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The microbiome and IgA nephropathy

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Abstract

The immunopathogenic mechanisms underlying immunoglobulin A nephropathy (IgAN) are poorly understood, yet it is one of the most common causes of kidney failure globally. The commonly referenced syndrome of synpharyngitic gross hematuria as a presenting feature of IgAN has led to a logical association between infections and development of IgAN, however no pathogenic organism has been clearly linked to IgAN. Advances in sequencing technology have enabled more detailed characterization of host microbial communities, and highlighted the interrelationship between microbiota and immune responses in health and disease. This review will summarize current thinking on the relationship between microbiota and development of IgAN with a focus on recent studies relating aberrant mucosal IgA-biased immune responses to microbiota and how this may be related to the immunopathogenesis of IgAN.

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Authors and Affiliations

  1. Department of Immunology, University of Toronto, Toronto, ON, Canada

    Kei Haniuda & Jennifer L. Gommerman

  2. Division of Nephrology, Department of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada

    Heather N. Reich

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  1. Kei Haniuda
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All authors contributed to the manuscript design and writing of the primary and revised text. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Heather N. Reich.

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Conflict of interest

Dr. Reich is the national coordinating investigator and is a site investigator for the NEFIGARD study of Nefecon in IgAN (Calliditas). Dr. Reich is also the national coordinating investigator for the ALIGN study of Atrasentan in IgAN (Chinook). She is a site investigator and member of the academic steering committee for the ARTEMIS study of OMS721 in IgAN (Omeros), and a site co-investigator for the study of Cemdisiran in IgAN (Alnylam). She has received honoraria for consultation from Novartis, and Travere related to treatment of IgAN. The Toronto Glomerulonephritis Fellowship is supported by the Louise Fast Foundation. She has no other financial or non-financial conflicts to declare and the authors did not receive support from any organization for the submitted work. Dr. Gommerman and Dr. Haniuda have no conflicts of interest to declare.

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This article is a contribution to the Special issue on: The IgA system, IgA nephropathy and IgA vasculitis - Guest Editors: Jürgen Floege & Jonathan Barratt.

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Haniuda, K., Gommerman, J.L. & Reich, H.N. The microbiome and IgA nephropathy. Semin Immunopathol 43, 649–656 (2021). https://doi.org/10.1007/s00281-021-00893-6

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