Advertisement

A case of secondary IgA nephropathy accompanied by psoriasis treated with secukinumab

  • Masahiko Ochi
  • Tadashi ToyamaEmail author
  • Mai Ando
  • Koichi Sato
  • Yasutaka Kamikawa
  • Akihiro Sagara
  • Shinji Kitajima
  • Akinori Hara
  • Yasunori Iwata
  • Norihiko Sakai
  • Miho Shimizu
  • Kengo Furuichi
  • Yasuhito Hamaguchi
  • Shuichi Kaneko
  • Takashi Wada
Case Report
  • 31 Downloads

Abstract

A 60-year-old man was diagnosed with psoriasis 4 years ago. Treatment with adalimumab (a monoclonal anti-TNF-α antibody) became ineffective 1 year ago, and proteinuria and urinary occult blood were detected. Treatment with topical medicine, ultraviolet therapy, and etretinate resulted in remission of psoriasis, and proteinuria and hematuria also improved. For maintenance of remission, treatment with secukinumab (a human anti-interleukin-17A monoclonal antibody) was initiated. After the induction phase, treatment was changed from once a week to once every 4 weeks. After 5 months, he developed nephritis with kidney dysfunction, hematuria, and severe proteinuria (14 g/g Cr) accompanied by pitting edema. After admission, treatment with secukinumab was continued. Kidney biopsy revealed IgA nephropathy with fibrocellular crescents, and immunofluorescence analysis did not detect galactose-deficient IgA1. With these findings, he was diagnosed as secondary IgA nephropathy associated with psoriasis. Tonsillectomy followed by steroid pulse therapy prevented proteinuria and kidney function. In this case, treatment of refractory psoriasis with secukinumab and tonsillectomy was effective, leading to remission of relapsing secondary IgA nephropathy. Therefore, secukinumab might play an immunological role in the treatment of nephropathy.

Keywords

IgA nephropathy Psoriasis Secukinumab IL-17A Biologics 

Notes

Compliance with ethical standards

Conflict of interest

All the authors have declared no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from the participant included in this article.

References

  1. 1.
    Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009;361(5):496–509.CrossRefGoogle Scholar
  2. 2.
    Wan J, Wang S, Haynes K, Denburg MR, Shin DB, Gelfand JM. Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study. BMJ. 2013;347:f5961.CrossRefGoogle Scholar
  3. 3.
    Chiu HY, Huang HL, Li CH, Yin YJ, Chen HA, Hsu ST, et al. Increased risk of glomerulonephritis and chronic kidney disease in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study. Br J Dermatol. 2015;173(1):146–54.CrossRefGoogle Scholar
  4. 4.
    Pouria S, Barratt J. Secondary IgA nephropathy. Semin Nephrol. 2008;28(1):27–37.CrossRefGoogle Scholar
  5. 5.
    Bagel J, Duffin KC, Moore A, Ferris LK, Siu K, Steadman J, et al. The effect of secukinumab on moderate-to-severe scalp psoriasis: results of a 24-week, randomized, double-blind, placebo-controlled phase 3b study. J Am Acad Dermatol. 2017;77:667–74.CrossRefGoogle Scholar
  6. 6.
    Armstrong AW, Villanueva Quintero DG, