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Li Q, Shi S, Liu L, Lv J, Zhu L, Zhang H. Neutrophil-to-lymphocyte ratio as an independent inflammatory indicator for poor renal prognosis in adult IgA vasculitis with nephritis. Int Immunopharmacol 2022; 111:109178. [PMID: 36027850 DOI: 10.1016/j.intimp.2022.109178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Skin-limited IgAV patients usually present self-limiting disease and good prognosis, while adult IgA vasculitis with nephritis (IgAV-N) present severe phenotype and poor prognosis. Previous studies showed that neutrophil-to-lymphocyte ratio (NLR) was an inflammatory indicator for predicting systemic involvement in children IgAV patients. In this study, we focused on adult IgAV-N patients to explore the relationship of NLR with disease phenotype and long-term renal prognosis. METHODS In this study, 245 IgAV-N patients, 1151 IgAN patients and 251 healthy controls were recruited. Composite endpoint was defined as 30% eGFR declined or end stage kidney disease. RESULTS IgAV-N patients presented increased white blood cells (WBC), neutrophils (NE), platelet-to-lymphocyte ratio (PLR), and NLR levels, while decreased lymphocyte (LY) than healthy controls. When compared to clinical and pathological features matched IgAN patients, IgAV-N patients still showed higher WBC, NE, and NLR levels. NLR showed the best performance for the diagnosis of IgAV-N with the highest area under the ROC curves (0.738). IgAV-N patients in high NLR group (>2.41) presented with sever baseline manifestations and more acute pathological lesions than low NLR group (≤2.41). 77 patients with regular follow-up were used for survival analysis. After adjusting some well-known risk factors, NLR levels remained as an independent risk factor for poor renal outcome in adult patients with IgAV-N (HR, 1.913; 95% CI, 1.314 to 2.787, P = 0.001). CONCLUSIONS NLR levels were associated with the clinical and pathological phenotypes, and NLR may serve as an independent risk factor for poor renal outcome in adult IgAV-N patients.
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Affiliation(s)
- Qianqian Li
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education
| | - Sufang Shi
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education
| | - Lijun Liu
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education
| | - Jicheng Lv
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education
| | - Li Zhu
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education.
| | - Hong Zhang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education
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New insights on IgA vasculitis with underlying solid tumor: a nationwide French study of 30 patients. Clin Rheumatol 2020; 40:1933-1940. [PMID: 33099711 DOI: 10.1007/s10067-020-05455-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE IgA vasculitis (IgAV) frequently occurs during or after a mucosal infection; it also rarely occurs in patients with cancer. We hypothesized that cancer could impact the baseline characteristics and/or outcome of vasculitis. We aimed to describe the presentation of IgAV in patients with cancer (IgAV ca+) compared to patients without cancer. METHODS We conducted a nationwide retrospective study of adult patients in France who presented with both IgAV and cancer. Baseline characteristics were described and compared with those of the 260 patients included in a nationwide French IgAV study. RESULTS Thirty patients were included. The mean age was 69 ± 12 years; 80% were men. Compared to patients without underlying cancer, IgAV ca+ patients were older (69 ± 12 vs. 50 ± 18 years; p < 0.0001) and they presented more frequently with necrotic purpura (53 vs. 26%; p < 0.002) and intra-alveolar hemorrhage (10 vs. 0.5%; p < 0.0001). IgAV ca+ patients frequently had elevated serum IgA levels (79 vs. 53%; p < 0.034); most (n = 22, 73%) had adenocarcinoma or urothelial carcinoma involving the large intestines (n = 6), bladder (n = 5), and lung (n = 5). Most IgAV ca+ patients had progressive cancer (n = 21); a minority had metastatic disease (n = 2) at IgAV diagnosis. After a median follow-up of 3 months, 8 deaths were observed but none was related to IgAV. CONCLUSION Compared to their noncancer counterpart, patients with IgAV related to cancer were older and more frequently presented with necrotizing purpura, intra-alveolar hemorrhage, and elevated serum IgA levels. Adult patients with IgAV and these latter characteristics should be carefully screened for cancer. Key Points • Clinical and biological characteristics of patients presenting with IgAV are distinct depending on the underlying cause of vasculitis related to cancer. • Patients with IgAV related to cancer are older, and compared to their counterparts without IgAV, they present more frequently with necrotic purpura, alveolar hemorrhage, and elevated serum IgA levels. • All adult patients with IgAV should be screened for cancer, and there should be a focus on elderly male patients presenting with necrotic purpura and/or alveolar hemorrhage.
