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Tota M, Baron V, Musial K, Derrough B, Konieczny A, Krajewska M, Turkmen K, Kusztal M. Secondary IgA Nephropathy and IgA-Associated Nephropathy: A Systematic Review of Case Reports. J Clin Med 2023; 12:jcm12072726. [PMID: 37048809 PMCID: PMC10094848 DOI: 10.3390/jcm12072726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Primary (pIgAN), secondary IgA nephropathy (sIgAN), and IgA-associated nephropathy can be distinguished. While pIgAN has been thoroughly studied, information about the etiology of sIgAN remains scarce. As concerns sIgAN, several studies suggest that different etiologic factors play a role and ultimately lead to a pathophysiologic process similar to that of pIgAN. In this article, we review a vast number of cases in order to determine the novel putative underlying diseases of sIgAN. Moreover, updates on the common pathophysiology of primary disorders and sIgAN are presented. We identified liver, gastrointestinal, oncological, dermatological, autoimmune, and respiratory diseases, as well as infectious, iatrogenic, and environmental factors, as triggers of sIgAN. As novel biological therapies for listed underlying diseases emerge, we suggest implementing drug-induced sIgAN as a new significant category. Clinicians should acknowledge the possibility of sIgAN progression in patients treated with TNF-α inhibitors, IL-12/IL-23-inhibitors, immune checkpoint inhibitors, CTLA-4, oral anticoagulants, thioureylene derivatives, and anti-vascular endothelial growth factor drugs.
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Affiliation(s)
- Maciej Tota
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Vanessa Baron
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland
- Faculty of Dentistry, Wroclaw Medical University, 50-435 Wrocław, Poland
| | - Katie Musial
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Bouchra Derrough
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Andrzej Konieczny
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Meram Medical Faculty, Necmettin Erbakan University, Konya 42090, Turkey
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wrocław, Poland
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Cicek N, Yildiz N, Asadov R, Yucelten AD, Tugtepe H, Alpay H. Kidney and Urinary Tract Involvement in Epidermolysis Bullosa: Is Routine Follow-Up Necessary? Dermatol Pract Concept 2021; 11:e2021051. [PMID: 34123558 DOI: 10.5826/dpc.1103a51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 10/31/2022] Open
Abstract
Background Several renal and urinary tract complications have been reported in patients with epidermolysis bullosa. Objective This study investigated kidney and urinary tract involvement in patients with epidermolysis bullosa. Patients and Methods Patients with epidermolysis bullosa in treatment at the Dermatology Unit were included in the study. Glomerular and tubular functions were investigated. Results The study included 16 patients (4 females, 12 males) of mean 11.1 years (SD = 8.1 years). Estimated GFR was normal in all patients except one with end-stage renal disease. Excluding this patient, the urinary albumin/creatinine ratio and the fractional excretion of sodium were normal. The mean beta-2 microglobulin/creatinine ratio was 278.8 μg/g, and it was abnormally high in 2 patients. The mean tubular phosphorus reabsorption was 92.6%; it was abnormally low in 1 patient. Severe kidney or urinary tract involvement was present in 2 patients with recessive dystrophic EB-generalized severe (RDEB-GS): one patient had obstructive bullous lesions in the urethra; the other had end-stage renal disease secondary to focal segmental glomerulosclerosis and was on peritoneal dialysis for 3 years. Conclusions Assessment for renal and urinary tract involvement should become a routine part of the evaluation of patients with any type of EB, but especially of patients with RDEB-GS. Patients with mild tubular dysfunction need long-term follow-up to detect early deterioration of renal function.
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Affiliation(s)
- Neslihan Cicek
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nurdan Yildiz
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ruslan Asadov
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayse Deniz Yucelten
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Halil Tugtepe
- Department of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Harika Alpay
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
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Soliman KM, Fülöp T, Ploth DW, Herberth J. Diffuse membranoproliferative glomerulonephritis with focal sclerosis and renal amyloidosis in an adult male with autosomal dominant dystrophic epidermolysis bullosa: a case report. Ren Fail 2020; 41:850-854. [PMID: 31498016 PMCID: PMC6746271 DOI: 10.1080/0886022x.2019.1614056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Previous reports of glomerular disease in adult patients with autosomal dominant dystrophic epidermolysis bullosa (EB) are limited and include post-infectious glomerulonephritis, IgA nephropathy, amyloidosis, and leukocytoclastic vasculitis. To our knowledge, membranoproliferative glomerulonephritis (MPGN) has not been described before. We report a case of a 39-year-old male with autosomal dominant dystrophic EB, presenting with bilateral leg swelling of one-week duration. There was no other significant past medical history. The physical examination was remarkable for scars and erosions over all body areas, with all extremities with blisters and ulcers covered, absent finger and toenails and bilateral lower extremity edema. Serum creatinine was 0.9 mg/dL, albumin 1.3 g/dL and urine protein excretion 3.7 g/24 h. Viral markers (hepatitis-B, C, and HIV), complement c3 and c4 levels and auto-immune antibody profile all remained negative or within normal limits. Renal ultrasound and echocardiogram were normal. Renal biopsy recovered 14 glomeruli, all with proliferation of mesangial and endothelial cells as well as an expansion of the mesangial matrix, focal segmental sclerosis and amorphous homogeneous deposits demonstrating apple-green birefringence under polarized light with Congo red stain. Our observation emphasizes the importance of recognizing MPGN and secondary amyloidosis in patients with EB, especially with the availability of newer treatment modalities.
