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Li Y, Xiong Z, Wang Y, Jiang Y, Shen Y, Hu X, Hu D, Li Z. The extent of intestinal involvement is closely related to the severity of IgAV: a risk stratification study based on CT. Ann Med 2025; 57:2462260. [PMID: 39918160 PMCID: PMC11809178 DOI: 10.1080/07853890.2025.2462260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 12/05/2024] [Accepted: 01/02/2025] [Indexed: 02/12/2025] Open
Abstract
OBJECTIVES To analyze the differences in clinical manifestations between children and adults with intestinal involvement in IgAV and to identify the specific subtypes requiring particular attention. METHODS A systematic review of the HIS system was conducted on patient data from four centers at Tongji Hospital between January 2015 and October 2022. Patients with a diagnosis of IgAV with intestinal involvement were further analyzed. Clinical manifestations, laboratory data, and CT findings at the time of initial hospitalization were recorded. The differences in clinical manifestations between children and adults were analyzed. The extent of intestinal involvement, linked to disease severity, was quantitatively assessed by evaluating the number of affected intestinal segments on CT imaging. Laboratory markers that could reflect severe intestinal involvement were explored. Furthermore, patients were classified based on the sites of involved intestinal segments: L1 type (duodenum and/or jejunum), L2 type (ileum), L3 type (duodenum and/or jejunum and ileum), and L4 type (limited to the colorectum). A comparison of the first three types was performed. RESULTS A total of 148 patients were enrolled (67 children and 81 adults). The proportion of joint pain and renal involvement was higher in adults. D-dimer level was an independent risk factor for severe intestinal involvement (OR = 1.104, p = .016). In the first three types patients based on the sites of involved intestinal segments, it found that L3 type patients had a longer hospital stay. CONCLUSION With the exception of joint pain and renal involvement, there were no significant differences in clinical symptoms between children and adults. CT imaging provided objective insights into the extent of intestinal involvement, which correlated with disease severity. Patients with widespread small bowel involvement displayed a more severe disease state.
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Affiliation(s)
- Yuanqiu Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziman Xiong
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufan Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchen Jiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, National Medical Center for major public health events, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tang J, Wang L, Zhou W, Mao Y, Zhang C, Shen J, Yin M, Yin L. IgA nephropathy and IgA vasculitis in a pediatric Crohn's disease patient with early IgA deposition in vascular walls of intestines. CEN Case Rep 2025; 14:335-344. [PMID: 40011366 DOI: 10.1007/s13730-025-00970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 01/07/2025] [Indexed: 02/28/2025] Open
Abstract
Patients with inflammatory bowel disease may present with extraintestinal manifestations. Crohn's disease complicated with IgA nephropathy or IgA vasculitis is relatively rare. In this case, an 11-year-old girl was diagnosed with Crohn's disease and infliximab was administered. 1 year after treatment, she presented with asymptomatic but persistent microscopic hematuria. The child was diagnosed with IgA vasculitis and IgA nephropathy at the fourth year of follow-up. To explore the association between Crohn's disease and IgA associated diseases, immunostaining for IgA and GdIgA1 deposition was retrospectively conducted in intestinal biopsy tissues obtained at the time of initiation and relapse of Crohn's disease. GdIgA1 deposition in intestinal tissues was found not only at the time of relapse of Crohn's disease, but also at the beginning of Crohn's disease when patient had neither exposure to any drug nor any symptom of IgA vasculitis or IgA nephropathy. The early appearance of GdIgA1 deposition indicated that Crohn's disease played a greater role in its formation than infliximab induction and the child might be prone to IgA associated diseases. Patients with Crohn's disease, especially those who receive tumor necrosis factor-alpha inhibitors are recommended to receive regular kidney examinations.
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Affiliation(s)
- Junqian Tang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Lan Wang
- Department of Gastroenterology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Wei Zhou
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Youying Mao
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Chenxing Zhang
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China
| | - Minzhi Yin
- Department of Pathology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China.
| | - Lei Yin
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai, 200127, China.
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Sun Y, Yang X, Xi L, Feng Z, Ren X. Correlation between the course of kidney injury and clinicopathology and prognosis of children with Henoch-Schönlein purpura nephritis. Int Urol Nephrol 2025; 57:1625-1631. [PMID: 39724485 DOI: 10.1007/s11255-024-04336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 12/19/2024] [Indexed: 12/28/2024]
Abstract
PURPOSE Henoch-Schönlein purpura nephritis (HSPN) has a poor prognosis and variable pathophysiology. The present study aimed to analyze the kidney injury, clinicopathology, and prognosis of HSPN children. METHODS This retrospective study examined 249 children with HSPN. The patients' pathological and clinical data were collected. The patients were divided into the following groups according to the duration of their kidney injury: groups with disease duration of < 2 weeks, 2 weeks to 1 month, 1-2 months, 2-4 months, 4-6 months, and ≥ 6 months. The clinicopathological and prognostic relationships were examined between the groups. RESULTS We enrolled 249 children with HSPN (average age of 10.12 ± 3.01 years). There were 161 boys (64.66%) and 88 girls (35.34%). Altogether, 191 children (76.71%) developed kidney injury within 2 months. A total of 37 children (14.86%) showed recurrent renal damage after 6 months. Most patient groups exhibited hematuria and proteinuria, with type III pathology being the most common. During 2 weeks and 1 month of kidney injury, the acute pathology index peaked and then decreased; then, it increased again after 4 months as recurrence occurred. The chronic pathology index was the highest in the group with a disease duration of 2-4 months and it increased with increasing disease duration. The prognosis worsens with the disease duration. CONCLUSION Children with HSPN showed disease remission after a duration of 4-6 months. The acute and chronic pathology indexes peaked between 2 weeks to 1 month and 2-4 months, respectively. Patients with kidney injury occurring within a month had a much higher remission rate.
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Affiliation(s)
- Yuying Sun
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Xiaoqing Yang
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Leying Xi
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Zhiyuan Feng
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Xianqing Ren
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China.
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Sağlam MK, Yıldırım S, Ergüven M, Sungur MA. Gastrointestinal features of pediatric iga vasculitis and their association with renal complications: an observational study. Eur J Pediatr 2025; 184:320. [PMID: 40310537 PMCID: PMC12045811 DOI: 10.1007/s00431-025-06157-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 04/21/2025] [Accepted: 04/26/2025] [Indexed: 05/02/2025]
Abstract
Immunoglobulin A (IgA) vasculitis is the most common systemic vasculitis in childhood, primarily affecting the skin, gastrointestinal system (GIS), joints, and kidneys. This study aimed to evaluate the clinical and laboratory characteristics of mild and severe GIS involvement in pediatric patients with IgA vasculitis and to investigate its association with renal involvement. A retrospective review was conducted on 794 pediatric patients diagnosed with IgA vasculitis between 1997 and 2024. Demographic data, clinical findings, and laboratory parameters were collected from patient records. GIS involvement was classified as mild (abdominal pain, vomiting, or occult blood in stool) or severe (melena, hematochezia, or intussusception). Renal involvement was defined based on hematuria, proteinuria, hypertension, or renal insufficiency. Among 794 patients, 430 (54.2%) were male, with a mean age at diagnosis of 7.8 ± 3.3 years. GIS involvement was observed in 422 (53.1%) patients, of whom 333 (78.9%) had mild GIS involvement and 89 (21.1%) had severe GIS involvement. Renal involvement was detected in 171 (21.5%) patients, and was more frequent in those with GIS involvement (26.3% vs. 16.1%, p = 0.001). GIS (55.6% (n = 306) vs. 47.1% (n = 115)) and renal (24.5% (n = 134) vs. 15.2% (n = 37)) involvement were more common in patients aged > 5 years than in patients ≤ 5 years (p = 0.027, p = 0.004, respectively). GIS involvement was significantly associated with leukocytosis (p < 0.001) and elevated C-reactive protein (CRP) (p = 0.018), but these parameters did not correlate with renal involvement. Patients with positive fecal occult blood tests had a significantly higher risk of renal involvement (p < 0.001). However, there was no significant difference in renal involvement between patients with mild and severe GIS involvement (p = 0.082). CONCLUSION GIS involvement, older age (> 5 years), and the presence of occult blood in stool were associated with a higher likelihood of renal involvement in pediatric IgA vasculitis. However, the severity of GIS involvement did not correlate with renal involvement, suggesting that renal pathology may be influenced by independent mechanisms rather than the severity of GIS symptoms. WHAT IS KNOWN • Older age, persistent palpable purpura, abdominal pain, GIS involvement, recurrent disease episodes are risk factors for renal involvement in IgA vasculitis. WHAT IS NEW • GIS involvement, fecal occult blood positivity, and age over five years were significantly associated with renal involvement in pediatric IgA vasculitis. However, the severity of GIS involvement did not predict the presence or severity of renal involvement.
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Affiliation(s)
- Mukaddes Kiliç Sağlam
- Department of Pediatrics, Düzce University Faculty of Medicine Hospital Konuralp, 81010, Düzce, Turkey.
| | - Sema Yıldırım
- Department of Pediatrics, İstanbul Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Müferet Ergüven
- Department of Pediatric, Rheumatology, Düzce University Faculty of Medicine Hospital Konuralp, Düzce, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, Düzce University Faculty of Medicine Hospital Konuralp, Düzce, Turkey
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Podraza Z, Poplicha K, Ufniarski T, Ucieklak J, Łysiak N, Mizerska-Wasiak M. Laboratory Findings and Clinical Features in IgA Vasculitis: Identifying Predictors of Kidney Involvement and Disease Relapse in Pediatric Patients. J Clin Med 2025; 14:3055. [PMID: 40364087 PMCID: PMC12073035 DOI: 10.3390/jcm14093055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Revised: 04/15/2025] [Accepted: 04/20/2025] [Indexed: 05/15/2025] Open
Abstract
Objective: This study aimed to identify clinical and laboratory predictors of kidney involvement and disease relapse in pediatric patients with IgA vasculitis (Immunoglobulin A vasculitis, IgAV). Materials and Methods: A retrospective cohort study was conducted on 173 children diagnosed with IgAV at the Children's Clinical Hospital of the Medical University of Warsaw between 2018 and 2022. Patients were categorized into groups based on renal involvement (IgAVN+ vs. IgAVN-) and disease recurrence. The analysis included demographic data, clinical manifestations, allergy history, presence of infection, duration of hospitalization, relapse occurrence, the interval between the first and second hospitalization, and laboratory markers. Results: Renal involvement was observed in 42% of cases, while disease recurrence occurred in 9.25% of patients. IgAVN+ patients were older, had longer hospital stays, and more frequently exhibited gastrointestinal symptoms, consistent with previous research. A history of allergic conditions was more prevalent in both the IgAVN+ and recurrence groups. An increase in IgA levels over time was associated with a higher risk of nephropathic development. Patients with recurrences had higher IgM levels and an elevated neutrophil-to-lymphocyte ratio (NLR) (p = 0.07). In the ROC (Receiver Operating Characteristic) analysis, a cutoff value of 1.67 for NLR (AUC 0.71; p = 0.0002; sensitivity 0.87; specificity 0.58) was identified as a risk factor for disease recurrence. Conclusions: Older age at disease onset, gastrointestinal involvement, and allergies are associated with renal involvement in pediatric IgAV. Immune dysregulation, reflected by elevated NLR and IgM, may contribute to disease recurrence. It is important to monitor changes in IgA levels over time, as an increase in IgA concentration is a risk factor for the development of nephropathy. Additionally, calculating the NLR is recommended, as it may indicate the probability of disease recurrence.
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Affiliation(s)
- Zofia Podraza
- Science Students’ Association at Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (Z.P.); (K.P.); (T.U.); (J.U.); (N.Ł.)
| | - Karol Poplicha
- Science Students’ Association at Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (Z.P.); (K.P.); (T.U.); (J.U.); (N.Ł.)
| | - Tomasz Ufniarski
- Science Students’ Association at Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (Z.P.); (K.P.); (T.U.); (J.U.); (N.Ł.)
| | - Jarosław Ucieklak
- Science Students’ Association at Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (Z.P.); (K.P.); (T.U.); (J.U.); (N.Ł.)
| | - Natalia Łysiak
- Science Students’ Association at Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (Z.P.); (K.P.); (T.U.); (J.U.); (N.Ł.)
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Konstantopoulou A, Tsoliakos I, Berikopoulou MM, Kiorsavva A, Theochari M, Drosatou P, Messaritaki A, Dimopoulou D. A case-based review of IgA vasculitis complicated with gastrointestinal infections: insights from a norovirus-associated case in an adolescent. Rheumatol Int 2025; 45:114. [PMID: 40261399 DOI: 10.1007/s00296-025-05876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Accepted: 04/10/2025] [Indexed: 04/24/2025]
Abstract
Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is a self-limited leukocytoclastic vasculitis targeting small-sized vessels. It is the most common vasculitis in children, but also targets adults who have usually worse prognosis. It typically presents with purpuric rash, arthritis, colicky abdominal pain and potential renal involvement. Gastrointestinal (GI) manifestations, although frequent, may be severe and occasionally complicated by infections. We present a 11-year-old male with a recent diagnosis of IgAV who was admitted with severe abdominal pain, hematemesis and hematochezia. Stool analysis identified Norovirus as the causative pathogen for the severe gastrointestinal symptoms. Treatment with proton pump inhibitors, high-dose corticosteroids and intravenous fluids resulted in symptoms resolution and clinical improvement. In addition, a case-based review of the literature was conducted to evaluate the prevalence of GI infections occurring after the development of IgAV that may result in severe complications or disease relapses. Thirty-five patients with a median age of 14 years were included in our study. Among these patients, 42.9% were diagnosed with a concomitant bacterial gastrointestinal pathogen, followed by 25.7% with viral gastroenteritis and 17.1% with parasitic gastrointestinal disease. Treatment was individualized, with 48.5% receiving corticosteroids and 8.6% receiving immunosuppressive therapy. This case and case-based review highlights the significance of careful management and monitoring of patients with IgAV complicated by infections, because severe complications can cause significant morbidity and mortality especially in adults.
