Up-regulation of urinary markers predict outcome in IgA nephropathy but their predictive value is influenced by treatment with steroids and azathioprine.
Title | Up-regulation of urinary markers predict outcome in IgA nephropathy but their predictive value is influenced by treatment with steroids and azathioprine. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Stangou, M., Papagianni A., Bantis C., Moisiadis D., Kasimatis S., Spartalis M., Pantzaki A., Efstratiadis G., & Memmos D. |
Journal | Clin Nephrol |
Volume | 80 |
Issue | 3 |
Pagination | 203-10 |
Date Published | 2013 Sep |
ISSN | 0301-0430 |
Keywords | Adolescent, Adult, Aged, Analysis of Variance, Azathioprine, Biological Markers, Biopsy, Creatinine, Cytokines, Disease Progression, Drug Therapy, Combination, Female, Fibrosis, Glomerulonephritis, IGA, Humans, Immunosuppressive Agents, Inflammation Mediators, Kaplan-Meier Estimate, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Proteinuria, Steroids, Time Factors, Treatment Outcome, Up-Regulation, Young Adult |
Abstract | OBJECTIVE: Steroids and immunosuppressants can delay progression of renal function in IgAN, but their possible effect in local cytokines has not been studied.MATERIAL AND METHODS: Histology in 53 IgAN patients (M/F 35/18 age 40.5 years (17 - 65)) was evaluated using the Oxford classification system. IL-1β, -2, -4, -5, -6, -10, -12 and -17, INF-γ and MCP-1 were measured subsequently by multiplex cytokine assay in first morning urine samples taken at the day of renal biopsy. After a 6-month course with RAASinhibitors + fish oils (FO), 35/53 patients, Group A, responded and continued on the same treatment, while in 18/53 who did not respond, Group B, steroids + azathiopine were added.RESULTS: The presence of endocapillary proliferation had significant correlation with the urinary excretion of pro-inflammatory and pro-fibrotic cytokines (IL-1β, MCP-1, IL-17, INF-γ, IL-6 and IL-10). Serum creatinine at time of diagnosis had significant correlation with proteinuria (p = 0.02), urinary levels of IL-1β (p = 0.03), IL-2 (p = 0.01) and MCP-1 (p = 0.03). GFR was reduced from 65 ± 29 to 57 ± 34 ml/min, p = 0.005 in Group A and remained stable in Group B patients (GFR from 63 ± 24 to 61 ± 30 ml/min, p = NS). Most of the measured cytokines in the urine predicted deterioration of renal function in Group A, but the urinary excretion of IL-6 seemed to predict renal function outcome in both groups of patients.CONCLUSION: Several cytokines are excreted in the urine of patients with IgAN, and their levels predict the outcome of the disease. Steroids + aza may exert their beneficial effect through suppression of the production or activation of most cytokines. |
DOI | 10.5414/CN107836 |
Alternate Journal | Clin. Nephrol. |
PubMed ID | 23611517 |