Hernán Trimarchi

Hospital Británico de Buenos Aires

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Mariano Forrester

Servicio Geológico Minero Argentino

Fernando Lombi

Hospital Británico

Jonathan Barratt

University of Leicester

Pablo Young

Hospital Británico de Buenos Aires

Vanesa Pomeranz

Hospital Británico de Buenos Aires

Romina Iriarte

Hospital Británico de Buenos Aires

Alexis Muryan

Hospital Británico de Buenos Aires

Vladimı́r Tesař

Charles University

Brad H. Rovin

The Ohio State University

Hong Zhang

Peking University

Cooperative Institutions

Hospital Británico de Buenos Aires

102

RELX Group (United States)

Pediatric Nephrology of Alabama

Inserm

University of Sydney

University of Toronto

Hospital Británico

Juntendo University

Istituti di Ricovero e Cura a Carattere Scientifico

Columbia University

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Practice Patterns in IgA Nephropathy: A Questionnaire-Based Survey

Journal of the American Society of Nephrology (2022)

Bhavik Bansal Amritesh Grewal Hernán Trimarchi Boon Wee Teo Yuko Shima

10.1681/asn.20223311s1503a

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Podocytopathy in the mesangial proliferative immunoglobulin A nephropathy: new insights into the mechanisms of damage and progression

Nephrology Dialysis Transplantation (2018)

Hernán Trimarchi Rosanna Coppo

Immunoglobulin A nephropathy (IgAN) was defined as a mesangiopathic disease, since the primary site of deposition of IgA immune material is the mesangium, and proliferation of mesangial cells and matrix excess deposition are the first histopathologic lesions. However, the relentless silent progression of IgAN is mostly due to the development of persistent proteinuria, and recent studies indicate that a major role is played by previous damage of function and anatomy of podocytes. In IgAN, the podocytopathic changes are the consequence of initial alterations in the mesangial area with accumulation of IgA containing immune material. Podocytes are therefore affected by interactions of messages originally driven from the mesangium. After continuous insult, podocytes detach from the glomerular basement membrane. This podocytopathy favours not only the development of glomerular focal and segmental sclerosis, but also the progressive renal function loss. It is still debated whether these lesions can be prevented or cured by corticosteroid/immunosuppressive treatment. We aimed to review recent data on the mechanisms implicated in the podocytopathy present in IgAN, showing new molecular risk factors for progression of this disease. Moreover, these observations may indicate that the target for new drugs is not only focused on decreasing the activity of mesangial cells and inflammatory reactions in IgAN, but also on improving podocyte function and survival.

Mesangial proliferative glomerulonephritis

10.1093/ndt/gfy413

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Abatacept and Glomerular Diseases: The Open Road for the Second Signal as a New Target is Settled Down

Recent Patents on Endocrine Metabolic & Immune Drug Discovery (2015)

Hernán Trimarchi

Glomerulopathy is the third most important cause of kidney disease. Proteinuria is the hallmark of glomerular damage, and a marker of progression of kidney disease, cardiovascular morbidity and mortality. Strategies to reduce proteinuria are partially successful, and despite proteinuria management, renal disease may still progress. Immunosuppression to treat glomerulopathies is nonspecific, partially effective and presents side-effects. It is critical to find safe drugs with specific podocyte molecular targets. Podocytes contain a complex array of proteins. Lymphocyte activation antigen B7-1 (CD80) is located on antigen presenting cells modulating CD4+ and CD8+ T cells by interacting with co-stimulator CD28, a glycoprotein located on T-cells, or with cytotoxic T-lymphocyte protein 4 (CTLA-4) co-inhibitor. Normally, podocytes do not express B7-1. However, certain glomerulopathies are associated with an increase on the surface of podocytes of B7-1, which reduces the ability of podocytes to attach to the surrounding glomerular basement membrane, favouring podocyturia and proteinuria. When the B7-1-CTLA-4 interaction takes place, the immune response is abrogated, while a B7-1-CD28 coupling leads to T cell activation. Abatacept binds to B7-1 by blocking the CD28 or potentiating the CTLA-4 signals. In B7-1 positive podocytes, abatacept may be a specific tool to decrease proteinuria. Selected patents are also briefly presented in this review. Keywords: Abatacept, B7-1, CD28, CD80, CTLA-4, glomerulopathy, podocyte, proteinuria.

