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  1. AU="Koirala, Abbal"
  2. AU="Morimoto, Hideto"
  3. AU="Hartman, Philip"
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  1. Artikel ; Online: Thrombotic microangiopathy following chimeric antigen receptor T-cell therapy.

    Wu, Matthew S / Koirala, Abbal

    Clinical nephrology. Case studies

    2023  Band 11, Seite(n) 17–21

    Abstract: Introduction: Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia and is associated with a variety of conditions and following hematopoietic stem cell transplantation. Chimeric antigen receptor T-cell (CAR-T) therapy ... ...

    Abstract Introduction: Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia and is associated with a variety of conditions and following hematopoietic stem cell transplantation. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel immunotherapeutic approach using genetically modified autologous T cells. CAR-T therapy has been linked with injuries to vascular endothelium, but a direct association between CAR-T and TMA has not been reported.
    Case reports: Two cases of TMAs following CAR-T treatment are reported here. In each case, clinical evidence of kidney injury, thrombocytopenia, and hemolytic anemia became apparent 2 - 3 months following CAR-T infusion. We describe the clinical course, management, and outcome of these experiences.
    Discussion/conclusion: CAR-T cell therapy-associated TMA (CAR-T TMA) appear to be an entity that shares overlapping clinical features with transplant-associated TMA (TA-TMA). Based on our preliminary clinical observations, we discuss the best clinical diagnosis/classification criteria, underlying pathophysiology, and the implication of the apparently self-limiting course. With increasing use of CAR-T cell treatment in hematologic malignancies, systematic studies will be necessary to improve management of CAR-T TMA.
    Sprache Englisch
    Erscheinungsdatum 2023-02-16
    Erscheinungsland Germany
    Dokumenttyp Case Reports
    ISSN 2196-5293
    ISSN (online) 2196-5293
    DOI 10.5414/CNCS111045
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Review of the Role of Rituximab in the Management of Adult Minimal Change Disease and Immune-Mediated Focal and Segmental Glomerulosclerosis.

    Aslam, Ahsan / Koirala, Abbal

    Glomerular diseases

    2023  Band 3, Heft 1, Seite(n) 211–219

    Abstract: Background: Minimal change disease and primary FSGS are podocytopathies but are also immune-mediated diseases. Rituximab acts via multiple mechanisms by tilting the balance between autoreactive B and T cells in favor of regulatory B and T cells. The ... ...

    Abstract Background: Minimal change disease and primary FSGS are podocytopathies but are also immune-mediated diseases. Rituximab acts via multiple mechanisms by tilting the balance between autoreactive B and T cells in favor of regulatory B and T cells. The consequences are decreased production of cytokines, chemokines, and permeability factors by these cells. In the past decade, we have seen the discovery of autoantibodies mediating nephrotic syndrome (anti-annexin A2 antibody, anti-UCHL1 antibody, and anti-nephrin antibody), and rituximab decreases their production. Rituximab also binds to podocyte SMPDL3b and has direct podocyte actions.
    Summary: Rituximab's role in managing these primary podocytopathies has been discussed in this brief review. Rituximab has been used extensively in children and adults with frequently relapsing and steroid-dependent nephrotic syndrome. However, rituximab is not very promising in adult steroid-resistant nephrotic syndrome. Although ofatumumab would cause prolonged B-cell depletion and is fully humanized, it is unclear if it is superior to rituximab in preventing relapse of nephrotic syndrome.
    Key messages: Rituximab therapy can induce prolonged remission in adults with frequently relapsing and steroid-dependent nephrotic syndrome. However, no good data exist on using rituximab in steroid-resistant nephrotic syndrome.
    Sprache Englisch
    Erscheinungsdatum 2023-08-18
    Erscheinungsland Switzerland
    Dokumenttyp Journal Article ; Review
    ISSN 2673-3633
    ISSN (online) 2673-3633
    DOI 10.1159/000533695
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: Steroid Minimization in Adults with Minimal Change Disease.

