IgA nephropathy is the most common form of primary glomerulonephritis which mainly accounts for the development of end-stage renal diseases. It is characterized by deposits of IgA1 in mesangium. The pathogenesis of IgA nephropathy is complicated. Moreover, there is a wide range of clinical features and variable histomorphologies in the diagnosed cases of IgA nephropathy. It was demonstrated that the galactose-deficient of IgA1 O-glycan chains led IgA1 to self-aggregation and eventual deposition in mesangium. Abnormality of glycosyltransferases, genetic mutation and immunologic disorder were involved in the aberrant glycosylation of IgA1 which was recognized as the key etiopathogenisis of IgA nephropathy. However, the exact source and the pathogenic mechanism of aberrantly glycosylated IgA1 remain obscure. The further studies on aberrant O-glycosylation of IgA1 would contribute to the understanding of IgA nephropathy and provide new therapeutical strategy.
Animals ; Glomerulonephritis, IGA ; etiology ; metabolism ; Glycosylation ; Humans ; Immunoglobulin A ; metabolism

OBJECTIVETo highlight current knowledge about M-type phospholipase A2 receptor (PLA2R) which is the first human autoantigen discovered in adult idiopathic membranous nephropathy.

DATA SOURCESRelevant articles published in English from 2000 to present were selected from PubMed. Searches were made using the terms "idiopathic membranous nephropathy, M-type PLA2R and podocyte."

STUDY SELECTIONArticles studying the role of M-type PLA2R in idiopathic membranous nephropathy were reviewed. Articles focusing on the discovery, detection and clinical observation of anti-PLA2R antibodies were selected.

RESULTSM-type PLA2R is a member of the mannose receptor family of proteins, locating on normal human glomeruli as a transmembrane receptor. The anti-PLA2R in serum samples from MN were primarily IgG4 subclass. Technologies applied to detect anti-PLA2R autoantibody are mainly WB, IIFT, ELISA and so on. Studies from domestic and overseas have identified a strongly relationship between circulating anti-PLA2R levels and disease activity.

CONCLUSIONRecent discoveries corresponding to PLA2R facilitate a better understanding on IMN pathogenesis and may provide a new tool to its diagnosis, differential diagnosis, risk evaluation, response monitoring and patient-specific treatment.

Animals ; Autoantigens ; metabolism ; Glomerulonephritis, Membranous ; immunology ; metabolism ; Humans ; Podocytes ; metabolism ; Receptors, Phospholipase A2 ; metabolism

Female ; Glomerulonephritis, IGA ; metabolism ; pathology ; Glomerulonephritis, Membranous ; metabolism ; pathology ; Glomerulosclerosis, Focal Segmental ; metabolism ; pathology ; Humans ; Kidney ; metabolism ; pathology ; Male ; Renal Insufficiency, Chronic ; metabolism ; pathology

Azathioprine is commonly used as immunosuppressive therapy for various inflammatory diseases including chronic glomerulonephritis. Myelosuppression is a common side effect of azathioprine, resulting in the need for dose reduction. However, severe pancytopenia or alopecia is not often encountered. Here, we report a case of severe myelosuppression, and alopecia totalis that occurred after azathioprine treatment in a patient with IgA nephropathy. A 10-year-old boy with IgA nephropathy was treated with oral deflazacort and later with azathioprine. After 4 weeks, the patient complained of hair loss, and despite a dose reduction in azathioprine, he developed bone marrow suppression and alopecia totalis in two weeks. The blood indices and alopecia of the patient had returned to normal after azathioprine withdrawal and 3 consecutive doses of granulocyte colony-stimulating factor. We suggest that physicians remain vigilant to the side effects of azathioprine. Unusual hair loss after azathioprine treatment might suggest a defect in the metabolism of the drug, warranting the discontinuation of azathioprine to prevent more severe side effects.
Alopecia* ; Azathioprine* ; Bone Marrow ; Child ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Granulocyte Colony-Stimulating Factor ; Hair ; Humans ; Immunoglobulin A* ; Male ; Metabolism ; Pancytopenia

BackgroundChronic kidney disease has become a leading public health concern in China, as it is associated with increased morbidity, mortality, and costs. However, the overall situation regarding common glomerular diseases in China remains unclear. Hence, the aim of this study was to assess the national profile of the common types of glomerulonephritis in China.

MethodsWe searched Medline, Embase, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang databases for English and Chinese language articles from inception to September 2017. We also collected potentially relevant studies and reviews using a manual search. The following words in combinations are as keywords: "renal biopsy", "kidney pathological diagnosis", and "spectrum of pathological types".

