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Brad H. Rovin - One of the best experts on this subject based on the ideXlab platform.
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Reimagining the Kidney Biopsy in the era of diagnostic biomarkers of glomerular disease.
Kidney International, 2019Co-Authors: Brad H. Rovin, Salem Almaani, Ana MalvarAbstract:Anti–phospholipase A2 receptor (PLA2R) antibody is a specific biomarker for primary membranous nephropathy (MN). Testing positive for anti-PLA2R has been postulated to establish a diagnosis of MN in the absence of a Kidney Biopsy. Bobart et al. tested this hypothesis and concluded that anti-PLA2R positivity is sufficient to diagnose primary MN and initiate treatment in a subset of patients with nephropathy. This biomarker, however, does not render the Kidney Biopsy obsolete, but encourages the application of molecular analyses to renal pathology to keep the Biopsy relevant.
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Anticoagulant-Related Nephropathy in Kidney Biopsy: A Single-Center Report of 41 Cases
Kidney Medicine, 2019Co-Authors: Sergey V. Brodsky, Brad H. Rovin, Anjali A. Satoskar, Jessica Hemminger, Lee A. Hebert, Margaret S. Ryan, Tibor NadasdyAbstract:Rationale & Objective In 2009, the first case of acute Kidney injury and occlusive red blood cell (RBC) tubular casts associated with a high international normalized ratio in a patient receiving warfarin was identified. This entity, named warfarin-related nephropathy, was later renamed anticoagulant-related nephropathy (ARN) after similar cases with other anticoagulants were described. We provide our 10-year experience with ARN based on a single-center Kidney Biopsy laboratory. Study Design The Kidney pathology database at the Ohio State University Wexner Medical Center (OSUWMC) was searched for native Kidney Biopsy cases consistent with ARN. Clinical data were obtained from patient medical records. Setting & Participants Native Kidney biopsies evaluated between January 1, 2009, and December 31, 2017 at OSUWMC. Results Among 8,636 native Kidney biopsies reviewed at the OSUWMC, there were 41 (0.5%) patients for whom deterioration in Kidney function could not be explained by Kidney Biopsy findings alone if anticoagulation was not considered. There were 63% men and 95% were white; average age was 62±14 years. Most were on warfarin therapy (N=28), although cases were also attributed to direct-acting anticoagulants (N=2), antiplatelet medications (N=1), heparin or enoxaparin (N=4), and disseminated intravascular coagulopathy (N=6). Morphologically, there was acute tubular necrosis and RBC casts. The majority of biopsies had an underlying glomerular disease and many patients had positive serologic test results. In all these cases, the severity of Kidney failure, RBC tubular casts, and hematuria were disproportionate to glomerular morphologic changes. Limitations Selection bias in the decision to perform a Kidney Biopsy. Conclusions ARN is an uncommon diagnosis in Kidney pathology practice, but it should be considered when the number of RBC tubular casts is disproportionate to the severity of glomerular changes in a Kidney Biopsy in patients either receiving anticoagulation therapy or who presented with acute coagulopathy. Our data suggest that anticoagulation aggravates underlying glomerular diseases rather than directly affecting the glomerular filtration barrier.
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The Kidney Biopsy in Systemic Lupus Erythematosus: A View of the Past and a Vision of the Future
Advances in Chronic Kidney Disease, 2019Co-Authors: Isabelle Ayoub, Salem Almaani, Brad H. Rovin, Clarissa A. Cassol, Samir V. ParikhAbstract:The Kidney Biopsy advanced our understanding of Kidney disease in systemic lupus erythematosus. It allowed for better recognition and classification of lupus nephritis (LN). Several LN classifications have been devised in an effort to inform treatment decision and predict prognosis, and these are being further updated. In this review, we will examine the role of diagnostic as well as repeat Kidney Biopsy in the management of LN, including the potential role of molecular interrogation as a step forward beyond conventional histology to guide the discovery of novel biomarkers and a precision medicine approach to the management of LN.
