Journal of nephropathology
Volume:10 Issue: 1, Jan 2020

Syndecan 1 (SCD1) is a lectin expressed at the surface of renal tubular epithelial cells and plasma cells. In epithelial cells, cell surface syndecan1 is cleaved by inflammation-induced proteases (eg, ADAMTS, MMP), since loss of cell surface syndecan1 is associated with higher susceptibility to cell damage.

To explore a potential additional value of SCD1 immunohistochemical expression in lupus nephritis specimens of different ISN/RPS classes and NIH activity and chronicity indices. Patients and

This retrospective study included 50 renal biopsy specimens diagnosed as lupus nephritis at the pathology laboratory, and electron microscopy (EM) laboratory of Ain-Shams University specialized hospitals. Data were collected from records as personal data, medical history and laboratory results including serum creatinine and proteinuria. Immunohistochemical expression of syndecan-1 was evaluated in renal tubular epithelial cells (TECs) followed by correlation with different clinicopathological parameters.

Fifty renal biopsy specimens with lupus nephritis including 14 cases of class II, 4 cases of class III, 20 cases of class IV and 12 cases of class V were re-evaluated. The mean serum creatinine was 1.57 ± 0.67 mg/dL. Nine cases (18%) were negative for proteinuria, while 41 cases (82%) were presented with proteinuria with a mean of 1.5 ± 0.9 g/24 h. There was no statistically significant difference in the percentage of SCD-1 expression with different lupus classes. Serum creatinine and albumin showed a statistically significantly different correlation with semiquantitative score of SCD-1 expression. The highest value of creatinine detected with score 1 of SCD-1 expression (P=0.038) and the highest value of urinary albumin was recorded with score 1 of SCD-1 expression. Accordingly, the lowest mean of urinary albumin recorded in SCD-1 score 3 (P<0.001). There was a weekly negative association between loss of SCD-1 expression and increased NIH activity and chronicity indices.

Loss of syndecan immunohistochemical expression in renal TECs in lupus nephritis is highly associated with proteinuria and elevated serum creatinine and can be used as a predictive marker for disease severity and progression.

Atorvastatin hinders cardiovascular disease by reducing cholesterol levels. Proprotein convertase subtilisin/kexin type 9 (PCSK9) enhances the secretion of insulin by binding to LDLreceptor. Sortilin is committed in the transfer of intracellular proteins through the plasma membrane.

The purpose of this research was to determine the effect of atorvastatin consumption on alterations in the levels of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA-R), PCSK9 and sortilin in diabetic patients and pre-diabetics. Patients and

This study was carried out on 80 individuals including normal subjects, diabetic patients and pre-diabetics. The participated individuals were divided as control group (i) (healthy individuals without diabetes mellitus), diabetic group receiving statin (ii), diabetic group not receiving statin (iii), pre-diabetic group receiving statin (iv) and pre-diabetic group not receiving statin (v). Levels of HMG-COA-R, PCSK9 and sortilin were determined by ELISA method.

In diabetics and pre-diabetics taking atorvastatin, the level of HMG-COA-R was not altered significantly compared to diabetics and pre-diabetics not taking atorvastatin, respectively (P> 0.05). The serum PCSK9 level in diabetics and pre-diabetics was significantly higher than the healthy individuals (P= 0.001). Additionally, the serum PCSK9 level in diabetics and pre-diabetics receiving atorvastatin was significantly higher than diabetics and pre-diabetics not receiving atorvastatin, respectively (P=0.001). The serum sortilin level in diabetics and pre-diabetics was significantly higher than the healthy individuals (P=0.001). In addition, the serum sortilin level in pre-diabetics receiving atorvastatin was significantly higher than pre-diabetics not receiving atorvastatin (P=0.001).

Atorvastatin improved insulin secretion and sensitivity by increasing serum sortilin and PCSK9 levels. Thereby, it prevented the development of diabetes in diabetics and the progression of pre-diabetes to diabetes in pre-diabetics.

Klotho allele status is associated with increased risk of cardiovascular diseases, diabetes and hypertension.

To determine if serum klotho level was lower among diabetic and hypertensive patients compared to control group. Patients and

This was a cross-sectional study of 90 participants. Thirty pure diabetic patients and 30 participants with pure hypertension were compared with the healthy control group. Multiple logistic regressions were used to examine the association between serum klotho and diabetes and hypertension. We also tested the cut off point of serum klotho to predict hypertension and diabetes by using ROC (receiver operating characteristic) curve.

The level of serum klotho was significantly lower in diabetic and hypertensive patients. Participants with higher klotho were less likely to have diabetes and hypertension [OR: 0.48, 95% CI (0.22-0.81)] even after adjustment for covariates. ROC curve for diabetes and hypertension indicated 0.8 area under the curve which was statistically significant.