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Affiliation(s)
- Argyro Konstantopoulou
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece
| | - Ioannis Tsoliakos
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece
| | - Maria M Berikopoulou
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece
| | - Aikaterini Kiorsavva
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece
| | - Maria Theochari
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece
| | - Panagiota Drosatou
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece
| | - Anna Messaritaki
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, Children's Hospital "Aghia Sofia", Thivon and Papadiamantopoulou, Athens, 11527, Greece.
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Shinotsuka Y, Taguchi K, Kodama G, Shibata R, Fukami K. Therapeutic plasma apheresis for IgA vasculitis-related gastrointestinal bleeding. Ther Apher Dial 2025. [PMID: 40254791 DOI: 10.1111/1744-9987.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 02/07/2025] [Indexed: 04/22/2025]
Abstract
INTRODUCTION Adult-onset IgA vasculitis (IgAV) often presents with severe renal and gastrointestinal (GI) complications, yet therapeutic guidelines for life-threatening manifestations remain unclear. METHODS We conducted a systematic text-mining analysis of all PubMed-indexed case reports of IgAV treated with therapeutic plasma exchange (TPE). RESULTS We describe an 80-year-old woman with refractory GI bleeding and rapidly progressive glomerulonephritis. Despite high-dose corticosteroids and cyclophosphamide, GI bleeding persisted and necessitated multiple transcatheter embolization. A total of seven sessions of TPE using fresh frozen plasma successfully controlled disease activity, resulting in improvement of GI bleeding. Literature review suggests that TPE may provide additive benefits in IgAV patients, particularly in those unresponsive to standard immunosuppressants. CONCLUSION This case supports the utility of TPE as a valuable adjunctive therapy in severe IgAV with organ-threatening manifestations and highlights the need for further studies to define optimal indications.
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Affiliation(s)
- Yuri Shinotsuka
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kensei Taguchi
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
- Research Institute of Medical Mass Spectrometry, Kurume University School of Medicine, Kurume, Japan
| | - Goh Kodama
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ryo Shibata
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
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Li M, Huang C, Xing H, Luo S, Lin Y, Kuang Y, Wang J, Huang S, Ye Z. Epigastric pain of unknown origin, esophageal and gastric involvement: a Henoch-Schönlein Purpura case report. Front Med (Lausanne) 2025; 12:1577291. [PMID: 40309729 PMCID: PMC12040902 DOI: 10.3389/fmed.2025.1577291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2025] [Accepted: 04/01/2025] [Indexed: 05/02/2025] Open
Abstract
Henoch-Schönlein Purpura (HSP) is an acute systemic vasculitis that primarily affects the skin, gastrointestinal tract, kidneys and joints. It predominantly occurs in children but can occur at any age. We report a case of 48-year-old male patient suffering from unexplained epigastric pain alternating between relapses and remissions. The patient's initial clinical manifestation was atypical, starting with severe epigastric pain, without cutaneous purpura, and with normal rheumatologic and immunologic markers, making diagnosis difficult. The patient was eventually diagnosed with HSP. This case highlights the importance of considering this diagnosis in patients with unexplained abdominal pain and emphasize the role of endoscopy in diagnosing complex cases.
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Affiliation(s)
- Mengmeng Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Chaoyuan Huang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hailun Xing
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shijuan Luo
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yiqun Lin
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuxiang Kuang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jing Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Suiping Huang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhenhao Ye
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
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Zhang Y, Yang H, Chen Y, Tang Y, Chen J, Huang J, Feng A, Weng Z, Li F, Lin J, Xie J, Zhang C, Chen J, Gao C, Nie X. Construction and diagnostic efficacy assessment of the urinary exosomal miRNA-mRNA network in children with IgA vasculitis nephritis. FASEB J 2025; 39:e70492. [PMID: 40166907 PMCID: PMC11959522 DOI: 10.1096/fj.202403111r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 02/17/2025] [Accepted: 03/18/2025] [Indexed: 04/02/2025]
Abstract
This study aimed to comprehensively evaluate the diagnostic potential of urinary exosomal microRNA (miRNA) in IgA vasculitis (IgAV) kidney injury by meticulously comparing the miRNA expression profiles in urine exosomes between children diagnosed with IgAV and those with IgA vasculitis nephritis (IgAVN). Urine samples were obtained from children with IgAV who were treated at our hospital from October 2022 to October 2023. These samples were then categorized into the IgAV group and the IgAVN group. High-throughput sequencing and bioinformatics analysis techniques were employed to conduct a thorough analysis of the differentially expressed miRNAs between the two groups. Additionally, the correlation between urinary exosomal miRNA and clinical parameters was evaluated. A total of 57 urinary exosomal miRNAs exhibited differential expression between the IgAV and IgAVN groups. Specifically, in the IgAVN group, 42 miRNAs were upregulated, while 15 were downregulated. Lasso regression analysis and ROC analysis identified five candidate urinary exosomal miRNAs with high diagnostic accuracy. A prediction of 95 target genes related to the candidate miRNAs led to the construction of an exosomal miRNA-mRNA regulatory network consisting of four key miRNAs and ten hub genes. Gene function and metabolic pathway analyses indicated that these ten hub genes were predominantly enriched in pro-fibrotic and inflammatory pathways. The analysis incorporating clinical parameters demonstrated a significant correlation between hsa-miR-383-5p and urinary protein levels. This research identified exosomal miRNAs and mRNAs with differential expression patterns associated with IgAVN and constructed the corresponding exosomal miRNA-mRNA network. It was determined that hsa-miR-3065-5p, hsa-miR-383-5p, hsa-miR-25-3p, and hsa-miR-450b-5p might mediate the pathogenesis of IgAVN by targeting pro-fibrotic and inflammatory pathways. Among them, exosomal hsa-miR-383-5p is highly likely to serve as a novel non-invasive biomarker for assessing the disease status of IgAVN, thereby offering new perspectives on the non-invasive diagnosis and treatment of IgAVN.
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Affiliation(s)
- Yunfan Zhang
- Department of PediatricsFuzong Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Huanhuan Yang
- Department of PediatricsFuzong Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Yi Chen
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Yuxian Tang
- Department of PediatricsFuzong Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Junyan Chen
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Jun Huang
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Ai Feng
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Zengfeng Weng
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Fenrong Li
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Jinfeng Lin
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Jingqi Xie
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Chunfang Zhang
- Department of Pediatrics900th Hospital of PLA Joint Logistic Support ForceFuzhouChina
| | - Jie Chen
- Department of PediatricsFujian Provincial HospitalFuzhouChina
| | - Chunlin Gao
- Department of PediatricsJinling Hospital, Medical School of Nanjing UniversityNanjingChina
| | - Xiaojing Nie
- Department of PediatricsFuzong Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of PediatricsFujian Provincial HospitalFuzhouChina
- Department of PediatricsDongfang Hospital of Xiamen University, School of Medical, Xiamen UniversityFuzhouChina
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Wang Y, Zhou X, Cheng G, Zhu R, Qi Z, Zhang W, Shu H, Wei Liu, Wang G, Qian Pu, Kong Y, Wang J. Identification of risk factors for renal progression in adults with IgAV: a retrospective cohort study of a single center in northwest China. Int Urol Nephrol 2025:10.1007/s11255-025-04511-4. [PMID: 40220120 DOI: 10.1007/s11255-025-04511-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Accepted: 04/05/2025] [Indexed: 04/14/2025]
Abstract
OBJECTIVES This investigation sought to examine the clinical and pathological characteristics, outcomes, and risk factors linked to the progression of renal function in adult-onset immunoglobulin A (IgA) vasculitis within a single center in northwest China. METHODS Data were retrospectively gathered from cases of adult-onset IgA vasculitis recorded at a tertiary hospital in northwest China, covering the period from January 2013 to August 2024. During the follow-up, clinical information was compared between patients who advanced to chronic kidney disease (CKD) stage 3 and those who did not. RESULTS A sum of 1082 adult-onset IgA vasculitis patients (632 men; median age of 37 years) were included. Among patients with baseline proteinuria >0.5 g/24h (43.9%), 40.7% progressed to chronic kidney disease (CKD) stage 3, while 5.1% developed end-stage renal disease (ESRD). COX regression analysis indicated that older age, renal pathological grade IV, hypertension (HTN), diabetes, hyperlipidemia, and hyperuricemia were independent risk factors for CKD stage 3 progression in individuals with adult-onset IgA vasculitis. CONCLUSIONS Older age and comorbidities such as hypertension and diabetes significantly increase the risk of renal progression in adult-onset IgAV. Early management of these comorbidities may mitigate the risk of CKD progression.
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Affiliation(s)
- Yingying Wang
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Xiaochun Zhou
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Gang Cheng
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Rongrong Zhu
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Zizhao Qi
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Wenjun Zhang
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Hong Shu
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Wei Liu
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Gouqin Wang
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Qian Pu
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Yuke Kong
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China
| | - Jianqin Wang
- The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China.
- Department of Nephrology, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730030, Gansu, People's Republic of China.
- Key laboratory of nephropathy, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China.
- Nephropathy Clinical Medical Research Center, The Second Hospital and Clinical Medical School, Lanzhou University, Lanzhou, 730000, Gansu, People's Republic of China.
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Xian W, Zhang H, Zeng H. Association between immune cells and allergic purpura: a Mendelian randomization study. Ital J Pediatr 2025; 51:112. [PMID: 40211366 PMCID: PMC11987331 DOI: 10.1186/s13052-025-01847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 01/09/2025] [Indexed: 04/13/2025] Open
Abstract
BACKGROUND Increasing evidence indicates a substantial correlation between the immune cells and the risk of allergic purpura. We utilized Mendelian randomization (MR) to investigate causal effect of immune cell on allergic purpura. METHODS Genetic instrumental variables for immune cells were sourced from an extensive genome-wide association study (GWAS) comprising 3757 participants. Summary statistics of allergic purpura, involving 470 cases and 216,099 controls, were obtained from FinnGen. The primary analysis employed the inverse-variance weighted (IVW) method. Rigorous sensitivity analyses including MR-Egger, weighted median and MR-PRESSO were conducted to ensure the reliability of the causal estimate. RESULTS We identified two immunophenotypes associated with an increased risk of allergic purpura: HLA-DR on CD14 + CD16- monocyte (OR: 1.2379; 95% CI: 1.0612-1.4440; P = 0.0066) and CD11b on basophil (OR: 1.2973; 95% CI: 1.0905-1.5433; P = 0.0033). The sensitivity analyses consistently yielded similar results for these immunophenotypes. CONCLUSIONS Our analyses confirmed a potential causal effect of HLA-DR on CD14 + CD16- monocyte, as well as CD11b on basophils, in relation to the risk of allergic purpura. Further studies are necessary to clarify the mechanisms by which these immunophenotypes influence the development of allergic purpura.
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Affiliation(s)
- Wei Xian
- Department of Pediatric Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
| | - Huiyi Zhang
- Sun Yat-Sen University School of Medicine, Shenzhen Campus of Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong Province, China
| | - Huasong Zeng
- Department of Pediatric Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
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12
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Moroni G, Calatroni M, Ponticelli C. The Recurrence of Systemic Diseases in Kidney Transplantation. J Clin Med 2025; 14:2592. [PMID: 40283422 PMCID: PMC12027678 DOI: 10.3390/jcm14082592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 03/31/2025] [Accepted: 04/08/2025] [Indexed: 04/29/2025] Open
Abstract
Kidney transplantation is the most effective replacement therapy for kidney failure, providing the best outcomes in terms of patient survival and offering a better quality of life. However, despite the progressive improvement in kidney survival, the recurrence of original disease remains one of the most important causes of graft loss and a major challenge that requires clinical vigilance throughout the transplant's duration. Additionally, the type and severity of recurrence affect both treatment options and graft survival. This is especially true for the recurrence of systemic diseases. In this narrative review, we will discuss the timing, frequency, severity, and treatment of post-transplant recurrence in three systemic diseases: lupus nephritis (LN), Antineutrophil Cytoplasmic Antibodies (ANCA)-associated glomerulonephritis (ANCA-GN), and Henoch-Schönlein purpura (HSP). The recurrence of lupus nephritis is less common than that of primary focal segmental glomerulosclerosis or C3 glomerulopathy. Its severity can range from mild mesangial to diffuse proliferative forms, with varying prognoses and treatment options, much like the original disease. In some patients with LN, as well as in those with ANCA-GN or HSP, the reactivation of the primary disease can affect other organs besides the kidneys, potentially leading to life-threatening conditions. These cases may require a multidisciplinary approach, making these transplants clinically more challenging. Extrarenal flare-ups often necessitate an increase in immunosuppression, which in turn raises the risk of infections. In these autoimmune diseases, the role of immunological tests in determining the timing of kidney transplants remains a topic of ongoing debate. However, elevated levels of certain immunological markers, such as anti-dsDNA antibodies, ANCA titers, or serum immunoglobulin A may indicate a reactivation of the disease, suggesting the need for more intensive patient monitoring.