    Koirala, Abbal / Jefferson, J Ashley

    Glomerular diseases

    2021  Band 1, Heft 4, Seite(n) 237–249

    Abstract: Background: Minimal change disease (MCD) causes approximately 10% of nephrotic syndrome in adults. While glucocorticoids (GCs) effectively induce remission in MCD, the disease has a high relapse rate (50-75%), and repeated exposure to GCs is often ... ...

    Abstract Background: Minimal change disease (MCD) causes approximately 10% of nephrotic syndrome in adults. While glucocorticoids (GCs) effectively induce remission in MCD, the disease has a high relapse rate (50-75%), and repeated exposure to GCs is often required. The adverse effects of GCs are well recognized and commonly encountered with the high doses and recurrent courses used in MCD.
    Summary: In this review, we will discuss the standard therapy of MCD in adults and then describe new therapeutic options in induction therapy and treatment of relapses in MCD, minimizing the exposure to GCs.
    Key messages: Steroid minimization strategies may decrease adverse effects in the treatment of MCD.
    Sprache Englisch
    Erscheinungsdatum 2021-07-29
    Erscheinungsland Switzerland
    Dokumenttyp Journal Article ; Review
    ISSN 2673-3633
    ISSN (online) 2673-3633
    DOI 10.1159/000517626
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: How Safe Is a Native Kidney Biopsy?

    Koirala, Abbal / Jefferson, J Ashley

    Clinical journal of the American Society of Nephrology : CJASN

    2020  Band 15, Heft 11, Seite(n) 1541–1542

    Mesh-Begriff(e) Biopsy ; Cohort Studies ; Hemorrhage ; Humans ; Kidney ; Nephrectomy
    Sprache Englisch
    Erscheinungsdatum 2020-10-15
    Erscheinungsland United States
    Dokumenttyp Editorial ; Comment
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.14890920
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  5. Artikel ; Online: Etiology and Management of Edema: A Review.

    Koirala, Abbal / Pourafshar, Negiin / Daneshmand, Arvin / Wilcox, Christopher S / Mannemuddhu, Sai Sudha / Arora, Nayan

    Advances in kidney disease and health

    2023  Band 30, Heft 2, Seite(n) 110–123

    Abstract: The development of peripheral edema can often pose a significant diagnostic and therapeutic challenge for practitioners due to its association with a wide variety of underlying disorders ranging in severity. Updates to the original Starling's principle ... ...

    Abstract The development of peripheral edema can often pose a significant diagnostic and therapeutic challenge for practitioners due to its association with a wide variety of underlying disorders ranging in severity. Updates to the original Starling's principle have provided new mechanistic insights into edema formation. Additionally, contemporary data highlighting the role of hypochloremia in the development of diuretic resistance provide a possible new therapeutic target. This article reviews the pathophysiology of edema formation and discusses implications for treatment.
    Mesh-Begriff(e) Humans ; Causality ; Acid-Base Imbalance ; Diuretics ; Edema
    Chemische Substanzen Diuretics
    Sprache Englisch
    Erscheinungsdatum 2023-03-01
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Review
    ZDB-ID 3156601-7
    ISSN 2949-8139
    ISSN (online) 2949-8139
    DOI 10.1053/j.akdh.2022.12.002
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  6. Artikel ; Online: Evaluation of the Modified Oxford Score in Recurrent IgA Nephropathy in North American Kidney Transplant Recipients: The Banff Recurrent Glomerulonephritis Working Group Report.

    Alachkar, Nada / Delsante, Marco / Greenberg, Ross S / Koirala, Abbal / Alhamad, Tarek / Abdalla, Basmah / Anand, Manish / Boonpheng, Ben / Blosser, Christopher / Maggiore, Umberto / Bagnasco, Serena M

    Transplantation

    2023  Band 107, Heft 9, Seite(n) 2055–2063

    Abstract: Background: The modified Oxford classification mesangial and endocapillary hypercellularity, segmental sclerosis, interstitial fibrosis/tubular atrophy, and the presence of crescents (MEST-C) of immunoglobulin A nephropathy (IgAN) was recently shown to ... ...

