Plasma Exchange as an Adjunctive Therapy for Crescentic IgA Nephropathy

Xie, Xinfang; Lv, Jicheng; Shi, Sufang; Zhu, Liangru; Liu, Lijun; Chen, Min; Wang, Yu; Cui, Zhao; Wang, Xin; Liu, Li; Yu, Xiao‐Juan; Zhou, Fu-de; Zhao, Minghui; Zhang, Hong

doi:10.1159/000448767

Cited by 21 publications

(16 citation statements)

References 27 publications

(47 reference statements)

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“…To 19 The absolute Gd-IgA1 value was multiplied by the paired IgA1 value, and the new value was the adjusted Gd-IgA1 (AD-Gd-IgA1) value for each sample.…”

Section: Measurement Of Plasma Iga1 and Gd-iga1mentioning

confidence: 99%

Secondary IgA Nephropathy Shares the Same Immune Features With Primary IgA Nephropathy

Wang

Xue

et al. 2020

Kidney International Reports

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Introduction: Galactose-deficient IgA1 (Gd-IgA1) and related IgA/IgG immune complexes have been identified as the key drivers in the pathogenesis of IgA nephropathy (IgAN). However, their roles in the development of secondary IgAN are still unknown. Methods: In this study, we measured the plasma Gd-IgA1 level, IgA/IgG complex, and Gd-IgA1 glomerular deposits in 100 patients with various kinds of secondary IgAN. Plasma Gd-IgA1 was measured using a lectin-based enzyme-linked immunosorbent assay, and Gd-IgA1 in glomerular deposits was examined by double immunofluorescent staining using its specific monoclonal antibody KM55. Results: Patients with secondary IgAN presented with higher plasma Gd-IgA1 levels compared to healthy controls (median, 354.61 U/ml; interquartile range [IQR], 323.93, 395.57 U/ml vs. median, 303.17 U/ml; IQR, 282.24, 337.92 U/ml, P < 0.001) or patients with other kidney diseases (median, 314.61 U/ml; IQR, 278.97, 343.55 U/ml, P < 0.001). A similar trend was observed in plasma IgA/IgG immune complexes or IgA1. There were no differences between secondary and primary IgAN in plasma Gd-IgA1 levels (median, 378.54

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“…To 19 The absolute Gd-IgA1 value was multiplied by the paired IgA1 value, and the new value was the adjusted Gd-IgA1 (AD-Gd-IgA1) value for each sample.…”

Section: Measurement Of Plasma Iga1 and Gd-iga1mentioning

confidence: 99%

Secondary IgA Nephropathy Shares the Same Immune Features With Primary IgA Nephropathy

Wang

Xue

et al. 2020

Kidney International Reports

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“…Furthermore, plasma exchange may also play a therapeutic role, and it has been shown to reduce proteinuria and serum creatinine levels, as well as dialysis dependency and kidney survival, when added to steroid and cyclophosphamide immunosuppression. 64 Use as a sole treatment for rapidly progressive forms of the disease is supported by evidence from case series; children with severe IgAN or Henoch-Schönlein purpura have demonstrated recovery with plasmapheresis alone, negating need for immunosuppressive therapy. 65,66 However, the use of plasma exchange remains less well defined in the adult population and certainly warrants further assessment in large RCTs.…”

Section: General Immunosuppressionmentioning

confidence: 99%

Primary IgA nephropathy: current challenges and future prospects

Prendecki¹,

McAdoo²,

Tam³

2018

IJNRD

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IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide, exhibiting a variable clinical and pathological course and significantly contributing to the global burden of chronic kidney disease and end-stage renal disease. Current standards of care focus on optimization of antihypertensive and antiproteinuric therapies (typically renin- angiotensin system blockade) to reduce disease progression. Much recent attention has focused on whether additional immunosuppression confers better outcomes than supportive management alone, and indeed, several trials have demonstrated renoprotective effects following the use of oral corticosteroids. However, results have been inconsistent, and perceived benefits must be balanced against risks and adverse effects associated with generalized immunosuppression, as highlighted by the high-profile STOP-IgAN and TESTING clinical trials. Recent translational research in vitro and animal models of IgAN have generated greater insight into potential therapeutic targets for this complex autoimmune disease. Deeper understanding of the roles of the mucosal immune barrier, complement activation and deposition, T-cell dependent and independent mechanisms of B cell activation, and of the deposition and downstream inflammatory signaling pathways of nephritogenic polymeric IgA1 complexes (e.g., signaling of immune receptors via spleen tyrosine kinase) has formed the rationale for the development of novel agents and clinical trials of more targeted therapies. However, translating findings into clinical practice is challenging, with many immunopathological features of IgAN specific to humans. Recent comprehensive reviews outline current understanding of mechanisms of IgAN as well as ongoing and future clinical trials; it is not our aim to replicate this here. Instead, we take a mechanistic approach to current treatment strategies, outlining advantages and limitations of each before exploring ongoing research with potential translation into future targeted therapies for this complex disease.

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“…• [22]. However, guidelines do not support plasma exchange in IgAN or HSP (ASFA category 3), even in the presence of crescents or severe extra-renal manifestations of HSP, due to the scarce data supporting plasmapheresis in these cases [16,18].…”

Section: Infection-associated Glomerular Diseasementioning

confidence: 99%

Plasma Exchange in Clinical Practice

Filipov¹,

Zlatkov²,

Dimitrov³

2018

Plasma Medicine - Concepts and Clinical Applications

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Plasma exchange (PEX) is a treatment method with increasing range of indications. However, due to the small number of randomized trials, its effectiveness is still under debate in certain conditions. The aim of our chapter is to present the major principles of PEX, discuss safety issues and reveal current data for treatment effectiveness of the method. Novel indications for PEX will also be discussed.

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Plasma Exchange as an Adjunctive Therapy for Crescentic IgA Nephropathy

Cited by 21 publications

References 27 publications

Secondary IgA Nephropathy Shares the Same Immune Features With Primary IgA Nephropathy

Secondary IgA Nephropathy Shares the Same Immune Features With Primary IgA Nephropathy

Primary IgA nephropathy: current challenges and future prospects

Plasma Exchange in Clinical Practice

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