The Density of Renal Lymphatics Correlates With Clinical Outcomes in IgA Nephropathy

Rodas, Lida; Barnadas, Esther; Pereira, Arturo; Anta, Natalia Castrejón de; Saurina, Anna; Calls, Jordi; Baños, Yolanda Calzada; Madrid, Antonio; Blasco, Miquel; Poch, Esteban; García‐Herrera, Adriana; Quintana, Luís F.

doi:10.1016/j.ekir.2021.12.029

Cited by 6 publications

(8 citation statements)

References 30 publications

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“… 7 The latter would underline the association of poor prognosis with segmental sclerosis and higher degrees of interstitial fibrosis/tubular atrophy as found in the study by Rodas et al. , 4 hallmarks of irreversible kidney damage. This will finally lead to nephron overload of remaining vital renal structures, which might induce lymphangiogenesis.…”

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confidence: 91%

“…The study by Rodas et al. 4 has some limitations, inherent with its retrospective design. In addition, the sample size of the study was low, the results could not be validated in an independent cohort of patients with IgAN, and there was no comparison to other entities leading to progressive kidney function decline, such as diabetic kidney disease.…”

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confidence: 99%

“…In the current issue of KI Reports , Rodas et al. 4 evaluated the density of lymphatic vessels on kidney biopsies and their role in outcome prediction in a cohort of 76 patients with IgAN. Baseline proteinuria of patients was 1.3 g/d, 89% received renin–angiotensin system inhibition, whereas a minority (21%) received glucocorticoids.…”

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confidence: 99%

“…This will finally lead to nephron overload of remaining vital renal structures, which might induce lymphangiogenesis. The specificity of lymphatic vessel density to IgAN remains obscure 4 and might simply indicate a consequence of chronic damage. In such scenario, a reduction in remnant nephron overload is warranted and step-wise initiation of renin–angiotensin system inhibition and sodium-glucose cotransporter 2 inhibition, alongside optimization of risk factors implicated in CKD progression, such as salt intake, obesity, poorly controlled hypertension, diabetes, among others, need to be considered.…”

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confidence: 99%

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Additional Refinement of CKD Prognostication Using Lymphatic Vessel Density: IgA Nephropathy as the Role Model?

Kronbichler

Shin

Geetha

2022

Kidney International Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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confidence: 91%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Additional Refinement of CKD Prognostication Using Lymphatic Vessel Density: IgA Nephropathy as the Role Model?

Kronbichler

Shin

Geetha

2022

Kidney International Reports

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“…IgA nephropathy (IgAN) is the most common primary glomerulonephritis (GN) worldwide and is characterized by histopathological criteria of mesangial codominant IgA staining on renal biopsy [ 1 ]. However, the pathogenesis remains complex and uncertain, with up to 1 in 4 patients experiencing end-stage kidney disease (ESKD) within 20 years of diagnosis [ 2 ]. An effective screening strategy is essential for identifying high-risk groups and reducing the incidence rate of ESKD.…”

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confidence: 99%

Triglyceride–Glucose Index May Predict Renal Survival in Patients with IgA Nephropathy

Qin

Tan

Wang

et al. 2022

JCM

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Background: The triglyceride–glucose (TyG) index is a simple, novel and reliable surrogate marker of insulin resistance. However, evidence for the prognostic impact of an elevated TyG index on IgA nephropathy (IgAN) is limited. Therefore, we evaluated the relationship between the TyG index and the risk of renal progression in IgAN. Method: This cohort study involved biopsy-proven IgAN between January 2009 and December 2018 in West China Hospital, in which patients were assigned to two groups based on the cut-off value of TyG using receiver operating characteristic (ROC) curves. A 1:1 matched-pair analysis was established to optimize the bias in IgAN by propensity score matching (PSM). The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The composite endpoint was defined by eGFR decreased ≥50% of the baseline level, end-stage kidney disease (ESKD), renal transplantation and/or death. Univariable and multivariable Cox proportional hazard models were applied to confirm the predictive value of the optimal marker. Results: Before PSM, a total of 1210 participants were ultimately included. During a median follow-up period of 55.8 months (range 37.20–79.09 months), 129 participants progressed to the composite endpoint (10.7%). After PSM, 386 patients were enrolled in the matched cohort, of whom 34 (9.3%) patients reached the endpoints. Based on the cut-off value of the TyG index, patients were divided into the low TyG index group (TyG ≤ 8.72, n = 690) and the high TyG index group (TyG > 8.72, n = 520). Further analysis demonstrated that a higher TyG index was significantly associated with a higher risk of reaching composite endpoints in IgAN patients in both the unmatched and matched cohorts (before PSM: HR 2.509, 95% CI 1.396–4.511, p = 0.002; after PSM: HR 2.654, 95% CI 1.299–5.423, p = 0.007). Conclusion: A high TyG index is associated with a higher risk of renal progression.

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Kidney Lymphatics

Russell

Itkin

Windsor

et al. 2023

Comprehensive Physiology

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Following significant advances in lymphatic biology, the important role of kidney lymphatics in kidney function and dysfunction is now being more fully appreciated. Kidney lymphatics begin in the cortex as blind-ended lymphatic capillaries and then coalesce into larger lymphatics that follow the main blood vessels out through the kidney hilum. Their function in draining interstitial fluid, macromolecules, and cells underpins their important role in kidney fluid and immune homeostasis. This article provides a comprehensive overview of recent and more established research findings on kidney lymphatics and the implications of these findings for kidney function and disease. The use of lymphatic molecular markers has greatly expanded our knowledge of the development, anatomy, and pathophysiology of kidney lymphatics. Significant recent discoveries include the diverse embryological source of kidney lymphatics, the hybrid nature of the ascending vasa recta, and the effects of lymphangiogenesis on kidney diseases such as acute kidney injury and renal fibrosis. On the basis of these recent advances, there is now an opportunity to link information from across multiple research disciplines to drive a new era of lymphatic-targeted therapies for kidney disease.

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The Density of Renal Lymphatics Correlates With Clinical Outcomes in IgA Nephropathy

Cited by 6 publications

References 30 publications

Additional Refinement of CKD Prognostication Using Lymphatic Vessel Density: IgA Nephropathy as the Role Model?

Additional Refinement of CKD Prognostication Using Lymphatic Vessel Density: IgA Nephropathy as the Role Model?

Triglyceride–Glucose Index May Predict Renal Survival in Patients with IgA Nephropathy

Kidney Lymphatics

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