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Affiliation(s)
- Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy;
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy;
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
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Su R, Ma Q, Zhao Y, He Y, Yu N, Lei Y, Wang Z, Chen J, Gao T. Deciphering the Pharmacological Mechanism of Compound Purpura Decoction in Treating Henoch-Schonlein Purpura by Network Pharmacology, Molecular Docking and Experimental Validation. Chem Biodivers 2025:e202402793. [PMID: 40045447 DOI: 10.1002/cbdv.202402793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 03/02/2025] [Accepted: 03/05/2025] [Indexed: 03/20/2025]
Abstract
Henoch-Schonlein purpura (HSP) is an immunoglobulin A (IgA)-mediated systemic vasculitis that frequently develops in children and may progress to serious complications. Compound purpura decoction (CPD), a classical herbal combination, exerts favourable effects on the clinical symptoms and prognosis of HSP; however, the underlying molecular mechanism remains unclear. First, high-performance liquid chromatography analysis identified five bioactive components in CPD, including protocatechuic acid, chlorogenic acid, mangiferin, baicalin and buddleoside, with contents of 0.011 ± 0.02, 0.577 ± 0.33, 0.150 ± 0.05, 1.132 ± 0.23 and 0.369 ± 0.23 mg/g, respectively. Additionally, we established an animal model of allergic purpura to evaluate the therapeutic effects of CPD on HSP. CPD effectively alleviated renal and cutaneous vasculitis and reduced IgA deposition. CPD could regulate the Treg/Th17 cell balance, decrease the levels of the proinflammatory factors interleukin-6 and tumour necrosis factor-α, and suppress the expression of C3 and C5 (p < 0.05). Network pharmacology analysis suggested that the mechanism of CPD in HSP treatment mainly involved epidermal growth factor receptor (EGFR)-related targets and pathways, followed by molecular docking confirming strong binding affinity between EGFR and the bioactive components (binding energy< -4.25 kcal/mol). Real-time quantitative polymerase chain reaction and western blot showed that CPD suppressed the activation of the EGFR/extracellular signal-regulated kinase (ERK) signalling pathway (p < 0.05), which could be associated with the inhibition of complement system activation. This study provides a new perspective for understanding the pathogenesis and treatment of HSP.
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Affiliation(s)
- Rong Su
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Quanwu Ma
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yuna Zhao
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yanping He
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Na Yu
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yaya Lei
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ziyan Wang
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jing Chen
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ting Gao
- Department of Pharmaceutical Preparation, General Hospital of Ningxia Medical University, Yinchuan, China
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Kulik TJ, Pettigrew ZJ. A High-Pressure Case of Constipation and Seizures. Pediatr Rev 2025; 46:159-164. [PMID: 40020735 DOI: 10.1542/pir.2022-005920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/05/2024] [Indexed: 03/03/2025]
Affiliation(s)
- Taylor J Kulik
- University of North Carolina, Chapel Hill, North Carolina
| | - Zachary J Pettigrew
- University of North Carolina, Chapel Hill, North Carolina
- Moses H. Cone Memorial Hospital, Greensboro, North Carolina
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Mannu A, Vasudevan B, Kashif AW, Kumari L. Adenovirus: a possible trigger for IgA vasculitis in children. BMJ Case Rep 2025; 18:e262856. [PMID: 39971621 DOI: 10.1136/bcr-2024-262856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
IgA vasculitis (IgAV), also called Henoch-Schönlein purpura (HSP), is an immune complex vasculitis characterised by IgA1-dominant immune deposits affecting small vessels (predominantly capillaries, venules or arterioles). It often involves the skin and gastrointestinal tract, frequently causes arthritis and rarely causes vasculitis in the kidney indistinguishable from IgA nephropathy. It usually presents as a purpuric non-blanching rash mostly on the lower limbs, although it may extend to the upper limbs and the trunk, and more rarely to the face. Respiratory tract infection or a history of exposure to antigens from certain foods, insects, drugs or vaccines may trigger the pathogenesis of IgAV. Adenovirus mostly causes acute respiratory diseases and occasionally causes gastroenteritis. Literature on the adenovirus as a trigger or direct involvement in the onset of IgAV is scarce. We report a few cases where IgAV is associated with adenovirus infection, and more research is required to establish this association.
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Affiliation(s)
- Anand Mannu
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Biju Vasudevan
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Lalita Kumari
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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Zheng H, Liu L, Yang M, Wang S. Antibiotic-induced IgA vasculitis: insights from a real-world retrospective analysis and pharmacovigilance assessment. Arch Dermatol Res 2025; 317:383. [PMID: 39930301 DOI: 10.1007/s00403-025-03925-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 01/22/2025] [Accepted: 01/27/2025] [Indexed: 05/08/2025]
Abstract
IgA vasculitis (IgAV) is a small-vessel vasculitis characterized by the deposition of immunoglobulin A (IgA) in the vessel walls, often presenting with cutaneous manifestations such as palpable purpura. Drug-induced IgAV is a rare but potentially severe condition. Several studies have suggested a possible association between antibiotics and IgAV. However, research on this link remains limited. This study aimed to identify antibiotics implicated in the onset of IgAV and to analyze the clinical characteristics of IgAV induced by antibiotics. Data on antibiotic-induced IgAV events were extracted from the FDA Adverse Event Reporting System (FAERS) database, and case reports were collected through literature searches. A pharmacovigilance analysis was conducted using FAERS data from 2003 to 2023 to evaluate adverse events related to IgAV caused by antibiotics, and case reports up to November 23, 2024, were reviewed for retrospective analysis. A total of 150 reports of antibiotic-induced IgAV were analyzed, with 13 antibiotics identified as associated with IgAV. The three antibiotics most strongly linked to IgAV were ofloxacin, vancomycin, and clarithromycin based on the FAERS database analysis. The median age of the cases was 58 years, with a male predominance. IgAV typically developed 4 days (1-15 days) after drug administration. Clarithromycin, vancomycin, and ciprofloxacin were the most frequently reported antibiotics in the literature, and they were also associated with poor renal outcomes, emphasizing the importance of regular follow-up to improve long-term renal prognosis. In conclusion, this study identified 13 antibiotics associated with IgAV, with ofloxacin, vancomycin, and clarithromycin being the most strongly linked to the condition.
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Affiliation(s)
- Hong Zheng
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
- Hunan Clinical Research Center of Pediatric Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Leping Liu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
- Hunan Clinical Research Center of Pediatric Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Minghua Yang
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China.
- Hunan Clinical Research Center of Pediatric Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
| | - Shengfeng Wang
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China.
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
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Basyouny A, Imam A, Abouzaid KA. An Atypical Presentation of Henoch-Schönlein Purpura With Features of Acute Hemorrhagic Edema of Infancy and Koebnerization: A Case Report. Cureus 2025; 17:e79179. [PMID: 40109788 PMCID: PMC11922498 DOI: 10.7759/cureus.79179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 02/17/2025] [Indexed: 03/22/2025] Open
Abstract
Immunoglobulin A vasculitis, also known as Henoch-Schönlein purpura (HSP), is a type of vasculitis that is most commonly found in children. Palpable purpura is a key feature and is often associated with joint, abdominal, or renal involvement. This case report presents an atypical presentation of HSP in a four-year-old male, characterized by overlapping features of Acute Hemorrhagic Edema of Infancy (AHEI) and Koebnerization (isomorphic response), which complicates the diagnosis. The patient initially presented with redness around his mouth and nose, followed by hematuria and the development of palpable purpura on the lower extremities and buttocks. Vascular swellings were noted on the palms, feet, and face, and cockade purpura appeared on the upper extremities. The patient also exhibited episodic joint pain, genital edema, and Koebnerization on the lower back and buttocks. The diagnosis of this case was challenged by the presence of AHEI-like features and Koebnerization. The patient responded well to treatment with prednisone and colchicine. This atypical case presentation of HSP underscores the clinical overlap between HSP and AHEI, as well as the rare occurrence of Koebnerization in HSP. It emphasizes the importance of recognizing atypical presentations to ensure timely and accurate diagnosis. Further research is required to explore the frequency, pathophysiology, and clinical implications of such cases to enhance diagnostic accuracy and management in pediatric vasculitis.
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Affiliation(s)
| | - Ahmad Imam
- Department of Anatomical Sciences, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
- Department of Anatomical Sciences, Cairo University, Cairo, EGY
| | - Kamal A Abouzaid
- Department of Anatomical Sciences, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
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Wang B, Xiang W, Zhu Z, Shen H. The influence of respiratory infections on Henoch-Schönlein purpura in children. BMC Infect Dis 2025; 25:118. [PMID: 39856587 PMCID: PMC11763152 DOI: 10.1186/s12879-025-10514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 01/16/2025] [Indexed: 01/27/2025] Open
Abstract
OBJECTIVE To explore the influence of respiratory infections on the onset of Henoch-Schönlein Purpura (HSP) in children, along with exploring potential underlying mechanisms. METHOD The present study conducted a statistical analysis on renal involvement indicators in 296 children with HSP who came to the Children's Hospital of Zhejiang University, as well as the IgA levels in 400 children with respiratory infections and 400 children with HSP. RESULTS Compared with the control group, children with HSP exhibited a significant increase in urine red blood cell count, urine microalbuminuria, and urine protein/creatinine ratio (P < 0.001). The monthly outpatient visits for children with respiratory infections exhibited a similar pattern to those with HSP, demonstrating a heightened prevalence during the autumn and winter. The level of IgA in children with respiratory infections and HSP were significantly higher than those in the control group (P < 0.001). CONCLUSION HSP can give rise to complications such as renal involvement. There exists a certain correlation between respiratory infections and the occurrence of HSP, which may be attributed to the elevation of IgA induced by respiratory infections. In conclusion, children with HSP should reinforce protective measures during the peak influenza season in order to prevent respiratory infections.
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Affiliation(s)
- Bili Wang
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Wenqing Xiang
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Zhouyue Zhu
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), University School of Medicine, International Campus, Zhejiang University, Haining, 314400, Zhejiang, China
| | - Hongqiang Shen
- National Clinical Research Center for Child Health, National Children's Regional Medical Center, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
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Gu Y, Zhang Y, Zheng Z, Zhu P. Clinical characteristics and risk factors analysis of abdominal symptoms in IgA vasculitis patients: a retrospective cohort study. Clin Rheumatol 2025; 44:349-356. [PMID: 39510986 DOI: 10.1007/s10067-024-07226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 10/28/2024] [Accepted: 11/03/2024] [Indexed: 11/15/2024]
Abstract
About 50% of children with IgA vasculitis (IgAV) have abdominal symptoms, usually colic mimic to acute abdomen. Since signs and symptoms of vasculitis may appear in any order, this may affect the diagnosis of children whose abdominal symptoms precede the appearance of purpura. It is necessary to identify the risk factors, pathogenesis, and specific biomarkers to improve the prevention and management of IgAV patients with abdominal symptoms. All the 278 patients were children who had been diagnosed with IgAV in Nanyang Central Hospital between January 2018 and December 2018. The patient's age, gender, clinical manifestations, laboratory examination, and medical history were retrospectively collected. All the patients were divided into two groups based on whether they had abdominal symptoms. Ridge regression and multivariate logistic regression model were used to find risk factors of IgAV patients with abdominal symptoms. Of the 278 patients, 54 patients had abdominal symptoms, and the remaining 224 patients had no abdominal symptoms. Patients with abdominal symptoms had a lower proportion of infections and higher IgM concentrations than patients with other symptoms. For patients over 12 years of age, platelet counts were lower in patients with abdominal symptoms. In addition, basophil count was identified as a protective factor, while IgM was identified as a risk factor. Infections, platelet counts, basophil count, and IgM concentration may be associated with abdominal symptoms in IgAV patients. Basophils and IgM may be involved in the pathological mechanism of abdominal symptoms.
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Affiliation(s)
- Yuhan Gu
- Department of Clinical Pharmacy, Nanyang Central Hospital, Nanyang, 473000, China.
| | - Yu Zhang
- Department of Clinical Pharmacy, Nanyang Central Hospital, Nanyang, 473000, China
| | - Zhixin Zheng
- Department of Clinical Pharmacy, Nanyang Central Hospital, Nanyang, 473000, China
| | - Ping Zhu
- Department of Neonatal Intensive Care Units, Nanyang Central Hospital, Nanyang, China
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Baud KL, Hankard A, Ramdani Y, Maisons V, Pillebout E, Augusto JF, Jourde-Chiche N, Faguer S, Ferreira-Maldent N, Maillot F, Halimi JM, Terrier B, Audemard-Verger A. Impact of gender on baseline presentation and outcome in adult IgA vasculitis. Rheumatology (Oxford) 2025; 64:143-148. [PMID: 38048626 DOI: 10.1093/rheumatology/kead648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES Adult IgA vasculitis (IgAV) is more common in males, but the potential impact of gender remains unclear. We aimed to describe the impact of gender on presentation and outcome in adult IgAV. METHODS We retrospectively analysed data from a multicentre retrospective cohort of 260 patients (IGAVAS). Comparisons were made according to gender status. RESULTS Data from 259 patients (95 females and 164 males) were analysed. Compared with females, baseline presentation in males was similar for cutaneous involvement (100% vs 100%, P = 1.0), joint involvement (60% vs 63%, P = 0.7), gastrointestinal involvement (57% vs 45%, P = 0.093) and glomerulonephritis (73% vs 64%, P = 0.16). Glomerulonephritis was more severe at baseline in males than in females, with a lower median estimated glomerular filtration rate (eGFR) [90 (IQR 59-105) vs 97 ml/min/1.73 m2 (76-116), P = 0.015] and increased median proteinuria (0.84 vs 0.58 g/day, P = 0.01). There were no differences in histological findings in patients who had a kidney biopsy. Methylprednisolone was more frequently used in males (40% vs22%, P = 0.015), as were immunosuppressants, especially cyclophosphamide (24% vs 6%, P = 0.0025) and azathioprine (10% vs 2%, P = 0.038). Analysis of treatment response showed that males had more frequent refractory disease (30% vs 13%, P = 0.004). Long-term outcomes (mortality and progression to chronic kidney failure) did not differ. CONCLUSION Kidney involvement in IgAV appears to be more severe in males, which is supported by more intensive treatment contrasting with a lower response rate. This study raises the question of gender as a new prognostic factor in adult IgAV.
