Abstract
BackgroundImmunoglobulin (Ig)A nephropathy (IgAN) is the most common form of primary glomerulonephritis in the world. Some bacteria were reported to be the candidate of the antigen or the pathogenesis of IgAN, but systematic analysis of bacterial flora in tonsil with IgAN has not been reported. Moreover, these bacteria specific to IgAN might be candidate for the indicator which can predict the remission of IgAN treated by the combination of tonsillectomy and steroid pulse.Methods and FindingsWe made a comprehensive analysis of tonsil flora in 68 IgAN patients and 28 control patients using Denaturing gradient gel electrophoresis methods. We also analyzed the relationship between several bacteria specific to the IgAN and the prognosis of the IgAN. Treponema sp. were identified in 24% IgAN patients, while in 7% control patients (P = 0.062). Haemophilus segnis were detected in 53% IgAN patients, while in 25% control patients (P = 0.012). Campylobacter rectus were identified in 49% IgAN patients, while in 14% control patients (P = 0.002). Multiple Cox proportional-hazards model revealed that Treponema sp. or Campylobactor rectus are significant for the remission of proteinuria (Hazard ratio 2.35, p = 0.019). There was significant difference in remission rates between IgAN patients with Treponema sp. and those without the bacterium (p = 0.046), and in remission rates between IgAN patients with Campylobacter rectus and those without the bacterium (p = 0.037) by Kaplan-Meier analysis. Those bacteria are well known to be related with the periodontal disease. Periodontal bacteria has known to cause immune reaction and many diseases, and also might cause IgA nephropathy.ConclusionThis insight into IgAN might be useful for diagnosis of the IgAN patients and the decision of treatment of IgAN.
Highlights
Immunoglobulin (Ig)A nephropathy (IgAN) is the most common form of primary glomerulonephritis in the world [1]
All samples including 68 tonsils with IgAN patients and 28 tonsils with control patients were analyzed by PCR-Denaturing gradient gel electrophoresis (DGGE) method followed by Partial least squares discriminant analysis (PLS-DA)
Haemophilus segnis were detected in 53% IgAN patients, while the bacteria were identified in 25% control patients (P = 0.012)
Summary
Immunoglobulin (Ig)A nephropathy (IgAN) is the most common form of primary glomerulonephritis in the world [1]. It is characterized by IgA deposition to glomerular mesangial cells in pathological point of view and sometimes macroscopic hematuria after upper respiratory infection in clinical point of view. Since it was firstly reported by Berger in 1968 [3], the etiology and cause of the disease has been an ultimate mystery [4], several genes [5,6] or single nucleotide polymorphism [7,8,9,10,11,12] were reported to be associated with incidence or progression of IgA nephropathy. These bacteria specific to IgAN might be candidate for the indicator which can predict the remission of IgAN treated by the combination of tonsillectomy and steroid pulse
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