Monitoring Immune Responses in IgA Nephropathy: Biomarkers to Guide Management

Abstract

IgA nephropathy (IgAN) is the commonest biopsy-reported primary glomerulonephritis worldwide. It has an incidence which peaks among young adults, and 30 to 40% of patients’ progress to end stage kidney disease within twenty years of diagnosis. Ten-year kidney survival rates have been reported to be as low as 35% in some parts of the world. The successful management of IgAN is limited by an incomplete understanding of the pathophysiology of IgAN and a poor understanding of how pathophysiology may vary both from patient to patient and between patient groups, particularly across races. This is compounded by a lack of rigorously designed and delivered clinical trials in IgAN. This is slowly changing, with a number of Phase 2 and 3 clinical trials of novel therapies targeting a number of different putative pathogenic pathways in IgAN due to report in the next 5 years. From our current, albeit limited, understanding of the pathophysiology of IgAN it is unlikely a single therapy will be effective in all patients with IgAN. The successful management of IgAN in the future is, therefore, likely to be reliant on targeted therapies, carefully selected based on an individualized understanding of a patient’s risk of progression and underlying pathophysiology. The potential role of biomarkers to facilitate personalization of prognostication and treatment of IgAN is immense. Here we review the progress made over the past decade in identifying and validating new biomarkers, with a particular focus on those that reflect immunological responses in IgAN.

Differentiation of T Helper 17 Cells May Mediate the Abnormal Humoral Immunity in IgA Nephropathy and Inflammatory Bowel Disease Based on Shared Genetic Effects

“…As a potential risk factor of renal insufficiency development in patients with IBD ( 24 ), the diagnosis of IgAN mainly relies on pathological biopsy ( 25 , 26 ). However, the acceptance rate and execution rate of renal biopsy are not sufficient.…”

Study on the Effect of Combination of Prednisone and Vitamin D in the Treatment of Primary Nephrotic Syndrome in Children

“…As an autoimmune disease, immune function plays an essential role in developing and progressing primary nephrotic syndrome [15]. It was found that the majority of children with nephropathy have significantly disturbed immune function, which was analyzed as a result of T-lymphocyte subsets that affect the immune status of the organism.…”

Sustained release of Lactobacillus casei cell wall extract can induce a continuous and stable IgA deposition model

“…Therefore, other susceptible strains, such as 129/Sv mice or genetically modified mice, subjected to LCWE challenges, may be more suitable for exhibiting the IgAN phenotype, which can better reflect the human situation and address the clinical problems. Thus, our model will be a useful tool for investigating IgA or IgA immune complex production and deposition in the kidney (hit1, 2, 3) [43] in IgAN.…”