October 2024
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1 Read
Journal of the American Society of Nephrology
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October 2024
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1 Read
Journal of the American Society of Nephrology
October 2024
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19 Reads
Journal of the American Society of Nephrology
October 2024
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1 Read
Journal of the American Society of Nephrology
October 2024
Journal of the American Society of Nephrology
October 2024
Journal of the American Society of Nephrology
October 2024
Journal of the American Society of Nephrology
July 2024
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67 Reads
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3 Citations
Diabetologia
Aims/hypothesis Diabetic kidney disease (DKD) is the leading cause of chronic and end-stage kidney disease in the USA and worldwide. Animal models have taught us much about DKD mechanisms, but translation of this knowledge into treatments for human disease has been slowed by the lag in our molecular understanding of human DKD. Methods Using our Spatial TissuE Proteomics (STEP) pipeline (comprising curated human kidney tissues, multiplexed immunofluorescence and powerful analysis tools), we imaged and analysed the expression of 21 proteins in 23 tissue sections from individuals with diabetes and healthy kidneys (n=5), compared to those with DKDIIA, IIA-B and IIB (n=2 each) and DKDIII (n=1). Results These analyses revealed the existence of 11 cellular clusters (kidney compartments/cell types): podocytes, glomerular endothelial cells, proximal tubules, distal nephron, peritubular capillaries, blood vessels (endothelial cells and vascular smooth muscle cells), macrophages, myeloid cells, other CD45⁺ inflammatory cells, basement membrane and the interstitium. DKD progression was associated with co-localised increases in inflammatory cells and collagen IV deposition, with concomitant loss of native proteins of each nephron segment. Cell-type frequency and neighbourhood analyses highlighted a significant increase in inflammatory cells and their adjacency to tubular and αSMA⁺ (α-smooth muscle actin-positive) cells in DKD. Finally, DKD progression showed marked regional variability within single tissue sections, as well as inter-individual variability within each DKD class. Conclusions/interpretation Using the STEP pipeline, we found alterations in protein expression, cellular phenotypic composition and microenvironment structure with DKD progression, demonstrating the power of this pipeline to reveal the pathophysiology of human DKD. Graphical Abstract
May 2024
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40 Reads
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1 Citation
Advances in Kidney Disease and Health
April 2024
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582 Reads
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3 Citations
Indian Journal of Nephrology
Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults. The discovery of phospholipase A2 receptor (PLA2R) as a target antigen has led to a paradigm shift in the understanding and management of MN. At present, serum PLA2R antibodies are used for diagnosis, prognostication, and guiding treatment. Now, with the discovery of more than 20 novel target antigens, antigen mapping is almost complete. The clinical association of certain antigens provides clues for clinicians, such as the association of nerve epidermal growth factor-like 1 with malignancies and indigenous medicines. Serum antibodies are detected for most target antigens, except exostosin 1 and 2 and transforming growth factor-beta receptor 3, but their clinical utility is yet to be defined. Genome-wide association studies and studies investigating environmental factors, such as air pollution, shed more light on the underpinnings of MN. The standard therapy of MN diversified from cyclical cyclophosphamide and steroids to include rituximab and calcineurin inhibitors over the past decades. Here, we provide a cutting-edge review of MN, focusing on genetics, immune system and environmental factors, novel target antigens and their clinical characteristics, and currently available and emerging novel therapies in MN.
April 2024
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44 Reads
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5 Citations
Kidney Medicine
Focal segmental glomerulosclerosis (FSGS) defines a distinct histologic pattern observed in kidney tissue that is linked to several distinct underlying causes, all converging on the common factor of podocyte injury. It presents a considerable challenge in terms of classification because of its varied underlying causes and the limited correlation between histopathology and clinical outcomes. Critically, precise nomenclature is key to describe and delineate the pathogenesis, subsequently guiding the selection of suitable and precision therapies. A proposed pathomechanism-based approach has been suggested for FSGS classification. This approach differentiates among primary, secondary, genetic, and undetermined causes, aiming to provide clarity. Genetic FSGS from monogenic mutations can emerge during childhood or adulthood, and it is advisable to conduct genetic testing in cases in which there is a family history of chronic kidney disease, nephrotic syndrome, or resistance to treatment. Genome-wide association studies have identified several genetic risk variants, such as those in apolipoprotein L1 (APOL1), that play a role in the development of FSGS. Currently, no specific treatments have been approved to treat genetic FSGS; however, interventions targeting underlying cofactor deficiencies have shown potential in some cases. Furthermore, encouraging results have emerged from a phase 2 trial investigating inaxaplin, a novel small molecule APOL1 channel inhibitor, in APOL1-associated FSGS.