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Affiliation(s)
- Karim M Soliman
- Department of Medicine, Division of Nephrology, Medical University of South Carolina , Charleston , SC , USA.,Department of Medicine, Division of Nephrology, Cairo University , Cairo , Egypt
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina , Charleston , SC , USA.,Medical Services, Ralph H. Jonson VA Medical Center , Charleston , SC , USA
| | - David W Ploth
- Department of Medicine, Division of Nephrology, Medical University of South Carolina , Charleston , SC , USA
| | - Johann Herberth
- Medical Services, Ralph H. Jonson VA Medical Center , Charleston , SC , USA
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Esposito S, Guez S, Manzoni F, Bosco A, Rigante D. Epidermolysis bullosa and the partnership with autoimmunity: what should we assimilate? Immunol Res 2015; 61:63-9. [PMID: 25412732 DOI: 10.1007/s12026-014-8583-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Bullous skin diseases are characterized by genetic abnormalities related to structural epidermal proteins or organ-specific autoantibodies against the same proteins and are revealed by blister formation on skin or mucous membranes, with differences in blister depth, morphology, and topography. Both inherited and autoimmune forms of these disorders can be framed in the context of epidermolysis bullosa. Their clinical spectrum varies from early lethal to mild variants with normal life expectancy, and several distinct phenotypes differ for age of onset, extent, location and depth of skin and mucous lesions, or scarring severity. Recently, different inflammatory processes blended with autoimmune phenomena have been demonstrated in both inherited and acquired epidermolysis bullosa, revealing that this overlapping might cause substantial implications in terms of disease course and outcome. Although several associations between epidermolysis bullosa in its different variants and autoimmune diseases have been reported, it is not yet completely clear how it happens and why this association occurs in only some patients. Autoantibodies are the primary cause of the disease in acquired epidermolysis bullosa, whereas they can be produced as a secondary event due to genetically determined skin damage in inherited epidermolysis bullosa, contributing significantly to the worsening of the disease. The awareness of this overlap may help in identifying new therapeutic approaches with immunosuppressive drugs that could have a significant impact in terms of prognosis.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 9, 20122, Milan, Italy,
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Srinivasaraghavan R, Krishnamurthy S, Chandar R, Mahadevan S, Chandrashekar L, Rajesh NG. Immunoglobulin A nephropathy in association with generalized inflammatory peeling skin syndrome. Pediatr Dermatol 2015; 32:244-7. [PMID: 25196305 DOI: 10.1111/pde.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe an 8-year-old girl born to second-degree consanguineous parents with complaints of recurrent episodes of hematuria for 6 months. She had generalized peeling of the skin since birth and recurrent purulent cutaneous infections. The clinical presentation and histopathology of the skin biopsy specimen were consistent with the inflammatory variant of peeling skin syndrome (PSS). She also had a single ventricle with pulmonary stenosis, for which a bidirectional Glenn shunt had been placed. The renal biopsy specimen showed immunoglobulin A (IgA) nephropathy. She responded well to enalapril and steroids, with a decrease in proteinuria. IgA nephropathy has not been previously reported in PSS. Complications such as IgA nephropathy in children with PSS would help to further delineate the diverse clinical presentations and the clinical course of this rare dermatosis. We discuss the mechanisms that could explain this hitherto unreported association.
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Affiliation(s)
- Rangan Srinivasaraghavan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Renal involvement in epidermolysis bullosa simplex: an unusual presentation. Indian J Pediatr 2014; 81:102-3. [PMID: 23229918 DOI: 10.1007/s12098-012-0907-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
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Sakan S, Basic-Jukic N, Tomasevic B, Kes P, Bandic Pavlovic D, Peric M. Vascular access for chronic hemodialysis in a patient with epidermolysis bullosa dystrophica Hallopeau-Siemens. Hemodial Int 2012; 17:126-9. [DOI: 10.1111/j.1542-4758.2012.00699.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sanja Sakan
- Department of Anesthesiology, Reanimatology and Intensive Care; University Hospital Center; Zagreb; Croatia
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension and Dialysis; University Hospital Center Zagreb; Zagreb; Croatia
| | - Boris Tomasevic
- Department of Anesthesiology, Reanimatology and Intensive Care; University Hospital Center; Zagreb; Croatia
| | - Petar Kes
- Department of Nephrology, Arterial Hypertension and Dialysis; University Hospital Center Zagreb; Zagreb; Croatia
| | - Daniela Bandic Pavlovic
- Department of Anesthesiology, Reanimatology and Intensive Care; University Hospital Center; Zagreb; Croatia
| | - Mladen Peric
- Department of Anesthesiology, Reanimatology and Intensive Care; University Hospital Center; Zagreb; Croatia
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Abstract
PURPOSE OF REVIEW This review highlights key findings, both clinical and basic, that have been published in the field of inherited epidermolysis bullosa within the past few years. RECENT FINDINGS New epidermolysis bullosa phenotypes, genotypes and modes of transmission have been identified, resulting in a revised classification system. Detailed evidence-based data are now available on the risk of extracutaneous complications in each of the major epidermolysis bullosa subtypes. Studies are now underway to try to better explain the biological aggressiveness of squamous cell carcinomas arising in epidermolysis bullosa skin. Cell and animal models have been refined and used to ascertain the feasibility of gene replacement therapy, stem cell transplantation, and treatment with injected allogeneic fibroblasts or recombinant type VII collagen. As a result, clinical trials are now being pursued to test each of these in humans. SUMMARY Epidermolysis bullosa is caused by mutations in at least 14 genes, leading to a broad spectrum of entities, each of which has its own relative risk for the development of specific extracutaneous complications and/or premature death. Intensive research, both basic and clinical, is bringing us closer to more effective treatments and possibly even a cure.
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