IgA-Dominant Glomerulopathy and Thrombotic Microangiopathy After Chemotherapy

Dvanajscak, Zeljko; Karl, Bethany; Sanchez, Amber P.; Walavalkar, Vighnesh

doi:10.1016/j.ekir.2017.10.011

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…The precise pathogenic mechanism underlying microangiopathy in the setting of IgA nephropathy and IgA vasculitis with nephritis remains to be determined. However, case reports indicate that various factors may increase the risk of developing microangiopathy in IgA nephropathy; these factors may include drug toxicity, HELLP syndrome, and the presence of antiphospholipid antibodies [5,[32][33][34][35][36][37]. Multiple factors may be required to cause microangiopathy in general, and in IgA nephropathy in particular; however, our data provide evidence that complement activation plays an important role in the development of microangiopathy in IgA nephropathy, irrespective of other factors.…”

Section: Discussionmentioning

confidence: 74%

Complement-mediated microangiopathy in IgA nephropathy and IgA vasculitis with nephritis

et al. 2019

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Complement factor C4d was recently observed in renal biopsies from patients who had IgA nephropathy and a poor prognosis. We previously reported that C4d is a common denominator in microangiopathies. In this retrospective cohort study, we investigated whether C4d is a marker of microangiopathy in both IgA nephropathy and IgA vasculitis with nephritis, and whether patients with C4d and microangiopathy have poor renal outcome. We examined 128 renal biopsies from adult and pediatric patients, including normotensive and hypertensive patients, who presented with IgA nephropathy or IgA vasculitis with nephritis. Biopsies were re-evaluated in accordance with the Oxford classification, scored for additional lesions, and stained for complement proteins using immunohistochemistry, including C4d and C5b-9. Clinical data were collected with a mean (±SD) follow-up period of 51 ± 39 months. Changes in estimated glomerular filtration rate over time were compared using linear mixed-effects models. Renal survival was analyzed using multivariable Cox regression. Microangiopathic lesions were present in 20% of all biopsies (23% and 9% of patients with IgA nephropathy and IgA vasculitis with nephritis, respectively). Microangiopathy was associated with C4d and C5b-9 deposits, a higher number of chronic lesions, and hypertension (all p < 0.05). Patients with C4d and microangiopathic lesions had significantly poorer renal survival than patients without these findings, corrected for hypertension (p < 0.01). In conclusion, patients with IgA nephropathy or IgA vasculitis with nephritis with a combination of C4d positivity and microangiopathy comprise a clinical subgroup with an increased number of chronic lesions, lower estimated glomerular filtration rate, and poorer renal survival, even when corrected for hypertension. These data suggest that complement activation is involved in the development of microangiopathy in patients with IgA nephropathy and IgA vasculitis with nephritis, and that complement-mediated microangiopathy contributes to disease progression.

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Section: Discussionmentioning

confidence: 74%

Complement-mediated microangiopathy in IgA nephropathy and IgA vasculitis with nephritis

et al. 2019

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(Immun‑)Pathologie von Medikamentennebenwirkungen in der Niere

Pfister

Amann

2018

Pathologe

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Nephrotoxicity or renal side effects of drugs are frequent and may vary in their clinical presentation. Various types of acute and chronic kidney disease are known to develop as a consequence or side effect of a long list of drugs with nephrotoxicity most commonly being associated with injury in the tubulointerstitial compartment. In addition, drug-induced glomerular and vascular disease have also been reported, either as the result of direct cellular injury or immune-mediated injury to glomerular or endothelial cells. From a clinical point of view it is important to recognize such drug-induced nephropathies early in order to prevent or adequately treat them to favour kidney recovery and to avoid long-lasting negative consequences for kidney function.This article will focus on the typical morphology and pathogenesis of some frequent drug-induced renal diseases.

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IgA-Dominant Glomerulopathy and Thrombotic Microangiopathy After Chemotherapy

Cited by 2 publications

References 25 publications

Complement-mediated microangiopathy in IgA nephropathy and IgA vasculitis with nephritis

Complement-mediated microangiopathy in IgA nephropathy and IgA vasculitis with nephritis

(Immun‑)Pathologie von Medikamentennebenwirkungen in der Niere

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