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Lafayette R, Kristensen J, Stone A, Barratt J. Targeted release of budesonide in primary IgA nephropathy - Authors' reply. Lancet 2024; 403:2786. [PMID: 38944527 DOI: 10.1016/s0140-6736(24)00796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 07/01/2024]
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Ying Y, Wang L, Ma S, Zhu Y, Ye S, Jiang N, Zhao Z, Zheng C, Shentu Y, Wang Y, Li D, Zhang J, Chen C, Huang L, Yang D, Zhou Y. An enhanced machine learning approach for effective prediction of IgA nephropathy patients with severe proteinuria based on clinical data. Comput Biol Med 2024; 173:108341. [PMID: 38552280 DOI: 10.1016/j.compbiomed.2024.108341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/02/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024]
Abstract
IgA Nephropathy (IgAN) is a disease of the glomeruli that may eventually lead to chronic kidney disease or kidney failure. The signs and symptoms of IgAN nephropathy are usually not specific enough and are similar to those of other glomerular or inflammatory diseases. This makes a correct diagnosis more difficult. This study collected data from a sample of adult patients diagnosed with primary IgAN at the First Affiliated Hospital of Wenzhou Medical University, with proteinuria ≥1 g/d at the time of diagnosis. Based on these samples, we propose a machine learning framework based on weIghted meaN oF vectOrs (INFO). An enhanced COINFO algorithm is proposed by merging INFO, Cauchy Mutation (CM) and Oppositional-based Learning (OBL) strategies. At the same time, COINFO and Support Vector Machine (SVM) were integrated to construct the BCOINFO-SVM framework for IgAN diagnosis and prediction. Initially, the proposed enhanced COINFO is evaluated using the IEEE CEC2017 benchmark problems, with the outcomes demonstrating its efficient optimization capability and accuracy in convergence. Furthermore, the feature selection capability of the proposed method is verified on the public medical datasets. Finally, the auxiliary diagnostic experiment was carried out through IgAN real sample data. The results demonstrate that the proposed BCOINFO-SVM can screen out essential features such as High-Density Lipoprotein (HDL), Uric Acid (UA), Cardiovascular Disease (CVD), Hypertension and Diabetes. Simultaneously, the BCOINFO-SVM model achieves an accuracy of 98.56%, with sensitivity at 96.08% and specificity at 97.73%, making it a potential auxiliary diagnostic model for IgAN.
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Affiliation(s)
- Yaozhe Ying
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Luhui Wang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Shuqing Ma
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Yun Zhu
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Simin Ye
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Nan Jiang
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Zongyuan Zhao
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Chenfei Zheng
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Institute of Chronic Nephropathy, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Yangping Shentu
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - YunTing Wang
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX, USA.
| | - Duo Li
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Institute of Chronic Nephropathy, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Ji Zhang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Institute of Chronic Nephropathy, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Chaosheng Chen
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Institute of Chronic Nephropathy, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Liyao Huang
- Key Laboratory of Intelligent Informatics for Safety & Emergency of Zhejiang Province, Wenzhou University, Wenzhou, 325035, China.
| | - Deshu Yang
- Key Laboratory of Intelligent Informatics for Safety & Emergency of Zhejiang Province, Wenzhou University, Wenzhou, 325035, China.
| | - Ying Zhou
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China; Institute of Chronic Nephropathy, Wenzhou Medical University, Wenzhou, 325000, China.
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Qu S, Zhou XJ, Zhang H. Genetics of IgA nephrology: risks, mechanisms, and therapeutic targets. Pediatr Nephrol 2024:10.1007/s00467-024-06369-7. [PMID: 38600219 DOI: 10.1007/s00467-024-06369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/24/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
IgA nephropathy (IgAN) is a genetically complex multifactorial trait. Over the past decade, population-based genome-wide association studies (GWAS) have identified more than 30 IgAN risk loci, providing novel perspectives on both the epidemiology of the disease and its underlying molecular mechanisms. In addition, the association between IgAN and galactose-deficient IgA1 (Gd-IgA1) presented another avenue for genetic exploration due to the heritability of the elevated serum Gd-IgA1 levels. These endeavors also yielded and enabled refinement of polygenic risk scores, which may help identify specific groups of individuals at significantly increased risks, leading to stratifications of medical treatments. In this review, we aim to explore the existing evidence for genetic causation in IgAN. We summarize the state of genetic research in IgAN and how it has led to the reformulation of the new pathogenesis model and novel therapeutic targets.
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Affiliation(s)
- Shu Qu
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, People's Republic of China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xu-Jie Zhou
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China.
