1
|
Weng M, Fu B, Zhuo Y, Lin J, Zou Z, Chen Y, Cui J, Li G, Chen C, Xu Y, Jiang D, Wan J. Association of time-averaged serum uric acid level with clinicopathological information and long-term outcomes in patients with IgA nephropathy. PeerJ 2024; 12:e17266. [PMID: 38650643 PMCID: PMC11034505 DOI: 10.7717/peerj.17266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Objective Whether serum uric acid (SUA) at baseline could been identiûed as a risk factor for progression in IgA nephropathy (IgAN) patients remains unclear, therefore, long- term SUA control levels must be monitored. We aimed to investigate the relevant factors affecting time-averaged SUA (TA-SUA) and to assess the prognostic value of TA-SUA in IgAN. Methods This retrospective study included 152 patients with IgAN. The relationships between TA-SUA and clinicopathological features and renal outcomes (defined as the doubling of the baseline serum creatinine level or end-stage renal disease) were analyzed in groups divided by quartiles of TA-SUA levels, the presence of hyperuricemia, and sex. Results Patients with high TA-SUA levels had higher levels of baseline SUA, blood urea nitrogen (BUN), triglycerides, serum C3 and serum C4 and were more likely to be male and have hypertension, proteinuria, poor renal function, and pathological injuries including high grades of tubular atrophy/interstitial fibrosis (T1-T2). These patients had a poorer prognosis compared with patients with low TA-SUA levels. The TA-SUA level was positively correlated with baseline age and BUN, triglycerides, serum C3, and serum C4 levels, and negatively correlated with baseline eGFR. Survival curve analysis indicated that persistent hyperuricemia was associated with significantly poorer renal outcomes than normo-uricemia in both men and women. The TA-SUA level also was an independent predictor of renal outcome in patients with IgAN, with optimal cutoû values of 451.38 µmol/L (area under the curve (AUC) = 0.934) for men and 492.83 µmol/L (AUC = 0.768) for women. Conclusions The TA-SUA level is associated with triglyceride level, complement component levels, renal function, and pathological severity of IgAN, and it may be a prognostic indicator in male and female patients with IgAN.
Collapse
Affiliation(s)
- Mengjie Weng
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Binbin Fu
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yongjie Zhuo
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jiaqun Lin
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhenhuan Zou
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yi Chen
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jiong Cui
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Guifen Li
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Caiming Chen
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yanfang Xu
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Dewen Jiang
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jianxin Wan
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
2
|
Chen Y, Yang A, Hou Y, Liu L, Lin J, Huang X, Li J, Liu X, Lu F, Lin Q, Yang H, Yue S, Jiang S, Wang L, Zou C. Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role? Ren Fail 2022; 44:1443-1453. [PMID: 36017686 PMCID: PMC9423834 DOI: 10.1080/0886022x.2022.2113796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Nephrotic syndrome (NS) and nephrotic-range proteinuria (NRP) are uncommon in IgA nephropathy (IgAN), and their clinicopathology and prognosis have not been discussed. Podocytes may play an important role in both clinical phenotypes. Methods We investigated 119 biopsy-proven IgAN patients with proteinuria over 2 g/d. The patients were divided into three groups according to proteinuria level: the overt proteinuria (OP) group, NS group, and NRP group. In addition, according to the severity of foot process effacement (FPE), the patients were divided into three groups: the segmental FPE (SFPE) group, moderate FPE (MFPE) group, and diffuse FPE (DFPE) group. The outcome was survival from a combined event defined by a doubling of the baseline serum creatinine and a 50% reduction in eGFR or ESRD. Results Compared with the NRP group, patients in the NS group had more severe microscopic hematuria, presented with more severe endocapillary hypercellularity and had a higher percentage of DFPE. The Kaplan–Meier curve showed that MFPE patients had a better outcome in the NRP group <50% of tubular atrophy/interstitial fibrosis. In the multivariate model, the NRP group (HR = 17.098, 95% CI = 3.835–76.224) was associated with an increased risk of the combined event, while MFPE (HR = 0.260, 95% CI = 0.078–0.864; p = 0.028) was associated with a reduced risk of the combined event. After the addition of renin-angiotensin system inhibitors (RASi), the incidence of the combined event in the MFPE group (HR = 0.179, 95% CI = 0.047–0.689; p = 0.012) was further reduced. Conclusions NS presented more active lesions and more severe FPE in IgAN. NRP was an independent risk factor for progression to the renal endpoint, while MFPE indicated a better prognosis in NRP without obvious chronic renal lesions, which may benefit from RASi.
Collapse
Affiliation(s)
- Yizhen Chen
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Aicheng Yang
- Department of Nephrology, The Affiliated Jiangmen TCM Hospital of Jinan University, Jiangmen, China
| | - Yuansheng Hou
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Longhui Liu
- Department of Nephrology, The Affiliated Jiangmen TCM Hospital of Jinan University, Jiangmen, China
| | - Jiehua Lin
- Department of Nephrology, The Affiliated Jiangmen TCM Hospital of Jinan University, Jiangmen, China
| | - Xiaodan Huang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jundu Li
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xusheng Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fuhua Lu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qizhan Lin
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haifeng Yang
- Department of Pathology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuling Yue
- Guangzhou Kingmed Diagnostic Laboratory Ltd, Guangzhou, China
| | - Shujun Jiang
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixin Wang
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuan Zou
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
3
|
Sági B, Késői I, Vas T, Csiky B, Nagy J, Kovács TJ. Left ventricular myocardial mass index associated with cardiovascular and renal prognosis in IgA nephropathy. BMC Nephrol 2022; 23:285. [PMID: 35974314 PMCID: PMC9382800 DOI: 10.1186/s12882-022-02909-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction In chronic kidney disease (CKD), like in IgA nephropathy (IgAN), cardiovascular (CV) mortality and morbidity are many times higher than in the general population, and left ventricular hypertrophy (LVH) is an independent risk factor for CV disease. This follow-up study investigated the association between left ventricular mass index (LVMI) and renal or cardiovascular outcomes. Methods We examined 118 IgAN patients prospectively. LVMI and LV geometry was investigated using echocardiography. The primary combined endpoints were total mortality, major CV events, and end-stage renal disease. Secondary endpoints, i.e.—cardiovascular or renal endpoints,—were also examined separately. Results Sixty seven percent were males, mean age 53.5 ± 13.5. Mean follow-up time: 184 months. LVMI inversely correlated with eGFR (corr. coefficient: -0.365; p < 0.01). We divided the patients into two groups based on the LVMI cut-off suggested by the literature. The presence of LVH caused a worse prognosis in primary (p < 0.001), renal endpoints (p = 0.01), and also in CV endpoints (p = 0.001). The higher LVMI in men significantly worsened the prognosis in all endpoints. Concentric hypertrophy meant a worse prognosis. Independent predictors of LVMI were gender and eGFR in uni- and multivariate regression and hemoglobin levels only in logistic regression. Independent predictors of the primary endpoint were LVMI, eGFR, gender, obesity, HT, DM, and metabolic syndrome in Cox regression analysis. Conclusion Increased LVMI may predict the progression to end-stage renal disease and CV events in IgAN. Determining LVMI may be a useful parameter not only in CV risk but also in the stratification of renal risk in CKD.
Collapse
Affiliation(s)
- Balázs Sági
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pecs, Hungary
| | - István Késői
- Department of Internal Medicine Cardiology, Mohács Hospital, Mohács, Hungary
| | - Tibor Vas
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary
| | - Botond Csiky
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pecs, Hungary
| | - Judit Nagy
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary
| | - Tibor József Kovács
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.
| |
Collapse
|
4
|
Moriyama T. Clinical and histological features and therapeutic strategies for IgA nephropathy. Clin Exp Nephrol 2019; 23:1089-1099. [PMID: 30968243 DOI: 10.1007/s10157-019-01735-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/24/2019] [Indexed: 01/21/2023]
Abstract
Chronic glomerulonephritis is the second most common reason, after diabetic nephropathy, for initiation of dialysis in Japan and IgA nephropathy (IgAN) is the most prevalent form of chronic glomerulonephritis. In the half century since IgAN was initially reported, our understanding of the long-term prognosis, clinical and histological features, pathogenesis of onset and progression, risk factors for progression, and appropriate treatment under different clinical and histological conditions, has steadily increased. Strong experimental and clinical evidence, the Clinical Practice Guidelines for IgA Nephropathy in Japan, the Oxford Classification, and the Kidney Disease Improving Global Outcomes guidelines have all contributed to the appropriate treatment of IgAN. Several intensive therapies, such as tonsillectomy, steroid therapy, and their combinations, can result in clinical remission, and prevent the progression to end stage renal disease (ESRD). However, some IgAN patients still progress to ESRD even when treated with intensive therapies. In this review, we discuss the clinical and histological features of IgAN, focusing primarily on our previous reports, and our opinions on therapeutic strategies for IgAN.
