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Hydroxychloroquine alleviates persistent proteinuria in IgA nephropathy

  • Nephrology - Original Paper
  • Published:
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Abstract

Purpose

Dendritic cells, Toll-like receptor (TLR), interleukin-6 (IFN-α), interferon-alpha (IFN-α) and tumor necrosis factor-alpha (TNF-α) play an important role in the pathogenesis of IgA nephropathy (IgAN). Hydroxychloroquine (HCQ) is an antimalarial agent and had a notable impact on immune activation by the reduction of circulating activated immune cells that including decreased TLR-expressing cells, reduced IFN-secreting DCs, reduced production of cytokines including IFN-α,IL-6 and TNF-α. We evaluated the efficacy of HCQ in reducing proteinuria in patients with IgAN.

Methods

Twenty-eight IgAN patients with persistent proteinuria (0.5–2.0 g/24 h) despite treatment with losartan for 3 months were matched to receive HCQ and losartan (group 1) or continue losartan therapy (group 2) for 24 weeks. The primary end point of this prospective, paired case–control study was reduction of proteinuria by 50% or more over entry level.

Results

Six patients (42.9%) in group one versus two patients (14.3%) in group 2 reach the primary end point (P = 0.004). By 24 weeks, the mean urinary protein excretion was 65.9 ± 25.5% (P = 0.002) and 95.3 ± 30.0% (P = 0.791) that of the corresponding baseline value in group 1 and group 2, respectively. Baseline proteinuria and histologic grades, blood pressure control and changes in serum creatinine and eGFR were not different between the two groups.

Conclusions

In selected patients with IgAN, HCQ is effective in ameliorating proteinuria.

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Abbreviations

IgAN:

IgA nephropathy

ESRD:

End stage renal disease

DCs:

Dendritic cells

TLR:

Toll-like receptor

IL-6:

Interleukin-6

IFN-α:

Interferon-alpha

TNF-α:

Tumor necrosis factor-alpha

HCQ:

Hydroxychloroquine

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Author's contribution

Ruitong Gao carried out data collection, statistical analysis and interpretation of results, as well as drafting the manuscript. Yubing Wen assessed the renal biopsies. Wei Wu participated in data collection. Xuemei Li conceived the study and participated in the study design, data collection, interpretation of results and drafting the manuscript. All authors critically revised the manuscript as well as reading and approving the final version prior to submission.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China

    Ruitong Gao, Yubing Wen & Xuemei Li

  2. Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, 100730, People’s Republic of China

    Wei Wu

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  1. Ruitong Gao
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  2. Wei Wu
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Correspondence to Xuemei Li.

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Gao, R., Wu, W., Wen, Y. et al. Hydroxychloroquine alleviates persistent proteinuria in IgA nephropathy. Int Urol Nephrol 49, 1233–1241 (2017). https://doi.org/10.1007/s11255-017-1574-2

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  • DOI: https://doi.org/10.1007/s11255-017-1574-2

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