Para-capillary electron-dense deposits reduce glomerular filtration in patients with primary glomerular diseases

Fukase, Shigeru; Kazama, Junichiro James; Mori, Honami; Iguchi, Seitaro; Takeda, Takeshi; Ueno, Mitsuhiro; Nishi, Shinichi; Narita, Ichiei; Gejyo, Fumitake

doi:10.1007/s10157-005-0401-8

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…46 Hence, the proliferation of extracellular matrix may be aggravated by the CsA in IMN patients with an FSGS lesion. The hydraulic permeability of the glomerular capillary walls is likely depressed by paracapillary electron-dense deposits, 47 basement membrane thickening and foot process broadening, 48 and increases of the ltration surface area and net pressure for ultra ltration are observed. In a study done by Gupta, the glomerulus was found to be enlarged in IMN patients with FSGS lesions; this nding supported the hypothesis of glomerular hyper perfusion as a cause of the development of FSGS in IMN.…”

Section: Discussionmentioning

confidence: 99%

Predictors assisting treatment choices between cyclophosphamide and cyclosporine in membranous nephropathy

Peng

Qin-qing

et al. 2023

Preprint

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Background: Cyclophosphamide (CTX) and cyclosporine (CsA) are used in idiopathic membranous nephropathy (IMN); however, limited data comparing their efficacy are available. We aimed to determine the baseline clinicopathological predictive factors of renal outcome in patients with IMN who received CTX or CsA. We also attempted to establish simple risk scores for predicting renal outcomes in IMN patients prescribed CsA-based initial treatment. Method: We retrospectively included 516 patients with biopsy-proven IMN from January 1, 2007 to October 31, 2019. The primary outcome was no remission and a decline of renal function in IMN patients who received CTX and CsA as initial treatment. Results: The CsA group showed higher complete remission (CR) rate at 6 months, and no significant difference in accumulative total remission between the two groups was observed in the initial 12 months. Independent predictors of primary outcomes were urine protein content and serum albumin in the CTX-based group and serum creatinine, triglyceride, and focal segmental glomerulosclerosis (FSGS) lesions in the CsA-based treatment group. The area under the receiver operating characteristic curve based on a three-variable risk score in predicting primary outcome was 0.791 (95% CI 0.720–0.862). IMN patients with FSGS lesions who received CsA-based initial treatment had a higher percentage of primary outcome and a lower CR rate. Conclusion: Serum creatinine, hypertriglyceridemia, and FSGS lesions were important predictors of a worse prognosis in CsA-based initial treatment patients. Our simple risk score was able to predict renal outcomes in IMN patients receiving CsA-based initial treatment with good discrimination. Name of the registry: Chinese Clinical TrialRegistry Trial registration number: ChiCTR2200059658 May 5, 2022 Retrospectively registered URL of trial registry record: https://www.chictr.org.cn/hvshowproject.aspx?id=168696

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Section: Discussionmentioning

confidence: 99%

Predictors assisting treatment choices between cyclophosphamide and cyclosporine in membranous nephropathy

Peng

Qin-qing

et al. 2023

Preprint

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“…In MN, subepithelial immune deposits may tamper with podocyte attachment to the glomerular basement membrane [ 10 ], and promote the formation of FSGS lesions. The hydraulic permeability of the glomerular capillary walls may be reduced by the epithelial immune complex [ 29 ], basement membrane thickening, and foot process broadening [ 30 ]. Subsequently, increases in the filtration surface area and net pressure for ultrafiltration are observed.…”

Section: Discussionmentioning

confidence: 99%

Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China

He,

Huang,

Liang

et al. 2023

Renal Failure

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Background Cyclophosphamide (CTX) and calcineurin inhibitors (CNIs) based regimens are recommended as immunosuppressive therapies for patients with idiopathic membranous nephropathy (IMN). Focal and segmental glomerular sclerosis (FSGS) lesions, which are common in membranous nephropathy (MN), are poor predictors of outcome. This study compared the differences of prognosis between two regimens in patients with IMN combined with FSGS lesions. Methods This retrospective study enrolled 108 patients with biopsy-proven IMN, accompanied with FSGS lesions, nephrotic syndrome and an estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m 2 who were treated with CTX or CNIs. We used propensity score matching (PSM) for balancing the confounding variables. Results During follow-up, 10 patients (10/55 [18.2%]; nine males) in the CNIs group showed a 50% decline in eGFR; eight had a not otherwise specified variant. Patients initially treated with CNIs had a significantly higher risk of progression to the primary outcome and a lower probability of complete or total remission. The relapse rate was higher in patients who initially received CNIs- than in those who received CTX-based treatment. Before PSM, age and 24-h urine protein level differed significantly between the groups. The PSM model included data from 72 patients. Worse outcomes were also noted among patients who initially received CNIs than those who received CTX-based treatments after matching. Conclusions Patients with MN combined with FSGS lesions have a higher risk of renal functional decline and a higher rate of relapse after CNIs than after CTX therapy.

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Para-capillary electron-dense deposits reduce glomerular filtration in patients with primary glomerular diseases

Abstract: PCEDD significantly affected FF levels in patients with primary glomerular diseases. FF may not be an accurate indicator of intraglomerular blood pressure in patients with overt PCEDD.

Cited by 2 publications

References 20 publications

Predictors assisting treatment choices between cyclophosphamide and cyclosporine in membranous nephropathy

Predictors assisting treatment choices between cyclophosphamide and cyclosporine in membranous nephropathy

Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China

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