Collapse
Affiliation(s)
- Takahito Moriyama
- Department of Nephrology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| |
Collapse
|
5
|
The beneficial effects of renin–angiotensin system inhibitors (RASI) on IgA nephropathy with tubulointerstitial lesions categorized by Oxford classification. Clin Exp Nephrol 2019; 23:834-840. [DOI: 10.1007/s10157-019-01713-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/04/2019] [Indexed: 12/26/2022]
|
6
|
Lechner SM, Abbad L, Boedec E, Papista C, Le Stang MB, Moal C, Maillard J, Jamin A, Bex-Coudrat J, Wang Y, Li A, Martini PGV, Monteiro RC, Berthelot L. IgA1 Protease Treatment Reverses Mesangial Deposits and Hematuria in a Model of IgA Nephropathy. J Am Soc Nephrol 2016; 27:2622-9. [PMID: 26850635 DOI: 10.1681/asn.2015080856] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/04/2016] [Indexed: 01/01/2023] Open
Abstract
IgA nephropathy (IgAN), characterized by mesangial IgA1 deposits, is a leading cause of renal failure worldwide. IgAN pathogenesis involves circulating hypogalactosylated IgA1 complexed with soluble IgA Fc receptor I (sCD89) and/or anti-hypogalactosylated-IgA1 autoantibodies, but no specific treatment is available for IgAN. The absence of IgA1 and CD89 homologs in the mouse has precluded in vivo proof-of-concept studies of specific therapies targeting IgA1. However, the α1KI‑CD89Tg mouse model of IgAN, which expresses human IgA1 and human CD89, allows in vivo testing of recombinant IgA1 protease (IgA1‑P), a bacterial protein that selectively cleaves human IgA1. Mice injected with IgA1‑P (1-10 mg/kg) had Fc fragments of IgA1 in both serum and urine, associated with a decrease in IgA1-sCD89 complexes. Levels of mesangial IgA1 deposits and the binding partners of these deposits (sCD89, transferrin receptor, and transglutaminase 2) decreased markedly 1 week after treatment, as did the levels of C3 deposition, CD11b(+) infiltrating cells, and fibronectin. Antiprotease antibodies did not significantly alter IgA1‑P activity. Moreover, hematuria consistently decreased after treatment. In conclusion, IgA1‑P strongly diminishes human IgA1 mesangial deposits and reduces inflammation, fibrosis, and hematuria in a mouse IgAN model, and therefore may be a plausible treatment for patients with IgAN.
Collapse
Affiliation(s)
- Sebastian M Lechner
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Lilia Abbad
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Erwan Boedec
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Christina Papista
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Marie-Bénédicte Le Stang
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Christelle Moal
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Julien Maillard
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Agnès Jamin
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Julie Bex-Coudrat
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France
| | - Yong Wang
- Shire, Bioprocess Development and Discovery Biology and Translational Research, Lexington, Massachusetts; and
| | - Aiqun Li
- Shire, Bioprocess Development and Discovery Biology and Translational Research, Lexington, Massachusetts; and
| | - Paolo G V Martini
- Shire, Bioprocess Development and Discovery Biology and Translational Research, Lexington, Massachusetts; and
| | - Renato C Monteiro
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France; Immunology Department, Bichat Hospital, Paris Public Assistance Hospitals, Department of Hospital and University (DHU) Fire, Paris, France
| | - Laureline Berthelot
- National French Institute of Health and Medical Research (INSERM) Unit 1149, Center of Research on Inflammation, Paris, France; Laboratory of Inflamex Excellency, Faculty of Medicine, Xavier Bichat Site, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France; National French Center of Scientific Research (CNRS) ERL8252, Paris, France;
| |
Collapse
|
7
|
Seki T, Asanuma K, Asao R, Nonaka K, Sasaki Y, Oliva Trejo JA, Kurosawa H, Hirayama Y, Horikoshi S, Tomino Y, Saito A. Significance of urinary full-length megalin in patients with IgA nephropathy. PLoS One 2014; 9:e114400. [PMID: 25502002 PMCID: PMC4264761 DOI: 10.1371/journal.pone.0114400] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 11/10/2014] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Megalin is highly expressed at the apical membranes of proximal tubular epithelial cells. A urinary full-length megalin (C-megalin) assay is linked to the severity of diabetic nephropathy in type 2 diabetes. This study examined the relationship between levels of urinary C-megalin and histological findings in adult patients with IgA nephropathy (IgAN). Design, Setting, Participants, & Measurements Urine