... Lupus nephritis is another significant kidney complication, occurring in approximately 60% of patients with systemic lupus erythematosus [5]. Collectively, all forms of kidney diseases are considered life-threatening, with poor diagnosis and ineffective therapies contributing to increased mortality and morbidity each year. ...
May 2024
Advances in Kidney Disease and Health
... Focal segmental glomerulosclerosis (FSGS) is a significant cause of nephrotic syndrome, particularly in adults [1,2]. It is characterized by segmental scarring of the glomeruli, leading to proteinuria and progressive loss of kidney function [3]. FSGS can arise primarily (idiopathic) or secondarily due to underlying conditions such as obesity, diabetes, infections, or nephrotoxic drugs [4]. ...
April 2024
Kidney Medicine
... LN is a form of glomerulonephritis with deposition of immune complexes (ICs) and complement, which results in renal tissue damage in the kidneys of LN patients, endothelial damage, and microthrombi formation [17]. Although renal biopsy has long been considered the "gold standard" for diagnosis of LN [18], its invasive nature and limited scope of renal tissue analysis warrant a more advanced approach. The need for non-invasive and sensitive diagnostic and prognostic methods is evident. ...
December 2023
Kidney Medicine
... Lupus nephritis (LN) is a glomerulonephritis arising from Systemic Lupus Erythematosus, a chronic autoimmune disease in which women of childbearing age are particularly implicated. In pregnancy, the disease results in increased risk to maternal health, including pre-eclampsia, hypertension, and thromboembolic events, as well as fetal risks, such as preterm birth, congenital heart block, and intrauterine growth restriction (11). Therefore, management of pregnancy in lupus nephritis patients requires careful planning and thorough monitoring for possible complications. ...
September 2023
Kidney Medicine
... [78] In addition, Flohr also gave insights into very promising ongoing clinical investigations of iptacopan for the treatment of kidney diseases such as IgA nephropathy (IgAN), [77c] C3 glomerulopathy (C3G), [77d] and Lupus Nephritis. [79] This further underlines the outstanding and pioneering work of the Novartis team, which made the therapeutic potential of FB inhibitors accessible to patients in various indications. ...
June 2023
Kidney Medicine
... To examine the ability of SCGP to recognize known tissue structures, we assessed its performance on a cohort of 17 tissue sections from 12 individuals with diabetes and various stages of diabetic kidney disease (DKD). 40 Tissue samples were imaged using the mIF platform CODEX 9 and further annotated for four major kidney compartments: glomeruli, blood vessels, distal tubules, and proximal tubules. This cohort will be referred to as the DKD Kidney dataset (STAR Methods) in the subsequent text. ...
April 2023
... These unexpected findings associated with SGLT2i and CV health were discovered after the US Food and Drug Administration (FDA) required evidence of CV safety involving the intake of new hypoglycemic agents [4][5][6][7][8][9]. Additionally, some evidence has also been attributed to them as likely retinal protective agents [10] and may also offer renal protection [11], thus placing them into a category of pleiotropic agents, as some authors say [12,13]. ...
February 2023
Kidney Medicine
... In 2021, Inker et al. developed two equations, namely CKD-EPI creatinine 2021 and CKD-EPI creatinine cystatin C 2021, which omit race and improve the accuracy of kidney function assessment [16]. Goodson et al. [28] evaluated the eGFR in 637 potential living kidney donors, comparing the accuracy of the MDRD formulas and CKD-EPI creatinine 2009 and CKD-EPI creatinine 2021 formulas with the mGFR assessed using iohexol. The results showed that the value calculated using the CKD-EPI creatinine 2021 formula was less biased and more accurate than those derived from previous creatinine-based estimated GFR equations, with a P30 value of 96.4% in Asian individuals. ...
October 2022
Kidney Medicine
... infection. The reason for this is unclear, but the urinary flow elevation related to the osmotic diuresis and natriuresis effects of SGLT2i may be a factor [11,27]. On the other hand, although a potential association of SGLT2i with musculoskeletal pain such as myopathy is a concern [14,15], our results did not show such an association. ...
September 2022
Kidney360
... In kidney transplant recipients, BK virus causes nephropathy and urologic complications, such as hemorrhagic cystitis or ureteral stenosis. JC virus is known to cause progressive multifocal leukoencephalopathy (PML) in HIV patients, but its involvement in polyomavirus allograft nephropathy (PVAN) is rare [2]. Here we describe two cases of JC-related nephropathy occurring late after kidney transplantation and provide a review of the literature. ...
June 2020
Transplantation