Journal of nephropathology
Volume:12 Issue: 2, Apr 2023

World kidney day is an international campaign focused on bringing awareness to kidney health throughout the world and reducing the incidence of renal disease and its related medical complications. This mini-review sought to take a short look on the renal impact of SARS-CoV-2, with a particular focus on post-COVID-19 nephropathy as a new dilemma in the era of nephrology, which can be a new concern for nephrologists that requires more attention and particular strategies. 

IgA vasculitis nephritis (Schönlein-Henoch purpura nephritis) is an autoimmune circumstance characterized by palpable purpura involving the lower limbs, arthralgia, abdominal pain and kidney involvement. It is possible that a cytokine storm following coronavirus disease 2019 (COVID-19) could lead to an immunological dysregulation responsible for IgA vasculitis nephritis in these cases. Reactivation or first onset of IgA vasculitis nephritis is uncommon; however, there have been increasing reports of this disease, as a complication of COVID-19 vaccination. It is possible that COVID-19 mRNA vaccination may trigger several auto-inflammatory and autoimmune cascades. Previous research has shown that Toll-like receptors play a role in the development of IgA vasculitis nephritis. Following injection of a COVID-19 mRNA vaccine, the uptake of double-stranded RNA by-products will trigger Toll-like receptors, leading to a series of intracellular cascades starting an innate immunity-driven process of cell-mediated and humoral- mediated immunity.

Immunoglobulin A (IgA) nephropathy is the most common type of glomerulonephritis worldwide characterized by excessive serum levels of glycosylated which triggers the generation of glycan-specific IgG and IgA autoantibodies. This pathological condition results in the formation of circulatory IgA immune complexes, which are essential for the development of glomerular inflammation, especially IgA nephropathy. The serum galactosylated IgA1, IgG, and IgA autoantibodies are suggested as the biomarkers of IgA nephropathy since IgA antibodies are early markers for disease activity too. Serum IgA antibodies emerged as the early COVID-19-specific antibody response about two days after initial symptoms of COVID-19 in comparison with IgG and IgM antibody concentrations, which appeared after five days. IgA nephropathy is frequently presented as microscopic or macroscopic hematuria and proteinuria with a male predominance. COVID-19 infection can include several organs aside from the lungs, such as kidneys through different mechanisms. It is demonstrated in most cases that short-lasting symptoms such as gross hematuria resolve either spontaneously or following a short course of steroids. This review summarized the reported cases of relapses or denovo reported cases of relapses or de-novo IgA nephropathy and IgA vasculitis following COVID-19 vaccination.

Chronic kidney disease (CKD) induces changes in the myocardium known to influence morbidity and mortality, most severe in patients with end stage renal disease.

The working hypothesis was that in patients on chronic hemodialysis the prevalence of left ventricular diastolic dysfunction is correlated with the inflammatory, oxidative, metabolic, nutritional, and atherosclerotic status. Patients and

An observational study was performed on 51 patients (age 59.76 ± 13.24 years) on hemodialysis treatment. Transthoracic cardiac ultrasound was conducted to evaluate LVDD. The burden of cardiac and arterial atherosclerosis was evaluated by cardiac ultrasound (aortic and mitral valve calcifications), vascular ultrasound (carotid and femoral atheroma plaques, common carotid intima-media thickness), and by abdominal radiography (aortic calcification score). Demographic and anthropometric parameters were determined. Blood samples were used to determine laboratory parameters reflecting the inflammatory, oxidative, and metabolic/nutrition status.

LVDD is positively correlated with the serum level of C-reactive protein (CRP) (P = 0.04), the total antioxidant capacity of the serum (P = 0.04), the presence (P = 0.022) and number (P = 0.04) of femoral plaques, the aortic calcification score (P = 0.02), aortic valve stenosis (P = 0.037), aortic annulus calcifications (P = 0.02) and mitral valve calcifications (P = 0.041). After the removal of the main confounder, degenerative aortic stenosis, only the associations with serum total antioxidant capacity (P = 0.04) and aortic calcification score (P = 0.02) maintain their statistical significance.

