IgA nephropathy: a perspective for 2021

Administration of sodium-glucose cotransporter-2 inhibitors in IgA nephropathy; a new strategy in the management?

“…IgA-nephropathy (IgAN) has been identified as the furthermost common type of glomerulopathy (1), and is responsible for a noteworthy percentage of the endstage renal disease burden worldwide (2). It constitutes a well-identified form of progressive chronic renal failure (3); however, the clinical course of the IgAN varies from isolated hematuria, microscopic or macroscopic, none-nephrotic rage proteinuria, nephrotic syndrome to rapidly progressive kidney disturbances (4).…”

“…It constitutes a well-identified form of progressive chronic renal failure (3); however, the clinical course of the IgAN varies from isolated hematuria, microscopic or macroscopic, none-nephrotic rage proteinuria, nephrotic syndrome to rapidly progressive kidney disturbances (4). It appears that various environmental factors can stimulate aberrant immunoglobulin-A (IgA) production in areas such as the mucosal-related lymphoid tissue of the alimentary tract, resulting in immune complex deposition in the glomerular structures of the Kidneys (1)(2)(3). Renal biopsy, which is necessary for the definitive diagnosis of IgAN, can result in a range of observations including mild proliferation to significant extra-capillary proliferation of mesangial cells (4).…”

“…Mesangial deposition of immune complexes, results in the activation and proliferation of these cells, and the subsequent secretion of pro-inflammatory cytokines, leading to tissue injury and disease development (6). It is suggested that the progression of immunoglobulin-A nephropathy is conducted through a four-hit processes, which is initiated with aberrant glycosylation of IgA1 and increase circulation of these galactose deficient IgA1 (Gd-IgA1), the subsequent generation of autoantibodies targeted against circulating Gd-IgA1, and the formation of immune complexes, some of which become deposited within the glomerulus structure and initiating tissue damage (1,2). In general, IgAN is most dominant in Asians, also observed in Caucasians, however, it is not as common in Africans (7).…”

Optimized synthesis, polymer conjugation, and proof‐of‐concept studies of the gd‐IgA1 epitope for antibody‐scavenging therapies in IgA nephropathy

“…IgA nephropathy (IgAN) is a highly prevalent and severe glomerular autoimmune disease that leads to a gradual reduction of kidney function up to end‐stage renal disease. Although the progression is often slow and shows large variability between patients, 40% of the patients will eventually require hemodialysis or a kidney transplant (Floege et al, 2021; Floege & Barratt, 2021; Suzuki & Novak, 2021). The pathology is complex and heterogenous, but all patients show IgA1‐IgG or IgA1‐IgM immune complex (IC) deposition in the glomeruli of the kidney (Floege & Barratt, 2021; Wyatt & Julian, 2013).…”

“…Although the progression is often slow and shows large variability between patients, 40% of the patients will eventually require hemodialysis or a kidney transplant (Floege et al, 2021; Floege & Barratt, 2021; Suzuki & Novak, 2021). The pathology is complex and heterogenous, but all patients show IgA1‐IgG or IgA1‐IgM immune complex (IC) deposition in the glomeruli of the kidney (Floege & Barratt, 2021; Wyatt & Julian, 2013). IgA1, the more common of the two IgA subclasses, has a unique hinge region with a high number of serine, threonine and proline residues.…”