ResultsWe identified 23 studies involving 176,355 patients from 15 provinces/cities in China. The detection rates of primary glomerulonephritis (PGN) and secondary glomerulonephritis (SGN) were 0.740 and 0.221, respectively. Over the past 30 years, the top five types of PGN were immunoglobulin A nephropathy (IgAN; 24.3%), mesangial proliferative glomerulonephritis (MsPGN; 10.5%), membranous nephropathy (MN; 12.6%), minimal change disease (MCD; 9.8%), and focal segmental glomerulosclerosis (FSGS; 4.6%), and the top four types of SGN were lupus nephritis (LN; 8.6%), Henoch-Schönlein purpura glomerulonephritis (4.1%), hepatitis B virus-associated glomerulonephritis (HBV-GN; 2.6%), and diabetic nephropathy (DN; 1.6%). The proportion of MN, MCD, HBV-GN, and DN tended to increase, while those of IgAN, MsPGN, FSGS, and LN tended to drop.

ConclusionsAlthough the incidence of SGN is increasing gradually, PGN is still the leading form of kidney disease in patients undergoing renal biopsies in China. IgAN and LN are the most common types of PGN and SGN, respectively. Differences between regions are related to various factors such as nationality, environment, and diet. Furthermore, unified standards and norms for evaluating renal biopsies are urgently needed.

Biopsy ; methods ; Glomerulonephritis ; diagnosis ; metabolism ; Humans ; Renal Insufficiency, Chronic ; diagnosis ; metabolism

Complement C3 ; metabolism ; Fluorescent Antibody Technique ; Glomerulonephritis, IGA ; diagnosis ; metabolism ; Glomerulonephritis, Membranous ; diagnosis ; metabolism ; Humans ; Immunoglobulin G ; metabolism ; Immunohistochemistry ; methods ; Kidney ; chemistry ; pathology ; ultrastructure ; Kidney Diseases ; diagnosis ; metabolism ; Microscopy, Electron ; Nephritis ; diagnosis ; metabolism

The aim of this study was to determine the relationship of alpha-smooth muscle actin (ASMA) and the proliferation marker Ki-67 of glomerulonephritis (GN). Immunohistochemical stainings with the usual streptavidin-biotin peroxidase method were performed on 86 renal biopsies using monoclonal 1A4 and Ki-67. The results of the quantitative evaluation of ASMA and Ki-67 were analyzed for the correlation between positive value of ASMA and Ki-67 in different GN. ASMA expressions of glomeruli were highest in acute post-infectious GN [APGN; 16.9 Fraction Volume (FV)%], followed by unclassified proliferative GN (UnGN; 12.5 FV%), membranoproliferative GN (MPGN; 8.5 FV%), lupus nephritis (LupusN; 6.3 FV%), IgA nephritis (IgAN; 5.6 FV%), and normal control (0.1 FV%). The Ki-67 staining was considerably elevated in lupusN (4.3 Ki-67 positives/glomerulus), APGN (2.7), MPGN (2.5), UnGN (1.66), IgAN (0.5), compared with that in normal control group (0.1 Ki-67 positives/glomerulus). Ki-67 value in each category of glomerular diseases was significantly different from that in the control biopsies (p<0.004). The relationship between morphometric results of ASMA and Ki-67 was statistically significant regardless of the diagnosis. (rs=0.425, p=0.000, ASMA= 0.1113+0.1665 Ki-67). In conclusion, the immunohistochemical assessment of ASMA and Ki-67 expression in GN might be a reliable indicator for the progression of GN. This study indicates that active cellular proliferation is associated with increased actin deposition in glomeruli.
Actins/*analysis ; Biopsy ; Cell Division ; Glomerulonephritis/*metabolism/pathology ; Human ; Immunohistochemistry ; Ki-67 Antigen/*analysis ; Kidney/pathology

OBJECTIVETo estimate the oxidative stress and oxidative damage induced by abnormal free radical reactions in IgA nephropathy (IgAN) patients' bodies.

METHODSSeventy-two IgA N patients (IgANP) and 72 healthy adult volunteers (HAV) were enrolled in a random control study design, in which the levels of nitric oxide (NO) in plasma, lipoperoxide (LPO) in plasma and in erythrocytes, and vitamin C (VC), vitamin E (VE) and beta-carotene (beta-CAR) in plasma as well as the activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) in erythrocytes were determined with spectrophotometric methods.

