Worse Urinary Findings after Stimulating Tonsils in Patients with IgA Nephropathy

Yamabe, Hideaki; Ohsawa, Hiroshi; Inuma, Hiroshi; Miyata, Mikio; Sasaki, Takashi; Yoshikawa, Shoko; Kaizuka, Mituaki; Tamura, Naoyuki; Onodera, Kenji

doi:10.1159/000187781

Cited by 7 publications

(12 citation statements)

References 6 publications

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“…Recurrent gross hematuria is often recognized in concomitance with acute episodes of mucosal infection, especially that of upper respiratory, gastrointestinal or urogenital tract, in a subset of patients with IgAN, suggesting that IgAN may be caused by hypersensitivity of mucosal IgA system. The clinical deterioration after tonsil stimulation is more frequent in IgAN than in other renal diseases (14). In addition, it has been reported that stimulation of the tonsils causes serum IL-6 elevation and changes in the urinary IL-6 levels in IgAN cases (15).…”

Section: Discussionmentioning

confidence: 99%

Association of Gene Polymorphism of Polymeric Immunoglobulin Receptor and IgA Nephropathy.

et al. 2001

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Objective In order to explore the possibility that genetic predisposition to dysfunction of mucosal immunity and the IgA processing pathway plays a role in the pathogenesis of mesangial IgAl deposition in IgAN, we examined the possible association of the gene polymorphismof plgR in the patients with and without IgAN. Subjects and Methods Genomic DNAof peripheral blood cells was isolated from 372 individuals including 172 histologically confirmed IgAN patients. Segments of the plgR gene were PCRamplified and restriction fragment length polymorphism was determined as Al and A2 with and without Pvu II site, respectively. Results The plgR genotype distribution was significantly different between the patients with IgAN and those without IgAN. Allele frequency ofA2 was higher in IgAN than in other renal diseases (Al and A2; 0.516 and 0.484 in IgAN, 0.641 and 0.359 in others, %2=9.84, P=0.0017, Odds ratio=1.71). Moreover, the subjects with A2A2genotype were associated with a relatively low level of serum IgA only in the patients with IgANbut not in other renal diseases. The difference of allele frequencies was moreremarkable in the patients with a serum IgA level of less than 300 mg/dl (Al and A2; 0.439 and 0.561 in IgAN, 0.702 and 0.298 in others, %2=12.44, P=0.0004, Odds ratio=3.01). Conclusion This is the first demonstration of the plgR gene polymorphisms in IgANwhich are associated with its clinical phenotype. Gene polymorphisms of plgR may be candidate genetic markers of susceptibility to IgAN. (Internal Medicine 40: 867-872, 2001)

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Section: Discussionmentioning

confidence: 99%

Association of Gene Polymorphism of Polymeric Immunoglobulin Receptor and IgA Nephropathy.

et al. 2001

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“…All patients gave informed consent, and each tonsil was stimulated for 5 min with the direct Tonsil Provocator (Nagashima Medical Instruments, Tokyo, Japan) producing an ultrashort wave (2,450 MHz, 12 W) [7, 8]. Serum and urine samples were obtained before and 3 h and 2 and 7 days after the tonsil stimulation.…”

Section: Methodsmentioning

confidence: 99%

“…The mechanical tonsil stimulation produces a similar condition to that induced by upper respiratory tract infection. The tonsil stimulation has been reported to increase proteinuria and hematuria in some cases with IgA nephropathy [7, 8]. However, the contribution of chronic tonsillitis to the progression of IgA nephropathy has not been determined.…”

Section: Introductionmentioning

confidence: 99%

“…Body temperature, white blood cell count (WBC), erythrocyte sedimentation rate, and proteinuria 2–3 h after tonsil stimulation are evaluated. When the body temperature rises over 0.5°C, the WBC increases by more than 1,000/mm 3 the erythrocyte sedimentation rate increases more than 10 mm/h, or the urinary protein excretion increases more than 30 mg/dl, it is regarded as a deleterious change [2, 7, 8]. But in patients with IgA nephropathy complicated by chronic tonsillitis, the results of the tonsil provocation test are not always correlated with the effect of tonsillectomy in long-term studies [5, 6].…”

Section: Introductionmentioning

confidence: 99%

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Increased Urinary Excretion of Macrophage-Colony-Stimulating Factor (M-CSF) in Patients with IgA Nephropathy: Tonsil Stimulation Enhances Urinary M-CSF Excretion

