The effectiveness of hydroxychloroquine and its effect on cell-mediated and humoral immunity in patients with immunoglobulin A nephropathy: results of a prospective controlled study

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective: evaluation of the clinical efficacy of using hydroxychloroquine (HCQ) compared with glucocorticosteroids (GCS) in patients with immunoglobulin a- nephropathy (Igan) and the effect of the treatment on cell-mediated and humoral immunity. Material and methods. Using flow cytometry and enzyme immunoassay methods, clinical, laboratory and immunological parameters were determined in з groups of patients with igan with glomerular filtration rate >50 ml/min and proteinuria (PU) >i g/day: group 1 - hcq (n=20), group 2 - gcs (n=20) and group з - maintenance therapy (n=12). results. a six-month course of hcq reduced the pu level (P=o.03), the relative number of tnk-cells (P=o.05) and δγT-lymphocytes (p=0.01), as well as their cytotoxic profile, and also reduced the serum April factor and immunoglobulin levels in patients with igan (P = o.05), which led to remission in 60% of patients. conclusion. hcq can be used as an effective alternative therapy in patients with igan.

Full Text

Restricted Access

About the authors

Kirill S. Komissarov

Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology; Belarusian Medical Academy of Postgraduate Education

Email: kirill_ka@tut.by
Cand. Sci. (Med.), Associate Professor, Head of the Department of Nephrology, Renal Replacement Therapy and Kidney Transplantation Minsk, Republic of Belarus

Daria B. Nizheharodava

Belarusian Medical Academy of Postgraduate Education; International State Ecological Institute named after A.D. Sakharov

Email: nzh@tut.by
Cand. Sci. (Biol.), Associate Professor, Head of the Department of Immunology and Biomedical Technologies, Research Laboratory Minsk, Republic of Belarus

Elena I. Minchenko

First City Clinical Hospital

Email: elena_nefro@mail.ru
Nephrologist, Department of Nephrology Minsk, Republic of Belarus

Galina I. Ivanchik

Belarusian Medical Academy of Postgraduate Education

Email: immunology.by@gmail.com
Senior Researcher at the Department of Immunology and Biomedical Technologies of the Research Laboratory Minsk, Republic of Belarus

Valery S. Pilotovich

Belarusian Medical Academy of Postgraduate Education

Email: pilotovich@mail.ru
Dr. Sci. (Med.), Professor at the Department of Urology and Nephrology Minsk, Republic of Belarus

Marina M. Zafranskaya

Belarusian Medical Academy of Postgraduate Education; International State Ecological Institute named after A.D. Sakharov

Email: zafranskaya@gmail.com
Dr. Sci. (Med.), Professor, Head of the Department of Immunology, International State Ecological Institute n.a. A.D. Sakharov Minsk, Republic of Belarus