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, People's Republic of China.
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, People's Republic of China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Peking University, Beijing, People's Republic of China
- Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Ștefan G, Zugravu A, Stancu S. Mortality in IgA Nephropathy: A Long-Term Follow-Up of an Eastern European Cohort. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:247. [PMID: 38399535 PMCID: PMC10890558 DOI: 10.3390/medicina60020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: IgA nephropathy (IgAN), the most common primary glomerulonephritis, has been extensively studied for renal outcomes, with limited data on patient survival, particularly in Eastern Europe. We aimed to investigate the long-term survival rate of patients with IgAN and the associated risk factors in an Eastern European cohort. Materials and Methods: We conducted a retrospective analysis of 215 IgAN patients (median age 44, 71% male) diagnosed at a Romanian tertiary center between 2010 and 2017. We assessed clinical and pathological attributes, including the Charlson comorbidity index, the prevalence of diabetes, renal function, and treatment with renin-angiotensin-system inhibitors (RASIs). Results: Over a median 7.3-year follow-up, 20% of patients died, mostly due to cardiovascular diseases. Survival rates at 1, 5, and 10 years were 93%, 84%, and 77%, respectively. Deceased patients had higher Charlson comorbidity index scores, greater prevalence of diabetes, and poorer renal function. They were less frequently treated with RASIs and more frequently reached end-stage kidney disease (ESKD). Conclusions: We report a 20% mortality rate in our Eastern European IgAN cohort, primarily due to cardiovascular diseases. Death correlates with increased age, comorbidity burden, decreased renal function at diagnosis, and the absence of RASI use. RASI treatment may potentially improve survival, highlighting its importance in managing IgAN.
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Affiliation(s)
- Gabriel Ștefan
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (A.Z.); (S.S.)
- Nephrology Department, “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Adrian Zugravu
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (A.Z.); (S.S.)
- Nephrology Department, “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
| | - Simona Stancu
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (A.Z.); (S.S.)
- Nephrology Department, “Dr. Carol Davila” Teaching Hospital of Nephrology, 010731 Bucharest, Romania
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Schena FP, Manno C, Strippoli G. Understanding patient needs and predicting outcomes in IgA nephropathy using data analytics and artificial intelligence: a narrative review. Clin Kidney J 2023; 16:ii55-ii61. [PMID: 38053972 PMCID: PMC10695518 DOI: 10.1093/ckj/sfad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 12/07/2023] Open
Abstract
This narrative review explores two case scenarios related to immunoglobulin A nephropathy (IgAN) and the application of predictive monitoring, big data analysis and artificial intelligence (AI) in improving treatment outcomes. The first scenario discusses how online service providers accurately understand consumer preferences and needs through the use of AI-powered big data analysis. The author, a clinical nephrologist, contemplates the potential application of similar methodologies, including AI, in his medical practice to better understand and meet patient needs. The second scenario presents a case study of a 20-year-old man with IgAN. The patient exhibited recurring symptoms, including gross haematuria and tonsillitis, over a 2-year period. Through histological examination and treatment with renin-angiotensin system blockade and corticosteroids, the patient experienced significant improvement in kidney function and reduced proteinuria over 15 years of follow-up. The case highlights the importance of individualized treatment strategies and the use of predictive tools, such as AI-based predictive models, in assessing treatment response and predicting long-term outcomes in IgAN patients. The article further discusses the collection and analysis of real-world big data, including electronic health records, for studying disease natural history, predicting treatment responses and identifying prognostic biomarkers. Challenges in integrating data from various sources and issues such as missing data and data processing limitations are also addressed. Mathematical models, including logistic regression and Cox regression analysis, are discussed for predicting clinical outcomes and analysing changes in variables over time. Additionally, the application of machine learning algorithms, including AI techniques, in analysing big data and predicting outcomes in IgAN is explored. In conclusion, the article highlights the potential benefits of leveraging AI-powered big data analysis, predictive monitoring and machine learning algorithms to enhance patient care and improve treatment outcomes in IgAN.