Abatacept

CD80

Glomerulopathy

Nephritis

10.2174/1872214809666150302104542

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Microangiopatía trombótica e injuria renal aguda en el primer trimestre de embarazo

Fronteras en Medicina (2018)

Ivan González-Hoyos Fernando Lombi Mariano Forrester Vanesa Pomeranz Romina Iriarte

La microangiopatía trombótica acompañada de injuria renal aguda (IRA) en el embarazo es un desafío diagnóstico y terapéutico.Presentamos el caso clínico de una mujer de 29 años de edad cursando el primer trimestre del embarazo, que presentó IRA, anemia hemolítica microangiopática y plaquetopenia, que se correlacionaron con hallazgos compatibles con microangiopatía trombótica (MAT) severa en la punción biopsia renal.Se decidió realizar un estudio genético para las mutaciones del complemento evidenciándose deleción heterocigota de los genes CFHR3/CFHR1 y anticuerpos anti factor H del complemento positivos, haciéndose el diagnóstico de síndrome urémico hemolítico atípico (SUHa).El tratamiento con plasmaféresis y recambio plasmático permitió una evolución clínica favorable de la paciente y estabilización de la función renal.

10.31954/rfem/201803/0154-0157

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[Hyperhomocysteinemia as a vascular risk factor in chronic hemodialysis patients].

PubMed (2005)

Hernán Trimarchi Pablo Young María L Díaz Juan Schropp Mariano Forrester

Homocysteine is an independent risk factor for cardiovascular disease in the general population. In addition, it plays a main role in the development of atherogenesis and thrombosis, particularly in end-stage renal disease patients. Therefore, hemodialysis patients are under the burden of homocysteine toxic effects, present in nearly 90% of dialysis patients. Our group found that folic acid is an efficient therapeutic approach to decrease homocysteine levels, and the addition of intravenous methylcobalamin potentiates this effect; however, methylcobalamin alone was unsuccessful to normalize homocysteine levels. With time a group of patients required a higher dose of folic acid to reduce hyperhomocysteinemia. Patients homozygous and, to a lesser extent heterozygous, to the C677T thermolabile variant of methylenetetrahydrofolate reductase (MTHFR) presented a reduced catalytic activity and required a higher folic acid dose. Vascular-access thrombotic events were similar in all patients according to the variants of the enzyme, suggesting that treating hyperhomocysteinemia was the key to lower the risk of thromboses. Noteworthy, hypohomocysteinemia, generally acompanying malnourishment, is associated to higher mortality. Albeit hyper-homocysteinemia is considered a vascular risk factor in renal failure patients, it has not yet been established in this population if its correction is associated with a decrease in the rate of vascular disease and thrombosis. However, given the mentioned evidence about the low risk and good tolerance of vitamin therapy, we believe it useful to know folate, cobalamin and homocysteine blood levels in chronic renal patients and start a prompt treatment, which may proof adequate to maintain homocysteine levels of 10 +/- 5 micromol/l.

