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Abstract
IgA nephropathy is defined by the presence of IgA-dominant or co-dominant immune deposits within glomeruli. Biopsy specimens meeting these diagnostic criteria have a range of histological changes that are reflected in the variable clinical course of IgA nephropathy. The impact of histology on outcomes in IgA nephropathy has been clarified in a number of large retrospective clinicopathological studies. These studies have consistently demonstrated that the stage of disease at presentation, as indicated by the extent of interstitial fibrosis and tubular atrophy in the biopsy, is the strongest histological predictor of renal survival. The effect of active proliferative lesions on the disease course is less clear cut, owing in part to considerable treatment bias in most published retrospective studies. There is evidence that endocapillary hypercellularity and cellular crescents are responsive to immunosuppressive therapy, but this observation requires confirmation in prospective randomized controlled trials. Future challenges include improving the reproducibility of histological scoring, particularly for the presence and extent of endocapillary lesions, and to improve prognostic modelling by combining histological data with clinical variables and biomarker data.
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Affiliation(s)
- Ian S D Roberts
- Department of Cellular Pathology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
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102
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Nagasawa Y, Iio K, Fukuda S, Date Y, Iwatani H, Yamamoto R, Horii A, Inohara H, Imai E, Nakanishi T, Ohno H, Rakugi H, Isaka Y. Periodontal disease bacteria specific to tonsil in IgA nephropathy patients predicts the remission by the treatment. PLoS One 2014; 9:e81636. [PMID: 24489644 PMCID: PMC3904818 DOI: 10.1371/journal.pone.0081636] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/15/2013] [Indexed: 12/30/2022] Open
Abstract
Background Immunoglobulin (Ig)A nephropathy (IgAN) is the most common form of primary glomerulonephritis in the world. Some bacteria were reported to be the candidate of the antigen or the pathogenesis of IgAN, but systematic analysis of bacterial flora in tonsil with IgAN has not been reported. Moreover, these bacteria specific to IgAN might be candidate for the indicator which can predict the remission of IgAN treated by the combination of tonsillectomy and steroid pulse. Methods and Findings We made a comprehensive analysis of tonsil flora in 68 IgAN patients and 28 control patients using Denaturing gradient gel electrophoresis methods. We also analyzed the relationship between several bacteria specific to the IgAN and the prognosis of the IgAN. Treponema sp. were identified in 24% IgAN patients, while in 7% control patients (P = 0.062). Haemophilus segnis were detected in 53% IgAN patients, while in 25% control patients (P = 0.012). Campylobacter rectus were identified in 49% IgAN patients, while in 14% control patients (P = 0.002). Multiple Cox proportional-hazards model revealed that Treponema sp. or Campylobactor rectus are significant for the remission of proteinuria (Hazard ratio 2.35, p = 0.019). There was significant difference in remission rates between IgAN patients with Treponema sp. and those without the bacterium (p = 0.046), and in remission rates between IgAN patients with Campylobacter rectus and those without the bacterium (p = 0.037) by Kaplan-Meier analysis. Those bacteria are well known to be related with the periodontal disease. Periodontal bacteria has known to cause immune reaction and many diseases, and also might cause IgA nephropathy. Conclusion This insight into IgAN might be useful for diagnosis of the IgAN patients and the decision of treatment of IgAN.
