Crohn's Disease-associated IgA Nephropathy May Prone to Better Renal Outcome

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2024 Jun 21

PMID 38904865

Authors

Zhihui Yang

Xiaochang Xu

Yejing Dong

Keping Wu

Shuping Zhao

Yimin Zhang

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Renal involvement in Crohn's Disease (CD) was rare in the population. Little was known between IgA nephropathy and CD. This study aimed to investigate the differences in clinical and outcome features of CD-associated IgA nephropathy (CD-IgAN) and primary IgA nephropathy (PIgAN).

Methods: Clinical data of patients diagnosed with IgAN by kidney biopsy were collected in the Sixth Affiliated Hospital of Sun Yat-sen University from January 1st, 2016 to June 1st, 2023. 17 patients with CD-IgAN and 87 patients with PIgAN were enrolled in this retrospective study.

Results: Compared with PIgAN patients, CD-IgAN patients had lower levels of urinary protein excretion (1.57 g per 24 h vs. 0.33 g per 24 h, p < 0.01), but higher levels of estimated glomerular filtration rate (77.63 ± 40.11 ml per min per 1.73m vs. 104.53 ± 32.97 ml per min per 1.73m, p = 0.008). From the point of renal pathology of PIgAN, patients with CD-IgAN had a less incidence of tubular atrophy or interstitial fibrosis (p = 0.001). CD-IgAN patients had a higher incidence of complete remission of proteinuria (45.8% vs. 81.8%, p = 0.031) or hematuria (10.4% vs. 45.4%, p = 0.019) than PIgAN patients after twelve-month treatments.

Conclusions: CD-IgAN manifests a milder progression of renal function than those PIgAN. After the treatment, proteinuria or hematuria are more prone to remit in patients with CD-IgAN.

References

de Souza H, Fiocchi C . Immunopathogenesis of IBD: current state of the art. Nat Rev Gastroenterol Hepatol. 2015; 13(1):13-27. DOI: 10.1038/nrgastro.2015.186. View

Pardi D, Tremaine W, Sandborn W, McCARTHY J . Renal and urologic complications of inflammatory bowel disease. Am J Gastroenterol. 1998; 93(4):504-14. DOI: 10.1111/j.1572-0241.1998.156_b.x. View

Ambruzs J, Walker P, Larsen C . The histopathologic spectrum of kidney biopsies in patients with inflammatory bowel disease. Clin J Am Soc Nephrol. 2013; 9(2):265-70. PMC: 3913236. DOI: 10.2215/CJN.04660513. View

Gesualdo L, Di Leo V, Coppo R . The mucosal immune system and IgA nephropathy. Semin Immunopathol. 2021; 43(5):657-668. PMC: 8551125. DOI: 10.1007/s00281-021-00871-y. View

Forshaw M, Guirguis O, Hennigan T . IgA nephropathy in association with Crohn's disease. Int J Colorectal Dis. 2005; 20(5):463-5. DOI: 10.1007/s00384-004-0696-z. View

Filiopoulos V, Trompouki S, Hadjiyannakos D, Paraskevakou H, Kamperoglou D, Vlassopoulos D . IgA nephropathy in association with Crohn's disease: a case report and brief review of the literature. Ren Fail. 2010; 32(4):523-7. DOI: 10.3109/08860221003710554. View

Bernstein C, Eliakim A, Fedail S, Fried M, Gearry R, Goh K . World Gastroenterology Organisation Global Guidelines Inflammatory Bowel Disease: Update August 2015. J Clin Gastroenterol. 2016; 50(10):803-818. DOI: 10.1097/MCG.0000000000000660. View

Zhao L, Ren G, Fan R, Feng X, Liu Z, Cheng Z . Spectrum and prognosis of renal histopathological lesions in patients with inflammatory bowel disease: a cross-sectional study from a single center in China. Clin Exp Med. 2021; 22(4):629-635. DOI: 10.1007/s10238-021-00766-0. View

Yuan J, Wang Z, Wang Y . Identification of common key genes associated with Crohn's Disease and IgA nephropathy. Eur Rev Med Pharmacol Sci. 2022; 26(10):3607-3620. DOI: 10.26355/eurrev_202205_28857. View

10.

Coppo R, Roccatello D, Amore A, Quattrocchio G, Molino A, Gianoglio B . Effects of a gluten-free diet in primary IgA nephropathy. Clin Nephrol. 1990; 33(2):72-86. View

11.

Dong J, Chen Y, Tang Y, Xu F, Yu C, Li Y . Body Mass Index Is Associated with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10(12):e0144872. PMC: 4684381. DOI: 10.1371/journal.pone.0144872. View

12.

Terasaka T, Uchida H, Umebayashi R, Tsukamoto K, Tanaka K, Kitagawa M . The possible involvement of intestine-derived IgA1: a case of IgA nephropathy associated with Crohn's disease. BMC Nephrol. 2016; 17(1):122. PMC: 5011876. DOI: 10.1186/s12882-016-0344-1. View

13.

Liu D, You J, Liu Y, Tang X, Tan X, Xia M . Serum immunoglobulin G provides early risk prediction in immunoglobulin A nephropathy. Int Immunopharmacol. 2018; 66:13-18. DOI: 10.1016/j.intimp.2018.10.044. View

14.

Mole C, Renoult E, Bene M, Seilles E, Kessler M, Revillard J . Serum secretory IgA and IgM and free secretory component in IgA nephropathy. Nephron. 1995; 71(1):75-8. DOI: 10.1159/000188677. View

15.

Joher N, Gosset C, Guerrot D, Pillebout E, Hummel A, Boffa J . Immunoglobulin A nephropathy in association with inflammatory bowel diseases: results from a national study and systematic literature review. Nephrol Dial Transplant. 2021; 37(3):531-539. DOI: 10.1093/ndt/gfaa378. View

16.

Hassler J . IgA nephropathy: A brief review. Semin Diagn Pathol. 2020; 37(3):143-147. DOI: 10.1053/j.semdp.2020.03.001. View

17.

Wyatt R, Julian B . IgA nephropathy. N Engl J Med. 2013; 368(25):2402-14. DOI: 10.1056/NEJMra1206793. View

18.

Zhang G, Tian Z, Xue Q . Comparison of clinical and pathological features of secondary IgA nephropathy of ankylosing spondylitis and primary IgA nephropathy. Clin Nephrol. 2022; 97(5):273-280. DOI: 10.5414/CN110645. View

19.

Riley A, Wall B, Cooke C . Favorable outcome after aggressive treatment of infection in a diabetic patient with MRSA-related IgA nephropathy. Am J Med Sci. 2009; 337(3):221-3. DOI: 10.1097/MAJ.0b013e318184a4a1. View

20.

Lee M, Suzuki H, Kato R, Fukao Y, Nakayama M, Kano T . Renal pathological analysis using galactose-deficient IgA1-specific monoclonal antibody is a strong tool for differentiation of primary IgA nephropathy from secondary IgA nephropathy. CEN Case Rep. 2020; 10(1):17-22. PMC: 7829275. DOI: 10.1007/s13730-020-00508-3. View