Membranous nephritis associated with acquired cytomegalovirus infection in a 19-month-old baby

Georgaki-Angelaki, Helen; Lycopoulou, Lilia; Stergiou, Nicolaos; Lazopoulou, Despina; Paraskevakou, Helen; Giannaki-Psinaki, Maria; Mentis, Αndreas

doi:10.1007/s00467-008-0966-z

Cited by 11 publications

(9 citation statements)

References 17 publications

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“…Some scholars also reported iMN accounted for 31.8% of membranous nephropathy, mean age was 43.9 ± 13.2 years old, and were mainly distributed between 40 to 60 years old, male and female ratio 1.53:1; [ 17 ] but some other data showed that in developed countries, iMN accounted for 60% to 80%, the sex ratio of MN patients was 1.3 to 2.3:1. [ 18 , 19 ] These results are different from our center that indicate that different country or different geographic environment in some country may have a certain impact on the development of disease.…”

Section: Discussioncontrasting

confidence: 87%

Clinicopathological features of atypical membranous nephropathy with unknown etiology in adult Chinese patients

et al. 2018

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Membranous nephropathy is typically classified as idiopathic and secondary, but nowadays the number of atypical membranous nephropathy (aMN) is increasing, many of which cannot determine its etiology in China. In this study, we compared the clinical and pathological characteristics of idiopathic membranous nephropathy (iMN) with aMN with unknown etiology from a single center in China.We retrospectively reviewed the clinical data of 577 patients with iMN and aMN at Peking University People's Hospital from January 2006 to December 2015 over a 10-year period, and analyzed their clinical and pathological characteristics. The level of serum phospholipase A2 receptors (PLA2R) antibody was detected in 106 iMN and 162 aMN patients.There were 278 iMN patients and 299 aMN patients who were included into this study in 3210 cases of renal biopsy during a 10-year period in our hospital. The average age of patients with iMN was significantly older than those with aMN (54.77 ± 13.01 vs 47.13 ± 16.16, P < .001). Around 75 patients (27%) were smokers in iMN patients, and 111 patients (37.1%) in aMN patients (P = .009). The mainly clinical manifestation of these 2 groups was nephrotic syndrome (61.5% in iMN group vs 58.4% in aMN group), but there were more patients accompanied with nephritis syndrome in aMN group than iMN group (17.1% vs 6.1%, P < .001). The immunofluorescence of renal biopsy showed “full house” in aMN group; and IgG subclass of the glomeruli demonstrated IgG4 (90.4%) was commonest in iMN group, but IgG1 (94.6%) in aMN group. 51 (48.1%) patients with iMN were detected positive PLA2R antibody in their serum, and 93 (57.4%) in aMN patients (P = .168). The patients with positive PLA2R antibody had higher positive rate of microscopic hematuria and urinary protein, lower albumin.The aMN patients are younger, higher smoking rate, its main clinical manifestation is nephrotic syndrome, but more of them accompanied with nephritis syndrome than those in iMN patients. Serum PLA2R antibody could not distinguish aMN from iMN. aMN could be a special glomerular disease in China, and need a further research on a larger scale.

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Section: Discussioncontrasting

confidence: 87%

Clinicopathological features of atypical membranous nephropathy with unknown etiology in adult Chinese patients

et al. 2018

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“…Since two of the non‐CTLA4‐Ig‐treated baboons died with high copies of bCMV in lungs, and development of bCMV may influence the development of proteinuria , we tested the sera for evidence of bCMV infection in the early postoperative period in recipients of Study 2. Despite all animals developing proteinuria in the first 20 days in the non‐CTLA4 Ig‐treated group in Study 2, no bCMV replication was observed in three of four baboons by POD 20 and the remaining baboon had only 19.4 copies/ml of serum at POD 10 and 242.95 copies/ml of serum at POD 20 (Fig.…”