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Affiliation(s)
- Kim-Liên Baud
- Department of Internal Medicine, CHU de Tours, Tours, France
| | | | - Yanis Ramdani
- Department of Internal Medicine, CHU de Tours, Tours, France
- University of Tours, Tours, France
| | | | - Evangeline Pillebout
- Department of Nephrology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Noémie Jourde-Chiche
- Nephrology, Aix-Marseille Université, C2VN, INSERM, INRAE, AP-HM CHU Conception, Marseille, France
| | | | | | - François Maillot
- Department of Internal Medicine, CHU de Tours, Tours, France
- Department of Internal Medicine, CHU de Caen, Caen, France
| | - Jean-Michel Halimi
- University of Tours, Tours, France
- Department of Nephrology, CHU de Tours, Tours, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin Paris, Paris, France
- Paris Cité University, Paris, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine, CHU de Tours, Tours, France
- Department of Internal Medicine, CHU de Caen, Caen, France
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Oni L, Platt C, Marlais M, McCann L, Barakat F, Hesseling M, Cottis H, Protheroe S, Haigh G, Nott K, Marro J, King E, Kelly J, Sussens J, Mulvaney S, Whitby T, Morgan I, Sharma A, Al-Jayyousi R, Cheung CK, Ng C, Lander AD, Simmons W, Melling C, Grandison R, Treitl L, Salama AD, Dudley J. National recommendations for the management of children and young people with IgA vasculitis: a best available evidence, group agreement-based approach. Arch Dis Child 2024; 110:67-76. [PMID: 39379139 PMCID: PMC11671997 DOI: 10.1136/archdischild-2024-327364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/18/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE IgA vasculitis (IgAV) is the most frequently experienced subtype of vasculitis seen in children. Most children fully recover, however, complications including chronic kidney disease are recognised. The aim of this project was to use a best available evidence, group agreement, based approach to develop national recommendations for the initial management of IgAV and its associated complications. METHODS A fully representative multiprofessional guideline development group (GDG), consisting of 28 members, was formed and met monthly. Graded recommendations were generated using nationally accredited methods, which included a predefined scope, open consultation, systematic literature review, evidence appraisal, review of national or international guidelines and a period of open consultation. Audit measures and research priorities were incorporated. RESULTS The IgAV GDG met over a 14-month period. A total of 82 papers were relevant for evidence synthesis. For the initial management, four topic areas were identified with five key questions generating six graded recommendations related to classification, specialist referral and musculoskeletal involvement. For the associated complications, five topic areas with 12 key questions generated 15 graded recommendations covering nephritis, gastrointestinal and testicular involvement, atypical disease and follow-up. Open consultation feedback was incorporated. The guidelines were endorsed by the UK Kidney Association and Royal College of Paediatrics and Child Health and are available online. CONCLUSION Despite IgAV being a rare disease with limited evidence, a national standardised approach to the clinical management for children and young people has been achieved. This should unite approaches to care and act as a foundation for improvement.
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Affiliation(s)
- Louise Oni
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
- Department of Paediatric Nephrology, Alder Hey Children’s Hospital, Liverpool
| | - Caroline Platt
- Bristol Renal Unit, Bristol Royal Hospital for Children, Bristol, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Farah Barakat
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Markus Hesseling
- Department of Paediatrics, Children’s health Ireland, Dublin, Ireland
| | - Hannah Cottis
- Department of Paediatrics, Royal Devon University Hospital, Devon, UK
| | - Sue Protheroe
- Department of Paediatric Gastroenterology, Birmingham Children’s Hospital, Birmingham, UK
| | - Gabrielle Haigh
- Department of Paediatrics, Betsi Cadwaladr Health Board, Wales, UK
| | - Kerstin Nott
- Department of Paediatric Rheumatology, Southampton Children’s Hospital, Southampton, UK
| | - Julien Marro
- University of Liverpool Medical School, Liverpool, UK
| | | | - Jane Kelly
- General Practice, Minchinhampton Surgery, Gloucestershire, UK
| | - Jill Sussens
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Shirley Mulvaney
- Department of Paediatric Emergency Medicine, Alder Hey Children’s Hospital, Liverpool, UK
| | - Thomas Whitby
- General Paediatrics, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | - Iona Morgan
- Department of Paediatrics, Royal Hospital for Children, Glasgow, UK
| | - Amita Sharma
- Department of Paediatrics, Royal Hospital for Children, Glasgow, UK
| | | | | | | | | | - William Simmons
- Department of Paediatric Pathology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Charlotte Melling
- Department of Paediatric Surgery, Alder Hey Children’s Hospital, Liverpool, UK
| | | | | | - Alan D Salama
- Department of Renal Medicine, UCL Centre for Kidney and Bladder Health, London, UK
| | - Jan Dudley
- Bristol Renal Unit, Bristol Royal Hospital for Children, Bristol, UK
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22
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Li J, Xu Y, Sun T, Zhang X, Liang H, Lin W, Yu H, Yang B, Yang H. Exploration of the pathogenesis of nephrotic syndrome and traditional Chinese medicine intervention based on gut microbiota. Front Immunol 2024; 15:1430356. [PMID: 39717782 PMCID: PMC11663840 DOI: 10.3389/fimmu.2024.1430356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 11/18/2024] [Indexed: 12/25/2024] Open
Abstract
Nephrotic syndrome (NS) represents a prevalent syndrome among various chronic kidney disease pathologies and is known for its higher severity and worse prognosis compared with chronic glomerulonephritis. Understanding its pathogenesis and identifying more effective treatment modalities have long been a concern of kidney specialists. With the introduction of the gut-kidney axis concept and the progress in omics technologies, alterations in the gut microbiota have been observed in primary and secondary NS. This link has been extensively researched in conditions such as diabetic nephropathy and immunoglobulin A (IgA) nephropathy. Thus, dysbiosis of the gut microbiota is seen as a crucial contributing factor in NS; however, there is a lack of comprehensive reviews that elucidate the changes in the gut microbiota across different NS conditions and that describe its mechanistic role in the disease. Moreover, serving as an innate regulator of the gut microbiota, traditional Chinese medicine (TCM) has the potential to exert a profound impact on the expression of inflammation-promoting agents, decreasing the levels of endotoxins and uremic toxins. In addition, it strengthens the stability of the intestinal barrier while controlling the metabolic function of the body through its efficient modulation of the gut microbiota. This intricate process yields far-reaching consequences for NS.
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Affiliation(s)
- Jing Li
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yupei Xu
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Tianhao Sun
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xiaotian Zhang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Huimin Liang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Wei Lin
- Department of Nephrology, Traditional Chinese Hospital of Xiamen, Xiamen, China
| | - Hangxing Yu
- Department of Nephrology, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Bo Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hongtao Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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23
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Gong YQ, Han L, Zhang JY, Yu J, Wu N, Hu WP, Xu Z, Liu W, Huang WF. Abdominal imaging and endoscopic characteristics of adult abdominal IgA vasculitis: a multicenter retrospective study. Ann Med 2024; 56:2408467. [PMID: 39324401 PMCID: PMC11429444 DOI: 10.1080/07853890.2024.2408467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND IgA vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is an IgA-mediated systemic small vessel vasculitis that tends to be more severe in adults than in children. Early diagnosis of IgAV involving the gastrointestinal tract remains difficult, especially in patients who present with gastrointestinal symptoms before purpura. This study aims to systematically analyze the abdominal imaging and endoscopic features of adult patients with abdominal IgAV, providing assistance to clinicians in the early recognition of this condition. PATIENTS AND METHODS This multicenter retrospective study was conducted in three large tertiary hospitals in China from January 2017 to January 2024. A total of 108 adult patients with abdominal IgAV, who had complete abdominal imaging and/or endoscopy results, were enrolled. The clinical manifestations, abdominal imaging findings, endoscopic characteristics, and serological indicators of the patients were analyzed. RESULTS The median age of the patients was 40 years (IQR: 26-55), with a male-to-female ratio of 2:1. Acute abdominal pain was the most common presenting symptom (100 patients, 92.59%). Bowel wall thickening was the most frequent finding on abdominal imaging (50/86 patients, 58.14%). Gastrointestinal endoscopy showed findings of congestion and erosion (32/67 patients, 47.76%), and erosion with ulcers (21/67 patients, 31.34%). Among patients with both imaging and endoscopic results, the duodenum (28/51 patients, 54.90%) and ileum (28/51 patients, 54.90%) were the most commonly affected sites. Laboratory findings revealed elevated white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), D-dimer and fibrinogen levels, along with decreased albumin level. Comparing patients with gastrointestinal symptoms versus purpura as the initial symptom, those with gastrointestinal symptoms had higher levels of WBC (p < 0.05) and NLR (p < 0.01). CONCLUSIONS The most common symptom in adult abdominal IgAV patients is acute abdominal pain. In the early stage of the disease, most patients exhibit elevated levels of WBC, NLR, CRP, D-dimer, and fibrinogen, along with decreased albumin level. The duodenum and ileum are the most commonly affected sites. By integrating these findings, clinicians can identify abdominal IgAV patients earlier and more accurately.
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Affiliation(s)
- Yu-Qing Gong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Lin Han
- Department of Gastroenterology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Juan Yu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Na Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei-Ping Hu
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhong Xu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei Liu
- Department of Gastroenterology, Yichang Central People’s Hospital, Yichang, China
- Institute of Digestive Disease, China Three Gorges University, Yichang, China
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
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24
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Yıldırım R, Cansu DÜ, Uludoğan BC, Çoban G, Acu B, Korkmaz C. Massive Gastrointestinal Bleeding in Patient With Immunoglobulin (Ig) A Vasculitis Patient due to Widespread Arterial Microaneurysms Treated With Intravenous Immunoglobulin (IVIG). Int J Rheum Dis 2024; 27:e70018. [PMID: 39690493 DOI: 10.1111/1756-185x.70018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 11/10/2024] [Accepted: 12/09/2024] [Indexed: 12/19/2024]
Affiliation(s)
- Reşit Yıldırım
- Department of Internal Medicine, Division of Rheumatology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Döndü Üsküdar Cansu
- Department of Internal Medicine, Division of Rheumatology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Burcu Ceren Uludoğan
- Department of Internal Medicine, Division of Rheumatology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Gökhan Çoban
- Department of Internal Medicine, Division of Gastroenterology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Berat Acu
- Department of Radiology, Division of Interventional Radiology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Cengiz Korkmaz
- Department of Internal Medicine, Division of Rheumatology, Eskişehir Osmangazi University, Eskişehir, Turkey
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25
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Xi L, Sun Y, Chen Y, Yang X, Su H, Ren X. Clinicopathological features and prognosis of IgA vasculitis nephritis with nephrotic-range proteinuria in children. Pediatr Nephrol 2024; 39:3241-3250. [PMID: 38980322 DOI: 10.1007/s00467-024-06441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND To investigate the clinical features, kidney pathology, treatment regimens, and clinical outcomes of IgA vasculitis nephritis (IgAVN) with nephrotic-range proteinuria in children. METHODS A retrospective review of children diagnosed with IgAVN between January 2019 and December 2022 was conducted. Participants were divided into two groups based on their urine protein/creatinine (UPCR) levels. Biodata, clinical characteristics, laboratory findings, pathologic features, treatment regimens, and outcomes were abstracted from case records and analyzed. RESULTS A total of 255 children were identified, 94 with nephrotic-range proteinuria (UPCR ≥ 200 mg/mmol) and 161 with non-nephrotic proteinuria (UPCR < 200 mg/mmol). Patients in the nephrotic-range proteinuria group were significantly younger and had worse grades of glomerular and acute tubulointerstitial injury compared to those in the non-nephrotic proteinuria group. Higher levels of blood urea nitrogen (BUN), D-dimer (DD), and fibrin degradation products (FDP), and lower levels of total protein (TP), albumin (ALB), urine creatinine (Cr), prothrombin time (PT), activated partial thromboplastin time (APTT), IgG, CD3 + cells, and CD4 + cells were found in patients in the nephrotic-range proteinuria group. Clinical outcome of patients with nephrotic-range proteinuria was significantly associated with ISKDC grading, proportion of glomerular crescents and severity of acute tubulointerstitial injury. CONCLUSIONS Children with nephrotic-range proteinuria exhibit more severe disordered immunologic function, hypercoagulability, glomerular and tubulointerstitial pathological damage, and have worse outcomes than those with lower proteinuria levels. Clinicians should pay great attention to the kidney injury and more extensive studies are required to identify optimal treatment regimens to improve outcomes in patients.
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Affiliation(s)
- Leying Xi
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yuying Sun
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yawei Chen
- Department of Oncology, Nanjing Drum Tower Hospital, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaoqing Yang
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Hang Su
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xianqing Ren
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China.
