Rauta Virpi, Teppo Anna-Maija, Törnroth Tom, Honkanen Eero, Grönhagen-Riska Carola
Helsinki University Central Hospital, Department of Medicine, Division of Nephrology Helsinki, Finland.
Nephrol Dial Transplant. 2003 Sep;18(9):1785-91. doi: 10.1093/ndt/gfg234.
IgA nephropathy (IgAN) and Henoch-Schönlein nephritis (HSN) share many clinical, histological and immunological features. It has been postulated that these two conditions have a common pathogenesis and that HSN might be a systemic form of IgAN. Activity of interleukin-1beta (IL-1beta) in urine has been found to be higher in IgAN and HSN patients than in healthy controls. Interaction between IL-1beta and interleukin-1 receptor antagonist (IL-1ra) plays a significant role in the regulation of inflammatory responses. We studied levels of urinary excretion of IL-1beta and IL-1ra in patients with IgAN and HSN.
Amounts of IL-1beta and IL-1ra excreted in 24-h urine samples collected from 241 IgAN, 26 HSN patients and from 33 healthy controls were determined. Results were expressed as cytokine/creatinine (ng/mmol) ratios.
Urinary IL-1beta excretion by the IgAN and HSN patients was no greater than urinary IL-1beta excretion by healthy controls. Urinary IL-1ra excretion by the IgAN patients was lower than urinary IL-1ra excretion by healthy controls (P < 0.05) and by the HSN patients (P < 0.01). In both patients and controls women had significantly higher IL-1ra, IL-1beta excretion levels and IL-1ra/IL-1beta ratios. The differences in urinary excretions of IL-1ra by the healthy controls and by the IgAN and HSN patients were significant in both sexes. Excretion of IL-1beta or IL-1ra did not correlate with excretion of urinary protein, duration of the disease or any histopathological variable. However, histopathological changes in renal biopsy specimens from patients with IL-1ra/IL-1beta ratios above normal were significantly milder than in renal biopsy specimens from patients with low or normal IL-1ra/IL-1beta ratios.
Urinary IL-1ra levels in IgAN patients were lower than urinary IL-1ra levels in healthy controls or HSN patients, a finding which may indicate that the two diseases have a different pathogenesis. Whether the male predominance in IgAN and HSN and the worse outcomes in males that have been reported previously in IgAN and HSN are connected with the lower excretion of IL-1ra and consequently lower IL-1ra/IL-1beta ratios in male patients than in female patients needs more thorough investigation.
IgA 肾病（IgAN）和过敏性紫癜性肾炎（HSN）具有许多临床、组织学和免疫学特征。据推测，这两种疾病具有共同的发病机制，且 HSN 可能是 IgAN 的一种全身性形式。已发现 IgAN 和 HSN 患者尿液中白细胞介素 -1β（IL -1β）的活性高于健康对照者。IL -1β与白细胞介素 -1 受体拮抗剂（IL -1ra）之间的相互作用在炎症反应调节中起重要作用。我们研究了 IgAN 和 HSN 患者尿液中 IL -1β和 IL -1ra 的排泄水平。
测定了从 241 例 IgAN 患者、26 例 HSN 患者以及 33 例健康对照者收集的 24 小时尿液样本中 IL -1β和 IL -1ra 的排泄量。结果以细胞因子/肌酐（ng/mmol）比值表示。
IgAN 和 HSN 患者尿液中 IL -1β的排泄量不高于健康对照者尿液中 IL -1β的排泄量。IgAN 患者尿液中 IL -1ra 的排泄量低于健康对照者（P < 0.05）以及 HSN 患者（P < 0.01）。在患者和对照者中，女性的 IL -1ra、IL -1β排泄水平以及 IL -1ra/IL -1β比值均显著更高。健康对照者与 IgAN 和 HSN 患者尿液中 IL -1ra 排泄量的差异在两性中均显著。IL -1β或 IL -1ra 的排泄与尿蛋白排泄、疾病持续时间或任何组织病理学变量均无相关性。然而，IL -1ra/IL -1β比值高于正常的患者肾活检标本中的组织病理学变化明显轻于 IL -1ra/IL -1β比值低或正常的患者肾活检标本。
IgAN 患者尿液中 IL -1ra 水平低于健康对照者或 HSN 患者尿液中 IL -1ra 水平，这一发现可能表明这两种疾病具有不同的发病机制。IgAN 和 HSN 中男性占主导以及先前报道的 IgAN 和 HSN 男性患者预后较差是否与男性患者中 IL -1ra 排泄较低以及因此导致的 IL -1ra/IL -1β比值低于女性患者有关，需要更深入的研究。
