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Immunoglobulin A nephropathy: Basic characteristics  [PDF]
Petrovi? Lada,?uri? Slobodan,Miti? Igor,Bo?i? Du?an 1
Medicinski Pregled , 2003, DOI: 10.2298/mpns0306281p
Abstract: Introduction Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis in many countries. Most clinical features of IgAN point to a renal problem, such as recurrent macroscopic hematuria or asymptomatic microscopic hematuria and proteinuria. Pathologic features of IgAN present with different types and different degrees of glomerular tubulointerstitial and vascular lesions. The aim of this study was detailed analysis of clinical and laboratory findings, as well as findings of immunofluorescence and light microscopy. We also investigated associations between these factors. Material and methods We investigated 60 patients who underwent renal biopsy. The study was partly retrospective and partly prospective. Results The average age of patients was 34.19 years. Male female ratio was 2.33:1. IgAN was most frequently asymptomatic (83.33%) as microhematuria and proteinuria, while gross hematuria was found in 16.667%. Renal biopsy material was analyzed by light microscopy revealing changes in all glomerular structures. Immunofluorescence microscopy demonstrated dominant IgA deposits. This study established association of glomerulosclerosis with clinical features of disease. Discussion and conclusions IgAN frequently develops in the 4th decade of life, mostly in males and presents as asymptomatic (83.33%). Patohistological changes include all glomerular structures. There is no specific serological test for IgAN, but pathological changes affect clinical features of the disease, as proteinuria and increase of creatinine concentration.
Umashankar Lakshmanadoss,Elangovan Balakrishnan,Michael R DiSalle
Journal of Basic and Clinical Pharmacy , 2010,
Abstract: Treatment with Intravenous Immunoglobulin (IVIg) has been found to be useful in patients with variety of diseases. IVIg infusions can produce allergic reactions. These adverse reactions are thought to be caused by activation of the complement cascade by the aggregation of IgG. To avoid this, a variety of stabilizing agents, including sucrose, are used. Sucrose is metabolized in the intestines by sucrase. If sucrose is given intravenously, this will be reabsorbed in to the proximal convoluted tubule and produce osmotic nephropathy which will present clinically as oliguric acute kidney injury. Patients with preexisting renal insufficiency, diabetes mellitus, elderly (>65 years), volume depletion and sepsis are more prone for these adverse effects and care should be taken not to use the IVIg with sucrose as a stabilizer in this population. If no other options are available, reductions in dose, concentration, and/or rate of administration of IVIg are warranted to reduce the incidence of renal failure. Pharmacist should be aware of the clinical scenario of the patient and choose the IVIg with appropriate stabilizer
A serum cytokine network in immunoglobulin A nephropathy  [cached]
Sang Hoon Woo,Sanchita Bhattacharya,Geraldine Derby,Isabella Taylor
Nephrology Reviews , 2012, DOI: 10.4081/nr.2012.e8
Abstract: Individual cytokines have been reported to be associated with the pathogenesis and prognosis of immunoglobulin A (IgA) nephropathy (IgAN). We attempted to characterize a broad cytokine matrix in the serum of patients, and investigate its association with renal function. Thirty-two cytokines were simultaneously measured from the serum of IgAN patients (n=22) and healthy controls (n=12). Clinical variables including annual inulin based GFR and 24-h proteinuria were collected on the IgAN patients over a 5-year period. There was a significant difference between serum cytokine signature of IgAN and control values. There was a significant increase in 9 serum cytokines in IgAN patients compared with healthy controls, and these consisted of inflammatory cytokines, growth factors and chemokines. These 9 cytokines demonstrated significant inter-correlation and formed a distinct pattern compared to controls. IgAN appears to be associated with the elevation of multiple serum cytokines in a highly coordinated fashion. The pattern of cytokine changes could serve as a disease biomarker and may provide insights into disease pathogenesis.