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26
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Chen L, Zhong C, Fan L, Luo M, Cai L, Zhang B, Zhang H. Effective treatment with intravenous immunoglobulin for Henoch-Schönlein purpura with refractory gastrointestinal symptoms in an adolescent: A CARE-compliant case report. Medicine (Baltimore) 2024; 103:e40370. [PMID: 39495971 PMCID: PMC11537644 DOI: 10.1097/md.0000000000040370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 10/16/2024] [Indexed: 11/06/2024] Open
Abstract
RATIONALE This article presents a complex case of refractory Henoch-Schönlein purpura (HSP), initially manifesting with complex gastrointestinal (GI) symptoms, and discusses diagnostic and therapeutic challenges encountered. It aims to enhance understanding of the disease and provide evidence for the potential efficacy of intravenous immunoglobulin (IVIG) treatment in this condition. PATIENT CONCERNS A 16-year-old male patient presented with persistent abdominal pain, nausea, vomiting, and constipation for 8 days, leading to hospital admission. DIAGNOSES Establishing a definitive diagnosis was challenging initially due to the absence of typical petechiae. However, the appearance of characteristic petechiae subsequently confirmed the diagnosis of HSP. INTERVENTIONS Initial treatment with methylprednisolone sodium succinate for 3 days failed to elicit improvement. Subsequently, IVIG was introduced as a combination therapy. OUTCOMES Following the combined administration of IVIG, the patient experienced complete resolution of abdominal pain, petechiae, and arthralgia within 4 days. LESSONS This case highlights the importance of considering HSP in the differential diagnosis of patients with complex GI symptoms. Furthermore, it suggests that IVIG may be a valuable therapeutic option for HSP patients with refractory GI symptoms. High-quality comparative trials are needed to establish more definitive evidence for the effectiveness of IVIG and to develop specific treatment guidelines.
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Affiliation(s)
- Liji Chen
- The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Cailing Zhong
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Longxiu Fan
- The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ming Luo
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Linkun Cai
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Beiping Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Haiyan Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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Auanassova A, Yessirkepov M, Kocyigit BF. SARS-CoV-2 as a trigger of IgA vasculitis: a clinical case and literature review. Rheumatol Int 2024; 44:2613-2620. [PMID: 39249140 DOI: 10.1007/s00296-024-05712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/21/2024] [Indexed: 09/10/2024]
Abstract
Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, has negatively affected global health. COVID-19 has been associated with a variety of autoimmune and inflammatory disorders, complicating its respiratory manifestations. SARS-CoV-2 triggers inflammatory reactions which may involve multiple organs and systems. The proof for IgA involvement in the immune reactions to coronavirus infection is growing, particularly in the case of IgA immune complex deposition diseases such as IgA vasculitis (IgAV) and IgA nephropathy.This report presents a case of IgAV caused by SARS-CoV-2 in a 53-year-old man. His symptoms included papillomatous, bright red rashes, urticaria throughout the body, aphthous stomatitis, pain in all joints and muscles, weakness, malaise, abdominal pain, face swelling, and arterial hypertension (160/100 mmHg). He received intravenous methylprednisolone (250 mg) and then oral methylprednisolone (16 mg) treatment, which improved his condition. This improvement included the disappearance of abdominal and joint pain and skin rashes.This article also provides an overview of published cases of IgAV after SARS-CoV-2. It may alert rheumatologists and allied specialists of clinical features of IgAV and guide them how to diagnose and treat this disease.
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Affiliation(s)
- Akerke Auanassova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Burhan Fatih Kocyigit
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana Health Practice and Research Center, Adana, Türkiye.
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28
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Kato S, Gold BD, Kato A. Gastrointestinal manifestations and pathogenesis in childhood immunoglobulin A vasculitis. Front Pediatr 2024; 12:1459394. [PMID: 39497734 PMCID: PMC11532042 DOI: 10.3389/fped.2024.1459394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 10/02/2024] [Indexed: 11/07/2024] Open
Abstract
Immunoglobulin A vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is the most common form of systemic vasculitis in childhood. The primary organs involved are the skin, gastrointestinal (GI) tract, joints, and kidneys. The spectrum of GI involvement in IgAV ranges from being mild and self-limited to severe manifestations often requiring surgical intervention. Galactose-deficient IgA1 on the immunoglobulin hinge region and its immune complexes are thought to play a central pathogenetic role in IgAV, however, an association between such molecules and specific GI mucosal damage remains unclear. GI endoscopy (both upper and lower) shows a variety of mucosal findings, many of which are not specific for IgAV. In upper GI endoscopy, however, the mucosal features can be diagnostic when found localized in the more distal part of upper GI tract (second and/or third parts of the duodenum). Abdominal computed tomography and capsule endoscopy have demonstrated that the small intestine is most commonly involved in IgAV. The GI mucosal involvement when evaluated microscopically shows IgA deposition which is histologically diagnostic. Conversely, leukocytoclastic vasculitis is less useful. Since the 1960s, cases of duodenojejunitis, in which IgAV was suspected but evident purpura was not dermatologically present, have often been labeled as "idiopathic". In a pediatric case series, IgA enteropathy, without dermatological manifestations (i.e., purpura), was reported to have similar symptoms, as well as endoscopic characteristics and immunohistological findings as in IgAV. Subsequently, several case reports provide additional supportive evidence that IgA enteropathy must be a variant of IgAV. Thus, the immunologically driven auto-immune vasculitis results in the symptom complex dependent on the organ system involved, and the subsequent clinical features which are manifested. Present classification criteria are useful and universally available for diagnosing IgAV. However, based upon current knowledge including IgA enteropathy, minor modification of the IgAV criteria is proposed in the review.
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Affiliation(s)
| | - Benjamin D. Gold
- GI Care for Kids, Children’s Center for Digestive Healthcare, LLC, Atlanta, GA, United States
| | - Ayumu Kato
- Department of Pediatrics, Sendai City Hospital, Sendai, Japan
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29
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Chen J, Chen P, Song Y, Wei J, Wu S, Wu F, Xu Z. The relationship between the severity and complications of Henöch-Schönlein purpura in children and dietary inflammatory index: a retrospective cohort study. PeerJ 2024; 12:e18175. [PMID: 39346080 PMCID: PMC11430262 DOI: 10.7717/peerj.18175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 09/04/2024] [Indexed: 10/01/2024] Open
Abstract
Purpose To investigate the association between the Dietary Inflammatory Index (DII) and disease severity as well as complications in children diagnosed with Henöch-Schönlein purpura (HSP), shedding light on the potential influence of dietary factors on HSP. Methods A retrospective cohort study was conducted, enrolling children aged 2-14 years diagnosed with HSP. Participants were divided into low and Pro-inflammatory dietary groups based on their DII scores. Biomarkers, nutrient intake, blood lipid profiles and disease complications were compared between the two groups. Spearman correlation analysis was performed to assess the relationship between DII and complications. Results A total of 115 patients, including 56 patients with anti-inflammatory dietary and 59 with pro-inflammatory dietary, were included. The pro-inflammatory dietary group demonstrated significantly elevated of C-reactive protein, tumor necrosis factor-α, interleukin-6, erythrocyte sedimentation rate, white blood cell count, eosinophils, IgE, consumption of total calories, protein, carbohydrates, fiber, fat intake, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, VLDL cholesterol, complications of renal, skin, gastrointestinal, coagulation and respiratory in comparison to the anti-inflammatory dietary group. DII was positively correlated with renal, skin, gastrointestinal, coagulation and respiratory complications. Conclusion The study highlights the potential influence of dietary inflammatory potential, as quantified by the DII, on disease severity and complications in children with HSP. Understanding the interplay between dietary patterns and inflammatory responses in pediatric vasculitis has implications for the management of HSP, emphasizing the relevance of considering dietary interventions to optimize clinical outcomes and improve the overall well-being of affected children.
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Affiliation(s)
- Jinshu Chen
- Department of Rheumatology and Immunology for Children's Nephropathy, Hainan Women and Children's Medical Center, Haikou, China
| | - Pihou Chen
- Department of Children's Rehabilitation, Hainan Women and Children's Medical Center, Haikou, China
| | - Yijin Song
- Department of Rheumatology and Immunology for Children's Nephropathy, Hainan Women and Children's Medical Center, Haikou, China
| | - Jiaxin Wei
- Department of Rheumatology and Immunology for Children's Nephropathy, Hainan Women and Children's Medical Center, Haikou, China
| | - Shiya Wu
- Department of Rheumatology and Immunology for Children's Nephropathy, Hainan Women and Children's Medical Center, Haikou, China
| | - Fan Wu
- Department of Rheumatology and Immunology for Children's Nephropathy, Hainan Women and Children's Medical Center, Haikou, China
| | - Zhiquan Xu
- Department of Rheumatology and Immunology for Children's Nephropathy, Hainan Women and Children's Medical Center, Haikou, China
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Terashima Y, Matsumoto M, Ozaki S, Nakagawa M, Nakagome S, Terasaki Y, Iida H, Mitsugi R, Kuramochi E, Okada N, Inoue T, Matsuki S, Kitagawa S, Fukuizumi A, Onda N, Takeuchi S, Miyanaga A, Kasahara K, Seike M. IgA vasculitis induced by carboplatin + nab-paclitaxel + pembrolizumab in a patient with advanced lung squamous cell carcinoma: a case report. Front Immunol 2024; 15:1370972. [PMID: 39206190 PMCID: PMC11349625 DOI: 10.3389/fimmu.2024.1370972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
A 73-year-old man with lung squamous cell carcinoma was administered carboplatin + nab-paclitaxel + pembrolizumab for four cycles. Subsequently, he presented with multiple purpuras on his extremities, joint swelling on his fingers, abdominal pain, and diarrhea, accompanied by acute kidney injury (AKI), increased proteinuria, hematuria, and elevated C-reactive protein levels. Skin biopsy showed leukocytoclastic vasculitis as well as IgA and C3 deposition in the vessel walls. Based on these findings, the patient was diagnosed with IgA vasculitis as an immune-related adverse event (irAE) induced by carboplatin + nab-paclitaxel + pembrolizumab. After discontinuation of pembrolizumab and glucocorticoids, the symptoms immediately resolved. Regular monitoring of skin, blood tests, and urinalysis are necessary, and the possibility of irAE IgA vasculitis should be considered in cases of purpura and AKI during treatment with immune checkpoint inhibitors.
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Affiliation(s)
- Yuto Terashima
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masaru Matsumoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Saeko Ozaki
- Department of Dermatology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Michiko Nakagawa
- Department of Dermatology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shun Nakagome
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Iida
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Ryotaro Mitsugi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Eri Kuramochi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Naoko Okada
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomoyasu Inoue
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoru Matsuki
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shingo Kitagawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Aya Fukuizumi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Naomi Onda
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Susumu Takeuchi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuo Kasahara
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Gan MY, Chua FZY, Chang ZY, Chua YT, Chan GC. Navigating Adult-Onset IgA Vasculitis-Associated Nephritis. Life (Basel) 2024; 14:930. [PMID: 39202674 PMCID: PMC11355272 DOI: 10.3390/life14080930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 09/03/2024] Open
Abstract
PURPOSE OF REVIEW IgA vasculitis (IgAV), formerly Henoch-Schonlein purpura, is the most common systemic vasculitis in childhood. In adults, however, this condition is poorly understood, yet associated with more severe disease and poorer outcomes. This necessitates the need for early diagnosis and management. SCOPE OF REVIEW We describe the pathophysiology, clinical manifestations, and diagnosis of IgAV in adults. Poor outcomes are often due to the high frequency of glomerulonephritis in IgAV-IgA vasculitis-associated nephritis (IgAVN). We hence also aim to summarize the latest clinical data regarding treatment strategies in IgAVN. The diagnosis and differentiation in histology between IgAVN and IgA nephropathy (IgAN) remain a challenge. Review of treatment therapies: Pathological mechanisms between IgAVN and IgAN appear to be consistent between the two, and data from IgAN are often extrapolated to IgAVN. The role of various immunosuppression therapies remains controversial, and in this review, we will discuss immunosuppression use and highlight evidence surrounding emerging and promising novel therapies in IgAVN/IgAN. Our aim for this review is to guide future treatment strategies and direct future studies.
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Affiliation(s)
- Ming Ying Gan
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Freda Zhi Yun Chua
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Zi Yun Chang
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore 119074, Singapore
| | - Yan Ting Chua
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Gek Cher Chan
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore 119074, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Suszek D, Grzywa-Celińska A, Emeryk-Maksymiuk J, Krusiński A, Redestowicz K, Siwiec J. IgA vasculitis after COVID-19: a case-based review. Rheumatol Int 2024; 44:1353-1357. [PMID: 38739223 PMCID: PMC11178596 DOI: 10.1007/s00296-024-05606-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
IgA-associated vasculitis (IgAV) known as Henoch - Schönlein purpura (HSP) disease is an inflammatory disorder of small blood vessels. It's the most common type of systemic vasculitis in children which can be associated with the inflammatory process following infections. IgA vasculitis is a rare and poorly understood systemic vasculitis in adults. Coronavirus disease 2019 (COVID-19) has been associated with HSP in both adults and children. A 58-year-old woman was diagnosed with HSP, fulfilling the clinical criteria: palpable purpura, arthritis, hematuria. The disclosure of the HSP disease was preceded by a infection of the respiratory tract. COVID-19 infection was confirmed via the presence of IgM and IgG antibodies. This case indicates the possible role of SARS-CoV-2 in the development of HSP. The clinical course of IgAV in adults appears to be different from pediatric IgAV, especially due to higher risk of renal complications. Symptoms of the disease quickly resolved with low-dose of steroids.
