Mesangial cell-binding activity of serum immunoglobulin G in patients with lupus nephritis

In vitro data showed that immunoglobulin G (IgG) from patients with lupus nephritis (LN) could bind to cultured human mesangial cells (HMC). The clinical relevance of such binding was unknown. Binding of IgG and subclasses was measured in 189 serial serum samples from 23 patients with Class III/IV+/-V LN (48 during renal flares, 141 during low level disease activity (LLDA)). 64 patients with non-lupus glomerular diseases (NLGD) and 23 healthy individuals were used as controls. HMC-binding was measured with cellular ELISA and expressed as OD index. HMC-binding index of total IgG was 0.12+/-0.09, 0.36+/-0.25, 0.59+/-0.37 and 0.74+/-0.42 in healthy subjects, NLGD, LN patients during LLDA, and LN flares respectively (P = 0.046, LN flare vs. LLDA; P<0.001, for healthy controls or NLGD vs. LN during flare or LLDA). Binding of serum IgG1 to HMC was 0.05+/-0.05, 0.15+/-0.11, 0.41+/-0.38 and 0.55+/-0.40 for the corresponding groups respectively (P = 0.007, LN flare vs. remission; P<0.001, for healthy controls or NLGD vs. LN during flare or remission). IgG2, IgG3 and IgG4 from patients and controls did not show significant binding to HMC. Total IgG and IgG1 HMC-binding index correlated with anti-dsDNA level (r = 0.26 and 0.39 respectively, P<0.001 for both), and inversely with C3 (r = -0.17 and -0.45, P<0.05 for both). Sensitivity/specificity of total IgG or IgG1 binding to HMC in predicting renal flares were 81.3%/39.7% (ROC AUC 0.61, P = 0.03) and 83.8%/41.8% (AUC 0.63, P = 0.009) respectively. HMC-binding by IgG1, but not total IgG, correlated with mesangial immune deposition in LN renal biopsies under electron microscopy. Our results showed that binding of serum total IgG and IgG1 in LN patients correlates with disease activity. The correlation between IgG1 HMC-binding and mesangial immune deposition suggests a potential pathogenic significance.published_or_final_versio

Transhepatic placement of haemodialysis catheter: A solution for vascular access exhaustion

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Transplant kidney herniation in an elderly patient

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Outcome of long-term treatment with mycophenolate mofetil in patients with severe lupus nephritis

Saturday Poster - Clinical Glomerular and Tubulointerstitial Disorders 2: abstract SA-PO337BACKGROUND: Corticosteroids with mycophenolate mofetil (MMF) has proven efficacy when used as induction or maintenance immunosuppression for proliferative lupus nephritis, but data on long-term mycophenolate mofetil treatment is lacking. METHODS: This was a single-centre retrospective study of patients with Class III/IV±V lupus nephritis who have received prednisolone and MMF continuously as treatment in the early phase and the long-term maintenance phase. RESULTS: 65 patientswere included. 31 patients were treated with only prednisolone and MMF throughout (Group I). 23 patients had their MMF substituted with azathioprine (AZA)(Group II) and 11 patients with calcineurin inhibitors (CNI)(Group III) at some point during the maintenance phase. The follow-up was 91.9±47.7 months. The 10-year patient and renal survival rates were 91% and 86% respectively, with no difference between the three groups. Relapse-free survival was higher in Group I than Group II and Group III (76% vs 56% vs 43% respectively at 5-year; 69% vs 32% vs 0% respectively at 10-year; I vs II, p=0.049; I vs III, p=0.019; II vs III, p=0.490). Patients who received MMF for more than 24 months showed better relapse-free survival than those treated for shorter durations (88% vs 48% respectively at 5-year; 81% vs 28% respectively at 10-year; p<0.001). Serum creatinine was lower in Group I at 10 years. Apart from more anemia with MMF treatment, the side-effects profile was similar in patients during MMF, AZA, or CNI treatment. CONCLUSIONS: Continuous treatment with corticosteroids and MMF as both induction and long-term maintenance immunosuppression is associated with favorable long-term outcome and possibly a lower risk of disease flare compared with other maintenance immunosuppressive medications.link_to_OA_fulltex

