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Nephrology, including fluid and electrolytes
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
10.16. A 6-year-old boy has transient macroscopic haematuria at the time of an upper respiratory tract infection. He has a past history of haematuria during two similar infections 6 and 10 months earlier. Which of the following statements is/are likely to be true?Renal histology would reveal a focal and/or segmental proliferative glomerulonephritis in about 50% of such cases.Serum IgA levels are likely to be elevated.The serum level of the 3rd component of complement would be normal.He is likely to progress to end-stage renal failure.The antistreptolysin O titre is likely to be raised after an episode of haematuria.
Genetic Control of Factors Involved in Bronchial Asthma, Hay Fever, and Other Allergic States
Published in Stephen D. Litwin, Genetic Determinants of Pulmonary Disease, 2020
Wilma Β. Bias, David G. Marsh, Thomas Α. Ε. Ρlatts-Mills
In summary, there seems to be a good correlation between levels of specific antiallergen antibody in the various immunoglobulin classes for allergic subjects. On the other hand, this relationship does not completely hold for nonallergic persons, some of whom have IgG and/or IgA but no detectable IgE. Most of such nonallergic individuals have low IgE phenotypes—that is to say, their IgE system is severely regulated—but have normal IgG and IgA levels. With less severe constraints on IgG and IgA production, some nonallergic persons can evidently synthesize antiallergen antibodies of both of these classes. In this respect, their antibody production seems to behave analogously to the IgE antibody production of people with high IgE phenotypes. It is clear that elucidation of the regulatory mechanisms involved in such complex situations will be of considerable importance in understanding the human immune response and its relationship to allergic disease.
Paracoccidioidomycosis
Published in Rebecca A. Cox, Immunology of the Fungal Diseases, 2020
Beatriz Jimenez-Finkel, Angela Restrepo-Moreno
Increased serum levels of IgG are detected at the time of diagnosis. These levels may be maintained throughout the course of active disease. After therapy, IgG levels usually return to normal.45, 57-72 In contrast, serum levels of IgA and IgM are normal at the time of the diagnosis (Table 2).72 Normal levels of IgM may indicate that the diagnosis was made in the chronic stage of the disease, when the IgM response had waned.65,72,73 Considering that P. brasiliensis affects mucosal membranes and the respiratory system, quantification of secretory IgA would be of interest.
IgA nephropathy in a child: Crohn’s disease-associated or adalimumab induced?
Published in Current Medical Research and Opinion, 2022
Francesco Graziano, Martina Busè, Nicola Cassata, Vincenzo Luca Lentini, Michele Citrano
Two years after diagnosis, when he was 11-year-old, the patient presented suddenly macroscopic hematuria. For this reason he was again admitted at our Unit. No infections or allergies were reported. Urinalysis at the time showed hematuria 3+, proteinuria 2+, dysmorphic RBCs and RBC casts. No stone formation was detected. Subsequent laboratory examinations showed acute renal failure, with important increases in BUN (138 mg/dL, normal 10–50 mg/dL) and in serum creatinine (4.58 mg/dL, normal 0.30–0.90 mg/dL). Estimate glomerular filtration rate (EGFR) was 20 ml/min/1.73 m2. CRP was 2 mg/dL (normal 0–0.5 mg/dL). Hb was 8.3 g/dL, PLT was 357.000/ul, white blood cells was 8300/ul (neutrophils: 68.2%; lymphocytes: 21.2%). Serum IgA was 285 mg/dL (normal 70-400 mg/dL). Serum IgG was 1319 (normal 360–1200 mg/dL). C3 and C4 were both normal. Serum Albumin was 3 g/dL (normal 3.5–4.8 g/dL). Serum protein electrophoresis showed increased gamma globulins without peak. Antinuclear antibodies (ANA), Extractable nuclear antigen (ENA), anti double–stranded DNA (anti ds-DNA) and antineutrophil cytoplasmic autoantibodies (p-ANCA and c-ANCA), anti–glomerular basement membrane (anti-GBM) antibody and IgG and IgM anticardiolipin antibodies were unremarkable. Screening for HBV, HCV and HIV was negative. No hypertension occurred.
Natural history of inflammatory and non-inflammatory dry eye in thyroid eye disease
Published in Orbit, 2021
Christopher Lo, Michael Yang, Daniel Rootman
However, an alternative theory would suggest that the inflammatory milieu in TED is leading to a primary inflammatory dry eye syndrome. An increased tear film osmolarity has been found to stimulate the release of inflammatory factors, such as IL-1beta, IL-6, IL-8, TNF-alpha, and matrix metalloproteinase (MMP)-9.6 Hyperosmolarity can also activate the mitogen-activated protein kinase (MAPK) signaling pathway in epithelial cells, which stimulate MMP-9 and cause ocular surface damage, goblet cell apoptosis, and dry eye.20,21 Patients with TED also have an elevated immunoglobulin A (IgA)/lysosome ratio, consistent with dysfunction of the lacrimal gland.22 Increased IgA levels were more often found in patients with chronic, quiescent disease.23 Additional tear composition studies have found IL-6, in particular, to correlate strongest with elevated CAS scores.24 Future studies including these specific inflammatory factors may be helpful in further developing our understanding of the etiopathology of primary inflammatory dry eye in TED patients. In addition, seeing how these levels may vary over the natural history of TED could elucidate how DES may also evolve during the transition from active to inactive disease.
Role of microbiota and related metabolites in gastrointestinal tract barrier function in NAFLD
Published in Tissue Barriers, 2021
Maria Victoria Fernandez-Cantos, Diego Garcia-Morena, Valeria Iannone, Hani El-Nezami, Marjukka Kolehmainen, Oscar P. Kuipers
Inside the mucus, SIgAs are the main immunoglobulins secreted on the intestinal mucosal surface and contribute to maintaining the homeostasis in the intestine. SIgAs are produced by plasma cells inside the mucosa, transported by the polymeric Ig receptor (pIgR) inside IECs and secreted into the lumen. SIgAs are able to neutralize invading microorganisms mainly interfering with the microbial adherence to IECs by forming intraluminal immune complexes. This process, defined as immune exclusion, prevents colonization and damage to IECs. SIgAs can also neutralize the invading pathogens that penetrate inside the lamina propria of the mucosa.53In addition, SIgAs are able to modulate the microbiota composition participating in the maintenance of GI tract homeostasis.54 And, their importance in GI tract has been shown in activation-induced cytidine deaminase (AID) deficient mice in which the SIgAs production is lacking due to the missing switch from Immunoglobulin M (IgM) to IgA. In the intestine of these mice an hyperplasia of lymphoid follicles has been observed suggesting that SIgAs are essential in preventing hyper-stimulation of the mucosal immune system.55 Despite the importance of SIgA in the GI tract, individuals with IgA deficiency do not present specific symptoms. This could be explained as a compensatory mechanism by an increased production of IgM observed in the intestine of these individuals.56 But it has been also reported that individuals with IgA deficiency could suffer from pulmonary infections, allergies and GI tract disorders.57