Sodium Cromoglycate Therapy in IgA Nephropathy: A Preliminary Short-Term Dial

Sato, Masashi; Takayama, Kimihiro; Kojima, Hiroomi; Koshikawa, Shozo

doi:10.1016/s0272-6386(12)80511-7

Cited by 18 publications

(6 citation statements)

References 17 publications

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“…By contrast, a Japanese study in which patients with IgAN were given SCG at a higher dosage (1,200 mg per day for 16 weeks) noted a significant reduction in proteinuria in the 15 SCG-treated patients compared with 15 control patients not treated with SCG 58 . Five of the 15 SCG-treated patients had decreased proteinuria by >50% 58 .…”

Section: Intervention Studiesmentioning

confidence: 95%

The mucosa–kidney axis in IgA nephropathy

2015

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Links between IgA nephropathy (IgAN) and the mucosa have been recognized since the 1970s. In particular, the observation of visible haematuria induced by respiratory infections in patients with IgAN and the association of IgAN with diseases in which the mucosa plays a part, especially coeliac disease, have been taken as evidence of a mucosa-kidney axis. Here, we review current evidence that links the mucosa, in particular the gastrointestinal mucosa, and IgA produced by the bone marrow with IgAN. Genome-wide association studies in patients with IgAN have identified risk loci in genes involved in the intestinal mucosal integrity and immune network. Furthermore, the systemic immune response to mucosal antigens in IgAN is increased. Moreover, patients with IgAN have an increased reactivity to dietary proteins associated with subclinical intestinal mucosal inflammation. Associations between IgAN and gastrointestinal diseases have also been reported in a small number of patients, but whether these diseases share a common pathogenesis or whether gastrointestinal inflammation exacerbates IgAN is uncertain. Indeed, mucosal alterations such as infections could activate the innate immune system, aggravate a pre-existing IgAN and promote disease manifestations such as macrohaematuria. Various clinical interventions and trials targeting the mucosa or presumed mucosa-associated mechanisms have so far not yielded consistent findings and the results of ongoing trials are eagerly awaited.

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Section: Intervention Studiesmentioning

confidence: 95%

The mucosa–kidney axis in IgA nephropathy

2015

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“…33-35] has yet been effec tive in controlled trials involving patients with moderate 1GAN. An open trial gave good results with sodium cromoglycate in IGAN [36], while another recently failed to show any influence on proteinuria [37]. An open trial has shown the benefit of danazol at a dose o f 200 mg/day, but the numerous side effects of this androgen have precluded its use and evaluation [38].…”

Section: Discussionmentioning

confidence: 99%

Immunomodulation with Low-Dose Immunoglobulins for Moderate IgA Nephropathy and Henoch-Schönlein Purpura

Rostoker

Desvaux-Belghiti²,

Pilatte

et al. 1995

Nephron

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Recently, our group has shown that a 3-month course of intravenous immunoglobulin (2 g/kg/monthly) followed by 6 months of intramuscular immunoglobulins (IMIG, 16.5%, 0.35 ml/kg every 15 days) was able to slow or to stop the decline in the glomerular filtration rate, to reduce proteinuria, hematuria, leukocyturia and the histological index of activity on renal biopsy in patients with severe forms of IgA nephropathy (IGAN) and Henoch-Schönlein purpura (HSP). The aim of this open prospective trial was to evaluate the efficacy and safety of low-dose immunoglobulin therapy in moderate IGAN and HSP with permanent proteinuria. Fourteen patients with moderate IGAN [idiopathic IGAN: n= 11; chronic idiopathic HSP: n = 3] and permanent albuminuria were treated with polyvalent IMIG (16.5%) for 9 months (0.35 ml/kg once a week for 1 month, followed by 0.35 ml/kg every 15 days for a further 8 months). Eligibility criteria in the study were Lee histological stage I, II or III, albuminuria between 300 and 2,000 mg/ day and a glomerular filtration rate > 70 ml/min/1.73 m². IMIG were well tolerated and only 1 patient withdrew from the trial. No viral, renal or immunological side effects were observed. IMIG induced a significant decrease in albuminuria as well as in the histological activity index in the 11 cases in which a follow-up biopsy was performed. There was also a decrease in serum IgA, serum β₂-microglobulin and IgA immune complex levels, and an increase in serum IgG₁ levels. Twelve of the 13 evaluable patients improved during treatment. Systemic symptoms disappeared after 2 months of starting IMIG in the 3 HSP patients. IMIG therapy for IGAN only appeared to be suspensive, since its withdrawal was followed by relapse. We conclude that IMIG may be an effective immunomodulatory treatment of IGAN and HSP, although prospective controlled trials are required to confirm these preliminary results.

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“…A summary of results of this study indicates that; (1) The pathogenesis of IgA N has not been fully eluci dated; however, the participation of virus, bacteria or food 23 antigens has been discussed on the basis of the results of experimental models [13,14]. From a series of our investiga tions concerning a food antigen in IgA N [15][16][17], a chronic and persistent exposure of antigens may be necessary to induce the deposition of IgA in glomerular mesangium, as previously discussed [13], which may indicate the conver sion from naive T cells to memory T cells. This may be one of the reasons that a persistent depletion of percentage of CD45RA+ T cells and a persistent elevation of that of CD45RO+ T cells in the peripheral blood are seen in IgA N. The conversion to memory cells from naive cells indi cates, partly, an elevation of helper T cell functions.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Serum IgA Levels and CD4 Subsets in IgA Nephropathy

Sato

Haizuka²,

Asakura³

1994

Nephron

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In this study, the relationship between serum levels of IgA (s-IgA) and CD4 subsets in peripheral blood was investigated in patients with IgA nephropathy (IgA N). We have also recently reported that the percentage of CD4 + CD45RA+ cells was significantly decreased in this disease. Serum levels of immunoglobulins (IgG, IgA, IgM) and the percentage of CD4 + CD45RA+ cells or CD4 + CD45RO + cells were measured by two-color analysis in blood samples obtained from 45 patients with IgA N, 30 patients with various glomerulonephritides and 30 healthy volunteers. A significant decrease of CD4 + CD45RA+ cells and a significant increase of CD4 + CD45RO+ cells were observed in the IgA N group. Moreover, in the IgA N group, s-IgA correlated negatively with the percentage of CD4 + CD45RA+ cells and correlated positively with that of CD4 + CD45RO + cells. After 1 and 2 years, the same analyses were serially performed in 15 nonmedicated patients with IgA N. Similar results concerning the relationship between s-IgA and CD4 subsets were obtained both after 1 and 2 years. The percent changes of s-IgA (Δs-IgA) correlated with ΔCD4 + CD45RO + cells: r = -0.66483 (p < 0.01) after 1 year, r = -0.69688 (p < 0.01) after 2 years. On the other hand, Δs-IgA correlated with ΔCD4 + CD45RA+ cells (p < 0.05) after 1 year, but no after 2 years. It was concluded that s-IgA levels strongly correlate with the percentage of CD4 + CD45RO+ cells in peripheral blood, in patients with IgA N.

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Sodium Cromoglycate Therapy in IgA Nephropathy: A Preliminary Short-Term Dial

Cited by 18 publications

References 17 publications

The mucosa–kidney axis in IgA nephropathy

The mucosa–kidney axis in IgA nephropathy

Immunomodulation with Low-Dose Immunoglobulins for Moderate IgA Nephropathy and Henoch-Schönlein Purpura

Relationship between Serum IgA Levels and CD4 Subsets in IgA Nephropathy

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