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characterising the immune profile of the Kidney Biopsy at lupus nephritis flare differentiates early treatment responders from non responders
Lupus science & medicine, 2015Co-Authors: Samir V. Parikh, Ana Malvar, Valeria Alberton, Huijuan Song, Bruno Lococo, Jay Vance, Jianying Zhang, Brad H. RovinAbstract:Introduction The Kidney Biopsy is used to diagnose and guide initial therapy in patients with lupus nephritis (LN). Kidney histology does not correlate well with clinical measurements of Kidney injury or predict how patients will respond to standard-of-care immunosuppression. We postulated that the gene expression profile of Kidney tissue at the time of Biopsy may differentiate patients who will from those who will not respond to treatment. Methods The expression of 511 immune-response genes was measured in Kidney biopsies from 19 patients with proliferative LN and 4 normal controls. RNA was extracted from formalin-fixed, paraffin-embedded Kidney biopsies done at flare. After induction therapy, 5 patients achieved a complete clinical response (CR), 10 had a partial response (PR) and 4 patients were non-responders (NRs). Transcript expression was compared with normal controls and between renal response groups. Results A principal component analysis showed that intrarenal transcript expression from normal Kidney, CR biopsies and NR biopsies segregated from each other. The top genes responsible for CR clustering included several interferon pathway genes (STAT1, IRF1, IRF7, MX1, STAT2, JAK2), while complement genes (C1R, C1QB, C6, C9, C5, MASP2) were mainly responsible for NR clustering. Overall, 35 genes were uniquely expressed in NR compared with CR. Pathway analysis revealed that interferon signalling and complement activation pathways were upregulated in both groups, while BAFF, APRIL, nuclear factor-κB and interleukin-6 signalling were increased in CR but suppressed in NR. Conclusions These data suggest that molecular profiling of the Kidney Biopsy at LN flare may be useful in predicting treatment response to induction therapy.
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The Kidney Biopsy in Lupus Nephritis: Past, Present, and Future
Seminars in Nephrology, 2015Co-Authors: Samir V. Parikh, Anthony Alvarado, Ana Malvar, Brad H. RovinAbstract:Since its incorporation into clinical practice in the 1950s, the percutaneous Kidney Biopsy has played an important role in advancing our understanding of lupus nephritis (LN). The Biopsy findings have been used to classify and subgroup LN in order to obtain an accurate diagnosis and also to inform treatment decisions and predict prognosis. Several classifications schemes have been applied clinically however despite this evolution in histopathologic classification, our ability to predict treatment response and determine prognosis remains limited. In this review we will examine the evolving role of the Kidney Biopsy in the management of LN, including the potentially larger role the Biopsy could play in the future.
Anthony Alvarado - One of the best experts on this subject based on the ideXlab platform.
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The Kidney Biopsy in Lupus Nephritis: Past, Present, and Future
Seminars in Nephrology, 2015Co-Authors: Samir V. Parikh, Anthony Alvarado, Ana Malvar, Brad H. RovinAbstract:Since its incorporation into clinical practice in the 1950s, the percutaneous Kidney Biopsy has played an important role in advancing our understanding of lupus nephritis (LN). The Biopsy findings have been used to classify and subgroup LN in order to obtain an accurate diagnosis and also to inform treatment decisions and predict prognosis. Several classifications schemes have been applied clinically however despite this evolution in histopathologic classification, our ability to predict treatment response and determine prognosis remains limited. In this review we will examine the evolving role of the Kidney Biopsy in the management of LN, including the potentially larger role the Biopsy could play in the future.
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the Kidney Biopsy in lupus nephritis is it still relevant
Rheumatic Diseases Clinics of North America, 2014Co-Authors: Brad H. Rovin, Samir Parikh, Anthony AlvaradoAbstract:The Kidney Biopsy is the standard of care for diagnosis of lupus nephritis and remains necessary to ensure accurate diagnosis and guide treatment. Repeat Biopsy should be considered when therapy modifications are necessary, as in cases with incomplete or no response, or when stopping therapy for those in remission. There are several promising biomarkers of Kidney disorders; however, these markers need to be validated in a prospective clinical trial before being applied clinically. Molecular analysis may provide the information presently lacking from current evaluation of Kidney disorders and may better inform on prognosis and treatment considerations.
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The value of repeat Kidney Biopsy in quiescent Argentinian lupus nephritis patients.
