2023-05-11 14:58:31
The differences between patients with IgA nephropathy are large. Some do not require treatment. For others, kidney function deteriorates rapidly and they need dialysis or a transplant to survive. On average, people lose their kidney function over a period of twenty years.
The cause of IgA nephropathy is not yet fully known. Nephrologist and researcher Raphaël Duivenvoorden of Radboud university medical center will conduct research into this. IgA is made by B cells in different parts of the body: the bone marrow and the intestines. What is known is that the IgA in the blood of these patients has changed shape, as it is less sugary.
The first hypothesis is that something goes wrong in the gastrointestinal tract. There are many B cells in the gut. They excrete poorly sugared IgA in the stool, which is normal. But it is not normal for it to enter the blood. Perhaps IgA is being sent the wrong way from the gut for unknown reasons.
The second hypothesis is that the cause lies in the bone marrow. The normal IgA is made there by B cells. They could also make poorly saccharified IgA. Why they do that is not clear.
Compare blood samples
To answer this question, Duivenvoorden will compare saliva and faeces samples and blood samples from IgA nephropathy patients with those from kidney patients without IgA nephropathy. Among other things, to investigate the microbial composition. Immune cells and their behavior are mapped in blood samples. Duivenvoorden: ‘It is plausible to think that it should be done at one of those locations.’
This knowledge should lead to an easier diagnosis of IgA nephropathy. ‘There is a whole spectrum of seriousness. In people who remain mild, you often do not do a kidney biopsy. But you don’t know for sure if it’s IgA nephropathy. In case of serious manifestations you do do a biopsy, because you have to be sure of the diagnosis before you treat. But there is a gray area. Many people are still in between these extremes. Diagnosing without a biopsy is therefore an end in itself. If you can recognize it earlier, you can treat more specifically.’
There have also been recent developments in the field of treatment. Until recently, there were few options. ‘If lowering the blood pressure isn’t enough, we give prednisone. But new therapies have recently emerged and some are still in development. The question then becomes: how should I treat which patient? And how do I pick out those who benefit from complement inhibitors, B cell-targeted therapy, or prednisone, for example? The right therapy for exactly that one patient is becoming increasingly important. Then you need to know exactly what is going on and how patients differ from each other.’
The idea for this study started when a patient with IgA nephropathy contacted Duivenvoorden because he wanted to contribute to research into this disease. He wanted to make a big donation for that. Together they thought of setting up a fund and Duivenvoorden proposed to design and implement this project. The Pioneer+scholarship of the Kidney Foundation supplements this amount. It is very special that a study has come about in this way, says Duivenvoorden. “This patient is really the engine.”
#search #IgA #nephropathy