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Open Access 09-07-2022 | Crohn's Disease | Original Article

Crohn’s disease may promote inflammation in IgA nephropathy: a case–control study of patients undergoing kidney biopsy

Authors: Minako Akiyama, Kosuke Shimomura, Hiroshi Yoshimoto, Minako Sako, Makoto Kodama, Keiko Abe, Mariko Gunji, Dedong Kang, Takashi Takaki, Yukihiro Wada, Masayuki Iyoda, Kazuho Honda

Published in: Virchows Archiv | Issue 4/2022

Abstract

Intestinal immunity has been closely associated with the pathogenesis and progression of renal diseases, a relationship known as the “gut–kidney axis.” To determine the association between immunoglobulin A nephropathy (IgAN) and Crohn’s disease (CD), a clinico-pathological study was performed on patients who had IgAN with CD (CD-IgAN) and without CD (NOS-IgAN). We enrolled 29 patients diagnosed with IgAN via renal biopsy at the Tokyo Yamate Medical Center from 2009 to 2017. The patients were divided into CD-IgAN (n = 18) and NOS-IgAN (n = 11) and evaluated for clinical and pathological findings. IgA subclasses and galactose-deficient IgA1 (Gd-IgA1) were examined via immunohistochemistry using formalin-fixed paraffin-embedded sections from renal biopsy. Our results showed no significant difference in the extent of mesangial IgA subclasses or Gd-IgA1 deposition according to the presence or absence of CD. Pathologically, however, those with CD-IgAN had remarkably higher percentage of global glomerulosclerosis and extent of interstitial fibrosis and tubular atrophy (IF/TA) compared to those with NOS-IgAN. Moreover, the extent of macrophage infiltration in the glomerulus and interstitium was significantly higher in CD-IgAN than in NOS-IgAN. Clinically, the CD-IgAN group had significantly worse responsiveness to steroid treatment compared to the NOS-IgAN group. In conclusion, the similar immunological characteristics of deposited IgA molecules in the glomeruli between the CD-IgAN and NOS-IgAN groups might suggest their etiological similarity. However, a renal pathology showing advanced glomerular and tubulointerstitial sclerosis accompanying increased macrophage infiltration and highly resistant clinical features in patients with CD-IgAN suggests that some pathophysiological factors in CD, including abnormal intestinal immunity, may promote and activate the inflammatory process in IgAN via undetermined mechanisms.

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Title: Crohn’s disease may promote inflammation in IgA nephropathy: a case–control study of patients undergoing kidney biopsy
Authors: Minako Akiyama
Kosuke Shimomura
Hiroshi Yoshimoto
Minako Sako
Makoto Kodama
Keiko Abe
Mariko Gunji
Dedong Kang
Takashi Takaki
Yukihiro Wada
Masayuki Iyoda
Kazuho Honda
Publication date: 09-07-2022
Publisher: Springer Berlin Heidelberg
Keywords: Crohn's Disease
Chronic Inflammatory Bowel Disease
IgA Nephropathy
Published in: Virchows Archiv / Issue 4/2022
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-022-03373-w

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