Immunoglobulin A nephropathy and chronic kidney disease

Nephrology ◽  
2010 ◽  
Vol 15 ◽  
pp. 23-26 ◽  
Author(s):  
YASUHIKO TOMINO
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Immunoglobulin A ◽  
Immunoglobulin A Nephropathy

Tildrakizumab Shows Significant Efficacy in Psoriasis Treatment With Comorbid Immunoglobulin A Nephropathy: A Case Report

2020 ◽  
Vol 5 (4) ◽  
pp. 160-163
Author(s):  
Eingun James Song
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Plaque Psoriasis ◽  
Global Assessment ◽  
Immunoglobulin A ◽  
Immunoglobulin A Nephropathy ◽  
Severe Plaque Psoriasis

Background: Chronic kidney disease is a relative contraindication for conventional systemic therapy in patients with psoriasis. Although biologic agents may be suitable in these patients due to their elimination via endogenous metabolism and protein degradation, no dedicated studies have evaluated the safety of biologics in patients with psoriasis and chronic kidney disease. Tildrakizumab—an anti-interleukin-23p19 monoclonal antibody—is approved for treatment of moderate-to-severe plaque psoriasis. Objective: To evaluate efficacy and safety of tildrakizumab in a 56-year-old woman with moderate-to-severe plaque psoriasis and comorbid immunoglobulin A nephropathy. Methods: Subcutaneous tildrakizumab 100 mg was administered at weeks 0, 4, 20, 33, and 48. Assessments included body surface area affected, physician’s global assessment score, and laboratory assessments. Results: At initial presentation, patient had predominantly plaque-type psoriasis involving 5% body surface area with a static physician’s global assessment score of 3. Patient failed an adequate trial of ultrapotent topical steroids. Baseline laboratory tests confirmed renal impairment with blood creatinine level of 2.0 mg/dL and an estimated glomerular filtration rate of 27.0 mL/min/1.73 m2. Administration of subcutaneous tildrakizumab 100 mg led to near-complete skin clearance by week 33, with a durable response to week 48. No treatment-related adverse events were reported through 48 weeks. Metabolic and hematological parameters remained grossly unchanged. Conclusion: Tildrakizumab was well tolerated and effective for treatment of moderate-to-severe plaque psoriasis in a patient with comorbid immunoglobulin A nephropathy.

Renal Outcomes of Pregnant Patients with Immunoglobulin A Nephropathy: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 49 (3) ◽  
pp. 214-224 ◽  
Author(s):  
Fan Wang ◽  
Jian-Da Lu ◽  
Ying Zhu ◽  
Ting-Ting Wang ◽  
Jun Xue
Keyword(s):  
Systematic Review ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Immunoglobulin A ◽  
Immunoglobulin A Nephropathy ◽  
Renal Outcomes

Background: Is the prognosis of immunoglobulin A nephropathy (IgAN) influenced by pregnancy and delivery? The answer to this question still remains to be a controversial topic. Here, we undertook a systematic review and meta-analysis to obtain the overall estimate of potential effect of IgAN and pregnancy on each other. Methods: We systematically searched MEDLINE, EMBASE, Chinese Biological Medicine and Cochrane for cohort and case-control studies; a total of 1,378 articles were reviewed and 9 studies were included in the end. OR and mean difference (MD) were calculated with a random-effects model, kidney events and pregnancy outcomes were analyzed respectively. Results: The key finding of the meta-analysis of 145 renal events in 1,198 participants was that there was no difference in renal outcomes (defined as doubling of serum creatinine (SCr), 50% decline in glomerular filtration rate [GFR] and end-stage kidney disease) of pregnant women compared with non-pregnant women who had IgAN (OR 0.90; 95% CI 0.59–1.37; p = 0.63). Subgroup analysis indicated that there was no significant difference between the 2 groups according to sample size, follow-up year, age, level of SCr and proteinuria at baseline. There was no difference in the change of the eGFR/creatinine clearance rate (mL/min/1.73 m2 per year) in IgAN patients with pregnancy compared with non-pregnancy (MD –0.11 mL/min; 95% CI –0.50–0.27; p = 0.57) as well. Women with IgAN had a higher likelihood of pregnancy outcomes compared with the Chinese general population, while they had a lower risk of preterm delivery, preeclampsia and low birth weight compared with those who had lupus nephritis or diabetic nephropathy. Conclusions: Pregnancy did not accelerate kidney disease deterioration in women with IgAN in stages of chronic kidney disease 1–3. Moreover, patients with IgAN had a relatively low risk of adverse pregnancy events compared with those with lupus nephritis or diabetic nephropathy.