Lupus, 2014Co-Authors: Anthony Alvarado, A Malvar, B Lococo, V Alberton, F Toniolo, Haikady N. Nagaraja, Brad H. RovinAbstract:BackgroundThe duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1–2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat Kidney Biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission.MethodsThe practice in a large Buenos Aires nephrology unit is to repeat a Kidney Biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more Kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease.ResultsDespite normalization of serum creatinine and reduction of proteinuria to
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the value of repeat Kidney Biopsy in quiescent argentinian lupus nephritis patients
Lupus, 2014Co-Authors: Anthony Alvarado, A Malvar, B Lococo, V Alberton, F Toniolo, Haikady N. Nagaraja, Brad H. RovinAbstract:BackgroundThe duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1–2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat Kidney Biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission.MethodsThe practice in a large Buenos Aires nephrology unit is to repeat a Kidney Biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more Kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease.ResultsDespite normalization of serum creatinine and reduction of proteinuria to <500 mg/d, 30% of patients still had significant activity at the last Biopsy. Conversely, 60% of patients with ongoing proteinuria (500–1000 mg/d), or stable but abnormal serum creatinine, ha...
Derek M. Fine - One of the best experts on this subject based on the ideXlab platform.
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predictors of Kidney Biopsy complication among patients with systemic lupus erythematosus
Lupus, 2012Co-Authors: Teresa K Chen, Michelle M Estrella, Derek M. FineAbstract:Kidney Biopsy is essential for the diagnosis and management of lupus nephritis. The risk of bleeding complication, however, is not defined in the systemic lupus erythematosus population. A retrospective cohort study was conducted to determine predictors of major and minor complications among patients with systemic lupus erythematosus undergoing percutaneous ultrasound-guided Kidney Biopsy. Major complications included bleeding necessitating intervention, hypotension requiring vasopressors or higher level of care or death. Minor complications included moderate or large (≥ 4 cm in largest diameter) perinephric hematoma, gross hematuria or voiding difficulties. All patients were observed for at least 23 h post-procedure. The overall incidence of bleeding was 10.5% (2.7% major, 7.8% minor). Adjusted logistic regression showed that for every 10,000 cells/mm3 decrease in platelet count, risk for major and any complication increased by 27% (odds ratio 1.27; 95% confidence intervals 1.06–1.51; p = 0.01) and 8% (o...
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Ritonavir-induced acute Kidney injury: Kidney Biopsy findings and review of literature.
Clinical Nephrology, 2011Co-Authors: Tariq Shafi, Michael J. Choi, Lorraine C. Racusen, Lisa A. Spacek, Cristine E. Berry, Mohamed G. Atta, Derek M. FineAbstract:Ritonavir therapy is not generally considered nephrotoxic. We report a case of acute Kidney injury secondary to ritonavir, with Kidney Biopsy demonstrating extensive acute tubular injury. This is the first report of a Kidney Biopsy and pathology in acute Kidney injury associated with ritonavir. A review of published medical literature on the topic is also presented.
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predictors of complication after percutaneous ultrasound guided Kidney Biopsy in hiv infected individuals possible role of hepatitis c and hiv co infection
Clinical Journal of The American Society of Nephrology, 2009Co-Authors: Sayed Tabatabai, Mohamed G. Atta, John C Sperati, Kashif Janjua, Christopher R Roxbury, Gregory M Lucas, Derek M. FineAbstract:Background and objectives: HIV-infected patients often undergo Kidney Biopsy. The risks of percutaneous ultrasound-guided Kidney Biopsy in this population are not well established. Design, setting, participants, & measurements: This was a case-control, single-center study of 1116 (243 with HIV infection and 873 without) consecutive ultrasound-guided biopsies from 1024 patients. The primary outcome was any major or minor complication. Major complications included Biopsy-associated bleeding that required transfusion, angiography, or surgery; hypotension that required intervention; and death. Minor complications included development of a hematoma or gross hematuria. The odds of complication was assessed with logistic regression. Results: Overall complication rates (8.6 versus 7.2%) did not significantly differ between HIV-infected and noninfected individuals. HIV-positive status did not predict complication. In the entire cohort, hepatitis C infection was associated with a 2.08 (95% confidence interval [CI] 1.47 to 2.93) increased odds of complication, and each 10,000-cells/mm 3 decrease in preBiopsy platelet count a 1.05 (95% CI 1.02 to 1.08) increased odds of complication. In addition, preBiopsy hematocrit 2 were associated with major complication. Whereas the association of preBiopsy platelet count was not modified by HIV infection, hepatitis C/HIV co-infection was associated with a 5.71 (95% CI 1.89 to 17.2) increased odds of complication as compared with 1.27 (95% CI 0.73 to 2.19) in hepatitis C–positive/HIV-negative individuals. Conclusions: Ultrasound-guided percutaneous Kidney Biopsy is a relatively safe, well-tolerated procedure in the HIV-infected population. HIV-infected individuals who are co-infected with hepatitis C seem to be at greatest risk.