Matsuda

Shikata²,

Wada³

et al. 1999

Nephron

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Upper respiratory tract infection including chronic tonsillitis is considered to be involved in the onset and/or the progression of IgA nephropathy. It is well known that deterioration of urinary findings occurs after episodes of upper respiratory tract infection in patients with IgA nephropathy. We previously showed that the expression of macrophage-colony-stimulating factor (M-CSF) is increased in the glomeruli of patients with IgA nephropathy and correlated with glomerular mesangial proliferation, suggesting that M-CSF plays an important role in the progression of IgA nephropathy. In the present study, we measured the serum and urinary concentrations of M-CSF in patients with IgA nephropathy associated with chronic tonsillitis. Furthermore, we evaluated the effects of the local provocation test of tonsils (mechanical tonsil stimulation) on the serum and urinary concentrations of M-CSF in the following three groups: (1) IgA nephropathy with severe mesangial proliferation, (2) IgA nephropathy with mild mesangial proliferation, and (3) patients with chronic tonsillitis without renal disease. The serum and urinary levels of M-CSF in the groups with severe and mild IgA nephropathy were significantly higher than those in the chronic tonsillitis group. The urinary M-CSF level but not the serum M-CSF level was positively correlated with the degrees of mesangial proliferation and glomerular M-CSF expression in the renal biopsy specimens. The urinary M-CSF concentration was significantly increased after tonsillitis stimulation in both mild and severe IgA nephropathy groups. Enhanced urinary excretion of M-CSF prolonged for 7 days after tonsil stimulation in the severe IgA nephropathy group; in contrast, the urinay M-CSF level was increased for only 2 days after tonsil stimulation in the mild IgA nephropathy group. The urinary M-CSF level was not changed in the chronic tonsillitis group after tonsil stimulation. The serum concentrations of M-CSF were not changed after tonsil stimulation in these three groups. Our present results suggest that tonsil stimulation contributes to the progression of IgA nephropathy via enhancement of glomerular production of M-CSF. The urinary excretion of M-CSF may be a useful predictor to evaluate the relevance of chronic tonsillitis to the disease and the indication of tonsillectomy in patients with IgA nephropathy.

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“…Furthermore, recurrence of mesangial IgA deposits is seen in approximately 50% of IgA nephropathy patients undergoing renal transplantation (4), while these deposits disappear in most patients without IgA nephropathy after renal transplantation from a patient with IgA nephropathy (5,6). In addition, patients with IgA nephropathy often develop gross hematuria following upper respiratory infection, and tonsil stimulation by an ultra short wave may cause deteriorated urinary findings at 3 h after the mechanical stimulation (7,8). These findings suggest that extrarenal factors and humoral factors are involved in IgA nephropathy.…”

Section: Introductionmentioning

confidence: 99%

Correlation of serum levels of complement C4a desArg with pathologically estimated severity of glomerular lesions and mesangial hypercellularity scores in patients with IgA nephropathy

Sogabe

Uto

Kanmura

et al. 2013

International Journal of Molecular Medicine

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Abstract. The aim of the present study was to explore serum biomarkers for the pathology of IgA nephropathy using serum proteomics. The subjects were 57 patients with IgA nephropathy who were divided into two groups (group 1, n=25; group 2, n=32) and 14 healthy controls. Serum protein profiles were analyzed using the ProteinChip surface-enhanced laser desorption ionization (SELDI) system. Associations between signal intensities of proteins and histological findings in patients with IgA nephropathy were studied in group 1. Serum levels of a candidate biomarker protein (complement component C4a desArg) for IgA nephropathy were determined by enzyme linked-immunosorbent assay (ELISA) in group 2 and the relationships of these levels with histological findings were evaluated. There were significant differences in 93 protein signals between patients in group 1 and controls. Among these signals, 3 proteins at 8592, 8757 and 8806 m/z were significantly correlated with the severity of glomerular lesions. The protein at 8592 m/z was identified as C4a desArg and the signal intensity of 8592 m/z was strongly correlated with serum C4a levels, including C4a desArg, determined by ELISA. In addition, the serum levels of C4a (mainly C4a desArg) were significantly higher in patients in group 2 compared to controls and were correlated with the severity of glomerular lesions and with mesangial hypercellularity scores. In conclusion, the serum levels of complement C4a desArg are significantly higher in patients with IgA nephropathy compared to healthy controls and are significantly correlated with the severity of glomerular lesions and mesangial hypercellularity scores. Thus, serum C4a desArg is a potential biomarker for the severity of histological findings in patients with IgA nephropathy.

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Worse Urinary Findings after Stimulating Tonsils in Patients with IgA Nephropathy

Cited by 7 publications

References 6 publications

Association of Gene Polymorphism of Polymeric Immunoglobulin Receptor and IgA Nephropathy.

Association of Gene Polymorphism of Polymeric Immunoglobulin Receptor and IgA Nephropathy.

Increased Urinary Excretion of Macrophage-Colony-Stimulating Factor (M-CSF) in Patients with IgA Nephropathy: Tonsil Stimulation Enhances Urinary M-CSF Excretion

Correlation of serum levels of complement C4a desArg with pathologically estimated severity of glomerular lesions and mesangial hypercellularity scores in patients with IgA nephropathy

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