References

  1. Schena F., Nistor I. Epidemiology of IgA Nephropathy: A Global Perspective. Semin. Nephrol. 2018;38(5):435-42. doi: 10.1016/j.semnephrol.2018.05.013
  2. Комиссаров К.С., Краско О.В., Дмитриева М.В. и др. Иммуноглобулина А-нефропатия в белорусской когорте. Клинико-морфологические особенности, факторы, ассоциированные с неблагоприятным исходом. Клин. нефрология. 2017;3:25-33. @@Komissarov K.S., Krasko O.V., Dmitrieva M.V., et al. IgA nephropathy in Belarusian cohort. Clinical and pathological peculiarities, factors, associated with unfavorable outcome. Clin. Nephrol. 2022;3:25-33 (In Russ.)
  3. Нижегородова Д.Б., Комиссаров К.С., Минченко Е.И. и др. Функциональный профиль γδт-лимфоцитов у пациентов с IgA-нефропатией. Нефрология и диализ. 2022;24(1):72-81. doi: 10.28996/2618-9801-2022-1-72-81. @@Nizheharodava D.B., Komissarov K., Minchenko E., et al. The function profile of y5t-lymphocytes in patients with IgA-nephropathy. Nephrol. Dial. 2022;24(1):72-81 (In Russ.)
  4. Kidney Disease: improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO Clinical Practice Guidline for Glomerulonephritis. Chapter 2: Immunoglobulin A-nephropathy (IgAN)/Immunoglobulin A vasculitis (IgAV). Kidney Int. Suppl. 2021;100(Suppl. 4): 115-28. doi: 10.1016/jkint.2021.05.021.
  5. Lv J., Zhang H, Chen Y., et al.Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial. Am. J. Kidney Dis. 2009;53:26-32. doi: 10.1053/j.ajkd.2008.07.029.
  6. Manno C., Torres D.D., Rossini M., et al. Randomized controlled clinical trial of corticosteroids plus ACE inhibitors with long-term follow-up in proteinuric IgA-nephropathy. Nephrol. Dial. Transplant. 2009;24:3694-701. doi: 10.1093/ndt/gfp356.
  7. Pozzi C., Andrulli S., Del Vecchio L., et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J. Am. Soc. Nephrol. 2004;15(1):157-63. doi: 10.1097/01.asn.0000103869.08096.4f.
  8. Rauen T., Eitner F., Fitzner C., et al. Investigators ST-I: Intensive supportive care plus immunosuppression in IgA-nephropathy. N. Engl. J. Med. 2015;373(23):2225-36. doi: 10.1056/nejmoa1415463.
  9. Lv J., Zhang H., Wong M.G., et al. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA. 2017;318(5):432-42. Doi: 10.1001/ jama.2017.9362.
  10. Kasitanon N., Fine D.M., Haas M., et al. Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis. Lupus. 2006;15(6):366-70. doi: 10.1191/0961203306lu2313oa.
  11. Gao R., Wu W., Wen Y., et al. Hydroxychloroquine alleviates persistent proteinuria in IgA nephropathy.Int. Urol. Nephrol. 2017;49(7):1233-41. doi: 10.1007/s11255-017-1574-2.
  12. Liu L.-J., Yang Y.-z., Shi S.-F., et al. Effects of hydroxychloroquine on proteinuria in IgA nephropathy: a randomized controlled trial. Am. J. Kidney Dis. 2019;74(1):15-22. doi: 10.1053/j.ajkd.2019.01.026.
  13. Levey A.S., Stevens L., Schmid C., et al. A New Equation to Estimate Glomerular Filtration Rate. Ann.Intern. Med. 2009;150(5):604-12. doi: 10.7326/0003-4819-150-9-200905050-00006.
  14. Trimarchi H., Barratt J., Cattran D., et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017;91(5):1014-21. doi: 10.1016/j.kint.2017.02.003.
  15. Stefan G., Mircescu G. Hydroxychloroquine in IgA nephropathy: a systematic review. Renal. Failure. 2021;43(1):1520-27. doi: 10.1080/0886022X.2021.2000875.
  16. Yang Y.-z., Chen P., Liu L.-J., et al.Comparison of the effects of hydroxychloroquine and corticosteroid treatment on proteinuria in IgA nephropathy: a case-control study. BMC. Nephrol. 2019;20(1):297-305. doi: 10.1186/s12882-019-1488-6.
  17. Robert T., Berthelot L., Cambier A., et al. Molecular insights into the pathogenesis of IgA nephropathy. Trend. Mol. Med. 2015;21(12):762-75. doi: 10.1016/j.molmed.2015.10.003.
  18. Mauthe M., Orhon I., Rocchi C., et al. Chloroquine inhibits autophagic flux by decreasing autophagosomelysosome fusion. Autophagy. 2018;14(8):1435-55. doi: 10.1080/15548627.2018.1474314.
  19. Paul S., Giri S., Lal G. Role of gamma-delta (yb) T Cells in autoimmunity. J. Leukoc. Biol. 2015;97:259-71. Doi: 10.1189/ jlb.3RU0914-443R.
  20. Fichtner A.S., Ravens S., Prinz I. Human y5 TCR Repertoires in Health and Disease. Cells. 2020;9(800):1-14. doi: 10.3390/cells9040800.
  21. Toyabe S., Harada W., Uchiyama M. Oligoclonally expanding gamma delta T lymphocytes induce IgA switching in IgA nephropathy. Clin. Exp. Immunol. 2001;124:110-17. Doi: W.1046/j.1365-2249.2001.01494.x
  22. Rosenkranz A., Knight S., Sethi S., et al. Regulatory interactions of aβ and γδ T cells in glomerulonephritis. Kidney Int. 2000;58(3):1055-66. doi: 10.1046/j.1523-1755.2000.00263.x.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies