ratio, 1.6). Subjects who were diagnosed before age 30 and those who developed hypertension before age 35 had worse renal survival than those subjects who were diagnosed after age 30 or those who remained normotensive after age 35, respectively (age of diagnosis: 49 versus 59 yr; P < 0.0001; risk ratio, 3.2; hypertension: 51 versus 65 yr; P < 0.0001; risk ratio, 4.4). Similarly, those who had an episode of gross hematuria before age 30 had a worse renal outcome than those who did not (49 versus 59 yr; P < 0.0001; risk ratio, 2.6). We have also calculated risk ratios for a combined model. When therapeutic interventions become available for this disease, these populations with high risk ratios should be considered for such interventions.

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Increased Risk of End-Stage Renal Disease in Familial IgA Nephropathy

Journal of the American Society of Nephrology ◽

10.1681/asn.v132453 ◽

2002 ◽

Vol 13 (2) ◽

pp. 453-460

Author(s):

Francesco Paolo Schena ◽

Giuseppina Cerullo ◽

Michele Rossini ◽

Salvatore Giovanni Lanzilotta ◽

Christian D’Altri ◽

...

Keyword(s):

Renal Disease ◽

Iga Nephropathy ◽

End Stage Renal Disease ◽

Upper Respiratory Tract ◽

Renal Survival ◽

First Degree Relatives ◽

Increased Risk ◽

Stage Renal Disease ◽

Tract Infections ◽

End Stage

ABSTRACT. Primary IgA nephropathy (IgAN) is characterized by recurrent episodes of macroscopic hematuria accompanied by upper respiratory tract infections or persistent asymptomatic microscopic hematuria with or without proteinuria. IgAN may involve one or more members of a family. Three generations of a cohort of 110 patients with biopsy-proven IgAN, living in Southern Italy, were checked for urinalysis, and the relative risk (RR) of developing the disease was evaluated. A total of 19 unrelated familial, 37 suspected, and 54 sporadic cases of IgAN were identified. Renal survival was estimated by the Kaplan-Meier method for censored data and compared by use of the log-rank test. More than 50% of the patients with IgAN clustered in kindred with more than two probably affected relatives. In 19 unrelated IgAN families, 8 had single-generation (SG) and 11 multigenerational (MG) involvement showing a prevalent vertical transmission of the trait. The RR was 16 times higher in first-degree relatives (odds ratio [OR], 16.4; 95% confidence interval [CI], 5.7 to 47.8; P < 0.0001) and >2 times higher, even if NS, in second-degree relatives (OR, 2.4; 95 % CI, 0.7 to 7.9; P = 0.145). The clinical and histologic picture of familial and sporadic IgAN appeared to be similar. The 20-yr renal survival rate from the apparent onset of the disease was significantly poorer in patients with familial (41%) than in patients with sporadic (94%) IgAN (P = 0.003). Furthermore, 15-yr renal survival from the time of renal biopsy was significantly worse in familial IgAN (P = 0.02); end-stage renal disease was present in 64% of familial and only in 8% of patients with sporadic IgAN. Finally, renal survival was significantly worse in patients belonging to families with SG rather than with MG involvement (P = 0.03). These data show, for the first time, that familial IgAN may be considered a nonbenign disease that occurs frequently in first-degree relatives. Familial IgAN has a poorer outcome than sporadic IgAN. Therefore, an accurate family history and urinalysis in all family members is urgently recommended in clinical practice. This procedure might avoid late referral of subjects with persistent and underestimated urinary abnormalities and late diagnosis of the disease.

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Association of serum bilirubin with renal outcomes in Han Chinese patients with chronic kidney disease

Clinica Chimica Acta ◽

10.1016/j.cca.2018.01.041 ◽

2018 ◽

Vol 480 ◽

pp. 9-16 ◽

Cited By ~ 5

Author(s):

Yan Liu ◽

Mengyuan Li ◽

Yaxiang Song ◽

Xinying Liu ◽

Jian Zhao ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Bilirubin ◽

Han Chinese ◽

Chinese Patients ◽

Renal Outcomes

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Relationship between renal biopsy and renal survival in elderly patients with chronic kidney disease: A propensity score matching approach

10.21203/rs.3.rs-21517/v1 ◽

2020 ◽

Author(s):

Xiaowei Lou ◽

Shizhu Yuan ◽

Wei Shen ◽

Yueming Liu ◽

Juan Jin ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Renal Biopsy ◽

Cox Regression ◽

Renal Survival ◽

Aged Patients ◽

Renal Outcomes ◽

Propensity Matching

Abstract Background The effect of renal biopsy on the prognosis of elderly patients with chronic kidney disease remains unclear. Thus, in this study, we aimed to evaluate the relationship between renal biopsy and renal survival in this population.Methods In this multi-centre retrospective study, the baseline characteristics among three groups were balanced by propensity matching. All patients were divided into three groups according to age and renal biopsy. The clinicopathological features at biopsy and renal outcomes during the follow-up were collected and analysed. Renal outcomes were defined as estimated glomerular filtration rate < 15 mL/min/1.73 m2, dialysis, renal transplantation, or death. The prognostic effects of renal biopsy were evaluated using Cox regression models. Results A total of 1313 patients were identified. After propensity matching, 390 patients were selected and divided into three groups. After a total follow-up period of 55 months, 20 (13.3%) patients (47.6% group 1 vs 7.41% group 2 vs 39.1% group 3) reached renal outcomes. No significant differences were found in renal outcomes among aged patients whether they underwent renal biopsy or not. Cox regression analysis revealed risk factors in aged patients including low albumin and high levels of proteinuria and serum creatinine (P < 0.05). Platelet count was significant only in aged patients who underwent renal biopsy (hazard ratio: 0.642, P < 0.05). Conclusion In conclusion, renal biopsy in the elderly has not shown benefits in terms of renal survival, conservative treatment appears to be a viable therapeutic option in the management of those people.

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Serum bilirubin and ischaemic stroke: a review of literature

Stroke and Vascular Neurology ◽

10.1136/svn-2019-000289 ◽

2020 ◽

Vol 5 (2) ◽

pp. 198-204

Author(s):

Xiao Wang ◽

Danhong Wu ◽

Ping Zhong

Keyword(s):

Ischaemic Stroke ◽

Serum Bilirubin ◽

Neuroprotective Effect ◽

Cochrane Library ◽

Cochrane Central Register ◽

Cochrane Database ◽

Central Register ◽

Comprehensive Search ◽

Endogenous Antioxidant ◽

The Cochrane Library

Bilirubin, a product of heme metabolism, is the most potent endogenous antioxidant which increases in many oxidative stress conditions such as stroke. It has been widely known to exert neuroprotective effect on stroke through mechanisms involved in development, therefore, it can influence the occurrence and prognosis of ischaemic stroke (IS). In this review, studies were identified by a comprehensive search of Pubmed, Embase, the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register) and Web of Science to examine the correlation between serum bilirubin levels and risks of developing IS as well as IS outcomes. Additional studies were identified by reviewing references and contacting authors.

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P0791MATRIX GLA PROTEIN AND PREMATURE VASCULAR CALCIFICATION IN PATIENTS WITH END-STAGE RENAL DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0791 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Lu Dai ◽

Abdul Rashid Tony Qureshi ◽

Jonaz Ripsweden ◽

Torkel B Brismar ◽

Magnus Söderberg ◽

...

Keyword(s):

Renal Disease ◽

Vascular Calcification ◽

Vitamin K ◽

End Stage Renal Disease ◽

Protective Factor ◽

Matrix Gla Protein ◽

Vascular Aging ◽

Dialysis Vintage ◽

Stage Renal Disease ◽

End Stage

Abstract Background and Aims Vitamin K is a potential protective factor against premature vascular aging and vascular calcification (VC). Whether vitamin K supplement could halt VC progression in patients with end-stage renal disease (ESRD) is not clear, partially due to the heterogeneity of measurements of VC in different vascular sites. Here we investigated the associations between non-phosphorylated, uncarboxylated matrix-Gla protein (dp-ucMGP), a circulating marker of vitamin K insufficiency, and premature vascular aging phenotypes evaluated by coronary artery calcium (CAC) scoring, aortic valve calcium (AVC) scoring, and histology scoring of presence of media calcification in vascular biopsies in patients with ESRD. Method In this observational cohort study, 223 ESRD patients (median age 54 years, 68% males) comprising non-dialysis patients (n=109), prevalent peritoneal dialysis (PD, n=80, median dialysis vintage 11.6 months) and prevalent hemodialysis patients (HD, n=34, median dialysis vintage 12.0 months) underwent baseline measurements of plasma dp-ucMGP and scoring of CAC and AVC by computed tomography scan. Framingham risk score (FRS), inflammation and other relevant clinical and biochemical data were determined at baseline. In a sub-group of patients (n=94), scoring of media calcification by histology in epigastric artery biopsies was also performed. Results Plasma dp-ucMGP levels (median 1568 pmol/L) significantly correlated with age (rho=0.38), presence of cardiovascular disease (CVD, rho=0.16), triglycerides (rho=0.19), FRS (rho=0.33), high-sensitivity C-reactive protein (hsCRP; rho=0.35), CAC score (rho=0.30) and AVC score (rho=0.24) but did not differ with regards to treatment modality (i.e. non-dialysis, PD and HD). In multivariate regression analyses, with adjustment for presence of CVD, FRS, hsCRP and triglycerides, increased dp-ucMGP levels were independently associated with increased CAC score (coefficients 0.12, p=0.04), but not with AVC score nor presence of media calcification in epigastric arteries. Conclusion Our data suggest that vitamin K insufficiency as indicated by increased dp-ucMGP levels associates with premature vascular calcification evaluated by CAC but not with AVC or media calcification assessed by histology. This discrepancy warrants further studies to explore the pathophysiological background between vitamin K metabolism and susceptibility of calcification in different vascular sites as well as the pattern of VC (i.e. intima and media calcification) within sites.

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Recent Advances in Treatments of Primary Focal Segmental Glomerulosclerosis in Children

BioMed Research International ◽

10.1155/2016/3053706 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Kyoung Hee Han ◽

Seong Heon Kim

Keyword(s):

Focal Segmental Glomerulosclerosis ◽

Calcineurin Inhibitors ◽

Steroid Treatment ◽

Renal Survival ◽

Steroid Resistant ◽

Segmental Glomerulosclerosis ◽

Risk Of Progression ◽

Traditional Therapies ◽

Stage Renal Disease ◽

End Stage

Focal segmental glomerulosclerosis (FSGS) is a nephrotic syndrome. Up to around 80% of cases of primary FSGS are resistant to steroid treatment. A large proportion of patients with steroid-resistant FSGS progress to end-stage renal disease. The purpose of treatment is to obtain a complete remission of proteinuria, a necessary step that precedes improved renal survival and reduces the risk of progression to chronic kidney disease. When this is not possible, the secondary goal is a partial remission of proteinuria. Reduction or remission of proteinuria is the most important factor predictive of renal survival. We will review the current updated strategies for treatment of primary FSGS in children, including traditional therapies consisting of corticosteroids and calcineurin inhibitors and novel therapies such as rituximab, abatacept, adalimumab, and fresolimumab.

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The Crescentic Implication of Renal Outcomes in Proliferative Lupus Nephritis

The Journal of Rheumatology ◽

10.3899/jrheum.170553 ◽

2018 ◽

Vol 45 (4) ◽

pp. 513-520 ◽

Cited By ~ 7

Author(s):

Fanghao Cai ◽

Fei Han ◽

Hongya Wang ◽

Haidongqin Han ◽

Jingyun Le ◽

...

Keyword(s):

Risk Factors ◽

Lupus Nephritis ◽

Renal Survival ◽

Endstage Renal Disease ◽

Tubular Atrophy ◽

Renal Outcomes ◽

Proliferative Lupus Nephritis ◽

Independent Risk Factors ◽

Cox Proportional Hazard Regression ◽

Renal Tubular

Objective.To determine the association between crescents and renal outcomes, and the implications on therapeutic choices.Methods.There were 231 patients with biopsy-proven proliferative lupus nephritis (PLN) who were divided into 4 groups: 59 patients were in the noncrescent group (NC); 59 patients exclusively with segmental crescents were in the segmental crescent group (SC); patients with circumferential crescents were categorized into 2 groups according to the crescentic ratio (C1 had 64 patients with ≤ 25%, and C2 had 49 patients with > 25%). Their baseline laboratory tests, histopathological manifestations, and outcomes were compared.Results.Remission rates in NC, SC, C1, and C2 groups were 92.1%, 85.4%, 95.0%, and 76.1%, respectively. Fewer patients in the C2 group achieved complete remission than the other 3 groups. For longterm outcomes evaluated by serum creatinine (SCr) doubling or endstage renal disease (ESRD), the renal survival rate was lowest in the C2 group (p = 0.003). Including clinical and pathological variables in the Cox proportional hazard regression model separately, the multivariate analysis revealed that these were independent risk factors for SCr doubling or ESRD: baseline SCr (with every 1 mg/dl increase: HR = 1.834, 95% CI 1.465–2.296; p < 0.001), hemoglobin (with every 1 g/l increase: HR = 0.970, 95% CI 0.947–0.992; p = 0.009), the proportions of cellular crescents (with every 1% increase: HR = 1.040, 95% CI 1.015–1.066; p = 0.002) and fibrocellular crescents (with every 1% increase: HR = 1.085, 95% CI 1.013–1.163; p = 0.020), and severe renal tubular atrophy (HR = 5.348, 95% CI 1.278–22.373; p = 0.022).Conclusion.PLN with crescents > 25% had worse renal outcomes both in short and long terms. Proportions of cellular and fibrocellular crescents were independent risk factors for poor renal survival.

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