Immunoglobulin A nephropathy and its prognostic factors  [PDF]
Petrovi? Lada,?uri? Slobodan,Miti? Igor,Bo?i? Du?an 1
Medicinski Pregled , 2002, DOI: 10.2298/mpns0212517p
Abstract: Introduction Immunoglobulin A nephropathy (IgAN) is a clinicopathological entity characterized by diffuse glomerular mesangial deposition of IgA as the predominant immunoglobulin. Renal biopsy reveals a spectrum of changes in glomerula, tubulointerstitium and blood vessels. 20-50% of all patients develop end-stage renal failure 20 years after onset of disease. The aim of this study was to investigate the incidence of IgAN and to analyze clinicopathological changes and prognosis of IgAN. Material and methods The study included 60 patients with biopsy-proved IgAN without some other systemic diseases or Henoch-Schonlen purpura. We analyzed clinical features of the disease, laboratory findings, findings of immunofluorescence and light microscopy and prognosis of IgAN. The study is partly retrospective and partly prospective. Results and discussion Incidence of the disease in the period 1981-1997 was 9.78%. At the moment of renal biopsy 63.16% of patients had normal renal function, 31.58% had stage I and 5.25% had stage II chronic renal failure. At the end of study 21.05% of investigated patients were included into the worse stage of renal failure in regard to the initial stage. Progression of renal damage correlated with special tubulointerstitial damage and heavy proteinuria. Conclusions In this study we found severe histopathological changes in the group with already impaired renal function and these changes correlated with laboratory findings, clinical features and prognosis. Normal renal function at the moment of renal biopsy pointed to risk for further damage. Changes in the tubulointerstitium and mesangium, heavy proteinuria and hypertension affect the disease prognosis. Evolution to the higher stage of renal failure was 1.24% per year and this requires long-term follow-up of patients with IgAN.
Microbiota and Metabolome Associated with Immunoglobulin A Nephropathy (IgAN)  [PDF]
Maria De Angelis, Eustacchio Montemurno, Maria Piccolo, Lucia Vannini, Gabriella Lauriero, Valentina Maranzano, Giorgia Gozzi, Diana Serrazanetti, Giuseppe Dalfino, Marco Gobbetti, Loreto Gesualdo
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099006
Abstract: This study aimed at investigating the fecal microbiota, and the fecal and urinary metabolome of non progressor (NP) and progressor (P) patients with immunoglobulin A nephropathy (IgAN). Three groups of volunteers were included in the study: (i) sixteen IgAN NP patients; (ii) sixteen IgAN P patients; and (iii) sixteen healthy control (HC) subjects, without known diseases. Selective media were used to determine the main cultivable bacterial groups. Bacterial tag-encoded FLX-titanium amplicon pyrosequencing of the 16S rDNA and 16S rRNA was carried out to determine total and metabolically active bacteria, respectively. Biochrom 30 series amino acid analyzer and gas-chromatography mass spectrometry/solid-phase microextraction (GC-MS/SPME) analyses were mainly carried out for metabolomic analyses. As estimated by rarefaction, Chao and Shannon diversity index, the lowest microbial diversity was found in P patients. Firmicutes increased in the fecal samples of NP and, especially, P patients due to the higher percentages of some genera/species of Ruminococcaceae, Lachnospiraceae, Eubacteriaceae and Streptococcaeae. With a few exceptions, species of Clostridium, Enterococcus and Lactobacillus genera were found at the highest levels in HC. Bacteroidaceae, Porphyromonadaceae, Prevotellaceae and Rikenellaceae families differed among NP, P and HC subjects. Sutterellaceae and Enterobacteriaceae species were almost the highest in the fecal samples of NP and/or P patients. Compared to HC subjects, Bifidobacterium species decreased in the fecal samples of NP and P. As shown by multivariate statistical analyses, the levels of metabolites (free amino acids and organic volatile compounds) from fecal and urinary samples markedly differentiated NP and, especially, P patients.