Hyperhomocysteinemia

Methylcobalamin

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Subject Index Vol. 87, 2001

The Nephron journals/Nephron journals (2001)

Yasuo Totsuka Claudio Angelini Salvatore Badalamenti Masako Ohnishi Shinichiro J. Tojo

10.1159/000045949

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Patient-reported outcome measures for life participation in patients with chronic kidney disease: a systematic review

Clinical Kidney Journal (2024)

Anastasia Hughes Angela Ju Rosanna Cazzolli Martin Howell Fergus Caskey

ABSTRACT Background The symptoms, comorbidities and treatment burden associated with chronic kidney disease (CKD) can be debilitating and limit life participation in patients with CKD not requiring kidney replacement therapy (KRT). The aim of this study was to identify the characteristics, content and psychometric properties of patient-reported outcome measures (PROMs) used to assess life participation in patients with CKD. Methods We searched MEDLINE, Embase, PsycINFO and CINAHL from database inception to February 2023 for all studies that reported life participation in patients with CKD (stages 1–5 not requiring kidney replacement therapy). We analysed the characteristics, dimensions of life participation and psychometric properties of the measures. Results From the 114 studies included, 20 (18%) were randomized trials, 3 (3%) were non-randomized trials and 91 (80%) were observational studies. Forty-one different measures were used to assess life participation, of which six (15%) were author-developed measures. Twelve (29%) measures assessed life participation specifically, while 29 (71%) measures assessed broader constructs such as quality of life, which included questions relevant to life participation. The 36-Item Short Form Health Survey (SF-36) and Kidney Disease Quality of Life Short Form (KDQOL-SF) were the most frequently used, in 39 (34%) and 24 (21%) studies, respectively. Many content domains for life participation were assessed, including physical activities (walking, running and sports), social activities, leisure activities, work or study and self-care. None of the measures for life participation were developed specifically for CKD. Four measures (EuroQol 5-dimension 3-level (EQ-5D-3L), Functional Assessment of Cancer Therapy - Anemia, Short Form 6-dimension and Short-From 36-dimension (SF-36)) had validation data collected in patients with CKD. Conclusion The measures for life participation used in patients with CKD vary in content, with few validated in the CKD population. There is a need for a validated measure to assess life participation in a meaningful and consistent way in all patients with CKD worldwide.

Patient-reported outcome

10.1093/ckj/sfae341

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Uso de plasma de convaleciente en el tratamiento de paciente con neumonía por COVID-19. Reporte de caso

Revista Hematología (2020)

Jhon Alexander Ávila Rueda О. С. Рабинович Pablo Young Hernán Trimarchi Agustín Montes

Sars-Cov-2, known as COVID-19, is a virus belonging to coronavirus family, whose characteristicis the development of respiratory diseases, mainly pneumonia, with a high risk of progression to acute respiratory distress syndrome, which in turn is related to high morbidity and mortality rates that vary from case to case. Although a specific management scheme is not available, the use of convalescent plasma has been proposed as a therapeutic alternative, so studies are currently being carried out to evaluate its efficacy, although there are preliminary reports of published studies with encouraging results with low risk and possible benefits of this therapy. We present our case experience regarding the use of convalescent plasma in a 24 years old patient diagnosed with COVID-19 pneumonia at our institution.

Convalescent plasma

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Rod of Asclepius. Symbol of medicine

Pablo Young Bárbara C Finn Julio E Bruetman Jorge Cesaro Gelos Hernán Trimarchi

Symbolism is one of the most archaic forms of human thoughts. Symbol derives from the Latin word symbolum, and the latter from the Greek symbolon or symballo, which means coincide, I make matches. The Medicine symbol represents a whole series of historical and ethical values. Asclepius Rod with one serpent entwined, has traditionally been the symbol of scientific medicine. In a misconception that has lasted 500 years, the Caduceus of Hermes, entwined by two serpents and with two wings, has been considered the symbol of Medicine. However, the Caduceus is the current symbol of Commerce. Asclepius Rod and the Caduceus of Hermes represent two professions, Medicine and Commerce that, in ethical practice, should not be mixed. Physicians should be aware of their real emblem, its historical origin and meaning.

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A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Sibeprenlimab Administered Subcutaneously in Patients With IgA Nephropathy

Journal of the American Society of Nephrology (2022)

Dana V. Rizk Vlado Perkovic Richard A. Lafayette Hernán Trimarchi Jonathan Barratt

10.1681/asn.20223311s1799c

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