Letter to the Editor
Immunoglobulin A Nephropathy in Rheumatic Diseases
Nefropatía IgA en las enfermedades reumáticas
Samantha Rodríguez-Muguruza
, Lourdes Mateo, Juana Sanint, Alejandro Olivé
Corresponding author
Servicio de Reumatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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array:4 [ 0 => array:2 [ "nombre" => "Hüseyin" "apellidos" => "Semiz" ] 1 => array:2 [ "nombre" => "Senol" "apellidos" => "Kobak" ] 2 => array:2 [ "nombre" => "Fidan" "apellidos" => "Sever" ] 3 => array:2 [ "nombre" => "Muamer" "apellidos" => "Karadeniz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300387?idApp=UINPBA00004M" "url" => "/21735743/0000001200000004/v3_201704050048/S2173574316300387/v3_201704050048/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Immunoglobulin A Nephropathy in Rheumatic Diseases" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "236" "paginaFinal" => "237" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Samantha Rodríguez-Muguruza, Lourdes Mateo, Juana Sanint, Alejandro Olivé" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Samantha" "apellidos" => "Rodríguez-Muguruza" "email" => array:1 [ 0 => "sam63100@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Lourdes" "apellidos" => "Mateo" ] 2 => array:2 [ "nombre" => "Juana" "apellidos" => "Sanint" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Olivé" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nefropatía IgA en las enfermedades reumáticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Immunoglobulin A nephropathy (IgAN) is a glomerulopathy characterized by the presence of mesangial deposits of IgA, either alone or showing predominance over other immunoglobulins.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The pathological study enables the diagnosis and evaluation of the disease activity. Its association with rheumatic diseases has been reported<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a>; however, the pathophysiological relationship is still not clear.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,4</span></a> For the purpose of establishing the prevalence, clinical features, analytical findings, treatment and outcome of IgAN in a cohort of patients with rheumatic disease, we conducted a retrospective study (1984–2014) in a university hospital serving a population of 850<span class="elsevierStyleHsp" style=""></span>000. We reviewed the pathological diagnoses of 27,215 patients being treated in the rheumatology department and selected those with a histological diagnosis of IgAN. We excluded the patients in whom the only rheumatic disease diagnosed was gout, osteoporosis or noninflammatory disease. We identified 6 patients (0.025%), all men. Of 1110 patients with rheumatoid arthritis, 2 (0.009%) had been diagnosed with IgAN. Of 287 patients with ankylosing spondylitis, 2 (0.69%) had IgAN. Only 1 (0.17%) of the 558 patients with psoriatic arthritis had received a diagnosis of IgAN, as was the case of 1 of the 13 patients (0.7%) with undifferentiated connective tissue disease. The mean age at the diagnosis of IgAN and of the rheumatic disease was 46.7 and 37 years, respectively (range: 34–54 and 18–67 years). The mean duration of the rheumatic disease prior to the diagnosis of IgAN was 15.4 years. Hematuria (100%), renal failure (100%) and nephrotic syndrome (8.6%) were the signs that led to the suspicion of the presence of IgAN. All 6 patients had hypertension and 8.6% had nephrotic-range proteinuria. The mean values of serum creatinine and 24-h proteinuria at the time of the diagnosis of IgAN were 1.85<span class="elsevierStyleHsp" style=""></span>mg/dL (range: 1.5–2.5) and 1.94<span class="elsevierStyleHsp" style=""></span>g (range: 0.8–4.12), respectively. Over the course of the disease, 3 patients (50%) required hemodialysis after a mean period of 5.6 years since the diagnosis (range: 2–11); all 3 underwent renal transplantation within an interval of 9–25 months after starting hemodialysis. One patient (16.6%) died at the age of 60 years (7 years after the diagnosis of IgAN) due to sepsis of pulmonary origin. During follow-up, the mean creatinine levels of the patients who did not receive dialysis was 1.4<span class="elsevierStyleHsp" style=""></span>mg/dL (range: 1.1–1.6); they were treated medically (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers).</p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of IgAN in the general population is 25–50 cases per 100<span class="elsevierStyleHsp" style=""></span>000 population<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> and, although in the majority of the patients with chronic inflammatory arthropathy, renal involvement is secondary to amyloidosis or an adverse drug reaction,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> there are reports that indicate the possible relationship between rheumatic diseases and IgAN.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a> Given the prevalence of IgAN in the general population, in some cases, its coexistence with a rheumatic disease may be coincidental. In patients with spondyloarthropathies, the relationship would be explained by the reported change in the catabolism of glycoprotein receptors and IgA-specific receptors (FcαR or CD89) found in tissue and peripheral blood.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The results of the present study do not differ from previous findings reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> The prevalence is higher in men and the clinical presentation is characterized by proteinuria, hypertension and hematuria. The cohort of patients of Azevedo et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> showed a higher frequency of calcaneal enthesitis and anterior uveitis. In accordance with our observations, in clinical practice, the diagnosis of IgAN should be considered in patients with a rheumatic disease who develop hematuria, proteinuria, renal failure and hypertension during the course of their disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Muguruza S, Mateo L, Sanint J, Olivé A. Nefropatía IgA en las enfermedades reumáticas. Reumatol Clin. 2016;12:236–237.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii:bcr07.2008.0394" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diffuse mesangial IgA glomerulonephritis in a patient with rheumatoid arthritis: a possible extra-articular manifestation in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Marinchev" 1 => "S. Atanasova" 2 => "R. Robeva" 3 => "T. 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Monteiro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Opin Rheumatol" "fecha" => "1999" "volumen" => "11" "paginaInicial" => "265" "paginaFinal" => "272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10411380" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000004/v3_201704050048/S2173574316300521/v3_201704050048/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000004/v3_201704050048/S2173574316300521/v3_201704050048/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300521?idApp=UINPBA00004M" ]
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| 2020 July | 26 | 21 | 47 |
| 2020 June | 36 | 29 | 65 |
| 2020 May | 35 | 9 | 44 |
| 2020 April | 21 | 12 | 33 |
| 2020 March | 5 | 6 | 11 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 25 | 7 | 32 |
| 2018 March | 66 | 7 | 73 |
| 2018 February | 29 | 2 | 31 |
| 2018 January | 12 | 6 | 18 |
| 2017 December | 38 | 6 | 44 |
| 2017 November | 21 | 6 | 27 |
| 2017 October | 20 | 4 | 24 |
| 2017 September | 23 | 9 | 32 |
| 2017 August | 17 | 5 | 22 |
| 2017 July | 32 | 10 | 42 |
| 2017 June | 32 | 12 | 44 |
| 2017 May | 56 | 15 | 71 |
| 2017 April | 30 | 12 | 42 |
| 2017 March | 22 | 5 | 27 |
| 2017 February | 15 | 8 | 23 |
| 2017 January | 15 | 3 | 18 |
| 2016 December | 46 | 20 | 66 |
| 2016 November | 45 | 27 | 72 |
| 2016 October | 52 | 19 | 71 |
| 2016 September | 64 | 4 | 68 |
| 2016 August | 98 | 12 | 110 |
| 2016 July | 40 | 17 | 57 |
Show all