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Affiliation(s)
- Dorota Suszek
- Department of Rheumatology and Connective Tissue Diseases, Medical University, Lublin, Poland.
| | - Anna Grzywa-Celińska
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
| | | | - Adam Krusiński
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
| | - Katarzyna Redestowicz
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
| | - Jan Siwiec
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
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Demouveaux A, Delclaux M, Goudot A, Duponchelle E, Cortet B, Flipo RM, Letarouilly JG. Association of axial spondyloarthritis and IgA vasculitis: Report of two cases. Joint Bone Spine 2024; 91:105723. [PMID: 38582363 DOI: 10.1016/j.jbspin.2024.105723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Adèle Demouveaux
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | - Martin Delclaux
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | - Astrid Goudot
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | | | - Bernard Cortet
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
| | - René-Marc Flipo
- Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
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Yu M, Song X, Guo J, Feng Q, Tian J. Exploring potential predictors of Henoch-Schönlein purpura nephritis: a pilot investigation on urinary metabolites. Eur J Pediatr 2024; 183:3117-3128. [PMID: 38668796 DOI: 10.1007/s00431-024-05573-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/29/2024] [Accepted: 04/14/2024] [Indexed: 06/22/2024]
Abstract
Henoch-Schönlein purpura nephritis (HSPN) is the most severe manifestation of Henoch-Schönlein purpura (HSP). This study aimed to determine the role of urine metabolomics in predicting HSPN and explore the potential mechanisms of HSP. A liquid chromatography-tandem mass spectrometry-based untargeted metabolomics analysis was performed to investigate the urinary metabolic profiles of 90 participants, comprising 30 healthy children (group CON) and 60 patients with HSP, including 30 HSP patients without renal involvement (group H) and 30 HSPN patients (group HSPN). The differentially expressed metabolites (DEMs) were identified using orthogonal partial least squares discriminant analysis (OPLS-DA), and subsequent bioinformatics analysis was conducted to elucidate the perturbed metabolic pathways. A total of 43 DEMs between H and HSPN groups were analyzed by the Kyoto Encyclopedia of Gene and Genome (KEGG) database, and the result indicates that glycine, serine and threonine metabolism, and cysteine and methionine metabolism were significantly disturbed. A composite model incorporating propionylcarnitine and indophenol sulfate was developed to assess the risk of renal involvement in pediatric patients with HSP. Conclusion: This study reveals the metabolic alterations in healthy children, HSPN patients, and HSP patients without renal involvement. Furthermore, propionylcarnitine and indophenol sulfate may be potential predictive biomarkers of the occurrence of HSPN. What is Known: • HSP is the predominant type of vasculitis observed in children. The long-term prognosis of HSP is contingent upon the extent of renal impairment. In severe nephritis, a delay in appropriate treatment may lead to fibrosis progression and subsequent development of chronic kidney disease (CKD), even leading to renal failure. • The application of metabolomics in investigating diverse renal disorders has been documented. Urine is a robust and sensitive medium for metabolomics detection. What is New: • The metabolic profiles were identified in urine samples of healthy children and those with HSP at the early stage of the disease. Different metabolites were identified between HSP patients without nephritis and those who developed HSPN. • These different metabolites may affect oxidative stress in the progression of HSPN.
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Affiliation(s)
- Minyi Yu
- Department of Rheumatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Xiaoxiang Song
- Department of Rheumatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Jie Guo
- Department of Rheumatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Qihua Feng
- Department of Rheumatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Jianmei Tian
- Department of Infectious Diseases, Children's Hospital of Soochow University, Suzhou, 215000, China.
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Liu C, Du LN, Zhao Q, Wang XT, Feng K, Yang Y, Yang Y. Immunoglobulin A Vasculitis With Intussusception in Children. Am Surg 2024; 90:1298-1308. [PMID: 38264960 DOI: 10.1177/00031348241229627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Immunoglobulin A (IgA) vasculitis with intussusception is acute and severe vasculitis combined with acute abdomen in children. The diagnosis of the disease depends on the results of imaging examinations, and its treatment mainly includes enema and surgery. The literature summarized the detailed diagnosis and treatment data in previous literature reports. METHODS We described the clinical manifestations, ultrasonic features, and treatment of patients admitted to a single center and reviewed previous literature regarding cases with detailed clinical data in the PubMed database within the past 20 years. RESULTS The review included 36 patients, including 22 boys and 14 girls. A total of 32 patients were diagnosed using ultrasound (88.9%). The main sites of intussusception were the ileum and ileocolon in 16 (44.4%) and 11 (30.6%) cases, respectively. Thirteen patients (36.1%) were treated with enema, with 6 responding to the treatment. 26 patients (72.2%) underwent surgical treatment. Patients with ileal intussusception were more likely to be treated with surgery than those with colonic intussusception (P < .05). The single-center clinical data of 23 patients showed that there was no significant difference in laboratory test findings between patients with and without surgical treatment (P > .05). Patients with long insertion lengths were more likely to require surgery and resection (P < .05). CONCLUSIONS Ultrasonography is the first-line investigation for diagnosis. The main sites of intussusception were ileum and ileocolon. The length of intubation was related to surgery; treatment is according to the intussusception site. Air enema is not suitable for intussusception of the small intestine.
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Affiliation(s)
- Chang Liu
- Department of Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li-Na Du
- Department of Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qian Zhao
- Department of Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin-Tai Wang
- Department of Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Kai Feng
- Department of Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yang Yang
- Department of Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Yang
- Department of Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Ruan Y, Xie L. Associations of MEFV gene variants, IL-33, and sST2 with the risk of Henoch-Schönlein purpura in children. Heliyon 2024; 10:e29469. [PMID: 38655333 PMCID: PMC11036003 DOI: 10.1016/j.heliyon.2024.e29469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
Objective Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children. HSP is a multifactorial inflammatory disease, but its pathogenesis is still unclear. The pathogenicity of familial Mediterranean fever gene (MEFV) variants in HSP remains controversial. The objective of this study was to evaluate relationships between MEFV variants and susceptibility to HSP and their associations with clinical outcomes. We also investigated levels of IL-33 and soluble suppression of tumorigenicity 2 (sST2) in children with HSP and their clinical significance. Methods We selected 100 children with HSP as the case group. The control group consisted of 50 children who visited the hospital for physical health examinations. All subjects were screened for MEFV gene exon mutations, and levels of IL-33 and sST2 were measured. Results The frequency of MEFV variants was significantly greater in HSP patients than in healthy controls. The variant with the highest frequency was E148Q. The frequency of the C allele of the MEFV variant E148Q was 32 % in HSP patients and 18 % in controls (P-adjust = 0.04). Patients with the MEFV E148Q variant had more frequent joint involvement and recurrent purpura and higher levels of IL-33 and C-reactive protein (CRP). Levels of IL-33 and sST2 in children with HSP were significantly higher than those in the control group, and the sST2/IL-33 ratio in children with HSP was unbalanced (P-adjust <0.05). Logistic regression analysis revealed the presence of E148Q and an unbalanced sST2/IL-33 ratio to be independent risk factors for HSP. Conclusion The results of this study suggest that the MEFV variant E148Q is associated with HSP susceptibility in Chinese children and that carriers of the variant may have more severe clinical manifestations and greater inflammatory responses. E148Q and the sST2/IL-33 ratio may play important roles in the pathogenesis of HSP.
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Affiliation(s)
- Yang Ruan
- Department of Laboratory Medicine, The Affiliated Children's Hospital Of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital) , Changsha, 410007, China
| | - Longlong Xie
- Pediatrics Research Institute of Hunan Province, The Affiliated Children's Hospital Of Xiangya School of Medicine, Central South University(Hunan Children’s Hospital) , Changsha, 410007, China
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Bradley J, Whitaker I, Lyons B, Mangla A. A Case Series of Unusual IgA Vasculitis. HCA HEALTHCARE JOURNAL OF MEDICINE 2024; 5:157-164. [PMID: 38984230 PMCID: PMC11229601 DOI: 10.36518/2689-0216.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Introduction Immunoglobulin A vasculitis (IgA)is a rare condition characterized by palpable purpura, often involving the skin, gastrointestinal tract, joints, and kidneys. Presentation is usually acute and is more common in children and adolescents of Southeast Asian and European descent. In the adult population, it is less common and therapies are not as well-established. Case Presentation Disease prevalence of IgA vasculitis outside Southeast Asian and European populations is not well-documented. In this case series, we present 2 cases of IgA vasculitis in 2 older adult males, one of Native American descent and one of African American descent. Conclusion IgA vasculitis must be considered within the adult population, and it is not limited to certain ethnic groups. Further research is needed to give clarity on the best treatment options for adults with IgA vasculitis. We believe that patients presenting with IgA vasculitis are best managed in a multidisciplinary approach, especially those patients with limited improvement despite the initiation of corticosteroids. Our 2 cases should raise awareness of IgA vasculitis in patients with skin rashes and elevated creatinine levels.
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Felix A, Assad Z, Bidet P, Caseris M, Dumaine C, Faye A, Melki I, Kaguelidou F, Valtuille Z, Ouldali N, Meinzer U. Common Seasonal Pathogens and Epidemiology of Henoch-Schönlein Purpura Among Children. JAMA Netw Open 2024; 7:e245362. [PMID: 38578638 PMCID: PMC10998156 DOI: 10.1001/jamanetworkopen.2024.5362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Importance Henoch-Schönlein purpura (HSP) is the most common type of vasculitis in children. The factors that trigger the disease are poorly understood. Although several viruses and seasonal bacterial infections have been associated with HSP, differentiating the specific associations of these pathogens with the onset of HSP remains a challenge due to their overlapping seasonal patterns. Objective To analyze the role of seasonal pathogens in the epidemiology of HSP. Design, Setting, and Participants This cohort study comprised an interrupted time-series analysis of patient records from a comprehensive national hospital-based surveillance system. Children younger than 18 years hospitalized for HSP in France between January 1, 2015, and March 31, 2023, were included. Exposure Implementation and relaxation of nonpharmaceutical interventions (NPIs) for the COVID-19 pandemic, such as social distancing and mask wearing. Main Outcomes and Measures The main outcomes were the monthly incidence of HSP per 100 000 children, analyzed via a quasi-Poisson regression model, and the estimated percentage of HSP incidence potentially associated with 14 selected common seasonal pathogens over the same period. Results The study included 9790 children with HSP (median age, 5 years [IQR, 4-8 years]; 5538 boys [56.4%]) and 757 110 children with the infectious diseases included in the study (median age, 0.7 years [IQR, 0.2-2 years]; 393 697 boys [52.0%]). The incidence of HSP decreased significantly after implementation of NPIs in March 2020 (-53.6%; 95% CI, -66.6% to -40.6%; P < .001) and increased significantly after the relaxation of NPIs in April 2021 (37.2%; 95% CI, 28.0%-46.3%; P < .001). The percentage of HSP incidence potentially associated with Streptococcus pneumoniae was 37.3% (95% CI, 22.3%-52.3%; P < .001), the percentage of cases associated with Streptococcus pyogenes was 25.6% (95% CI, 16.7%-34.4%; P < .001), and the percentage of cases associated with human rhino enterovirus was 17.1% (95% CI, 3.8%-30.4%; P = .01). Three sensitivity analyses found similar results. Conclusions and Relevance This study found that significant changes in the incidence of HSP simultaneously with major shifts in circulating pathogens after NPIs for the COVID-19 pandemic indicated that approximately 60% of HSP incidence was potentially associated with pneumococcus and group A streptococcus. This finding suggests that preventive measures against these pathogens could reduce the incidence of pediatric HSP.
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Affiliation(s)
- Arthur Felix
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Competence Centre RAISE Antilles-Guyane, EpiCliV Research Unit, Department of General Pediatrics, Martinique University Hospital, University of French West Indies, Martinique, France
| | - Zein Assad
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
| | - Philippe Bidet
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
- Department of Microbiology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marion Caseris
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Dumaine
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, INSERM UMR-1123, ECEVE, Paris, France
| | - Isabelle Melki
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Pediatrics, Rheumatology and Pediatric Internal Medicine, Children’s Hospital, Bordeaux, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zaba Valtuille
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naïm Ouldali
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Infection, Antimicrobials, Modeling, Evolution, Paris Cité University, INSERM UMR 1137, Paris, France
| | - Ulrich Meinzer
- Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases (RAISE), Department of General Pediatrics, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche sur l’inflammation UMR 1149, Université Paris Cité, INSERM, Paris, France
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Glassock RJ. Prognostic Scoring in IgA Vasculitis. Clin J Am Soc Nephrol 2024; 19:409-411. [PMID: 38598194 PMCID: PMC11025687 DOI: 10.2215/cjn.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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Liang Y, Zhao C, Zhao L, Sheng D, Chen B, Zhao G, Wang Q, Zhang L. Taxonomic and functional shifts of gut microbiome in immunoglobulin A vasculitis children and their mothers. Front Pediatr 2024; 12:1356529. [PMID: 38410769 PMCID: PMC10895042 DOI: 10.3389/fped.2024.1356529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Objectives To examine the gut microbiota characteristics in children with immunoglobulin A vasculitis and their interrelationships with the host, while evaluate the vertical inheritance of microbiota in the development and progression of IgA vasculitis. Methods This study investigated the gut microbiome of 127 IgA vasculitis mother-child pairs and 62 matched healthy mother-child pairs, and compared the gut microbial composition of different groups. The pathway enrichment analysis evaluated potential gut microbiome-mediated pathways involved in the pathophysiology of IgA vasculitis. The Spearman correlation analysis illustrated the relationships between clinical variables and bacterial biomarkers. Results This study identified distinct intestinal microbiome in IgA vasculitis children compared to healthy children, and further pointed out the association in gut microbiota between IgA vasculitis children's and their mother's. The relative abundance of Megamonas and Lactobacillus in IgAV children was positively correlated with that in their mothers. The pathway enrichment analysis found microbial biosynthesis of vitamins and essential amino acids was upregulated in children with IgA vasculitis. Correlation analysis showed bacterial biomarkers were correlated with indicators of blood coagulation. Conclusion Children with IgA vasculitis have unique bacterial biomarkers and may affect coagulation function, and their gut microbiome was closely associated with that of their mothers. The observed association in gut microbiota between IgA vasculitis children and their mothers suggested a potential intergenerational influence of the maternal microbiota on the development or progression of IgA vasculitis in children.
