Clinical features and prognosis of patients with anti-GBM disease combined with mesangial IgA deposition

Frontiers in Immunology, Год журнала: 2024, Номер 15

Опубликована: Июль 22, 2024

Introduction Anti-GBM diseases with IgA deposition in the mesangial region are rarely described.The factors influencing renal prognosis patients anti-GBM disease combined unknown. Methods We searched pathological reports of First Affiliated Hospital Zhengzhou University from 2015 to 2023 and found that a total 72 25 deposition. studied clinical features, prognosis, affecting Results Their median age was 44 years, their distribution unimodal. The proportion oliguria or anuria significantly lower than classic (13.04 vs. 42.31%, p=0.030). 24-hour urinary protein excretion higher [median:3.25 1.12g/24h, Interquartile range(IQR):1.032~3.945 0.63~1.79g/24h, p=0.020], serum creatinine (SCr) level at initial diagnosis lower(median:456.0 825.5μmol/L, IQR:270.0~702.0 515.8~1231.2μmol/L, p=0.002), peak SCr (median: 601.0 907.2μmol/L, IQR: 376.5~937.0 607.0~1361.2μmol/L, p=0.007), complement 3(C3) higher(median: 1.275 1.015g/L, IQR:1.097~1.462 0.850~1.220g/L, p=0.027). They had better outcomes during follow-up (p<0.001). After adjustment for hypertension, anuria, crescents%, still an independent protective factor (p=0.003) ESRD patients. Hypertension (p=0.026) levels (p=0.004) were risk Discussion Patients have less severe impairment disease.

Язык: Английский

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Urinary soluble CD163: A novel biomarker suggests who should receive glucocorticoids in IgA nephropathy

Kidney International Reports, Год журнала: 2024, Номер 9(10), С. 2848 - 2850

Опубликована: Авг. 9, 2024

See [article type, i.e., Clinical Research] on Page xxx. Several long-term cohorts have revealed that the outcomes of patients with IgA nephropathy (IgAN) are far worse than previously expected. With rapidly emerging clinical research, supportive therapy for IgAN has expanded from renin angiotensin system blockade to include sodium-glucose cotransporter 2 inhibitors, and endothelin A receptor antagonists.1Caster D.J. Lafayette R.A. The treatment primary nephropathy: Change, Change.Am J Kidney Dis. 2024; 83: 229-240https://doi.org/10.1053/j.ajkd.2023.08.007Abstract Full Text PDF PubMed Scopus (8) Google Scholar,2Selvaskandan H. Barratt J. Cheung C.K. Novel paradigms: nephropathy.Kidney Int Rep. 9: 203-213https://doi.org/10.1016/j.ekir.2023.11.026Abstract (4) Scholar Among specific subpopulations IgAN, low-dose corticosteroids, hydroxychloroquine, mycophenolate mofetil, B-cell targeting agents, complement antagonists also been explored as potentially beneficial interventions.1Caster As all new therapeutics, risks treatment, such hyperkalemia, fluid retention, heart failure, hepatotoxicity, infection, need be balanced potential benefits patient. Optimizing is notoriously challenging clinicians; however, current data derived these trials insufficient develop a comprehensive algorithm guide decision making.2Selvaskandan Scholar, 3Lafayette R. Kristensen Stone A. et al.Efficacy safety targeted-release formulation budesonide in (NefIgArd): 2-year results randomised phase 3 trial.Lancet. 2023; 402: 859-870https://doi.org/10.1016/S0140-6736(23)01554-4Abstract (60) 4Lv Wong M.G. Hladunewich M.A. al.Effect oral methylprednisolone decline kidney function or failure TESTING randomized trial.JAMA. 2022; 327: 1888-1898https://doi.org/10.1001/jama.2022.5368Crossref (129) 2021 Disease: Improving Global Outcomes guidelines5Kidney (KDIGO) Glomerular Work GroupKDIGO practice guideline management glomerular.Kidney Suppl. 2021; 100: S1-S276https://doi.org/10.1016/j.kint.2021.05.021Abstract (1066) outlined glucocorticoids mofetil may used who remain at high risk progression despite maximum care, use agents should carefully considered, taking into account patients' toxicity drugs. Caution advised because immunosuppressive therapy, particularly glucocorticoids, can pose significant demonstrated by study.4Lv crucial question then becomes, which more likely respond glucocorticoid therapy? According recent study,6Harada K. Akai Y. Yamaguchi al.Prediction corticosteroid responsiveness based fibroblast-specific protein 1 (FSP1) nephropathy.Nephrol Dial Transplant. 2008; 23: 3152-3159https://doi.org/10.1093/ndt/gfn240Crossref (15) experienced decrease proteinuria less 1.0 g/d, known responders, had significantly lower number 1–positive (FSP1+) cells their renal tissue nonresponders. amount interstitial damage, percentage glomerulosclerosis per total glomeruli, chronic inflammation showed positive correlation FSP1+ cells. Cox regression analysis was strongest most predictor responsiveness. Patients >32.6 cells/HPF diagnosis were exhibit steroid resistance.6Harada Nevertheless, detected tissue, counterproductive dynamic monitoring, they only predict resistance IgAN.6Harada In this issue International Reports, study Li al. 7Li Lv M. al.Correlation urinary soluble CD163 levels disease activity response https://doi.org/10.1016/j.ekir.2024.07.031Abstract (u-sCD163) correlated both IgAN. cross-sectional analysis, baseline u-sCD163 associated macrophage infiltration, crescentic area, well active lesions. They demonstrate probability benefiting alone, whereas relative benefit much higher.7Li Compared placebo, full-dose regimens lowered levels, reduction events, included ³40% estimated glomerular filtration rate, death due disease.7Li findings consistent previous higher intensity CD206+ CD68+ infiltration increased likelihood immunosuppression.8Xie D. Zhao Xu X. al.Intensity glomeruli predicts nephropathy.J Am Soc Nephrol. 32: 3187-3196https://doi.org/10.1681/ASN.2021060815Crossref (26) Collectively, studies suggest inflammatory lesions related receive early immunosuppression. extends our repertoire identifying infiltration; though previously, could confirmed histologically through biopsy, we now measurements, practical tool monitoring across varied settings. This novel biomarker extraordinarily stable over years storage, expands centers limited resources being able reliably send out testing biomarker. unanswered questions concerning selection remain. Can magnitude change degree glucocorticoids? Does responders imply relapse IgAN? Will accompany remission alone? recurrent transplanted kidneys? Another important concern how optimize promptly assess efficacy therapeutic drugs become available. Targeted-release budesonide, newer preparation, proven good side effects treatment.3Lafayette It will interesting see whether lead changes u-sCD163, allowing us expand its predicting therapy. Questions around when existing therapies repurposed setting For example, employing components monitored? Our work using proteomics technology multiple urine pathological parameters, suggesting role biomarkers management,9Wang Wu C. Chen S. al.Urinary profile characteristics.Front Immunol. 141117995https://doi.org/10.3389/fimmu.2023.1117995Crossref (3) further evaluation needed. Whether u-SCD163 therapeutics remains seen. Further exploring yet-unanswered needed integration making. New emerging, knowledge base continuously expanding. Undoubtedly, play an optimizing decisions prognostication toolkit continues grow. validation care help improve patients. GL scientific advisor AstraZeneca. other author declared no competing interests. Elevated Ambient Temperature Associated Increased Cardiovascular Disease–Risk HemodialysisKidney Reports

