Mima Akira, Nakamoto Takahiro, Matsuki Takamasa, Kido Suguru, Saito Yuta, Morikawa Takaaki, Matsumoto Keishi, Gotoda Hidemasa, Lee Shinji
Department of Nephrology, Osaka Medical and Pharmaceutical University, Osaka, Japan
Department of Nephrology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
In Vivo. 2025 May-Jun;39(3):1731-1738. doi: 10.21873/invivo.13975.
BACKGROUND/AIM: It is well known that infliximab is an anti-tumor necrosis factor chimeric factor that is effective in treating inflammatory bowel diseases, such as Crohn's disease. Recently, there have been reports of new onset or flare-ups of immunoglobulin A (IgA) nephropathy during infliximab therapy for Crohn's disease. Inflammatory bowel disease-associated IgA nephropathy has been associated with IgA2; However, its activation by infliximab is still unknown.
We report our experience with two patients who experienced acute exacerbations of pre-existing abnormal urinalysis and renal dysfunction 1-18 years following infliximab treatment for Crohn's disease. Renal biopsies at the time of renal disease flare-up revealed IgA nephropathy in one patient and mesangial proliferative nephropathy in the other. Immunostaining results showed no clear predominance of intraglomerular expression of IgA2, and the patient diagnosed with IgA nephropathy entered remission with high dose methylprednisolone pulse therapy and oral corticosteroids, without the need for tonsillectomy. In contrast, the patient with mesangial proliferative nephritis had many devastated glomeruli, thus corticosteroids were not administrated, and the patient was followed up.
The clinical course of our patients, along with similar cases reported in the literature, indicates that infliximab therapy for Crohn's disease is linked to a relatively high risk of new-onset IgA nephropathy or disease relapse. This report is notable because it is the first to compare the expression of IgA1 and IgA2 in glomeruli in nephritis associated with infliximab therapy.
背景/目的：众所周知，英夫利昔单抗是一种抗肿瘤坏死因子嵌合因子，对治疗炎症性肠病如克罗恩病有效。最近，有报道称在英夫利昔单抗治疗克罗恩病期间出现了免疫球蛋白A（IgA）肾病的新发或病情复发。炎症性肠病相关的IgA肾病与IgA2有关；然而，英夫利昔单抗对其激活作用仍不清楚。
我们报告了两名患者的情况，他们在接受英夫利昔单抗治疗克罗恩病1至18年后，原有异常尿检和肾功能不全出现急性加重。肾病发作时的肾活检显示，一名患者为IgA肾病，另一名患者为系膜增生性肾病。免疫染色结果显示肾小球内IgA2表达无明显优势，被诊断为IgA肾病的患者通过大剂量甲泼尼龙冲击治疗和口服糖皮质激素进入缓解期，无需进行扁桃体切除术。相比之下，患有系膜增生性肾炎的患者有许多严重受损的肾小球，因此未给予糖皮质激素治疗，对该患者进行了随访。
我们患者的临床病程以及文献中报道的类似病例表明，英夫利昔单抗治疗克罗恩病与新发IgA肾病或疾病复发的相对高风险有关。本报告值得注意，因为它首次比较了英夫利昔单抗治疗相关肾炎中肾小球内IgA1和IgA2的表达。