A proton nuclear magnetic resonance-based metabonomics study of metabolic profiling in immunoglobulin a nephropathy
Sui, Weiguo;Li, Liping;Che, Wenti;Guimai, Zuo;Chen, Jiejing;Li, Wuxian;Dai, Yong;
Clinics , 2012, DOI: 10.6061/clinics/2012(04)10
Abstract: objectives: immunoglobulin a nephropathy is the most common cause of chronic renal failure among primary glomerulonephritis patients. the ability to diagnose immunoglobulin a nephropathy remains poor. however, renal biopsy is an inconvenient, invasive, and painful examination, and no reliable biomarkers have been developed for use in routine patient evaluations. the aims of the present study were to identify immunoglobulin a nephropathy patients, to identify useful biomarkers of immunoglobulin a nephropathy and to establish a human immunoglobulin a nephropathy metabolic profile. methods: serum samples were collected from immunoglobulin a nephropathy patients who were not using immunosuppressants. a pilot study was undertaken to determine disease-specific metabolite biomarker profiles in three groups: healthy controls (n = 23), low-risk patients in whom immunoglobulin a nephropathy was confirmed as grades i-ii by renal biopsy (n = 23), and high-risk patients with nephropathies of grades iv-v (n = 12). serum samples were analyzed using proton nuclear magnetic resonance spectroscopy and by applying multivariate pattern recognition analysis for disease classification. results: compared with the healthy controls, both the low-risk and high-risk patients had higher levels of phenylalanine, myo-inositol, lactate, l6 lipids ( = ch-ch2-ch = o), l5 lipids (-ch2-c = o), and l3 lipids (-ch2-ch2-c = o) as well as lower levels of β -glucose, α-glucose, valine, tyrosine, phosphocholine, lysine, isoleucine, glycerolphosphocholine, glycine, glutamine, glutamate, alanine, acetate, 3-hydroxybutyrate, and 1-methylhistidine. conclusions: these metabolites investigated in this study may serve as potential biomarkers of immunoglobulin a nephropathy. point scoring of pattern recognition analysis was able to distinguish immunoglobulin a nephropathy patients from healthy controls. however, there were no obvious differences between the low-risk and high-risk groups in our research. these resu
Conservative management, immunosuppressive treatment or both for patients with primary immunoglobulin A nephropathy?  [cached]
Dimitrios S. Goumenos
Nephrology Reviews , 2010, DOI: 10.4081/nr.2010.e13
Abstract: Immunoglobulin A nephropathy (IgAN) is the most commonly encountered primary glomerulonephritis and it usually follows an indolent clinical course. However, hypertensive patients with proteinuria and renal insufficiency at presentation and patients with severe histological involvement are at high risk to develop end-stage renal failure. Patients with normal renal function, mild proteinuria (<1 g/24h) and mild histopathological involvement need only observation, whereas patients with heavy proteinuria, impaired renal function and moderate to severe histopathological involvement are usually treated with immunosuppressive drugs. Angiotensin converting enzyme (ACE) inhibitors are used in patients with arterial hypertension and/or proteinuria 1-2 g/24h. Corti-costeroids are indicated in patients with heavy proteinuria (>3 g/24h) and in progressive disease despite treatment with ACE inhibitors. Combinations of corticosteroids and cytotoxic drugs are saved for patients with IgA nephropathy and a rapidly progressive course. Fish oil might be an alternative to corticosteroids in cases with renal insufficiency and chronic histological lesions.
Outcomes of renal transplantation in patients with immunoglobulin A nephropathy in India  [cached]
Chacko B,George J,Neelakantan N,Korula A
Journal of Postgraduate Medicine , 2007,
Abstract: Background: There is a paucity of data on the course of renal transplant in patients with immunoglobulin A (IgA) nephropathy (IgAN) from India. While the natural history of IgAN in the Indian context is rapidly progressive, the post-transplant course remains speculative. Aim: To study the graft survival in renal transplant recipients whose native kidney disease was IgAN and the incidence and correlates of recurrent disease. Settings and Designs: Retrospective case control study from a Nephrology unit of a large tertiary care center. Materials and Methods: The outcomes of 56 transplant patients (58 grafts) with biopsy-proven IgAN and of 116 patients without IgAN or diabetic nephropathy, transplanted during the same period were analyzed. Correlates of biopsy-confirmed recurrent disease were determined. Statistical Analysis: Means were analyzed by Student′s t test and Mann-Whitney test; proportions were determined by Chi-square analysis and graft survival curves were generated using the Kaplan-Meier. Results: Five-year graft survival for IgA patients was not significantly different from that in the reference group (90% and 79%, P = 0.6). During a mean follow-up of 42 months (range, 1-144), 28 event graft biopsies were required in 20 grafts of IgAN. Histological recurrence was diagnosed in five of the 20 available biopsies (25%) after a mean duration of 28 months. Recurrence did not correlate with donor status, HLA B35 and A2, recipient age, gender or immunosuppression. Conclusions: Renal transplantation is an appropriate treatment modality for IgA nephropathy patients with end-stage renal disease in India, despite the potential for recurrent disease. The posttransplant course is an indolent one when compared to the malignant pretransplant phase.
