Mucosal Immunity in Primary Glomerulonephritis

Abstract

To study the specificity of gut hyperpermeability in primary glomerulonephritis, we investigated intestinal permeability by means of ⁵¹Cr-EDTA testing in 20 healthy individuals and in 30 patients with Immunoglobulin A nephropathy (IgA GN), 25 with idiopathic nephrotic syndrome (INS) and 20 with immune complex glomerulonephritis (IC-GN; membranous + membranoproliferative glomerulonephritis). Gut permeability was statistically increased in each patient group versus the controls [controls: 2% (0.4-3.9); IgA GN: 3.25% (0.7-17.70); INS: 3.71% (0.82-10); IC-GN: 3.40% (0.30-16); results are median (range); p < 0.005, nonparametric Mann-Whitney test]. An increase in intestinal permeability exceeding the upper limit of control values (95th percentile) was observed in 36% of IgA GN, 60% of INS and 50% of IC-GN patients. We conclude that intestinal permeability is frequently increased in primary glomerulonephritis and may also be increased in types of glomerulonephritis other than IgA GN.

Role of the kidney in the metabolism of apolipoprotein A-IV: influence of the type of proteinuria

“…On the other hand, experiments in experimental nephrotic rats revealed a compensatory increase in intestinal apoA-IV mRNA levels in response to the urinary loss of apoA-IV (37). ApoA-IV could also be lost into the intestinum by an intestinal hyperpermeability, resulting in a leakage of enterocyte-derived apoA-IV into the intestinal lumen (38). Similar intestinal losses in patients with nephrotic syndrome have been described for albumin (39,40).…”

Measurement of the intestinal permeability in chronic kidney disease

“…The studies that used 51 Cr-EDTA as a marker for intestinal permeability corrected for renal function by dividing the 24 h 51 Cr-EDTA excretion by the plasma creatinine level [20][21][22][23]34] . The radioactivity is nevertheless a major disadvantage that has caused this method to be considered out of date.…”

“…Further research is required to evaluate difference between the influence of HD vs PD on the intestinal permeability. Studies assessing the intestinal permeability in mild to moderate CKD, mostly IgA nephropathy patients [15,23,27,34] , yielded conflicting results. Even though some studies [21,34] reported a significantly increased permeability compared to the healthy controls, other studies could not confirm this finding [15,16,27] .…”

IgA Glycosylation in IgA Nephropathy

“…However, it is not clear that tonsil is strictly a mucosal lymphoid tissue. One study showed that raised serum and salivary levels o f secretory IgA, suggesting mucosal activation, were not restricted to IgAN, but were also formd in other primary glomerulonephritides (Rostoker 1992). Studies on duodenal lamina propria show that mucosal…”