    Abstract Background: The modified Oxford classification mesangial and endocapillary hypercellularity, segmental sclerosis, interstitial fibrosis/tubular atrophy, and the presence of crescents (MEST-C) of immunoglobulin A nephropathy (IgAN) was recently shown to be a predictor of graft failure in Asians with recurrent IgAN. We aimed to validate these findings in a cohort from North American centers participating in the Banff Recurrent Glomerulopathies Working Group.
    Methods: We examined 171 transplant recipients with end-stage kidney disease because of IgAN; 100 of them with biopsy-proven recurrent IgAN (57 of them had complete MEST-C scores) and 71 with no recurrence.
    Results: IgAN recurrence, which was associated with younger age at transplantation ( P  = 0.012), strongly increased the risk of death-censored graft failure (adjusted hazard ratio, 5.10 [95% confidence interval (CI), 2.26-11.51]; P  < 0.001). Higher MEST-C score sum was associated with death-censored graft failure (adjusted hazard ratio, 8.57 [95% CI, 1.23-59.85; P  = 0.03] and 61.32 [95% CI, 4.82-779.89; P  = 0.002] for score sums 2-3 and 4-5 versus 0, respectively), and so were the single components endocapillary hypercellularity, interstitial fibrosis/tubular atrophy, and crescents ( P  < 0.05 each). Overall, most of the pooled adjusted hazard ratio estimates associated with each MEST-C component were consistent with those from the Asian cohort (heterogeneity I2 close to 0%, and P  > 0.05).
    Conclusions: Our findings may validate the prognostic usefulness of the Oxford classification for recurrent IgAN and support the inclusion of the MEST-C score in allograft biopsies diagnostic reports.
    Mesh-Begriff(e) Humans ; Glomerulonephritis, IGA/complications ; Glomerulonephritis, IGA/diagnosis ; Glomerulonephritis, IGA/surgery ; Kidney Transplantation/adverse effects ; Transplant Recipients ; Fibrosis ; Atrophy/complications ; Atrophy/pathology ; North America ; Biopsy ; Kidney/pathology
    Sprache Englisch
    Erscheinungsdatum 2023-08-21
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/TP.0000000000004640
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  7. Artikel ; Online: Global transcriptomic changes occur in aged mouse podocytes.

    Wang, Yuliang / Eng, Diana G / Kaverina, Natalya V / Loretz, Carol J / Koirala, Abbal / Akilesh, Shreeram / Pippin, Jeffrey W / Shankland, Stuart J

    Kidney international

    2020  Band 98, Heft 5, Seite(n) 1160–1173

    Abstract: Glomerular podocytes undergo structural and functional changes with advanced age, that increase susceptibility of aging kidneys to worse outcomes following superimposed glomerular diseases. To delineate transcriptional changes in podocytes in aged mice, ... ...

    Abstract Glomerular podocytes undergo structural and functional changes with advanced age, that increase susceptibility of aging kidneys to worse outcomes following superimposed glomerular diseases. To delineate transcriptional changes in podocytes in aged mice, RNA-seq was performed on isolated populations of reporter-labeled (tdTomato) podocytes from multiple young (two to three months) and advanced aged mice (22 to 24 months, equivalent to 70 plus year old humans). Of the 2,494 differentially expressed genes, 1,219 were higher and 1,275 were lower in aged podocytes. Pathway enrichment showed that major biological processes increased in aged podocytes included immune responses, non-coding RNA metabolism, gene silencing and MAP kinase signaling. Conversely, aged podocytes showed downregulation of developmental, morphogenesis and metabolic processes. Canonical podocyte marker gene expression decreased in aged podocytes, with increases in apoptotic and senescence genes providing a mechanism for the progressive loss of podocytes seen with aging. In addition, we revealed aberrations in the podocyte autocrine signaling network, identified the top transcription factors perturbed in aged podocytes, and uncovered candidate gene modulations that might promote healthy aging in podocytes. The transcriptional signature of aging is distinct from other kidney diseases. Thus, our study provides insights into biomarker discovery and molecular targeting of the aging process itself within podocytes.
    Mesh-Begriff(e) Aging/genetics ; Animals ; Kidney Glomerulus ; Mice ; Podocytes ; Signal Transduction ; Transcriptome
    Sprache Englisch
    Erscheinungsdatum 2020-06-25
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1016/j.kint.2020.05.052
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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