LVDD is positively correlated with inflammation and oxidative stress markers and with the severity of aortic calcification.

Medical renal diseases stand as one of the major health problems in pediatric age group considering its morbidity/mortality and the subsequent management plans.

In this manuscript, the spectrum of histopathological patterns of medical nephropathic lesions in Egyptian pediatric patients over duration of five years is reported with clinical indications. Patients and

We conducted a retrospective study for analysis of our pathological reports of renal needle biopsies during the period from January 2014 until January 2019. One hundred and sixteen cases were included.

The most commonly encountered pediatric renal pathology was minimal change disease (27.59%), followed by congenital glomerular diseases (22.41%), focal segmental glomerulosclerosis (12.93%), and thrombotic microangiopathy (7.76%). The most common clinical indication for biopsy was nephrotic syndrome (37.07%) followed by impaired renal functions with elevated serum creatinine (21.55%). In addition, we report very rare histological findings in few cases including infantile nephropathic cystinosis, Barakat syndrome and C3 glomerulopathy.

Minimal change disease and congenital glomerular diseases accounted for half of pediatric renal pathologies in the study population. The most common clinical indication for renal biopsy was nephrotic syndrome. Electron microscopic examination and genetic studies are mandatory for proper evaluation of pediatric nephropathies.

No single nutrition parameter can accurately assess nutritional status, to predict outcomes and to drive the priorities for nutrition care in patients undergoing hemodialysis (HD).

The aim of this study was to assess the nutritional status of HD patients using two validated assessment tools; the “7-point subjective global assessment” (SGA) and “malnutrition inflammation score” (MIS); to determine participants’ daily energy intakes (DEI) and daily protein intakes (DPI); and also to examine the relationship of these parameters with hospitalization and mortality. Patients and

This is a 12-month prospective, single HD-center study that recruited 77 HD participants from an outpatient center in South Florida. For the purpose of this analysis, participants with SGA ≤ 5 and MIS > 7 and were considered to have an inadequate nutritional status represented by SGA-I and MIS-I, respectively. Inadequate energy (DEI-I) and inadequate protein (DPI-I) intake were defined using cutoff values. The outcomes and endpoints of this study were hospitalizations and mortality, registered over 12 months.

Fifty-five male and 22 female patients from a single HD center participated in the study. During the 12-month study, 63.6% of participants were hospitalized, 7% transplanted and 13% died. The group of participants with an inadequate nutritional status (defined as SGA-I and MIS-I) and inadequate energy intake (defined as DEI-I) had an increased hazard ratio for mortality [SGA-I and DEI-I [HR: 7.18 (95% CI: 1.18-43.43; P = 0.032] and [MIS-I and DEI-I [HR: 13.23, 95% CI: 2.1-83.2; P = 0.006] and the likelihood of hospitalization increased almost 3-fold [HR: 2.73, 95% CI: 1.09-6.842; P = 0.031], in the case of MIS-I.

These results indicated that energy intake lower than 25 kcal/kg/day increases the risks of hospitalization and mortality for those HD patients with an impaired nutritional status.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are the most recent pharmaceutical group for type 2 diabetes (T2D) treatment. Evidence indicates contradictory relationships between sodium-glucose cotransporter-2 inhibitors and bladder cancer (BC). Hence, this study aims to investigate the relationship between SGLT2 inhibitors and BC in patients with T2D.

This study is a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). International databases including Cochrane, Web of Science, Scopus, PubMed, and Google Scholar were conducted for searching with keywords and without time and language limitations. The reference searching stage continued upgrading until November, 2022. Data analysis was performed with STATA 14 software. The tests with P values lower than 0.05 were considered statistically significant.