Gas in the renal shadow of a plain abdominal X-ray: emphysematous pyelonephritis

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Ruptured abdominal aortic aneurysm as a cause of spontaneous hemoperitoneum in a patient on peritoneal dialysis

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Epstein syndrome presenting as renal failure in young patients

Two young Chinese patients presented with renal failure and thrombocytopenia. Further investigations showed the presence of large platelets and high-frequency sensorineural hearing deficit. Genetic studies confirmed mutations in the gene encoding the myosin heavy chain (MYH-9), and Epstein Syndrome was diagnosed. One patient underwent deceased-donor kidney transplantation with satisfactory graft function. Epstein Syndrome is a rare genetic disorder with autosomal dominant inheritance. Clinicians should be aware of this entity when a young patient presents with renal failure and thrombocytopenia. © 2009 Informa UK Ltd All rights reserved.link_to_subscribed_fulltex

The Case Recurrent oral ulcers and diarrhea in a renal transplant patient

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Binding activity of serum immunoglobulin G to renal proximal tubular epithelial cells and its clinical correlation in lupus nephritis

Session - Clinical Nephrology, Primary and Secondary Glomerulonephritis - 1: no. FP149This free journal suppl. entitled: 52nd ERA-EDTA Congress, May 28th-31st, 2015, London, United KingdomINTRODUCTION AND AIMS: In vitro data suggested that immunoglobulin G (IgG) from lupus nephritis (LN) patients could bind to proximal renal tubular epithelial cells (PTEC), but its clinical relevance remained to be defined. METHODS: The binding activities of IgG and its subclasses to PTEC were measured with cellular ELISA in 189 serial serum samples from 23 Class III/IV±V LN patients (48 during renal flares, 141 during remission), and compared with samples from 64 patients with non-lupus glomerular diseases (NLGD) and 23 healthy controls. The binding indices of serum IgG to PTEC were expressed as OD. RESULTS: Total IgG PTEC-binding indices were 0.34±0.16, 0.29±0.16, 0.62±0.27 and 0.83±0.38 in healthy controls, NLGD, LN patients during remission, and LN patients during renal flare (P<0.001, remission vs. renal flare; P<0.001, healthy controls or NLGD vs. LN during remission or renal flare). PTEC-binding index for IgG1 was 0.09 ±0.05, 0.16±0.12, 0.44±0.34 and 0.71±0.46 for the corresponding groups (P<0.001, remission vs. renal flare; P<0.001, healthy controls or NLGD vs. LN during remission or renal flare). No significant binding to PTEC was observed for IgG2, IgG3 or IgG4. Sixteen of 48 episodes (33.3%) of nephritic flares, despite clinical response to immunosuppressive therapies, showed persistent seropositivity (mean duration 9.4±3.1 months) for PTEC-binding IgG. Total IgG and IgG1 PTEC-binding demonstrated a positive association with anti-dsDNA titres (r=0.34 and 0.52 respectively, P<0.001 for both), but a negative correlation with C3 level (r=-0.26 and -0.50 respectively, P=0.002 and <0.001). Sensitivity/specificity of PTEC-binding index in predicting renal flares was 45.8%/80.1% for total IgG (ROC AUC 0.630, P=0.007) and 87.5%/35.5% for IgG1 (ROC AUC 0.615, P=0.018). IgG1 PTEC-binding index correlated with tubulo-interstitial inflammation score in renal biopsies from corresponding patients. CONCLUSIONS: Total IgG and IgG1 PTEC-binding index in LN patients correlated with clinical and serological activity, and in combination could predict LN flares

Polymicrobal CAPD peritonitis after hysteroscopy

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