Язык: Английский

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Utilizing complement inhibition in IgA nephropathy

Nephrology, Год журнала: 2024, Номер 29(S2), С. 44 - 46

Опубликована: Сен. 1, 2024

Abstract The role of complement in the pathogenesis IgA nephropathy has been heavily explored over past 50 years. This led to general acceptance that plays an important clinical presentation and risk for progression disease patients with nephropathy. Herein, we review evidence activation nephropathy, focusing on lectin alternate pathways are main actors. We entering era intense investigation various inhibitors complement, which should ultimately be best indicator contributions lectin, common burden. More importantly, will see if these efforts result discovery clinically relevant options managing this disease.

Язык: Английский

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Emerging perspectives in the management of IgA nephropathy: a comprehensive review

Porto Biomedical Journal, Год журнала: 2024, Номер 9(6)

Опубликована: Ноя. 1, 2024

Abstract IgA nephropathy (IgAN) is the most prevalent form of primary glomerulonephritis worldwide and a leading cause chronic kidney disease renal failure. This disorder characterized by deposition immune complexes containing galactose-deficient forms complement C3 in glomeruli. Until now, management relied mainly on optimized supportive care. Systemic corticosteroid therapy proposed for patients at high risk progression, but effectiveness safety this approach are under debate. A significant proportion do not respond to current therapies require replacement young age, with substantial costs impact quality life. Recently, there have been multiple joint efforts improve understanding IgAN pathophysiology. International collaborations resulted ongoing clinical trials that providing new insights toward innovative therapeutic options such as SGLT2 inhibitors, dual endothelin angiotensin receptor blockers, targeted-release budesonide, B-cell proliferation differentiation system blockers. Based evidence, revision guidelines manage expected occur near future. In addition novelty agents, also growing interest noninvasive biomarkers screening, stratification monitor course disease, response treatment. review, we discuss knowledge pathophysiology IgAN, management, emerging advances translation research.

Язык: Английский

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Post-transplant IgA nephropathy: a rapidly evolving field of kidney transplant medicine

Journal of Nephrology, Год журнала: 2024, Номер unknown

Опубликована: Ноя. 20, 2024

Язык: Английский

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