Section: Resultsmentioning

confidence: 99%

Upregulation of CD80 on glomerular podocytes plays an important role in development of proteinuria following pig-to-baboon xeno-renal transplantation - an experimental study

et al. 2018

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We have previously reported that co-transplantation of the kidney with vascularized donor thymus from α-1,3-galactosyltransferase gene knockout pigs with an anti-CD154 with rituximab-based regimen led to improved xenograft survival in baboons with donor-specific unresponsiveness. However, nephrotic syndrome emerged as a complication in which the glomeruli showed mild mesangial expansion with similarities to minimal change disease (MCD) in humans. Since MCD is associated with CD80 expression in glomeruli and elevated urinary excretion, we evaluated a potential role for CD80 in xenograft nephropathy. Study 1 confirmed high urinary CD80 excretion in nephrotic animals with renal xenografts showing CD80 expression in glomeruli. In Study 2, baboons receiving xenografts received CTLA4-Ig once a week from the second postoperative week or no CTLA4-Ig. The non-CTLA4-Ig group developed severe proteinuria with modest mesangial expansion with high urinary excretion of CD80 and documented CD80 expression in glomerular podocytes. All of the recipients in non-CTLA4-Ig groups had to be euthanized before POD 60. In contrast, CTLA4-Ig group showed a marked reduction in proteinuria and survived significantly longer, up to 193 days. These results demonstrate that anti-CD80 targeted therapy represents a promising strategy for reduction of proteinuria following renal xeno-transplantation with improved survival.

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“…CMV has been implicated in nephritis and rejection in renal transplant recipients [De Keyzer et al, 2011]. Additionally, it has been suggested that CMV may be involved in childhood nephritis [Platt et al, 1985;Matsukura et al, 2006;Georgaki-Angelaki et al, 2009] and congenital nephrotic syndrome [Evans and Lyon, 1991;Batisky et al, 1993;Giani et al, 1996;Eddleston et al, 1997;Barbi et al, 1998;Frishberg et al, 2003;Besbas et al, 2006]. Since children with renal disease are treated generally by immunosuppressive drugs, these patients are considered to be at high risk for reactivation of herpesviruses.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the shedding of three β‐herpesviruses in urine and saliva of children with renal disease

Yamamoto

Morooka

Hashimoto

et al. 2013

Journal of Medical Virology

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Cytomegalovirus (CMV), human herpesvirus 6 (HHV-6) and 7 (HHV-7) are important pathogens in immunocompromised patients. To elucidate the kinetics of the three β-herpesviruses in saliva and urine samples were collected serially from children with renal diseases. Twenty children with renal diseases were enrolled in this study. A total of 240 saliva and urine samples were collected monthly from the patients over a 1-year period. Viral DNAs loads were measured by real-time PCR. In 10 CMV seropositive patients CMV DNA was detected rarely in saliva and CMV DNA load was lower than the other two β-herpesviruses DNA loads. All patients were seropositive for HHV-6B and the virus was detected frequently in saliva. Two of 20 patients were HHV-7 seronegative. High copies of viral DNA were detected continuously in saliva of the HHV-7 seropositive patients. Although neither CMV nor HHV-6B DNA load was different among the three renal diseases, HHV-7 DNA load was different among the diseases (P = 0.039). HHV-6B DNA loads were significantly higher in patients with immunosuppressive treatment compared to those without treatment (P = 0.013). Although CMV DNA was detected in urine samples collected from 5 of 10 CMV seropositive patients, HHV-6B and HHV-7 DNA were detected at relatively low frequencies in urine. No remarkable temporal associations between viral DNA excretion and proteinuria or immunosuppressive treatment were demonstrated. The pattern of viral DNA excretion in saliva and urine were different among the three viruses. No temporal correlation was observed between viral infection and renal diseases.

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Membranous nephritis associated with acquired cytomegalovirus infection in a 19-month-old baby

Cited by 11 publications

References 17 publications

Clinicopathological features of atypical membranous nephropathy with unknown etiology in adult Chinese patients

Clinicopathological features of atypical membranous nephropathy with unknown etiology in adult Chinese patients

Upregulation of CD80 on glomerular podocytes plays an important role in development of proteinuria following pig-to-baboon xeno-renal transplantation - an experimental study

Analysis of the shedding of three β‐herpesviruses in urine and saliva of children with renal disease

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