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Harzallah A, Kaaroud H, Laadhari N, Goucha R, Abderrahim E, Turki S, Hmida FB, Barbouch S, Abdallah TB. [Renal prognosis of IgA vasculitis nephritis in adult patients: a monocentric study of 25 cases]. Pan Afr Med J 2019; 31:9. [PMID: 30923593 PMCID: PMC6431421 DOI: 10.11604/pamj.2018.31.9.10594] [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] [Received: 08/25/2016] [Accepted: 02/27/2018] [Indexed: 11/18/2022] Open
Abstract
La néphropathie de la vascularite à IgA conditionne le pronostic de cette affection chez l’adulte. Le but de notre étude était d’étudier les caractéristiques cliniques de cette atteinte rénale chez l’adulte et d’identifier les facteurs de pronostic rénal. Il s’agit d’une étude monocentrique rétrospective portant sur les patients ayant une vascularite à IgA (purpura rhumatoïde) (critères de l’EULAR) avec une atteinte rénale prouvée histologiquement et classée selon la classification de Pillebout. Nous avons analysé la survie rénale et identifier les facteurs de pronostic rénal. Vingt cinq patients ont été inclus (genre ratio M/F = 2,57) d’âge moyen au diagnostic du purpura rhumatoïde de 35,76 ans. Un purpura était présent dans 100% des cas avec une atteinte articulaire dans 28%. Une insuffisance rénale était présente dans 44% des cas. La classification histologique la plus fréquente était la classe II. Une rémission clinique a été observée dans 44% des cas et une évolution vers le stade terminal de l’insuffisance rénale chronique dans 36% des cas. La survie rénale à 195 mois était de 57%. Les facteurs pronostiques identifiés étaient l’atteinte digestive (p = 0,022), l’insuffisance rénale initiale (p = 0,0004), la classification glomérulaire (p = 0001) et la sévérité des lésions histologiques, le traitement par bloqueurs du système rénine angiotensine (p = 0,01) et les échanges plasmatiques (p = 0,03). Notre étude montre que l’atteinte rénale au cours des vascularites à IgA peut être relativement sévère avec un mauvais pronostic rénal. L’identification des facteurs pronostiques cliniques et histologiques pourrait guider l’élaboration d’études thérapeutiques prospectives.
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Affiliation(s)
- Amel Harzallah
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Hayet Kaaroud
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Narjess Laadhari
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie
| | - Rim Goucha
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Ezzeddine Abderrahim
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Sami Turki
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Fethi Ben Hmida
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Samia Barbouch
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie.,Laboratoire de Recherche de Pathologie Rénale, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de Médecine Interne A, Hopital Charles Nicolle, Tunis, Tunisie.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
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Rituximab therapy for IgA-vasculitis with nephritis: a case series and review of the literature. Immunol Res 2018; 65:186-192. [PMID: 27449502 DOI: 10.1007/s12026-016-8827-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Henoch-Schonlein purpura, also called IgA-vasculitis, is a systemic small vessels vasculitis with immunoglobulin A1-dominant immune deposits. The optimal treatment remains controversial. Because IgA-vasculitis is characterized by leukocyte infiltration of the blood vessel walls along with immunoglobulin A deposition, and because glucocorticosteroids inhibit inflammatory processes, early administration of glucocorticosteroids has been postulated to be effective, but this indication remains controversial. Immunosuppressive agents (azathioprine, cyclophosphamide, cyclosporine, mycophenolate) have been used in combination with glucocorticosteroids without definitive evidence of effectiveness. The efficacy of rituximab in adult IgA-vasculitis has been reported in few cases. We described a monocentric experience on the use of rituximab in adult IgA-vasculitis with biopsy-proven nephritis. The patients achieved a complete remission of nephritis and syndromic manifestations, and no patients experienced adverse reactions. These data have been compared with the limited literature nowadays available.
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Kim SK, Ryu SS, Park S, Park SK, Choi WJ, Sun SH. Korean herbal medicine for treating henoch-schonlein purpura with yin deficiency: five case reports. J Pharmacopuncture 2015; 17:70-5. [PMID: 25780723 PMCID: PMC4332006 DOI: 10.3831/kpi.2014.17.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
Objectives: The purpose of this study is to report the clinical effect of Korean medicine (KM) treatment for Henoch-Schonlein purpura (HSP). Methods: Five HSP patients who demonstrated a Yin deficiency and who had a history of a previous upper respiratory tract infection were included in this study. Four patients had arthritis and three had severe stomachache. One of them appeared to have proteinuria and hematuria before starting KM treatment. Results: All patients were improved with only herbal medicine, Jarotang (JRT). Purpura in the lower extremities and abdominal pain, which were not treated by using a corticosteroid, disappeared and had not recurred after 6 months. Conclusion: These cases indicate that JRT may be effective in treating HSP in patients who demonstrate Yin deficiency, even though the number of cases was limited to five.