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Affiliation(s)
- Yijia Liang
- Microbiome-X, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Changying Zhao
- Microbiome-X, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lanlan Zhao
- Microbiome-X, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dashuang Sheng
- Microbiome-X, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bin Chen
- Microbiome-X, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guoping Zhao
- Microbiome-X, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, China
- CAS Key Laboratory of Computational Biology, Bio-Med Big Data Center, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Qinghua Wang
- School of Biological Science and Technology, University of Jinan, Jinan, China
| | - Lei Zhang
- Microbiome-X, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, China
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Rigante D, Guerriero C, Silvaroli S, Paradiso FV, Sodero G, Laferrera F, Franceschi F, Candelli M. Predictors of Gastrointestinal Involvement in Children with IgA Vasculitis: Results from a Single-Center Cohort Observational Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:215. [PMID: 38397327 PMCID: PMC10887107 DOI: 10.3390/children11020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Background and objective: IgA vasculitis (IgAV), a predominantly pediatric leukocytoclastic disease, has an unpredictable, though largely benign, evolution. The aim of this study was to retrospectively investigate any potential clinical or laboratory predictors of gastrointestinal involvement in a single-center cohort of children with IgAV. Patients and methods: A total of 195 children with a history of IgAV, regularly followed-up for an average period of 1 ± 2.6 years via outpatients clinics of the pediatric rheumatology unit in our University, were assessed, analyzing their clinical and laboratory variables in relationship with their disease evolution and outcome. Results: Univariate analysis showed that a higher neutrophil granulocyte count and lower lymphocyte count (expressed as a percentage of the total white blood cells) were significantly associated with the presence of gastrointestinal involvement at the first examination (65.2 ± 13% versus 58.8 ± 12%, p = 0.02, and 26.4 ± 11% versus 32.1 ± 11%, p = 0.02, respectively). A positive pharyngeal swab for Streptococcus pyogenes, a deficiency of 25-hydroxyvitamin D, a persistence of purpuric rash for more than 1 month, and purpuric lesions in the genital area were also associated with gastrointestinal involvement (p = 0.0001, p = 0.0001, p = 0.007 and p = 0.001, respectively). However, multiple logistic regressions with correction for the patients' sex and age showed that lower 25-hydroxyvitamin D levels, persistent rash, and genital lesions were independently and significantly associated with signs of gastrointestinal involvement. We then performed a secondary analysis (both univariate and multivariate) to investigate whether vitamin D deficiency was associated with other IgAV manifestations: we found that only 25-hydroxyvitamin D deficiency remained significantly associated with gastrointestinal involvement in IgAV. Conclusions: Patients with IgAV and vitamin D deficiency might be more prone to developing gastrointestinal manifestations of variable severity.
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Affiliation(s)
- Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Cristina Guerriero
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Sara Silvaroli
- Unit of Pediatric Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Filomena Valentina Paradiso
- Unit of Pediatric Surgery, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giorgio Sodero
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Laferrera
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Franceschi
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Department of Emergency Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Marcello Candelli
- Department of Emergency Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
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Qi L, Jiang W, He W, Li X, Wu J, Chen S, Liao Z, Yu S, Liu J, Sun Y, Wu Q, Dong C, Wang Q. Transcriptome profile analysis in spinal cord injury rats with transplantation of menstrual blood-derived stem cells. Front Mol Neurosci 2024; 17:1335404. [PMID: 38361743 PMCID: PMC10867146 DOI: 10.3389/fnmol.2024.1335404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Menstrual blood-derived stem cells (MenSCs) are vital in treating many degenerative and traumatic disorders. However, the underlying molecular mechanisms remain obscure in MenSCs-treating spinal cord injury (SCI) rats. Methods MenSCs were adopted into the injured sites of rat spinal cords at day 7 post surgery and the tissues were harvested for total RNA sequencing analysis at day 21 after surgery to investigate the expression patterns of RNAs. The differentially expressed genes (DEGs) were analyzed with volcano and heatmap plot. DEGs were sequentially analyzed by weighted gene co-expression network, functional enrichment, and competitive endogenous RNAs (ceRNA) network analysis. Next, expression of selected miRNAs, lncRNAs, circRNAs and mRNAs were validated by quantitative real-time polymerase chain reaction (qRT-PCR). Bioinformatics packages and extra databases were enrolled to scoop the genes functions and their interaction relationships. Results A total of 89 lncRNAs, 65 circRNAs, 120 miRNAs and 422 mRNAs were significantly upregulated and 65 lncRNAs, 72 circRNAs, 74 miRNAs, and 190 mRNAs were significantly downregulated in the MenSCs treated rats compared to SCI ones. Current investigation revealed that MenSCs treatment improve the recovery of the injured rats and the most significantly involved pathways in SCI regeneration were cell adhesion molecules, nature killer cell mediated cytotoxicity, primary immunodeficiency, chemokine signaling pathway, T cell receptor signaling pathway and B cell receptor signaling pathway. Moreover, the lncRNA-miRNA-mRNA and circRNA-miRNA-mRNA ceRNA network of SCI was constructed. Finally, the protein-protein interaction (PPI) network was constructed using the top 100 DE mRNAs. The constructed PPI network included 47 nodes and 70 edges. Discussion In summary, the above results revealed the expression profile and potential functions of differentially expressed (DE) RNAs in the injured spinal cords of rats in the MenSCs-treated and SCI groups, and this study may provide new clues to understand the mechanisms of MenSCs in treating SCI.
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Affiliation(s)
- Longju Qi
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
- Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Wenwei Jiang
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
- Rehabilitation Medicine Center, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, Jiangsu, China
| | - Wenhua He
- Department of Basic Medicine, Luohe Medical College, Luohe, Henan, China
| | - Xiangzhe Li
- Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Jiahuan Wu
- Rehabilitation Medicine Center, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, Jiangsu, China
| | - Shiyuan Chen
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Zehua Liao
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
- Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Shumin Yu
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Jinyi Liu
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Yuyu Sun
- Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Qinfeng Wu
- Rehabilitation Medicine Center, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, Jiangsu, China
| | - Chuanming Dong
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Qinghua Wang
- Laboratory Animal Center, School of Medicine, Nantong University, Nantong, Jiangsu, China
- Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
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Yu M, Yang Y, Zhang J, Liu R, Huang L, Wu J, Kang Z, Zhou J, Yang Z. Association between TRAF1/C5 Gene Polymorphisms and IgA Vasculitis in Chinese Children. Immunol Invest 2024; 53:281-293. [PMID: 38117213 DOI: 10.1080/08820139.2023.2295477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To investigate the association between loci rs3761847 and rs10818488 of tumor necrosis factor receptor-associated factor 1/complement C5 (TRAF1/C5) gene and the susceptibility to IgAV. METHODS 100 blood samples of children with IgAV and 100 blood samples of healthy children were collected from the Third Xiangya Hospital of Central South University from June 2017 to June 2019. The target gene fragment was amplified by polymerase chain reaction (PCR), and the single nucleic acid gene polymorphism of the gene loci was detected by PCR sequencing based typing technique. The association between gene polymorphism of each locus and susceptibility to IgAV was analyzed. RESULTS There were significant differences in both genotype (P < .05) and allele frequencies (P < .05) of rs3761847 of TRAF1/C5 gene between the IgAV group and the control group.Besides, the risks of developing IgAV in children with the TT genotype was 0.495 times and in children with the C allele was 1.627 times of that in children with other genotypes and alleles, respectively (P < .05). For IgAV patients, renal involvement risk in children with CC genotype was 5.859 times of that in children with other genotypes (P < .05). There were no significant differences in genotype (P > .05) and allele frequencies (P > .05) of rs10818488 of TRAF1/C5 gene between the IgAV group and the control group. IgAV patients with TT genotype had a 3.2 times higher risk of renal involvement than those with other genotypes (P < .05). CONCLUSIONS There is an association between locus rs3761847 of TRAF1/C5 gene single nucleotide polymorphisms and susceptibility to IgAV. The T allele at locus rs3761847 of TRAF1/C5 gene may be a protective factor for IgAV. The C allele at locus rs3761847 and the T allele at locus rs10818488 of TRAF1/C5 gene may be associated with kidney injury in IgAV.
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Affiliation(s)
- Meng Yu
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Yeyi Yang
- Department of Nephropathy and Rheumatology, Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Juan Zhang
- Department of Pediatrics, Zhuzhou Central Hospital, Zhuzhou, Hunan, P.R. China
| | - Rui Liu
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Lihua Huang
- Central Laboratory, The Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Jiping Wu
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Zhijuan Kang
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Jin Zhou
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Zuocheng Yang
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
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Jianati R, Liu XX, Zhu XJ. [Research advances in the etiology and pathogenesis of immunoglobulin A vasculitis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1287-1292. [PMID: 38112149 PMCID: PMC10731969 DOI: 10.7499/j.issn.1008-8830.2307065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein purpura, has complex etiology and pathogenesis which have not been fully clarified. The latest research shows that SARS-CoV-2 and related vaccines, human papilloma vaccine, and certain biological agents can also induce IgAV. Most studies believe that the formation of galactose-deficient IgA1 (Gd-IgA1) and Gd-IgA1-containing immune complex plays a crucial role in the pathogenesis of IgAV. It is hypothesized that the pathogenesis of IgAV is associated with the binding of IgA1 to anti-endothelial cell antibodies. In addition, genetics also constitutes a major focus of IgAV research. This article reviews the new advances in the etiology of IgAV and summarizes the role of Gd-IgA1, Gd-IgA1-containing immune complex, anti-endothelial antibody, IgA1 conjugates, T lymphocyte immunity, and genetic factors in the pathogenesis of IgAV.
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Affiliation(s)
- Reaila Jianati
- Department of Hematology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China (Zhu X-J, . cn)
| | - Xi-Xi Liu
- Department of Hematology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China (Zhu X-J, . cn)
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Taşkın RB, Aydın İ, Aytaç G, Imamoglu S, Tunçay SC, Bulut İK, Karaca NE, Aksu G, Berdeli A, Kütükçüler N. Analysis of IL-1β, TGF-β, IL-5, ACE, PTPN22 gene polymorphisms, and gene expression levels in Turkish children with IgA vasculitis. Mol Biol Rep 2023; 51:15. [PMID: 38085361 DOI: 10.1007/s11033-023-08944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Immunoglobulin-A vasculitis (IgAV) is an inflammatory disease that affects small blood vessels. This study was performed to identify an association between protein tyrosine phosphatase non-receptor type 22 (PTPN22) + 788G > A (rs33996649), transforming growth factor-beta (TGF-β) -509C > T (rs18004069), interleukin 1-beta (IL-1β) -511C > T (rs16944), interleukin 5 (IL-5) -746C/T (rs2069812), and angiotensin-converting enzyme (ACE) I/D (rs4646994) gene polymorphisms, susceptibility to IgAV, as well as the mRNA levels of IL-1β, IL-1β, and TGF-β. METHOD A total of 53 patients with IgAV and 50 healthy controls were enrolled. PTPN22, TGF-β, IL-1β, ACE gene polymorphisms, ACE gene I/D polymorphisms, and mRNA expression levels were analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, allele-specific PCR, and real-time PCR with TaqMan kits, respectively. RESULTS PTPN22, TGF-β, IL-1β, IL-5, and ACE variants showed no genotype or allele differences between patients with IgAV and controls. Increased levels of IL-1β and TGF-β mRNA expressions were observed in patients with IgAV (p < 0.001). Patients with the IL-1β AG genotype showed significantly increased amounts of arthritis than patients with non-AG (p = 0.004). Age at disease onset was found to be significantly different in patients with IgAV according to the presence of TGF-β TT genotype (p = 0.047). CONCLUSION Polymorphisms in PTPN22, TGF-β, IL-5, IL-1β, and ACE genes are unlikely to confer susceptibility to IgAV. However, the presence of the AG genotype of IL-1β is associated with susceptibility to IgAV-related arthritis. This is the first study to report a significant increase in serum mRNA levels of IL-1β and TGF-β in IgAV patients, supporting a susceptibility to IgAV in childhood.
