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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">Arias et al&#46;<span class="elsevierStyleSup">1</span> deserve compliments for sharing their experience on 13 children presenting with idiopathic nephrotic syndrome &#40;INS&#41; and diffuse dominant deposits of immunoglobulin M &#40;IgM&#41; on immunoflourescence &#40;IF&#41; study of renal biopsies&#46; This pattern of immunohistochemical findings in combination with a variety of morphological lesions is popularly called IgM nephropathy &#40;IgMN&#41;&#44; the most controversial entity in the recent nephrology history&#46;<span class="elsevierStyleSup">2-6</span> The article by Arias et al&#46;<span class="elsevierStyleSup">1</span> is helpful in clarifying some of the controversies on the topic&#44; but includes a small number of patients&#46; I take this opportunity to emphasize some points about this disease&#46;</p><p class="elsevierStylePara">1&#46; The observed frequency varies among the studies&#46;<span class="elsevierStyleSup">1-3</span> We&#44;<span class="elsevierStyleSup">2</span> in particular&#44; found a high frequency of 18&#46;5&#37; of IgMN in the largest study on children as compared to 5&#46;17&#37; observed by Arias et al&#46;<span class="elsevierStyleSup">1</span> A close scrutiny of both studies will help explain this discrepancy&#46; The denominator used to calculate the frequency of IgMN in our study comprised of biopsied children presenting with INS&#44; whereas&#44; Arias et al&#46; used all biopsies for this purpose&#46; A host of other factors also contribute to this phenomenon in different studies&#44; such as disease definition&#44; minimum threshold of IgM positivity used to define the disease&#44; exclusion or inclusion of lesions of focal segmental glomerulosclerosis and so on&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">2&#46; The authors used the term of minimal change disease &#40;MCD&#41; in Table 2 for describing the pattern of minor glomerular alterations in IgMN&#46; I think&#44; it is better to avoid this term&#44; as it denotes a definite disease entity&#46; Instead&#44; the term of&#44; minor glomerular changes&#44; be used to describe the above pattern of lesions in IgMN&#46;</p><p class="elsevierStylePara">3&#46; The authors did not give the minimum threshold of IgM positivity used to define the disease and the central measures&#177;dispersion of follow-up period&#46; Only minimum follow-up of six months is stated&#46;</p><p class="elsevierStylePara">4&#46; A number of discrepancies in the numbers of morphological patterns in results and figure captions and some other places are found&#46;</p><p class="elsevierStylePara">5&#46; In results&#44; it is stated that hematuria was found in four patients&#44; but in Table 1&#44; it is present in seven patients&#46; Similarly&#44; high blood pressure is stated to be present in two patients&#44; while in Table 1&#44; it is found in three patients&#46;</p><p class="elsevierStylePara">6&#46; The caption of Table 3 reads as &#8220;Histological findings and treatment received&#8221;&#46; However&#44; there are no histological findings in the table contents&#46;</p><p class="elsevierStylePara">7&#46; No units for serum creatinine in Table 1 and for creatinine and proteinuria at one year are given in Table 3&#46;</p><p class="elsevierStylePara">8&#46; Another point of ambiguity is the timing of the classification of treatment responses into&#44; for example&#44; cortico-resistant or cortico-dependant&#46; Whether it was done before performing the biopsy or at last follow-up&#63; It needs clarification for a better understanding of the disease course&#46;</p><p class="elsevierStylePara">9&#46; Finally&#44; it is heartening to note that western investigators have listened to our calls and a group has found in an experimental study in mice that IgM activates the complement system within the glomerulus and leads to glomerulosclerosis&#46;<span class="elsevierStyleSup">6</span> This represents a landmark study in the investigation of this disease&#46; We hope that the same group will continue their efforts to elucidate the pathogenesis of the disease in near future&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p>"
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IgM nephropathy in children: clinicopathological analysis
IgM nephropathy in children: clinicopathological analysis
