Immunosuppressive agents for treating IgA nephropathy

Natale, Patrizia; Palmer, Suetonia C.; Ruospo, Marinella; Saglimbene, Valeria; Craig, Jonathan C.; Vecchio, Mariacristina; Samuels, Joshua; Molony, Donald A.; Schena, Francesco Paolo; Strippoli, Giovanni F.M.

doi:10.1002/14651858.cd003965.pub3

Cited by 59 publications

(47 citation statements)

References 110 publications

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“…Concerning corticosteroids in adult IgAN, three main clinical studies [ 48 , 49 , 50 ] and one meta-analysis [ 51 ] are available. They showed that corticosteroids, after optimization supportive treatment (mainly RAAS blockers) and in addition to it, can decrease proteinuria and slow loss of kidney function, particularly in patients with persistent proteinuria more than 1 g/g and preserved renal function (eGFR > 50 mL/min/1.73 m 2 ).…”

Section: Treatmentmentioning

confidence: 99%

IgA Vasculitis and IgA Nephropathy: Same Disease?

Pillebout

2021

JCM

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Many authors suggested that IgA Vasculitis (IgAV) and IgA Nephropathy (IgAN) would be two clinical manifestations of the same disease; in particular, that IgAV would be the systemic form of the IgAN. A limited number of studies have included sufficient children or adults with IgAN or IgAV (with or without nephropathy) and followed long enough to conclude on differences or similarities in terms of clinical, biological or histological presentation, physiopathology, genetics or prognosis. All therapeutic trials available on IgAN excluded patients with vasculitis. IgAV and IgAN could represent different extremities of a continuous spectrum of the same disease. Due to skin rash, patients with IgAV are diagnosed precociously. Conversely, because of the absence of any clinical signs, a renal biopsy is practiced for patients with an IgAN to confirm nephropathy at any time of the evolution of the disease, which could explain the frequent chronic lesions at diagnosis. Nevertheless, the question that remains unsolved is why do patients with IgAN not have skin lesions and some patients with IgAV not have nephropathy? Larger clinical studies are needed, including both diseases, with a common histological classification, and stratified on age and genetic background to assess renal prognosis and therapeutic strategies.

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Section: Treatmentmentioning

confidence: 99%

IgA Vasculitis and IgA Nephropathy: Same Disease?

Pillebout

2021

JCM

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“…This condition has now become a global public health problem. IgA nephropathy (IgAN) and lupus nephritis (LN) is the most common primary and secondary glomerular diseases, respectively, and tend to affect young adults, with nearly 20% of patients progressing to ESRD after 10 years because of limited drug treatment options ( Mahajan et al, 2020 ; Natale et al, 2020 ). Although both diseases have complex and varied clinical manifestations, many overlaps have been noted.…”

Section: Introductionmentioning

confidence: 99%

Weighted Gene Co-expression Network Analysis Reveals Different Immunity but Shared Renal Pathology Between IgA Nephropathy and Lupus Nephritis

et al. 2021

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Both IgA nephropathy (IgAN) and lupus nephritis (LN) are immunity-related diseases with a complex, polygenic, and pleiotropic genetic architecture. However, the mechanism by which the genetic variants impart immunity or renal dysfunction remains to be clarified. In this study, using gene expression datasets as a quantitative readout of peripheral blood mononuclear cell (PBMC)- and kidney-based molecular phenotypes, we analyzed the similarities and differences in the patterns of gene expression perturbations associated with the systematic and kidney immunity in IgAN and LN. Original gene expression datasets for PBMC, glomerulus, and tubule from IgAN and systemic lupus erythematosus (SLE) patients as well as corresponding controls were obtained from the Gene Expression Omnibus (GEO) database. The similarities and differences in the expression patterns were detected according to gene differential expression. Weighted gene co-expression network analysis (WGCNA) was used to cluster and screen the co-expressed gene modules. The disease correlations were then identified by cell-specific and functional enrichment analyses. By combining these results with the genotype data, we identified the differentially expressed genes causatively associated with the disease. There was a significant positive correlation with the kidney expression profile, but no significant correlation with PBMC. Three co-expression gene modules were screened by WGCNA and enrichment analysis. Among them, blue module was enriched for glomerulus and podocyte (P < 0.05) and positively correlated with both diseases (P < 0.05), mainly via immune regulatory pathways. Pink module and purple module were enriched for tubular epithelium and correlated with both diseases (P < 0.05) through predominant cell death and extracellular vesicle pathways, respectively. In genome-wide association study (GWAS) enrichment analysis, blue module was identified as the high-risk gene module that distinguishes LN from SLE and contains PSMB8 and PSMB9, the susceptibility genes for IgAN. In conclusion, IgAN and LN showed different systematic immunity but similarly abnormal immunity in kidney. Immunological pathways may be involved in the glomerulopathy and cell death together with the extracellular vesicle pathway, which may be involved in the tubular injury in both diseases. Blue module may cover the causal susceptibility gene for IgAN and LN.

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“…Glomerular diseases are still common causes of end-stage renal disease (ESRD), a global health epidemic affecting more than 2 million people worldwide [1][2][3][4]. Many glomerular diseases are immunologically mediated disorders [1,[5][6][7][8], and immunosuppressive medications put glomerular disease patients at a high risk of various infections, such as pneumonia, Mycobacterium tuberculosis and hepatitis B virus reactivation, which contribute to the progression of disease per se and mortality [9][10][11][12][13][14]. In recent years, accumulating data have shown an increased rate of opportunistic infections in glomerular disease patients with longterm use of glucocorticoids and (or) immunosuppressive agents, especially in nephrotic syndrome, IgA nephropathy, lupus nephritis and vasculitis patients [14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.

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Immunosuppressive agents for treating IgA nephropathy

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 59 publications

References 110 publications

IgA Vasculitis and IgA Nephropathy: Same Disease?

IgA Vasculitis and IgA Nephropathy: Same Disease?

Weighted Gene Co-expression Network Analysis Reveals Different Immunity but Shared Renal Pathology Between IgA Nephropathy and Lupus Nephritis

Nocardiosis in glomerular disease patients with immunosuppressive therapy

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