The four reviewed studies with a sample size comprising 497 755 individuals indicated the impact of SGLT2 inhibitors on BC of patients with T2D (OR: 0.68; 95% CI: 0.37, 1.2). The effect of dapagliflozin, canagliflozin and empagliflozin administration on the incidence of BC among the T2D patients were (OR: 0.72; 95% CI: 0.39, 1.30), (OR: 0.53; 95% CI: 0.23, 1.20), and (OR: 0.51; 95% CI: 0.20, 1.28), respectively.

The general conclusion of this study revealed that SGLT2 inhibitors did not increase the risk of BC in T2D patients. The analysis of subgroups also indicated that the administration of dapagliflozin, canagliflozin, and empagliflozin also did not increase the risk of BC in T2D patients.

Bladder cancer is the single most prevalent urinary tract malignancy in humans with a higher risk in diabetic patients. Pioglitazone is among the conventional antidiabetic drugs. The present study thus seeks to investigate the association between the administration of pioglitazone and the incidence of bladder cancer in type II diabetic patients through a meta-analysis and systematic analysis.

International databases including Web of Science, Medline/PubMed, Scopus, and Google Scholar search engine were explored. To integrate the results of studies odds ratio (OR), risk ratio (RR) or hazard ratio (HR) logarithm was extracted from each study, and the I2 index or the Cochran’s Q test were conducted to examine the heterogeneities across studies. Data analysis was carried out in STATA version14 considering a significance level of p<0.05.

The 15 examined studies had investigated a total of 5,353,528 patients (1,536,723 patients in case groups and 3,816,805 patients in control groups). The relative risk of bladder cancer was [RR: 1.20 (95% CI: 1.09-1.32)] in pioglitazone users. Bladder cancer risk in pioglitazone users was higher by [RR: 1.14 (95% CI: 1.03-1.25)] compared to those who had never taken pioglitazone, [RR: 1.32 (95% CI: 1.02-1.70] compared to sulfonylurea users, and [RR: 1.57 (95% CI: 1.23-2)] compared to dipeptidyl peptidase-4 (DPP-4) users. Moreover, the relative risk between pioglitazone consumption and bladder cancer was reported to be [RR: 1.27 (95% CI: 0.96-1.68)] in patients with a follow-up shorter than five years and [RR: 1.24 (95% CI: 1.09-1.41)] is patients with a follow-up of five years or longer. On the other hand, the relative risk between pioglitazone consumption and bladder cancer was [RR: 1 (95% CI: 0.69-1.45)] in 50-59 age group, [RR: 1.20 (95% CI: 1.04-1.38)] in the 60-69 age group, and [RR: 1.33 (95% CI: 1.14-1.56)] in the 70-79 age group.

Patients who receive pioglitazone had a 20% higher risk of bladder cancer compared to those who had not taken pioglitazone or prescribed other medication such as sulfonylurea and DPP-4s.

Implication for health policy/practice/research/medical education:

This case illustrates the clinical course, diagnostic challenge and management difficulties associated with adult-onset severe nephrotic syndrome secondary to diffuse podocytopathy, with needs for bilateral nephrectomy as a last resource of therapeutic measure.

Please cite this paper as: 

Oliveira J, Sala I , Freitas J, Tavares J, Santos S, Campos A, Santos Lascasas J, Mendonça T, Cabrita A. Refractory diffuse podocytopathy. J Nephropathol. 2023;12(2):e17314.

Tubulointerstitial nephritis and uveitis syndrome (TINU) combines tubulointerstitial nephritis and uveitis and is a known cause of kidney failure in children and adults. This is a challenging diagnosis since renal and ocular manifestations may not occur simultaneously and may be present in several alternative diagnosis. The authors report the case of a 28-year-old patient with acute kidney injury (AKI) and biopsy-proven acute tubulointerstitial nephritis. Bilateral symptomatic uveitis presented six months after the initial presentation. Physicians in charge of patients with kidney disease attributed to acute tubulointerstitial nephritis must bear in mind the need for ophthalmologic surveillance for at least one year post-diagnosis. Although a diagnosis of exclusion, its incidence may be higher than described. Kidney disease is believed to be self-limited and prognosis still, most patients will require systemic therapy and relapses are common.