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Affiliation(s)
- Sung-Kyun Kim
- Department of Clinical Medicine, Dongkyung Korean Medicine Clinic, Daejeon, Korea
| | - Seung-Seon Ryu
- Department of Clinical Medicine, Dongkyung Korean Medicine Clinic, Daejeon, Korea
| | - Sunju Park
- Department of Preventive Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea
| | - Sang-Kyun Park
- Department of Meridian & Acupoints, College of Korean Medicine, Sangji University, Wonju, Korea
| | - Woo-Jin Choi
- Department of Neuropsychiatry, College of Korean Medicine, Sangji University, Wonju, Korea
| | - Seung-Ho Sun
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, Korea
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Recent understanding on diagnosis and management of central nervous system vasculitis in children. Clin Dev Immunol 2012; 2012:698327. [PMID: 23008735 PMCID: PMC3447380 DOI: 10.1155/2012/698327] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/28/2012] [Accepted: 08/13/2012] [Indexed: 12/17/2022]
Abstract
Central nervous system vasculitides in children may develop as a primary condition or secondary to an underlying systemic disease. Many vasculitides affect both adults and children, while some others occur almost exclusively in childhood. Patients usually present with systemic symptoms with single or multiorgan dysfunction. The involvement of central nervous system in childhood is not frequent and it occurs more often as a feature of subtypes like childhood polyarteritis nodosa, Kawasaki disease, Henoch Schönlein purpura, and Bechet disease. Primary angiitis of the central nervous system of childhood is a reversible cause of severe neurological impairment, including acute ischemic stroke, intractable seizures, and cognitive decline. The first line therapy of CNS vasculitides is mainly based on corticosteroids and immunosuppressor drugs. Other strategies include plasmapheresis, immunoglobulins, and biologic drugs. This paper discusses on current understanding of most frequent primary and secondary central nervous system vasculitides in children including a tailored-diagnostic approach and new evidence regarding treatment.
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Ding W, Sun S, Zhen J, Yu Y. Urinary excretion and renal production of hepatocyte growth factor in children with Henoch-Schönlein purpura. J Int Med Res 2011; 38:1933-41. [PMID: 21226996 DOI: 10.1177/147323001003800606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study measured urinary excretion and renal levels of hepatocyte growth factor (HGF) in children with Henoch-Schönlein purpura (HSP), examining the relationship between HGF, proteinuria and renal pathological changes. Seventy-eight patients with HSP aged 6 - 18 years were divided into three groups, based on urinary albumin excretion rate. Urinary HGF concentration was measured by enzyme-linked immunosorbent assay. Renal biopsies were performed in 22 patients; renal levels of HGF protein were determined immunohistochemically. Compared with controls, urinary HGF was significantly increased in patients with normoalbuminuria and microalbuminuria, especially in those with microalbuminuria; no differences were observed between patients with macroalbuminuria and controls. Little or no HGF was present in normal kidney, but HGF was present in renal tissue in all HSP patients, particularly those with microalbuminuria. Urinary HGF was strongly correlated with the presence of renal HGF. These results suggest that HGF is associated with proteinuria and renal pathological changes in children with HSP. The detection of urinary HGF in children with HSP may be a non-invasive, effective, method for early diagnosis of renal injury.
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Affiliation(s)
- W Ding
- Department of Paediatric Nephrology, Provincial Hospital Affiliated to Shandong University, Jinan, China
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Abstract
IgA nephropathy is the primitive glomerulonephritis the most frequently encountered worldwide. In about one case out of three, it is responsible for the progression from progressive renal failure to end-stage renal failure. The pathophysiological mechanisms of this disease which is mediated by immune complexes remain unclear. The presentation, clinical progression and optical microscope aspect of the renal biopsy may widely vary, making any histological classification very difficult. Most therapeutic studies include the patients only on clinical criteria of severity. The only consensual management is that of patients with a nephropathy and mild glomerular lesions and a nephritic syndrome, or with an extracapillar glomerulonephritis and a rapidly progressive renal failure; corticoids are indicated in former cases while corticoids must be combined with immunosuppressive agents in the latter ones. Corticotherapy may be considered in patients with a proteinuria higher than 1g/day without renal failure. In any patient with primitive IgA nephropathy, the overall management used for chronic glomerulopathy must be initiated, including, in case of arterial hypertension or proteinuria, the renin-angiotensin system blockade.
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