This study found that serum klotho was associated with lower odds of diabetes and hypertension. Further longitudinal studies are necessary to confirm this finding.

HIV immune complex disease of the kidney (HIVICK) is a rare but increasingly well-recognised cause of renal dysfunction and proteinuria in HIV-positive patients. A 56-year-old man with known HIV, diabetes mellitus type 2, liver cirrhosis and previous Hepatitis C virus (HCV) presented with a labile estimated glomerular filtration rate and significant proteinuria. Electron microscopy from a renal biopsy identified capillary wall deposition for IgG, IgM, Kappa, Lambda and focal C1q consistent with membranoproliferative glomerulonephritis (MPGN) and associated immune complex disease. A second opinion of the images confirmed the diagnosis of HIVICK. The increased recognition of HIVICK in HIV patients should prompt further research into the causes and treatment options available.

End-stage renal disease (ESRD) is an advanced stage of chronic kidney disease requiring hemodialysis (HD). The long-term efficacy of HD in ESRD patients highly depends on treatment adherence.

This study aimed to validate the health action process approach (HAPA) questionnaire to predict treatment adherence in HD patients. Patients and

This cross-sectional study was conducted in in three teaching and two private hospitals in Shiraz during 2018. A total of 220 patients with ESRD under HD were selected using convenience sampling method. Furthermore, the validity, clarity, and comprehensiveness of the questionnaire were validated by a group of patients and experts. Then the exploratory factor analysis (EFA) was performed, and the reliability was determined using Cronbach’s alpha. Internal consistency was assessed using test-retest method (one-month interval) and calculating intra-class correlation coefficient (ICC) index.

Content validity index (CVI) and content validity ratio (CVR) were obtained 0.98 and 0.95 respectively indicating adequate content validity. Six constructs (risk perception, action self-efficacy, behavioral intention, planning, maintenance self-efficacy and recovery self-efficacy) were extracted using EFA. These constructs explained 51.4% of total variance. The Cronbach’s alpha of different constructs ranged from 0.68 to 0.82. Furthermore, the ICC ranged from 0.67 to 0.78 indicating an acceptable internal consistency.

The HAPA questionnaire is a valid and reliable tool for assessing treatment adherence in HD patients. Further studies are recommended on larger sample sizes and other Iranian populations.

Implication for health policy/practice/research/medical education: The histological pattern of membranous nephropathy with lambda chain restriction is a rare finding and a few described cases did not have any known secondary etiology. The author announces it as a quite rare entity, and emphasizes the integration of histologi-cal, clinical and laboratory findings. Please cite this paper as: Ribeiro CI, Gomes AM, Carmo R, Luís A. Membranous nephropathy with light chain restriction. J Nephropathol. 2021;10(1):e03. DOI: 10.34172/jnp.2021.03.

Light chain proximal tubulopathy (LCPT) is an uncommon renal disease characterized by the accumulation of monoclonal light chains within proximal tubular epithelial cells, with or without crystal formation. We report a rare case of lambda LCPT with crystals. Renal biopsy showed substantial acute tubular injury with unusual cytoplasmic changes affecting proximal tubules. In addition, abnormal tubular casts suggested concomitant light chain cast nephropathy. A clonal plasma cell infiltrate was present in the tubulointerstitial compartment. Immunofluorescence demonstrated strong staining for lambda light chain in tubular epithelial cells. Despite the absence of discernible crystals on light microscopy (LM), they were readily identified when ultrastructural evaluation was undertaken. Crystalline inclusions demonstrated positive immunogold labelling for lambda.

Implication for health policy/practice/research/medical education: Glomerulocystic kidney disease (GCKD) is a very uncommon entity that encompasses a wide group of kidney diseases characterized by cystic dilation of Bowman’s space associating collapse and retraction of glomerular clews. It can appear both in children, usually in the context of congenital disease, and in the adult, more common of acquired etiology. Only a few cases have been published to date. We report a case of special interest due to its finding in a preimplantation biopsy from an asymptomatic donor. Please cite this paper as: Moreno-Ramírez M, Villanego F, Caro A, Cazorla JM, García A, García T, et al. Glomerulocytis kidney: an unexpected finding in preimplantation biopsy. J Nephropathol. 2021;10(1):e02. DOI: 10.34172/jnp.2021.02.

Implication for health policy/practice/research/medical education: Patients with chronic kidney diseases exhibit a very high cardiovascular risk. The COVID-19 outbreak has worsened this risk by the addition of a new cardiac pathology and the exacerbation of pre-existing cardiovascular diseases in patients with chronic impairment of kidney function. Please cite this paper as: Asserraji M, Maoujoud M, Belarbi M, Zemraoui N. Collision of COVID-19 pandemic with cardiovascular risk in chronic kidney disease patients; a heavy “triple peine”. J Nephropathol. 2021;10(1):e01. DOI: 10.34172/jnp.2021.01.