Comment on: IgA nephropathy with early kidney disease is associated with increased arterial stiffness and renin-angiotensin system activity

We read with great interest the article by Abdi-Ali et al. entitled IgA nephropathy with early kidney disease is associated with increased arterial stiffness and renin-angiotensin system activity in the recent issue of Journal of the Renin-Angiotensin-Aldosterone System. In a study on 10 normotensive IgA nephropathy (IgAN) subjects with early kidney disease and 10 gender- and blood pressure-matched healthy controls, blood pressure and arterial stiffness, expressed as pulse wave velocity and aortic augmentation index, at baseline and in response to 60 min of angiotensin II (AngII) infusion were measured. They found that IgAN patients had an increased aortic augmentation index and a trend towards increased circulating renin-angiotensin system components at baseline, compared with controls

COVID-19 and renal involvement; evolving role of thromboinflammation, vascular and glomerular disease in the pathogenesis

Coronavirus disease 2019 (COVID-19), the currently prevailing pandemic that has besieged the whole world, is caused by a novel coronavirus, named as, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially, there was a focus on respiratory disease, which was and is the most predominant presentation. However, with increasing spread of the infection and consequent increasing knowledge and experience about the disease, it has become apparent that the virus has wide-ranging effects on other organs and systems, including heart, blood, kidney and gastrointestinal tract. A variety of mechanisms are involved in viral damage of these organs. Blood vessels, particularly the microvasculature, and blood clotting systems are also frequently targeted by the virus, especially in severe cases. This review narrates the available evidence on the mechanisms underlying hypercoagulability and thrombotic tendency in COVID-19 disease

Association of glomerular C4d deposition with various demographic data in IgA nephropathy patients; a preliminary study.

BACKGROUND IgA nephropathy (IgAN) is the most prevalent primary chronic glomerulopathy worldwide. Thus, it is of vital importance to search for factors aggravating the disease progress, monitor disease activity and predict disease-specific therapy. C4d is a well-known biomarker of the complement cascade with a potential to meet the above needs. OBJECTIVES The aim of our study was, therefore, to determine whether C4d staining at the time of kidney biopsy had any correlation with the demographic, clinical and biochemical variables in IgAN. PATIENTS AND METHODS The definition of IgAN requires the presence of diffuse and global IgA deposits which were graded ≥2+ and weak C1q deposition. C4d immunohistochemical staining was conducted retrospectively on 29 renal biopsies of patients with IgAN, which were selected randomly from all biopsies. C4d immunohistochemical staining was performed on 3-μm deparaffinized and rehydrated sections of formaldehyde-fixed, paraffin-embedded renal tissues. RESULTS Of 29 selected patients, 68% were male. In this study, 54.2±25 percent of glomeruli in all biopsies were positive for C4d. The mean and standard deviation (SD) of serum creatinine and the magnitude of proteinuria were 1.72±1.2 mg/dl and 1582±1214 mg/day, respectively. In this study, we observed statistically significant correlations of percent C4d positivity with the serum creatinine (r=0.61, p=0.0005), magnitude of proteinuria (r=0.72, p=0.0001), the proportion of globally sclerotic glomeruli (r=0.43, p=0.02) and the proportion of tubulointerstitial fibrosis (r=0.54, p=0.0023). CONCLUSIONS The results from our investigation on C4d positivity in biopsy-proven cases of IgAN are in accord with some of the previous studies. These findings, however, require further validation in larger samples

Clinicopathological correlations in lupus nephritis; a single center experience.

BACKGROUND Renal biopsies play an important role in the diagnosis, management and prognosis of patients with lupus nephritis (LN). OBJECTIVES To determine the correlation between the pathological features of LN and the demographic, clinical and laboratory parameters. PATIENTS AND METHODS This retrospective study was conducted from 2008 to 2014 on all consecutive cases of biopsy-proven LN at a nephropathology laboratory in Iran. The demographic, clinical and laboratory data were obtained from patients(') files and the biopsy findings from the original biopsy request forms. RESULTS Of the 84 patients enrolled, 69 (82.2%) were females and 15 (17.8%) males. The mean age was 32.7±12 years. The mean serum creatinine was 1.5±0.94 mg/dl and the mean 24-h proteinuria, 1.6±1.9 grams. The majority of cases belonged to classes III and IV. The extracapillary proliferation was found in 42.86% of biopsies and endocapillary proliferation in 66.67% of biopsies. Patients of class IV-LN had a higher mean serum value of creatinine in comparison to class III-LN (2.19±1.09 versus 1.2±0.56 mg/dl; p= 0.0001). There was no significant difference of 24-h proteinuria between the two classes (p= 0.882). A significant association of serum creatinine with 24-h proteinuria (p= 0.041) was seen. Serum creatinine had significant positive correlation with activity percent (p< 0.001), and chronicity percent (p= 0.006), and also with proportion of glomeruli with crescents (p < 0.001). While there was a significant relationship of proteinuria with chronicity percent (p= 0.001), this association for activity percent was not significant (p= 0.094). Furthermore, the association of proteinuria with totally sclerotic glomeruli and proportion of crescents was not statistically significant (p= 0.186 and p= 0.0145 respectively). CONCLUSIONS In conclusion, the results from our study on biopsy-proven cases of LN largely concur with the previously reported studies from Iran and other parts of the world