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Affiliation(s)
- Yasuyuki Nagasawa
- Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
- Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan
- * E-mail:
| | - Kenichiro Iio
- Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
| | - Shinji Fukuda
- Laboratory for Epithelial Immunobiology, RIKEN Research Center for Allergy and Immunology, Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, Japan
- Graduate School of Nanobioscience, Yokohama City University, Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, Japan
- Institute for Advanced Biosciences, Keio University, Mizukami, Kakuganji, Tsuruoka, Yamagata, Japan
| | - Yasuhiro Date
- Laboratory for Epithelial Immunobiology, RIKEN Research Center for Allergy and Immunology, Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, Japan
- Department of Life Science and Medical Bioscience, Waseda University, Wakamatsu-cho, Shinjuku-ku, Tokyo, Japan
| | - Hirotsugu Iwatani
- Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
| | - Ryohei Yamamoto
- Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
| | - Arata Horii
- Department of Otolaryngology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otolaryngology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
| | - Enyu Imai
- Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
| | - Takeshi Nakanishi
- Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan
| | - Hiroshi Ohno
- Laboratory for Epithelial Immunobiology, RIKEN Research Center for Allergy and Immunology, Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, Japan
- Graduate School of Nanobioscience, Yokohama City University, Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, Japan
| | - Hiromi Rakugi
- Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan
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Hastings MC, Moldoveanu Z, Suzuki H, Berthoux F, Julian BA, Sanders JT, Renfrow MB, Novak J, Wyatt RJ. Biomarkers in IgA nephropathy: relationship to pathogenetic hits. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2013; 7:615-27. [PMID: 24175678 PMCID: PMC4557957 DOI: 10.1517/17530059.2013.856878] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION IgA nephropathy, the most prevalent glomerular disease in the world, requires a renal biopsy for diagnosis. Reliable biomarkers are needed for the non-invasive diagnosis of this disease and to more fully delineate its natural history and risk for progression. AREAS COVERED In this review, the authors examine serum levels of galactose-deficient IgA1 (Gd-IgA1) and glycan-specific IgG and IgA autoantibodies that are integral to pathogenesis of IgA nephropathy. They also explore biomarkers related to alternative and lectin pathways of complement activation and serum and urinary peptide biomarkers detected by mass spectrometric methods. The literature search included review of all publications having IgA nephropathy in the title that were cited in PubMed and Scopus over the past 10 years and a non-systematic review of abstracts published for the annual meetings of the American Society of Nephrology and the International Symposia on IgA Nephropathy. EXPERT OPINION Serum Gd-IgA1 level and glycan-specific autoantibody levels are prime candidates to become diagnostic biomarkers for IgA nephropathy because of their central role in the earliest stages of disease pathogenesis. Assays for serum levels of complement proteins C3 and factor H are readily available in clinical practice and deserve continued study, either alone or in tandem with total serum IgA or serum Gd-IgA1 levels, as prognostic biomarkers for patients with IgA nephropathy. Urinary peptidomic data are also reviewed because this approach can successfully differentiate patients with IgA nephropathy from healthy controls and from patients with other forms of renal disease.
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Affiliation(s)
- Margaret Colleen Hastings
- Children's Foundation Research Institute at Le Bonheur Children's Hospital , 50 North Dunlap, Room 520 Research Tower, Memphis, TN 38103-2893 , USA +1 901 287 5366 ; +1 901 287 6337 ;
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104
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Floege J. Primary glomerulonephritis: A review of important recent discoveries. Kidney Res Clin Pract 2013; 32:103-10. [PMID: 26877924 PMCID: PMC4714100 DOI: 10.1016/j.krcp.2013.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/29/2013] [Indexed: 01/29/2023] Open
Abstract
The publication of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines on the treatment of glomerular diseases in 2012 marked a milestone in this field, as it is the first time that comprehensive guidelines are provided for such disease entities. The current review focuses on major findings, both pathogenesis related and clinical, in the primary glomerulonephritis that have been made after the guidelines came into effect.
