Recent Advancements on Lupus Podocytopathy: A Rising Entity of Nonimmune Complex-Mediated Nephropathy Associated with Systemic Lupus Erythematosus
Jinil Yoo*, Hugo Villanueva
Division of Nephrology, Montefiore Medical Center – Albert Einstein College of Medicine, Bronx, NY, USA
Lupus nephritis (LN), a common and serious complication of systemic lupus erythematosus (SLE) is considered as a typical immune-complex mediated disease, and currently classified into 6 classes, primarily based on histologic findings of glomerular involvement, which became accepted worldwide for diagnosis, prognosis, and treatment guide. In recent years, a rising numbers of cases are reported to have a nonimmune complex-mediated glomerular podocytopathy among SLE patients presenting with nephrotic syndrome. The kidney biopsy done in those patients showed some with minimal change disease-like features, some with mesangial proliferation and some with focal segmental glomerulosclerosis on light microscopy (LM), but all with diffuse foot process effacement (FPE), and no glomerular capillary proliferation/inflammation on LM as seen in class lll and IV LN and no glomerular capillary immune deposits on immunofluorescence (IF) study, observed in class V LN, suggestive of podocyte injury caused by a nonimmune complex mediated pathway, called as “lupus podocytopathy”. Although it is not accepted as a class of LN, the case of lupus podocytopathy of non-immune complex origin is growing and emerging as a distinct entity, of active lupus nephritis, since lupus podocytopathy usually occurs concurrently with extrarenal and active serologic activity, and mostly within 6 months of SLE onset.
View / Download Pdf The Role of CT-Based Radiomics in Precise Imaging of Renal Cancer
Marta Ligero1, Kinga Bernatowicz1, Raquel Perez-Lopez1,2*
Radiomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, 08035, Spain
Radiology Department, Vall d’Hebron University Hospital, Barcelona, 08035, Spain
*M.L. and K.B. are joint first authors. They have contributed equally to the literature systematic review and drafting of the manuscript.
The application of advanced computational analysis to medical imaging opens a plethora of opportunities in the field of radiology, allowing for more accurate tissue characterization and, eventually, advancing towards precision medicine through imaging biomarkers. In this review, we briefly introduce the methodology for radiomics analysis and the main challenges for implementation of radiomics-based tools in clinical practice. Based on systematic review of published studies, we also summarize here the main advances regarding CT-based radiomics applications in renal cancer with regards to tumor characterization (diagnosis, grading, prognosis), gene expression prediction (radiogenomics) and response evaluation.
View / Download Pdf Alterations of cAMP/cGMP Signaling Pathways in Lupus Nephritis
Issaka Yougbare
Systemic lupus erythematosus (SLE) is an autoimmune disease with a broad spectrum of clinical manifestations, but its pathogenesis remains fairly understood. Cyclic nucleotide signaling pathways in immune cells and kidney are emerging as cellular mechanisms governing SLE disease progression. Upregulations of cGMP/cAMP metabolism lead to lupus nephritis and abnormal kidney remodeling/hypertrophy. PDE4 family remains the major cAMP hydrolyzing enzyme as PDE1 is responsible for cGMP breakdown in kidney. SLE disease progression to lupus nephritis is correlated with increase PDE1 and PDE4 activities resulting in lower cyclic nucleotide levels in kidney. Administration of Nimodipine, a PDE1 inhibitor prevents the lymphoproliferative phenotype and exert anti-proliferative effects on mesangial cells while PDE4 inhibitor NCS 613 prevents inflammatory cytokines release, immune complex deposition, and nephritis in MRL/lpr lupus prone mice. In this review, we highlight recent findings of alterations of cyclic nucleotide signaling pathways in lupus nephritis. Given the role of cAMP/cGMP signaling in kidney function, dual inhibition of PDE1 and PDE4 may represent a promising therapeutic approach to tackle lupus nephritis.
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