scholarly journals SGLT2 inhibition requires reconsideration of fundamental paradigms in chronic kidney disease, ‘diabetic nephropathy’, IgA nephropathy and podocytopathies with FSGS lesions

2020 ◽  
Author(s):  
Hans-Joachim Anders ◽  
Anna Julie Peired ◽  
Paola Romagnani
Keyword(s):  
Chronic Kidney Disease ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Glucose Transporter ◽  
Immunoglobulin A ◽  
Adverse Outcomes ◽  
Glucose Transporter 2 ◽  
Research Activities ◽  
Background Therapy ◽  
Sglt2 Inhibition

Abstract In 2020, the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial first demonstrated that inhibition of the sodium–glucose transporter-2 (SGLT2) with dapagliflozin attenuates the progression of chronic kidney disease (CKD) with proteinuria in patients with or without diabetes at an unprecedented effect size. These results have far-reaching implications for a series of traditional concepts in Nephrology. It now became obvious that CKD with and without diabetes involves a predominant SGLT2-driven pathophysiology compared with the other pathogenic pathways currently under consideration. As SGLT2 inhibition is similarly efficacious in diabetic and non-diabetic CKD with proteinuria, treating CKD rather than ‘diabetic nephropathy’ becomes the central paradigm. Indeed, in older adults with type 2 diabetes, CKD is rather of multifactorial origin. As the DAPA-CKD trial included more patients with immunoglobulin A nephropathy (IgAN) than any of the previous IgAN trials, dual renin-angiotensin/SGLT2 inhibition may become the new standard. The same applies for patients with podocytopathy-related focal segmental glomerulosclerosis lesions. From now on, IgAN and podocytopathy trials without SGLT2 inhibition as background therapy and without glomerular filtration rate decline as primary outcome criterion will be of limited value. These and other potential implications will trigger broad discussions and secondary research activities with conclusions difficult to predict today. However, one is for sure: Nephrology after the DAPA-CKD trial will be not the same as it was before. Finally!

Kidney disease

2016 ◽  
Author(s):  
Kate Wiles ◽  
Kate Bramham ◽  
Catherine Nelson-Piercy
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Renal Disease ◽  
Lupus Erythematosus ◽  
Immunoglobulin A ◽  
Fetal Loss ◽  
Kidney Injury ◽  
Premature Delivery ◽  
In Pregnancy

This chapter describes the physiological adaptations to pregnancy in women with and without renal disease, reports pregnancy outcomes in women with both acute kidney injury and chronic kidney disease, and discusses a management strategy for antenatal and peripartum care. Acute kidney injury (AKI) is difficult to define in pregnancy because of the physiological increase in glomerular filtration. A normal creatinine can mask renal injury in pregnancy. This chapter considers important causes of AKI in pregnancy including pre-eclampsia, HELLP syndrome, thrombotic microangiopathy, acute fatty liver of pregnancy, systemic lupus erythematosus, urinary tract infection, and obstruction. The trend in the developed world for delaying pregnancy and the increasing prevalence of obesity mean that greater numbers of pregnancies will be complicated by chronic kidney disease. Maternal and fetal complications increase with worsening prepregnancy renal function including the development of pre-eclampsia, fetal growth restriction, premature delivery, and fetal loss. Prepregnancy counselling and the intrapartum management for women with lupus nephritis, immunoglobulin A nephropathy, polycystic kidney disease, and diabetic nephropathy are discussed. Renal replacement therapies in pregnancy including both dialysis and renal transplantation are considered, and practical guidance on renal biopsy, anaesthesia, and the pharmacology of renal disease in pregnancy is offered.