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Affiliation(s)
- Jürgen Floege
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule University of Aachen, Aachen, Germany
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105
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Nasri H, Sajjadieh S, Mardani S, Momeni A, Merikhi A, Madihi Y, Ghiessari A, Emami Naieni A. Correlation of immunostaining findings with demographic data and variables of Oxford classification in IgA nephropathy. J Nephropathol 2013; 2:190-5. [PMID: 24475448 DOI: 10.12860/jnp.2013.30] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 12/01/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Oxford classification for IgA nephropathy (IgAN) did not include pattern of immunostaining in the analysis. OBJECTIVE The aim of this study is to determine the potential correlation between the immunostaining data and morphologic variables of Oxford classification (MEST) and various clinical and demographic data of patients with IgAN. PATIENTS AND METHODS The pathologic diagnosis of IgAN requires the demonstration of IgA-dominant mesangial or mesangio-capillary immune deposits through immunofluorescence (IF) microscopy. The immune deposits were semiquantitatively assessed as 0 to 3+ positive bright. These were correlated with various clinical, demographic and histological variables of Oxford classification. RESULTS A total of 114 biopsies were enrolled to the study (70.2% were male). Mean age of the patients was 37.7 ± 13.6 years. This study showed that, only C3 deposits had a significant correlation with serum creatinine. Other antibodies (IgA, IgM and IgG) had no significant association with serum creatinine. This study also showed that IgA deposition score had significant positive association with endocapillary proliferation (E) and segmental glomerulosclerosis (S) variables of Oxford classification. Moreover, IgM deposition score had positive association with S variable. There was no significant association of IgG deposition score with four morphologic variables of Oxford classification. There was significant association of C3 deposition score with S and E variables too. CONCLUSIONS The significant relationships of IgA and C3 deposits with some of the Oxford variables need more attention. We propose to further investigate this aspect of IgAN disease.
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Affiliation(s)
- Hamid Nasri
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Sajjadieh
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Mardani
- Department of Nephrology, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ali Momeni
- Department of Nephrology, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Alireza Merikhi
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yahya Madihi
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alaleh Ghiessari
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afsoon Emami Naieni
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
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107
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Zhou XJ, Cheng FJ, Qi YY, Zhao YF, Hou P, Zhu L, Lv JC, Zhang H. FCGR2B and FCRLB gene polymorphisms associated with IgA nephropathy. PLoS One 2013; 8:e61208. [PMID: 23593433 PMCID: PMC3625155 DOI: 10.1371/journal.pone.0061208] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background IgA nephropathy (IgAN) is a complex syndrome characterized by deposition of IgA and IgA containing immune complexes (ICs) composed of IgG and complement C3 proteins in the mesangial area of glomeruli. The low-affinity receptors for the Fc region of IgG (FcγRs) are involved in autoantibody/immune complex-induced organ injury as well as ICs clearance. The aim of the study was to associate multiple polymorphisms within FCGR gene locus with IgAN in a large Chinese cohort. Patients and Methods 60 single nucleotide polymorphisms (SNPs) spanning a 400 kb range within FCGR gene locus were analyzed in 2100 DNA samples from patients with biopsy proven IgAN and healthy age- and sex-matched controls from the same population in Chinese. Results Among the 60 SNPs investigated, 15 gene polymorphisms within FCGR gene locus (25%) were associated with susceptibility to IgAN. The most significantly associated SNPs within individual genes were FCGR2B rs12118043 (p = 8.74*10−3, OR 0.76, 95% CI 0.62–0.93), and FCRLB rs4657093 (p = 2.28*10−3, OR 0.77, 95% CI 0.65–0.91). Both conditional analysis and linkage disequilibrium analysis suggested they were independent signals associated with IgAN. Associations between FCGR2B rs12118043 and proteinuria (p = 3.65×10−2) as well as gross hematuria (p = 4.53×10−2), between FCRLB rs4657093 and levels of serum creatinine (p = 2.67×10−2) as well as eGFR (p = 5.41*10−3) were also observed. Electronic cis-expression quantative trait loci analysis supported their possible functional significance, with protective genotypes correlating lower gene expressions. Conclusion Our data from genetic associations and expression associations revealed potentially pathogenic roles of Fc receptor gene polymorphisms in IgAN.
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Affiliation(s)
- Xu-jie Zhou
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Fa-juan Cheng
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Yuan-yuan Qi
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Yan-feng Zhao
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Ping Hou
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Li Zhu
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Ji-cheng Lv
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, People's Republic of China
- * E-mail:
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Meng H, Ohtake H, Ishida A, Ohta N, Kakehata S, Yamakawa M. IgA Production and Tonsillar Focal Infection in IgA Nephropathy. J Clin Exp Hematop 2012; 52:161-70. [DOI: 10.3960/jslrt.52.161] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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