samples voided in the morning on the day of renal biopsy were obtained from 73 patients with IgAN (29 men and 44 women; mean age, 33 years) and 5 patients with membranous nephropathy (MN). Renal pathologic variables were analyzed using the Oxford classification of IgAN, the Shigematsu classification and the Clinical Guidelines of IgAN in Japan. The levels of urinary C-megalin were measured by sandwich ELISA. Results Histological analysis based on the Oxford classification revealed that the levels of urinary C-megalin were correlated with mesangial hypercellularity in IgAN patients (OR = 1.76, 95% CI: 1.04–3.27, P<0.05). There was a significant correlation between the levels of urinary C-megalin and the severity of chronic extracapillary abnormalities according to the Shigematsu classification in IgAN patients (β = 0.33, P = 0.008). The levels of urinary C-megalin were significantly higher in all risk levels of IgAN patients requiring dialysis using the Clinical Guidelines of IgAN in Japan than in the control group. The levels of urinary C-megalin were significantly higher in the high risk and very high risk grades than in the low risk grade (P<0.05). The levels of urinary C-megalin were significantly higher in MN patients compared to the control group. Conclusions The levels of urinary C-megalin are associated with histological abnormalities in adult IgAN patients. There is a possibility that urinary C-megalin is an independent predictor of disease progression of IgAN. In addition, our results suggest that urinary C-megalin is a marker of glomerular abnormalities in various glomerular diseases as well as IgAN.
Collapse
Affiliation(s)
- Takuto Seki
- Division of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan; TMK project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuhiko Asanuma
- Division of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan; TMK project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rin Asao
- Division of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kanae Nonaka
- Division of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan; TMK project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yu Sasaki
- Division of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - Hiroyuki Kurosawa
- Reagents Development Department, Denka Seiken Co. Ltd., Niigata, Japan
| | - Yoshiaki Hirayama
- Reagents Development Department, Denka Seiken Co. Ltd., Niigata, Japan
| | - Satoshi Horikoshi
- Division of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yasuhiko Tomino
- Division of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akihiko Saito
- Department of Applied Molecular Medicine, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| |
Collapse
|
8
|
Moriyama T, Tanaka K, Iwasaki C, Oshima Y, Ochi A, Kataoka H, Itabashi M, Takei T, Uchida K, Nitta K. Prognosis in IgA nephropathy: 30-year analysis of 1,012 patients at a single center in Japan. PLoS One 2014; 9:e91756. [PMID: 24658533 PMCID: PMC3962373 DOI: 10.1371/journal.pone.0091756] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/15/2014] [Indexed: 11/21/2022] Open
Abstract
Background Little is known about the long-term prognosis of patients with IgA nephropathy (IgAN). Methods This retrospective cohort analysis evaluated clinical and histological findings at the time of renal biopsy, initial treatment, patient outcomes over 30 years, and risk factors associated with progression in 1,012 patients diagnosed with IgAN at our center since 1974. Results Of the 1,012 patients, 40.5% were male. Mean patient age was 33±12 years and mean blood pressure was 122±17/75±13 mmHg. Mean serum creatinine concentration was 0.89±0.42 mg/dL, and mean estimated glomerular filtration rate (eGFR) was 78.5±26.2 ml/min/1.73 m2. Mean proteinuria was 1.19±1.61 g/day, and mean urinary red blood cells were 36.6±35.3/high-powered field. Histologically, mesangial hypercellularity was present in 47.6% of patients, endothelial hypercellularity in 44.3%, segmental sclerosis in 74.6%, and tubular atrophy/interstitial fibrosis in 28.8% by Oxford classification. Initial treatment consisted of corticosteroids in 26.9% of patients, renin-angiotensin-aldosterone system inhibitor in 28.9%, and tonsillectomy plus steroids in 11.7%. The 10-, 20-, and 30-year renal survival rates were 84.3, 66.6, and 50.3%, respectively. Tonsillectomy plus steroids dramatically improved renal outcome. Cox multivariate regression analysis showed that higher proteinuria, lower eGFR, and higher uric acid at the time of renal biopsy were independent risk factors for the development of end stage renal disease (ESRD). Conclusions IgAN is not a benign disease, with about 50% of patients progressing to ESRD within 30 years despite treatment.