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Kidney Biopsy in lupus nephritis look before you leap
Nephrology Dialysis Transplantation, 2006Co-Authors: Geoffrey R Bihl, Michelle Petri, Derek M. FineAbstract:Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease primarily affecting women of reproductive age. There is a particular pre-disposition to develop SLE in those of African descent, including a growing incidence in sub-Saharan Africa [1,2]. When compared with white patients, a more aggressive course of disease and poorer outcomes are noted. Such effects are also seen with lupus Kidney disease, which is also more common in black patients [3]. Indeed, during the course of their disease, the Kidney is a major target organ in up to 60% of patients with SLE, with 25–50% presenting with Kidney involvement already at the time of lupus diagnosis. The presentation of lupus nephritis is highly variable, ranging from mild asymptomatic proteinuria to rapidly progressive glomerulonephritis with haematuria and red cell casts. Features invariably include some degree of glomerular proteinuria—nephrotic in 45–65% of the cases. Several studies have illustrated the lack of reliability of diagnoses rendered on the basis of clinical features alone [4,5]. Therefore, making a diagnosis on clinical grounds alone is problematic and risky, underscoring the need for Kidney Biopsy. With diverse renal histopathological findings possible in SLE-affected patients, Biopsy determines not only the diagnosis and prognosis, but also substantially guides management of this complex disease. As the therapeutic armamentarium for lupus nephritis expands, it becomes even more imperative that the correct diagnosis be made prior to instituting therapy. In deciding whether to perform a Biopsy, one must balance the risks of the Biopsy procedure against the risks of limited diagnostic information, which may result in progression of potentially preventable renal disease or the unnecessary use of a possibly toxic therapy.
F Toniolo - One of the best experts on this subject based on the ideXlab platform.
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The value of repeat Kidney Biopsy in quiescent Argentinian lupus nephritis patients.
Lupus, 2014Co-Authors: Anthony Alvarado, A Malvar, B Lococo, V Alberton, F Toniolo, Haikady N. Nagaraja, Brad H. RovinAbstract:BackgroundThe duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1–2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat Kidney Biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission.MethodsThe practice in a large Buenos Aires nephrology unit is to repeat a Kidney Biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more Kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease.ResultsDespite normalization of serum creatinine and reduction of proteinuria to
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the value of repeat Kidney Biopsy in quiescent argentinian lupus nephritis patients
Lupus, 2014Co-Authors: Anthony Alvarado, A Malvar, B Lococo, V Alberton, F Toniolo, Haikady N. Nagaraja, Brad H. RovinAbstract:BackgroundThe duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1–2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat Kidney Biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission.MethodsThe practice in a large Buenos Aires nephrology unit is to repeat a Kidney Biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more Kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease.ResultsDespite normalization of serum creatinine and reduction of proteinuria to <500 mg/d, 30% of patients still had significant activity at the last Biopsy. Conversely, 60% of patients with ongoing proteinuria (500–1000 mg/d), or stable but abnormal serum creatinine, ha...
A Malvar - One of the best experts on this subject based on the ideXlab platform.
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The value of repeat Kidney Biopsy in quiescent Argentinian lupus nephritis patients.
Lupus, 2014Co-Authors: Anthony Alvarado, A Malvar, B Lococo, V Alberton, F Toniolo, Haikady N. Nagaraja, Brad H. RovinAbstract:BackgroundThe duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1–2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat Kidney Biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission.MethodsThe practice in a large Buenos Aires nephrology unit is to repeat a Kidney Biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more Kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease.ResultsDespite normalization of serum creatinine and reduction of proteinuria to
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the value of repeat Kidney Biopsy in quiescent argentinian lupus nephritis patients
Lupus, 2014Co-Authors: Anthony Alvarado, A Malvar, B Lococo, V Alberton, F Toniolo, Haikady N. Nagaraja, Brad H. RovinAbstract:BackgroundThe duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1–2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat Kidney Biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission.MethodsThe practice in a large Buenos Aires nephrology unit is to repeat a Kidney Biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more Kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease.ResultsDespite normalization of serum creatinine and reduction of proteinuria to <500 mg/d, 30% of patients still had significant activity at the last Biopsy. Conversely, 60% of patients with ongoing proteinuria (500–1000 mg/d), or stable but abnormal serum creatinine, ha...