Vogt-Koyanagi-Harada Syndrome in Two Patients with Immunoglobulin A Nephropathy
Acta Medica Okayama , 2007,
Abstract: We describe herein 2 patients who developed Vogt-Koyanagi-Harada syndrome in the course of renal biopsy-proven immunoglobulin A (IgA) nephropathy. A 61-year-old man with an 11-year history of IgA nephropathy and a 16-year history of thyroiditis, and a 56-year-old man with a 5-year history of IgA nephropathy developed Vogt-Koyanagi-Harada syndrome. At the time of the eye disease presentation, IgA nephropathy was stable without corticosteroids in both patients. Vogt-Koyanagi-Harada syndrome was successfully treated with intravenous administration of prednisolone tapered from 200 mg daily. Vogt-Koyanagi-Harada syndrome is associated with IgA nephropathy, suggesting a similar autoimmune mechanism for both diseases.
Nefropatía por Inmunoglobulina A: Guía de práctica clínica Immunoglobulin A nephropathy: Clinical Practice Guidelines  [cached]
Alicia Fayad,Javier Robaina Sindin,Mónica Calvo Abeucci,Hernán Trimarchi
Medicina (Buenos Aires) , 2011,
Abstract: La nefropatía por Inmunoglobulina A (N.IgA) es la causa más frecuente de enfermedad glomerular a nivel mundial, 15-50% de los pacientes presentan pérdida progresiva de la función renal en 10-20 a os; el resto remisión clínica o hematuria/ proteinuria persistente. Su tratamiento óptimo es incierto. Nuestro objetivo fue desarrollar recomendaciones basadas en la evidencia a través de búsqueda en bases de datos Medline, Embase, Lilacs, Cochrane Trials Register. Los investigadores analizaron la calidad de los estudios independientemente, usando la Cochrane Renal Group checklist: aleatorización, carácter ciego, intención de tratar y pérdidas en el seguimiento. La evidencia se clasificó en niveles y la recomendación en grados, según el Centre for Evidence-Based Medicine, Oxford, con dos enfoques principales: Terapia inmunosupresora (corticoides, citostáticos, ciclosporina A y micofenolato mofetilo): Nivel I a, grado A. Terapia combinada con inmunosupresores en adultos: Nivel II b, grado B. Corticoides más ciclofosfamida o azatioprina en ni os: Nivel II b, grado C. Ciclosporina y micofenolato-mofetilo: Nivel II b, grado B. Terapia no inmunosupresora: inhibidores del sistema renina-angiotensina (IEAC) y/o bloqueantes del receptor de angiotensina II (BRAII), aceite de pescado, estatinas, antiplaquetarios y tonsilectomía: Nivel I a, grado A. Ni os: IECA y BRAII con monitoreo de función renal y de nivel sérico de potasio: Nivel I b, grado B. En nefropatía progresiva, antiplaquetarios como tratamiento coadyuvante: Nivel I, grado C. Aceite de pescado como soporte adicionado de BRAII e IECA en pacientes con lesiones histológicas leves y baja reducción de la filtración glomerular: Nivel II b, grado B (no en ni os). No hay evidencias para recomendar estatinas en ni os; en mayores de 5 a os con síndrome nefrótico e hipercolesterolemia usar sólo con monitoreo de fosfocreatin-kinasa sérica. No hay evidencias para recomendar la tonsilectomía. Immunoglobulin A nephropathy (N.IgA) is the world most common glomerular disease; 15-50% of patients develop loss of renal function in 10-20 years, and the rest remission or mild proteinuria/ hematuria. The optimal treatment is uncertain. Our aim was to develop evidence-based recommendations through research in Medline, Embasse, Lilacs and Cochrane Central Register of Controlled Trials. The study-quality was independently assessed by the reviewers following the Cochrane Renal Group checklist: randomization, blinding, intention-to-treat analysis and follow-up period. Levels of evidence and grades of recommendation were assigned according
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