IgA nephropathy (IgAN) is an autoimmune disease in which poorly galactosylated IgA1 is the antigen recognized by naturally occurring anti-glycan antibodies, leading to formation of nephritogenic circulating immune complexes. Incidence of IgAN displays geographical and racial disparity: common in Europe, North America, Australia, and east Asia, uncommon in African Americans, many Asian and South American countries, Australian Aborigines, and rare in central Africa. In analyses of sera and cells from White IgAN patients, healthy controls, and African Americans, IgAN patients exhibited substantial enrichment for IgA-expressing B cells infected with Epstein-Barr virus (EBV), leading to enhanced production of poorly galactosylated IgA1. Disparities in incidence of IgAN may reflect a previously disregarded difference in the maturation of the IgA system as related to the timing of EBV infection. Compared with populations with higher incidences of IgAN, African Americans, African Blacks, and Australian Aborigines are more frequently infected with EBV during the first 1-2 years of life at the time of naturally occurring IgA deficiency when IgA cells are less numerous than in late childhood or adolescence. Therefore, in very young children EBV enters "non-IgA" cells. Ensuing immune responses prevent infection of IgA B cells during later exposure to EBV at older ages. Our data implicate EBV-infected cells as the source of poorly galactosylated IgA1 in circulating immune complexes and glomerular deposits in patients with IgAN. Thus, temporal differences in EBV primo-infection as related to naturally delayed maturation of the IgA system may contribute to geographic and racial variations in incidence of IgAN.
- MeSH
- černoši MeSH
- dítě MeSH
- IgA nefropatie * epidemiologie etnologie MeSH
- imunoglobulin A MeSH
- imunokomplex MeSH
- infekce virem Epsteina-Barrové * epidemiologie etnologie MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- virus Epsteinův-Barrové MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Austrálie MeSH
IgA nephropathy (IgAN) is the dominant type of primary glomerulonephritis worldwide. However, IgAN rarely affects African Blacks and is uncommon in African Americans. Polymeric IgA1 with galactose-deficient hinge-region glycans is recognized as auto-antigen by glycan-specific antibodies, leading to formation of circulating immune complexes with nephritogenic consequences. Because human B cells infected in vitro with Epstein-Barr virus (EBV) secrete galactose-deficient IgA1, we examined peripheral blood B cells from adult IgAN patients, and relevant controls, for the presence of EBV and their phenotypic markers. We found that IgAN patients had more lymphoblasts/plasmablasts that were surface-positive for IgA, infected with EBV, and displayed increased expression of homing receptors for targeting the upper respiratory tract. Upon polyclonal stimulation, these cells produced more galactose-deficient IgA1 than did cells from healthy controls. Unexpectedly, in healthy African Americans, EBV was detected preferentially in surface IgM- and IgD-positive cells. Importantly, most African Blacks and African Americans acquire EBV within 2 years of birth. At that time, the IgA system is naturally deficient, manifested as low serum IgA levels and few IgA-producing cells. Consequently, EBV infects cells secreting immunoglobulins other than IgA. Our novel data implicate Epstein-Barr virus infected IgA+ cells as the source of galactose-deficient IgA1 and basis for expression of relevant homing receptors. Moreover, the temporal sequence of racial-specific differences in Epstein-Barr virus infection as related to the naturally delayed maturation of the IgA system explains the racial disparity in the prevalence of IgAN.