Specific renal conditions in pregnancy

2015 ◽  
Author(s):  
Kate Bramham ◽  
Catherine Nelson-Piercy
Keyword(s):  
Kidney Disease ◽  
Lupus Erythematosus ◽  
Immunoglobulin A ◽  
Reflux Nephropathy ◽  
Immunoglobulin A Nephropathy ◽  
Polycystic Kidney ◽  
Disease Exacerbation ◽  
Urological Disorders ◽  
Single Kidney ◽  
In Pregnancy

Pre-pregnancy glomerular filtration rate, proteinuria, and blood pressure are usually more important in determining the risk of pregnancy in patients with chronic kidney disease, but some diseases may be exacerbated in pregnancy, or appear more liable to complications. This chapter considers immunoglobulin A nephropathy, systemic lupus erythematosus (which may also be associated with some manifestations in the infant), diabetic nephropathy, polycystic kidney disease, reflux nephropathy, single kidney, urological disorders, and angiomyolipomata. Distinguishing underlying renal disease exacerbation from pre-eclampsia and other complications of pregnancy can be challenging. Renal biopsy is sometimes indicated.

scholarly journals Secretory Immunoglobulin a (SigA) Testing in Saliva from End-Stage Patients with Chronic Kidney Disease Undergoing Dialysis Treatment and in Control Healthy Subjects

2020 ◽  
Vol 47 (2) ◽  
pp. 18-21
Author(s):  
A. Nenova-Nogalcheva ◽  
D. Konstantinova ◽  
P. Pechalova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Immunoglobulin A ◽  
Chronic Dialysis ◽  
Control Group ◽  
Clinical Group ◽  
Dialysis Treatment ◽  
Mean Values ◽  
Female Patients ◽  
End Stage

AbstractThe purpose of the present study was to measure SIgA levels in saliva in control healthy patients and in patients with end-stage chronic kidney disease (CKD) undergoing dialysis treatment.Methods: 90 participants, divided into 2 groups (Clinical Group and Control Group), had their SigA levels measured from a salivary liquid medium using radial Immunodiffusion (or Mancini method). The Clinical Group comprised 70 end-stage CKD patients on chronic dialysis treatment; the Control Group consisted of 20 clinically healthy individuals. SIgA mean values of the participants from the Clinical Group and the Control Group were 161.46 ± 105.76 and 69.70 ± 25.67 mg/l, respectively.Results: SIgA mean levels in female patients from the Clinical group were significantly higher compared to the mean values in male patients (p = 0.004). The SIgA levels in healthy participants from the Control Group did not reveal statistically significant gender-related dependencies (p = 0.699). Statistical correlation between gender and SigA levels was not established for either group. However, a statistically significant positive correlation was found between the duration of the hemodialysis treatment and SIgA levels (r = 0.46, p < 0.001).Conclusion: The results of the SIgA testing for both groups differed statistically. In the Control Group SIgA levels did not prove to be dependent on gender and age, whereas female patients with chronic renal failure exhibited significantly increased SIgA levels. The studies have outlined a tendency towards increasing SIgA levels among younger patients as well as in patients, undergoing chronic dialysis treatment for over 5 years.

scholarly journals Aliskiren and the dual complement inhibition concept

2019 ◽  
Vol 13 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Maria Vanessa Perez-Gomez ◽  
Alberto Ortiz
Keyword(s):  
Kidney Disease ◽  
Haemolytic Uraemic Syndrome ◽  
Immunoglobulin A ◽  
High Dose ◽  
Complement Factor ◽  
C3 Glomerulopathy ◽  
Immunoglobulin A Nephropathy ◽  
Complement Inhibition ◽  
Direct Renin Inhibitor ◽  
Dense Deposit

Abstract In this issue of Clinical Kidney Journal, Plasse et al. report on the use of high-dose aliskiren as an adjunct therapy in a patient treated with eculizumab for haemolytic uraemic syndrome (HUS). This follows the recent description of the complement factor 3 (C3) activating activity of the enzyme renin and the successful therapeutic use of the direct renin inhibitor aliskiren in three cases of C3 glomerulopathy/dense deposit disease. We discuss the potential clinical and pathophysiological implications of these reports on nephropathies linked to complement, from HUS to C3 glomerulopathy to immunoglobulin A nephropathy as well as the concept of dual complement inhibition for kidney disease.

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