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Affiliation(s)
- Raziye Burcu Taşkın
- Faculty of Medicine, Department of Pediatric Rheumatology, Ege University, Izmir, Turkey.
| | - İlyas Aydın
- Faculty of Medicine, Department of Pediatric Rheumatology, Ege University, Izmir, Turkey
| | - Gülçin Aytaç
- Faculty of Medicine, Department of Pediatric Rheumatology, Ege University, Izmir, Turkey
| | - Süleyman Imamoglu
- Faculty of Medicine, Department of Pediatric Rheumatology, Ege University, Izmir, Turkey
| | - Secil Conkar Tunçay
- Faculty of Medicine, Department of Pediatric Nephrology, Ege University, Izmir, Turkey
| | - İpek Kaplan Bulut
- Faculty of Medicine, Department of Pediatric Nephrology, Ege University, Izmir, Turkey
| | - Neslihan Edeer Karaca
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Immunology, Ege University, Kazimdirik Neighborhood, University Street Number: 9, 35100, Bornova, Izmir, Turkey
| | - Güzide Aksu
- Faculty of Medicine, Department of Pediatric Rheumatology, Ege University, Izmir, Turkey
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Immunology, Ege University, Kazimdirik Neighborhood, University Street Number: 9, 35100, Bornova, Izmir, Turkey
| | - Afig Berdeli
- Faculty of Medicine, Department of Pediatric Rheumatology, Ege University, Izmir, Turkey
| | - Necil Kütükçüler
- Faculty of Medicine, Department of Pediatric Rheumatology, Ege University, Izmir, Turkey
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Immunology, Ege University, Kazimdirik Neighborhood, University Street Number: 9, 35100, Bornova, Izmir, Turkey
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Maisons V, Ramdani Y, Hankard A, Messiaen C, Jannot AS, Sautenet B, Halimi JM, Maillot F, Pillebout É, Audemard-Verger A. New insights into epidemiological data and impact of the COVID-19 pandemic on IgA vasculitis in children and adults: a French nationwide cohort. Rheumatol Int 2023; 43:1791-1798. [PMID: 37438546 DOI: 10.1007/s00296-023-05387-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
IgA vasculitis (IgAV) is a small size vasculitis for which epidemiologic data are strikingly lacking, especially about the adult form. Additionally, the COVID-19 pandemic seems to have profoundly modified the incidence of this disease. Here, we aimed to establish some relevant epidemiological data in both pediatric and adult IgAV. We performed an observational study using a national database called "BNDMR" on IgAV, which gathers patients managed in the French network of experts on rare diseases. We primarily performed descriptive statistics over the 2010-2022 period. Then, we compared the North-South geographical areas, the seasonality, and the impact of COVID-19 with that of other patients reported in the same centers. We collected data from 1988 IgAV patients. The sex ratio was 1.57 for adults and 1.05 for children. The annual incidence in 2021 was 0.06 for 100,000 adults and 0.50 for 100,000 children. Compared with other diseases reported into the BNDMR, IgAV was more common in the South than in the North of France (OR 4.88 [4.17-5.74] in adults and OR 1.51 [1.35-1.68] in children). IgAV was also observed more frequently in winter and autumn. Strikingly, we observed a decrease in incidence during the COVID-19 pandemic period in children (OR 0.62 [0.47-0.81]). Our study provides both new insights and confirmations of IgAV epidemiological data: winter and autumn seasonality, more pronounced male predominance in adults, decreasing incidence of pediatric IgAV during the COVID-19 pandemic and increasing incidence in the South of France.
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Affiliation(s)
- Valentin Maisons
- University of Tours, Tours, France.
- Department of Nephrology, Hopital Bretonneau, CHU Bretonneau, CHU de Tours, 2 boulevard Tonnellé, 37000, Tours, France.
- SPHERE INSERM U1246, Université de Tours, Université de Nantes, Tours, France.
| | - Yanis Ramdani
- University of Tours, Tours, France
- Department of Internal Medicine and Clinical Immunology, CHU Tours, Tours, France
| | | | - Claude Messiaen
- Banque Nationale de Données Maladies Rares (BNDMR), DSI-I&D, APHP, Paris, France
| | - Anne-Sophie Jannot
- Banque Nationale de Données Maladies Rares (BNDMR), DSI-I&D, APHP, Paris, France
| | - Bénédicte Sautenet
- University of Tours, Tours, France
- Department of Nephrology, Hopital Bretonneau, CHU Bretonneau, CHU de Tours, 2 boulevard Tonnellé, 37000, Tours, France
- SPHERE INSERM U1246, Université de Tours, Université de Nantes, Tours, France
| | - Jean-Michel Halimi
- University of Tours, Tours, France
- Department of Nephrology, Hopital Bretonneau, CHU Bretonneau, CHU de Tours, 2 boulevard Tonnellé, 37000, Tours, France
| | - François Maillot
- University of Tours, Tours, France
- Department of Internal Medicine and Clinical Immunology, CHU Tours, Tours, France
| | | | - Alexandra Audemard-Verger
- University of Tours, Tours, France
- Department of Internal Medicine and Clinical Immunology, CHU Tours, Tours, France
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Qin J, Zhang L, Ke B, Liu T, Kong C, Jin C. Causal relationships between circulating inflammatory factors and IgA vasculitis: a bidirectional Mendelian randomization study. Front Immunol 2023; 14:1248325. [PMID: 37753071 PMCID: PMC10518517 DOI: 10.3389/fimmu.2023.1248325] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Background IgA vasculitis (IgAV) is an immune-associated vasculitis, yet its exact etiology remains unclear. Here, we explore the interaction between IgAV and inflammatory factors using bidirectional Mendelian randomization (MR). Methods We conducted a bidirectional summary-level MR analysis to delineate the causality of C-reactive protein (CRP), procalcitonin (PCT), and 41 circulating inflammatory regulators with IgAV. Data on genetic variants related to inflammation were obtained from three genome-wide association studies (GWASs) on CRP, PCT, and human cytokines, whereas data on IgAV was from large meta-analyses of GWAS among 216 569 FinnGen Biobank participants. The primary MR analysis was performed using the inverse-variance weighted (IVW) approach, and the sensitivity analyses were carried out using MR-Egger, weighted median, weighted mode, and MR-pleiotropy residual sum and outlier. Results This study revealed the association of CRP higher levels with increased risk of IgAV through IVW method (Estimate odds ratio [OR] = 1.41, 95% confidence interval [CI]: 1.01-1.98, P = 0.04), MR-Egger (OR = 1.87, CI: 1.15-3.02, P = 0.01), weighted median (OR = 2.00, CI: 1.21-3.30, P = 0.01) and weighted mode (OR = 1.74, CI: 1.13-2.68, P = 0.02). Furthermore, elevated IL-8 was strongly implicated with a higher risk of IgAV (IVW OR = 1.42, CI: 1.05-1.92; P = 0.02). Conversely, genetically predicted IgAV was associated with decreased levels of TNF-β (IVW estimate β = -0.093, CI: -0.178 - -0.007; P = 0.033). Additionally, no such significant statistical differences for other inflammatory factors were found. Conclusion Our current study using bidirectional MR analysis provides compelling evidence for a causal effect of CRP, PCT, and circulating inflammatory regulators on IgAV. These findings contribute to a better understanding of the pathogenesis of IgAV and emphasize the potential of targeting inflammatory factors for therapeutic interventions.
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Affiliation(s)
- Jiading Qin
- Medical College of Nanchang University, Nanchang, China
- Department of Hematology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Ling Zhang
- Medical College of Nanchang University, Nanchang, China
- Department of Hematology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Bo Ke
- Department of Hematology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Key Biologic Laboratory of Blood Tumor Cell of Jiangxi Province, Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Tingting Liu
- Department of Hematology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Chunfang Kong
- Department of Hematology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Chenghao Jin
- Medical College of Nanchang University, Nanchang, China
- Department of Hematology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Soochow, China
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Zeng Q, Wang WR, Li YH, Liang Y, Wang XH, Yan L, Yu RH. Diagnostic and prognostic value of galactose-deficient IgA1 in patients with IgA nephropathy: an updated systematic review with meta-analysis. Front Immunol 2023; 14:1209394. [PMID: 37671165 PMCID: PMC10475574 DOI: 10.3389/fimmu.2023.1209394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
Objectives Galactose-deficient IgA1 (Gd-IgA1) is a critical effector molecule in the pathogenesis of IgA nephropathy (IgAN), a leading renal disease without noninvasive assessment options. This updated systematic review aimed to determine the diagnostic and prognostic value of Gd-IgA1 assessment in biological fluids in patients with IgAN. Methods PRISMA guidelines were followed in this review. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, VIP Information/China Science and Technology Journal Database, and WANFANG for studies published between database inception and January 31, 2023. Eligible studies that evaluated aberrant IgA1 glycosylation in IgAN patients relative to controls were identified, and random effects meta-analyses were used to compare Gd-IgA1 levels in different groups. The quality of the evidence was assessed using the Newcastle-Ottawa Scale. This study was registered on PROSPERO (CRD42022375246). Findings Of the 2727 records identified, 50 were eligible and had available data. The mean Newcastle-Ottawa Scale score was 7.1 (range, 6-8). Data synthesis suggested that IgAN patients had higher levels of blood and/or urine Gd-IgA1 compared with healthy controls (standard mean difference [SMD]=1.43, 95% confidence interval [CI]=1.19-1.68, P<0.00001), IgA vasculitis patients (SMD=0.58, 95% CI=0.22-0.94, P=0.002), and other kidney disease patients (SMD=1.06, 95% CI=0.79-1.33, P<0.00001). Moreover, patients with IgAN had similar levels of serum Gd-IgA1 compared to first-degree relatives (SMD=0.38, 95% CI= -0.04-0.81, P=0.08) and IgA vasculitis with nephritis patients (SMD=0.12, 95% CI= -0.04-0.29, P=0.14). In addition, ten studies demonstrated significant differences in serum Gd-IgA1 levels in patients with mild and severe IgAN (SMD= -0.37, 95% CI= -0.64--0.09, P=0.009). Conclusions High serum and urine Gd-IgA1 levels suggest a diagnosis of IgAN and a poor prognosis for patients with this immunological disorder. Future studies should use more reliable and reproducible methods to determine Gd-IgA1 levels. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022375246, identifier CRD42022375246.
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Affiliation(s)
| | | | | | - Ying Liang
- Department of Nephrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | | | | | - Ren-Huan Yu
- Department of Nephrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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尹 婷, 彭 晓, 傅 睿, 汪 滢, 吕 炎, 邓 燕, 付 佳, 张 智. [Clinical characteristics, pathology, and prognosis of children with diffuse endocapillary proliferative Henoch-Schönlein purpura nephritis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:837-842. [PMID: 37668032 PMCID: PMC10484084 DOI: 10.7499/j.issn.1008-8830.2303022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/15/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To investigate the clinical characteristics, pathology, and prognosis of children with diffuse endocapillary proliferative Henoch-Schönlein purpura nephritis (DEP-HSPN). METHODS A retrospective analysis was performed on the clinical, pathological, and prognosis data of 44 children with DEP-HSPN and 765 children without DEP-HSPN. The children with DEP-HSPN were diagnosed by renal biopsy in Jiangxi Provincial Children's Hospital from January 2006 to December 2021. RESULTS Among the 809 children with purpura nephritis, 44 (5.4%) had DEP-HSPN, with a mean age of (8±3) years, and there were 29 boys (65.9%) and 15 girls (34.1%). Compared with the non-DEP-HSPN group, the DEP-HSPN group had a significantly shorter time from onset to renal biopsy and a significantly higher proportion of children with respiratory infection or gross hematuria, and most children had nephrotic syndrome. The DEP-HSPN group had significantly higher levels of 24-hour urinary protein, urinary protein grading, microscopic hematuria grading, serum creatinine, and blood urea nitrogen and significantly lower levels of serum albumin and complement C3 (P<0.05). The DEP-HSPN group had a higher pathological grading, with predominant deposition of IgA in the mesangial area and capillary loops, and higher activity scores in the modified semi-quantitative scoring system (P<0.05). The Kaplan-Meier survival analysis showed that there was no significant difference in the renal complete remission rate between the two groups (P>0.05). CONCLUSIONS Children with DEP-HSPN have a rapid onset, severe clinical manifestations and pathological grading, and high activity scores in the modified semi-quantitative scoring system. However, most of the children with DEP-HSPN have a good prognosis, with a comparable renal complete remission rate to the children without DEP-HSPN.
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50
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Wang J, Sun M, Li G, Yin D, Hu C, Sun J. The Spectrum and Age-Sex Patterns Among Outpatients with Allergic Diseases - Yichang City, Hubei Province, China, 2018-2021. China CDC Wkly 2023; 5:681-686. [PMID: 37593139 PMCID: PMC10427338 DOI: 10.46234/ccdcw2023.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/25/2023] [Indexed: 08/19/2023] Open
Abstract
What is already known about this topic? Allergic diseases have affected an estimated 40% of the population in China. However, our understanding of the full spectrum of these diseases remains insufficient. What is added by this report? Between 2018 and 2021, Yichang City documented 625,929 outpatient visits mainly related to skin and mucous membrane allergies (77.90%) and allergic respiratory conditions (19.64%). In 2021, the occurrence of outpatient visits for conditions such as allergic rhinitis, acute atopic conjunctivitis, and atopic dermatitis increased. The demographic analysis revealed that male patients comprised the majority of the under 18 age bracket (56.05%), while female patients were predominantly represented in the 18 to 65 age bracket (61.79%). What are the implications for public health practice? This constitutes the first analysis of the spectrum of allergic diseases, utilizing regional outpatient data, which has substantial implications for understanding the disease burden.
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Affiliation(s)
- Jinyi Wang
- Jiangsu Taizhou People’s Hospital, Taizhou City, Jiangsu Province, China
| | - Mingwei Sun
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, China
| | - Dapeng Yin
- Hainan Center for Disease Control and Prevention, Haikou City, Hainan Province, China
| | - Chi Hu
- Yichang Center for Disease Control and Prevention, Yichang City, Hubei Province, China
| | - Jinfang Sun
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
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