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Affiliation(s)
- Francesco Paolo Schena
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
- Schena Foundation, Policlinic, Bari, Italy
| | - Carlo Manno
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Giovanni Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
- School of Public Health, University of Sydney, Sydney, NSW, Australia
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Ruan Y, Hong F, Lin M, Wang C, Lian F, Cao F, Yang G, Huang L, Huang Q. Clinicopathological characteristics, risk factors and prognostic value of intrarenal vascular lesions in IgA nephropathy. Eur J Intern Med 2023; 117:91-97. [PMID: 37451907 DOI: 10.1016/j.ejim.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The aim was to study clinicopathological characteristics, risk factors and renal outcome in IgA nephropathy (IgAN) patients with vascular lesions. METHODS We enrolled a Chinese cohort with 458 biopsy-confirmed primary IgAN patients for a retrospective analysis. They were divided into three groups according to vascular lesions: no vascular lesions (n = 239), arterio-/arteriolosclerosis (n = 181) and microangiopathic lesions (n = 38). The clinicopathological features and renal outcome were recorded. In univariate and multivariate models, association between vascular lesions and renal outcome and vascular lesions associated clinical factors were analyzed. RESULTS Patients with vascular lesions presented worse clinical characteristics with regard to blood pressure and kidney function, and segmental glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis (T1/2) and lymphocytes and monocytes infiltration were more common. Furthermore, older age, hyperuricemia, proteinuria, global glomerulosclerosis and endocapillary hypercellularity (E1) were more severe in patients with simple arterio-/arteriolosclerosis. By multivariate logistic regression, age, MAP and eGFR were significantly associated with vascular lesions. Vascular lesions, especially arterio-/arteriolosclerosis, were significantly associated with poorer renal survival in IgAN patients, and renal survival was similar whether patients with arterio-/arteriolosclerosis received immunosuppressive therapy. In addition to eGFR, arterio-/arteriolosclerosis, along with arterial intimal fibrosis, was an independent predictor for renal survival in multivariate Cox analyses. CONCLUSION IgAN patients with vascular lesions, especially with arterio-/arteriolosclerosis, presented more severe clinicopathological features. Renal function, blood pressure and age contributed to distinguishing patients with vascular lesions. Arterio-/arteriolosclerosis lesions were associated with poorer renal survival.
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Affiliation(s)
- Yiping Ruan
- Department of Nephrology, Fujian Provincial Clinical College, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China.
| | - Fuyuan Hong
- Department of Nephrology, Fujian Provincial Clinical College, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Miao Lin
- Department of Nephrology, Fujian Provincial Clinical College, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Chen Wang
- Department of Pathology, Fujian Provincial Hospital, Fuzhou, China
| | - Fayang Lian
- Epidemiology and Clinical Research Unit, Fujian Provincial Hospital, Fuzhou, China
| | - Fang Cao
- Department of Nephrology, Fujian Provincial Clinical College, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Guokai Yang
- Department of Nephrology, Fujian Provincial Clinical College, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Lanting Huang
- Department of Nephrology, Fujian Provincial Clinical College, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Qiaoyun Huang
- Department of Computer Engineering, Fuzhou University Zhicheng College, Fuzhou, China
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Chen YT, Jiang WZ, Lu KD. Novel COL4A3 synonymous mutation causes Alport syndrome coexistent with immunoglobulin A nephropathy in a woman: A case report. World J Clin Cases 2023; 11:5947-5953. [PMID: 37727481 PMCID: PMC10506036 DOI: 10.12998/wjcc.v11.i25.5947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Alport syndrome (AS) is an inherited disease of the glomerular basement membrane caused by mutations in genes encoding α3, α4, or α5 chains of type IV collagen. It manifests with hematuria or proteinuria, which is often accompanied by hearing impairments and ocular abnormalities. Histopathologically, AS shows mesangial proliferation and sometimes incidental immunoglobulin A (IgA) deposition. Hematuria or proteinuria is also a common presentation in patients with IgA nephropathy that makes it difficult to differentially diagnose AS and IgA nephropathy solely based on these clinical and pathological features. CASE SUMMARY Herein, we present the case of a 59-year-old female patient who was admitted to our hospital with persistent microscopic hematuria and occasional proteinuria that had lasted for > 2 years. This patient had a familial history of renal disease and was diagnosed with autosomal dominant AS (ADAS) and IgA nephropathy based on the findings of renal biopsy as well as genetic testing performed using whole-exome sequencing, which suggested that the patient carried a novel heterozygous variation (c.888G>A:p.Gln296Gln) in the COL4A3 gene that enriches the mutation spectrum of ADAS. The proband received an angiotensin receptor blocker therapy after a definitive diagnosis was established. After one year of therapy, a significant reduction in proteinuria was observed. The number of microscopic red blood cells per high-power field decreased to one-quarter of the baseline levels. Renal function also maintained well during the follow-up. CONCLUSION Our case highlights the significance of performing kidney biopsy and genetic testing in the diagnosis of AS and familial IgA nephropathy.
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Affiliation(s)
- Yu-Ting Chen
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Wen-Ze Jiang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Ke-Da Lu
- Department of Nephrology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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