Muhammed Mubaraka
a Histopathology Department, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Sindh, Pakistan,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">Arias et al&#46;<span class="elsevierStyleSup">1</span> deserve compliments for sharing their experience on 13 children presenting with idiopathic nephrotic syndrome &#40;INS&#41; and diffuse dominant deposits of immunoglobulin M &#40;IgM&#41; on immunoflourescence &#40;IF&#41; study of renal biopsies&#46; This pattern of immunohistochemical findings in combination with a variety of morphological lesions is popularly called IgM nephropathy &#40;IgMN&#41;&#44; the most controversial entity in the recent nephrology history&#46;<span class="elsevierStyleSup">2-6</span> The article by Arias et al&#46;<span class="elsevierStyleSup">1</span> is helpful in clarifying some of the controversies on the topic&#44; but includes a small number of patients&#46; I take this opportunity to emphasize some points about this disease&#46;</p><p class="elsevierStylePara">1&#46; The observed frequency varies among the studies&#46;<span class="elsevierStyleSup">1-3</span> We&#44;<span class="elsevierStyleSup">2</span> in particular&#44; found a high frequency of 18&#46;5&#37; of IgMN in the largest study on children as compared to 5&#46;17&#37; observed by Arias et al&#46;<span class="elsevierStyleSup">1</span> A close scrutiny of both studies will help explain this discrepancy&#46; The denominator used to calculate the frequency of IgMN in our study comprised of biopsied children presenting with INS&#44; whereas&#44; Arias et al&#46; used all biopsies for this purpose&#46; A host of other factors also contribute to this phenomenon in different studies&#44; such as disease definition&#44; minimum threshold of IgM positivity used to define the disease&#44; exclusion or inclusion of lesions of focal segmental glomerulosclerosis and so on&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">2&#46; The authors used the term of minimal change disease &#40;MCD&#41; in Table 2 for describing the pattern of minor glomerular alterations in IgMN&#46; I think&#44; it is better to avoid this term&#44; as it denotes a definite disease entity&#46; Instead&#44; the term of&#44; minor glomerular changes&#44; be used to describe the above pattern of lesions in IgMN&#46;</p><p class="elsevierStylePara">3&#46; The authors did not give the minimum threshold of IgM positivity used to define the disease and the central measures&#177;dispersion of follow-up period&#46; Only minimum follow-up of six months is stated&#46;</p><p class="elsevierStylePara">4&#46; A number of discrepancies in the numbers of morphological patterns in results and figure captions and some other places are found&#46;</p><p class="elsevierStylePara">5&#46; In results&#44; it is stated that hematuria was found in four patients&#44; but in Table 1&#44; it is present in seven patients&#46; Similarly&#44; high blood pressure is stated to be present in two patients&#44; while in Table 1&#44; it is found in three patients&#46;</p><p class="elsevierStylePara">6&#46; The caption of Table 3 reads as &#8220;Histological findings and treatment received&#8221;&#46; However&#44; there are no histological findings in the table contents&#46;</p><p class="elsevierStylePara">7&#46; No units for serum creatinine in Table 1 and for creatinine and proteinuria at one year are given in Table 3&#46;</p><p class="elsevierStylePara">8&#46; Another point of ambiguity is the timing of the classification of treatment responses into&#44; for example&#44; cortico-resistant or cortico-dependant&#46; Whether it was done before performing the biopsy or at last follow-up&#63; It needs clarification for a better understanding of the disease course&#46;</p><p class="elsevierStylePara">9&#46; Finally&#44; it is heartening to note that western investigators have listened to our calls and a group has found in an experimental study in mice that IgM activates the complement system within the glomerulus and leads to glomerulosclerosis&#46;<span class="elsevierStyleSup">6</span> This represents a landmark study in the investigation of this disease&#46; We hope that the same group will continue their efforts to elucidate the pathogenesis of the disease in near future&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript&#46;</p>"
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