Background: The connection between uric acid (UA) and renal impairment is well known due to the urate capacity to precipitate within the tubules or extra-renal system. Emerging studies allege a new hypothesis concerning UA and renal impairment involving a pro-inflammatory status, endothelial dysfunction, and excessive activation of renin–angiotensin–aldosterone system (RAAS). Additionally, hyperuricemia associated with oxidative stress is incriminated in DNA damage, oxidations, inflammatory cytokine production, and even cell apoptosis. There is also increasing evidence regarding the association of hyperuricemia with chronic kidney disease (CKD), cardiovascular disease, and metabolic syndrome or diabetes mellitus. Conclusions: Important aspects need to be clarified regarding hyperuricemia predisposition to oxidative stress and its effects in order to initiate the proper treatment to determine the optimal maintenance of UA level, improving patients’ long-term prognosis and their quality of life.
Immunoglobulin A (IgA) nephropathy is one of the most common glomerulonephritis. Its clinical manifestations vary from asymptomatic forms to cases with nephritic syndrome or nephrotic-range proteinuria. The prognosis depends on the level of proteinuria, decline of glomerular filtration rate and control of blood pressure. The pathognomonic histological changes are represented by the granular IgA deposits in the mesangium. The treatment consists of comprehensive support care and immunosuppressive therapy. We discuss the case of a 50-year-old man who presented microscopic hematuria, nephrotic-range proteinuria and decreased renal function, exacerbated in the last 6 months prior the admission. We performed a renal biopsy and granular deposits were present in the glomerular mesangium that were highly suggestive for IgA nephropathy. Immunosuppressive therapy was instituted immediately, but the decline of the renal function continued and renal replacement therapy was needed. Patients with poor prognosis have an unsatisfactory response to the immunosuppressants, especially those with a delayed diagnosis.
IgA Nephropathy (IgAN) is one of the most frequent types of glomerulonephritis encountered in adults from Western countries and Asia. IgAN is responsible for approximately 40% of end-stage renal disease (ESRD) mediated by glomerular impairment. The majority of adult IgAN patients present a slowly progressive pattern towards ESRD. Current types of treatment are based mainly on supportive care: i.e., life style risk factors, measures that lower blood pressure and reduce proteinuria, weight loss, smoking cessation or glycaemia control. Because IgAN is an immune complex-mediated disease, immunosuppression therapy gains more and more attention as a modality of treatment. Despite the beneficial effects, the value of immunosuppression remains controversial due to high rates of adverse reactions. The aim of this review is to highlight the benefits and limitations of promoting immunosuppression in IgAN with mild to moderate proteinuria despite supportive antiproteinuric therapy up titrated to maximum tolerated doses.
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