RESULTSCompared with the HAV group, the averages of NO in plasma, and LPO in plasma and in erythrocytes in the IgANP group were significantly increased (P<0.0001), while those of VC, VE and beta-CAR in plasma as well as those of SOD, CAT and GPX in erythrocytes in the IgANP group were significantly decreased (P<0.0001). Linear correlation analysis showed that with the increase of the values of NO, and LPO in plasma and in erythrocytes, and with the decrease of those of VC, VE, beta-CAR, SOD, CAT and GPX in the IgAN patients, the degree of histological damage of tubulointerstitial regions was increased gradually (P<0.0001); and that with the prolongation of the duration of disease the values of NO, and LPO in plasma and erythrocytes were increased gradually, while those of VC, VE, beta-CAR, SOD, CAT and GPX were decreased gradually (P<0.005). The discriminatory correct rates of the above biochemical parameters reflecting oxidative damage of the IgAN patients were 73.8%-92.5%, and the correct rates for the HAV were 70.0%-91.3% when independent discriminant analysis was used; and the correct rate for the IgAN patients was increased to 98.8%, the correct rate for the HAV was increased to 100% when stepwise discriminant analysis was used. The above biochemical parameters' reliability coefficient (alpha) were used to estimate the oxidative damage of the IgAN patients as 0.8145, the standardized item alpha=0.9730, F=53273.5681, P<0.0001.

CONCLUSIONSA series of free radical chain reactions caused serious pathological aggravation in the IgANP' bodies, thus resulting in oxidative damage in their bodies. In treating IgANP, therefore, it is necessary that suitable dose antioxidants should be supplemented to them so as to alleviate the oxidative damage in their bodies.

Adult ; Antioxidants ; metabolism ; Female ; Free Radicals ; blood ; Glomerulonephritis, IGA ; blood ; Humans ; Male ; Oxidative Stress

C1q nephropathy is a rare type of glomerulonephritis manifested as the deposition of C1q in the glomerular mesangium during immunofluorescent staining. Systemic lupus erythematosus and type I membranoproliferative glomerulonephropathy need to be excluded in the diagnosis of C1q nephropathy. C1q nephropathy has various manifestations under a light microscope, mainly including minimal change disease, focal segmental glomerulosclerosis, and proliferative glomerulonephritis. This disease is mainly manifested as persistent proteinuria or nephrotic syndrome and occurs more frequently in boys. Currently, glucocorticoids are mainly used for the treatment of this disease. Patients with C1q nephropathy show a good response to immunosuppressant treatment, but have a high rate of glucocorticoid resistance. Therefore, in this case, methylprednisolone pulse therapy or a combination with immunosuppressant treatment helps to achieve a good prognosis.
Complement C1q ; metabolism ; Diagnosis, Differential ; Glomerulonephritis ; diagnosis ; drug therapy ; etiology ; Glucocorticoids ; therapeutic use ; Humans ; Prognosis

To determine the relationship between the urinary endothelin (ET-1), nitric oxide (NO) levels and the clinical, pathologic types of primary glomerulonephritis (GN) patients, urinary levels of ET-1 and NO were detected in 27 patients with biopsy-proven primary GN and 12 normal controls by radioimmunoassay and by copper-plated and cadmium column reduction assay, respectively. The results showed that urinary ET-1 levels in the patients with primary GN were significantly higher than in normal controls (p < 0.01), while the urinary ET-1 levels in patients with moderate mesangial proliferation GN were significantly higher than those in patients with mild mesangial proliferation GN (p < 0.05). Urinary ET-1 levels in patients whose clinical feature was nephrotic syndrome were found to be higher than in patients whose clinical feature was nephritic syndrome. However, urinary NO levels were to the contrary (p < 0.05). The ratio of ET-1/NO in primary GN patients was significantly higher than that in normal controls, and it positively correlated with the 24-hour urinary excretion of protein. These results suggest that urinary ET-1 levels are related to the proliferation of mesangial cells. The imbalance between ET-1 and NO may be related to the pathogenesis of primary GN and the occurrence of proteinuria.
Adolescence ; Adult ; Endothelin-1/urine* ; Endothelin-1/physiology ; Female ; Glomerulonephritis/urine* ; Glomerulonephritis/etiology ; Human ; Male ; Middle Age ; Nitric Oxide/urine* ; Nitric Oxide/physiology ; Nitric-Oxide Synthase/metabolism