Collapse
Affiliation(s)
- Takahito Moriyama
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
- * E-mail:
| | - Kayu Tanaka
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Chihiro Iwasaki
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Oshima
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Ayami Ochi
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Kataoka
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuyo Itabashi
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Takei
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiko Uchida
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kosaku Nitta
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
9
|
Ye Z, Zhang L, Xu L, Shi W, Hu H, Shi X, Zhong W, Hou S, Yan H, Zhang B, Xia Y, Wang W, Feng Z, Wang L, Liang Y. Probucol combined with valsartan in immunoglobulin A nephropathy: A multi-centre, open labelled, randomized controlled study. Nephrology (Carlton) 2013; 19:40-6. [PMID: 24191893 DOI: 10.1111/nep.12177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Zhiming Ye
- Southern Medical University; Guangzhou China
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Li Zhang
- Southern Medical University; Guangzhou China
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Lixia Xu
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Wei Shi
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Haitang Hu
- Department of Nephrology; The First People's Hospital of Shunde; Foshan China
| | - Xiaofeng Shi
- Department of Nephrology; Jiangmen Central Hospital; Jiangmen China
| | - Weiqiang Zhong
- Department of Nephrology; Huizhou People's Hospital; Huizhou China
| | - Shuan Hou
- Depatrtment of Nephrology; Shenzhen Hospital of Piking University; Shenzhen China
| | - Honghong Yan
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Bin Zhang
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Yunfeng Xia
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Wenjian Wang
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Zonglin Feng
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Liping Wang
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| | - Yongzheng Liang
- Department of Nephrology; Guangdong General Hospital, Guangdong Academy of Medical Sciences; Guangzhou China
| |
Collapse
|
10
|
Matsuzaki K, Suzuki Y, Nakata J, Sakamoto N, Horikoshi S, Kawamura T, Matsuo S, Tomino Y. Nationwide survey on current treatments for IgA nephropathy in Japan. Clin Exp Nephrol 2013; 17:827-33. [PMID: 23519367 PMCID: PMC3889220 DOI: 10.1007/s10157-013-0779-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/21/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND A wide variety of treatments, including tonsillectomy and steroid pulse therapy (TSP), are performed for the various stages of IgA nephropathy (IgAN) in Japan. However, the current status of treatments for IgAN patients in Japan is still unclear. The objective of the present study was to investigate the current status of treatments for IgAN patients. METHODS A nationwide survey was conducted in 2008 by sending questionnaires to the 1,194 teaching hospitals of the Japanese Society of Nephrology (JSN) via Progressive Renal Diseases Research, Research on intractable disease, from the Ministry of Health, Labour and Welfare of Japan. RESULTS Among the total 376 hospitals (31.4 %) that responded, 188 hospitals (66.2 % in the internal medicine departments) performed TSP, out of which 137 hospitals (61.4 %) had begun to perform TSP in the period from 2004 to 2008. The following two major steroid pulse protocols in TSP were used: (1) three cycles over 3 consecutive weeks and (2) three cycles every 2 months. Approximately 68 % of pediatric hospitals (68 hospitals) performed combination therapy with prednisolone, azathioprine, heparin-warfarin and dipyridamole. The clinical remission rates for hematuria and proteinuria after TSP tended to be higher than those following other corticosteroid therapies. Almost all hospitals prescribed antiplatelet agents and renin angiotensin system inhibitor (RAS-I). CONCLUSION In addition to popular treatments such as antiplatelet agents and RAS-I, TSP is becoming a standard treatment for adult IgAN patients in Japan.