- MeSH
- B-lymfocyty imunologie MeSH
- galaktosa MeSH
- IgA nefropatie epidemiologie virologie MeSH
- imunoglobulin A metabolismus MeSH
- infekce virem Epsteina-Barrové epidemiologie MeSH
- kojenec MeSH
- lidé MeSH
- prevalence MeSH
- rasové skupiny * MeSH
- virus Epsteinův-Barrové fyziologie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- chronická renální insuficience etiologie MeSH
- dialýza ledvin MeSH
- glomerulonefritida epidemiologie etiologie klasifikace MeSH
- hodnocení rizik statistika a číselné údaje MeSH
- IgA nefropatie epidemiologie etiologie MeSH
- karcinom z renálních buněk epidemiologie etiologie MeSH
- kardiovaskulární nemoci epidemiologie etiologie MeSH
- lidé MeSH
- nefrolitiáza epidemiologie etiologie MeSH
- obezita * epidemiologie komplikace MeSH
- transplantace ledvin MeSH
- Check Tag
- lidé MeSH
- MeSH
- ANCA-asociované vaskulitidy epidemiologie etiologie terapie MeSH
- antirenální glomerulonefritida epidemiologie etiologie terapie MeSH
- fokálně segmentální glomeruloskleróza epidemiologie etiologie terapie MeSH
- glomerulonefritida * imunologie klasifikace terapie MeSH
- IgA nefropatie epidemiologie etiologie terapie MeSH
- imunosupresiva farmakologie terapeutické užití MeSH
- lidé MeSH
- membranoproliferativní glomerulonefritida epidemiologie etiologie terapie MeSH
- membranózní glomerulonefritida epidemiologie etiologie terapie MeSH
- nefritida při lupus erythematodes epidemiologie etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: There is a need for early identification of children with immunoglobulin A nephropathy (IgAN) at risk of progression of kidney disease. METHODS: Data on 261 young patients [age <23 years; mean follow-up of 4.9 (range 2.5-8.1) years] enrolled in VALIGA, a study designed to validate the Oxford Classification of IgAN, were assessed. Renal biopsies were scored for the presence of mesangial hypercellularity (M1), endocapillary hypercellularity (E1), segmental glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis (T1-2) (MEST score) and crescents (C1). Progression was assessed as end stage renal disease and/or a 50 % loss of estimated glomerular filtration rate (eGFR) (combined endpoint) as well as the rate of renal function decline (slope of eGFR). Cox regression and tree classification binary models were used and compared. RESULTS: In this cohort of 261 subjects aged <23 years, Cox analysis validated the MEST M, S and T scores for predicting survival to the combined endpoint but failed to prove that these scores had predictive value in the sub-group of 174 children aged <18 years. The regression tree classification indicated that patients with M1 were at risk of developing higher time-averaged proteinuria (p < 0.0001) and the combined endpoint (p < 0.001). An initial proteinuria of ≥0.4 g/day/1.73 m2and an eGFR of <90 ml/min/1.73 m2were determined to be risk factors in subjects with M0. Children aged <16 years with M0 and well-preserved eGFR (>90 ml/min/1.73 m2) at presentation had a significantly high probability of proteinuria remission during follow-up and a higher remission rate following treatment with corticosteroid and/or immunosuppressive therapy. CONCLUSION: This new statistical approach has identified clinical and histological risk factors associated with outcome in children and young adults with IgAN.
- MeSH
- analýza přežití MeSH
- biopsie MeSH
- chronické selhání ledvin epidemiologie patologie MeSH
- dítě MeSH
- hodnoty glomerulární filtrace MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- IgA nefropatie farmakoterapie epidemiologie patologie MeSH
- imunosupresiva MeSH
- kohortové studie MeSH
- kojenec MeSH
- ledviny patologie MeSH
- lidé MeSH
- předškolní dítě MeSH
- progrese nemoci MeSH
- proteinurie epidemiologie patologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- sexuální faktory MeSH
- stanovení cílového parametru MeSH
- věkové faktory MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa epidemiologie MeSH
BACKGROUND/AIMS: The aim of our study was to retrospectively analyse data of 520 Czech patients with IgA nephropathy (IgAN) and to specify the risk factors affecting renal survival of IgAN patients. METHODS: Cox proportional hazards regression model was used to evaluate the effects of different variables on renal survival during a median follow up of six years. McNemar´s test was used to analyse the progression of renal function according to Bartosik´s formula. RESULTS: In our retrospective analysis of 520 Czech IgAN patients Cox proportional hazards regression model with five variables [hypertension, sex, GFR, proteinuria, age] was used. Significant regression coefficient was found for GFR, hypertension and proteinuria. Using stepwise algorithm GFR (OR = 3.09), hypertension (OR = 2.09) and proteinuria (OR = 1.97) were found as the most important factors for renal survival in our group of IgAN patients. Among patients with CKD 3 we found significantly better renal survival in patients with proteinuria < 1g/day compared to patients with higher proteinuria. We did not find the significant difference between predicted progression of renal function due to Bartosik´s formula and real progression of renal parametres assessed by GFR at the end of the follow up in our group of IgAN patients. CONCLUSION: Our retrospective study of 520 Czech IgAN patients confirmed GFR, hypertension and proteinuria as the most important factors affecting the prognosis of IgAN patients. We validated Toronto Bartosik´s formula to predict prognosis of IgAN patients.