Collapse
Affiliation(s)
- Keiichi Matsuzaki
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| | - Junichiro Nakata
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| | - Naoko Sakamoto
- National Research Institute for Child Health & Development, Tokyo, Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| | - Satoshi Horikoshi
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| | - Tetsuya Kawamura
- Jikei University School of Medicine, Tokyo, Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| | - Seiichi Matsuo
- Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
- Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Japan, http://jin-shogai.jp/mt/public/hp/
| |
Collapse
|
11
|
Wang H, Fu W, Jin Z, Wang Y, Yao W, Yin P, Peng W. Advanced IgA nephropathy with impaired renal function benefits from losartan treatment in rats. Ren Fail 2013; 35:812-8. [PMID: 23751143 DOI: 10.3109/0886022x.2013.794686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment with angiotensin receptor blockers (ARBs) is successful in mitigating IgA nephropathy (IgAN), independent of blood pressure changes, but the therapeutic role of ARB in advanced IgAN with impaired renal function is to be ascertained. The present study was performed to investigate the effect of losartan on advanced IgAN induced by staphylococcal enterotoxin B (SEB) combined with 5/6 nephrectomy in rats. METHODS Fifty-four male SD rats were randomly divided into three group: Rats in the model group were treated with SEB plus 5/6 nephrectomy, and those in the losartan group were gavaged with losartan (33.3 mg kg(-1 )d(-1)) besides the treatment with SEB plus 5/6 nephrectomy. The urine and blood biochemical changes of rats were tested. IgA, IgG, IgM and C3 depositions were studied dynamically with immunofluorescence. The renal tissue structures were observed under light microscopy. The expressions of TGF-β1, FN, alpha-SMA and FGF-1 in rat renal tissues were determined with immunohistochemical methods and real-time PCR. RESULTS At 12 weeks, rats with SEB treatment plus 5/6 nephrectomy showed gradually increased urinary red blood cell (URBC) with a gradual elevation of the 24 h urinary protein, serum BUN and Scr, but losartan treatment lowered the levels of 24 h urinary protein, serum BUN and Scr. A large number of IgA depositions in the mesangial area, glomerulosclerosis and tubulointerstitial fibrosis were found in the model group, and the losartan group showed relieved injury. The expressions of TGF-β1, FN, alpha-SMA and FGF-1 were significantly elevated in the model. Losartan lessened their expressions. CONCLUSION Losartan treatment can delay the progression of advanced IgA nephropathy with impaired renal function.
Collapse
Affiliation(s)
- Hao Wang
- Department of Nephrology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | | | | | | | | | | | | |
Collapse
|
12
|
Moriyama T, Nakayama K, Ochi A, Amemiya N, Tsuruta Y, Kojima C, Itabashi M, Takei T, Uchida K, Nitta K. Comparison of inhibitors of renin-angiotensin-aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function. Clin Exp Nephrol 2011; 16:231-7. [PMID: 22038185 DOI: 10.1007/s10157-011-0545-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND The adaptation of steroid therapy and the effect of renin-angiotensin-aldosterone system inhibitors (RASIs) for advanced immunoglobulin A nephropathy (IgAN) patients with impaired renal function are still controversial. METHODS We divided 63 IgAN patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m(2) and proteinuria ≥ 0.5 g/day into two groups: the RASI group (RASI, n = 33), treated with RASIs alone; and the combination group (COMBI, n = 30), treated with corticosteroids and RASIs. We analyzed the clinical and histological background, renal survival rate, and the risk factors for progression. RESULTS Renal function (mean eGFR: COMBI 46.4 vs. RASI 47.0 ml/min/1.73 m(2)), the amount of proteinuria (median: COMBI 1.39 vs. RASI 1.17 g/g creatinine) and histological backgrounds were not significantly different between the groups, but urinary red blood cells (U-RBCs) were significantly higher in the COMBI group than in the RASI group (median: COMBI 30.0 vs. RASI 10.0 counts/high-power field, P = 0.0171). The serial change in proteinuria did not differ until 5 years after treatment, but U-RBCs were significantly decreased in both groups (P < 0.0001), and eGFR was significantly decreased in the RASI group (P < 0.001) but not in the COMBI group. The results for each year after treatment did not differ significantly between both groups. The renal survival rate was not significantly different between the groups. There was no independent risk factor for progression by Cox regression analysis. CONCLUSION Combination therapy with steroids and RASIs was not superior to monotherapy with RASIs for advanced IgAN with impaired renal function.
Collapse
Affiliation(s)
- Takahito Moriyama
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|