- MeSH
- algoritmy MeSH
- analýza přežití MeSH
- dospělí MeSH
- IgA nefropatie epidemiologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- senioři MeSH
- vyšetření funkce ledvin MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
α-Actinin 4, encoded by ACTN4, is an F-actin crosslinking protein which belongs to the spectrin gene superfamily. It has a head-to-tail homodimer structure with three main domains. Mutations in ACTN4 are associated with idiopathic nephrotic syndrome (NS). However, until today only a few mutations have been described in this gene. We used genomic DNA of 48 patients with focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) to screen for ACTN4 mutations by high-resolution melting analysis (HRM). Suspect samples were sequenced and compared with healthy controls. To investigate the prevalence and possible effect of some substitutions found in FSGS/MCD patients we also looked for these changes in patients with IgA nephropathy (IgAN) and membranous glomerulonephritis (MGN). We found 20 exonic and intronic substitutions in the group of 48 Czech patients. The substitution 2242A>G (p.Asn748Asp) is a candidate mutation which was identified in one patient but not in any of the 200 healthy controls. Exon 19 seems to be a variable region due to the amount of revealed polymorphisms. In this region we also found three unreported substitutions in IgAN patients, c.2351C>T (p.Ala784Val), c.2378G>A (p.Cys793Tyr) and c.2393G>A (p.Gly798Asp). These substitutions were not found in any tested healthy controls. To conclude, the ACTN4 mutations are not a frequent cause of FSGS/MCD in Czech adult patients. One new ACTN4 mutation has been identified.
- MeSH
- aktinin genetika MeSH
- bodová mutace MeSH
- denaturace nukleových kyselin MeSH
- dospělí MeSH
- exony genetika MeSH
- fokálně segmentální glomeruloskleróza epidemiologie genetika MeSH
- IgA nefropatie epidemiologie genetika MeSH
- introny genetika MeSH
- konsenzuální sekvence MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipoidní nefróza epidemiologie genetika MeSH
- membranózní glomerulonefritida genetika MeSH
- missense mutace MeSH
- molekulární sekvence - údaje MeSH
- mutační analýza DNA MeSH
- sekvence aminokyselin MeSH
- sekvenční homologie aminokyselin MeSH
- sekvenční seřazení MeSH
- substituce aminokyselin MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
IgA nefropatie patří mezi nejčastější primární glomerulonefritidy. Klinicky se projevuje epizodami makroskopické hematurie ve vazbě na respirační infekci či asymptomatickým močovým nálezem, mikroskopickou hematurií s nebo bez proteinurie. Diagnóza je založena na renální biopsii, kde v imunofluorescenci dominují depozita imunoglobulinu IgA v mezangiu glomerulů. Léčebně je nutná důsledná kontrola krevního tlaku s využitím antiproteinurického efektu inhibitorů angiotenzin konvertujícího enzymu či blokátoru receptorů pro angiotenzin II. U nemocných s velkou proteinurií a aktivním nálezem v renální biopsii se využívá imunosupresivní terapie (prednizon, cyklofosfamid, azathioprin). I při využití těchto léčebných postupů má onemocnění závažnou prognózu, v průběhu 20 let dospěje 20–30 % pacientů do chronického selhání ledvin s nutností použití některé z metod náhradní funkce ledvin. IgA nefropatie představuje závažný medicínský i ekonomický problém a celosvětově je tomuto onemocnění věnována velká pozornost.
IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide. Asymptomatic urine testing, microscopic haematuria with or without proteinuria, identifies around 40 % of patients with IgAN. Commonly, the clinical presentation of macroscopic haematuria is provoked by upper respiratory tract infection. The diagnosis is based on renal biopsy. IgAN is characterized by diffuse mesangial deposition of immunoglobulin A (IgA). The cornerstone of treatment is rigorous blood pressure control using ACE inhibitors (angiotensin converting enzyme) and/or ARB (angiotensin II receptor blockers) to reduce hemodynamic stress and proteinuria. Immunosuppressive therapy is indicated in patients with persistent proteinuria (above 1g/day) and active lesions in renal biopsy. IgAN is a progressive disease with serious prognosis because 20 to 30 % of patients reach end-stage renal disease within 20 years.
- MeSH
- hypertenze etiologie terapie MeSH
- IgA nefropatie * diagnóza epidemiologie etiologie terapie MeSH
- lidé MeSH
- management nemoci MeSH
- prognóza MeSH
- proteinurie etiologie terapie MeSH
- renální insuficience etiologie prevence a kontrola terapie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
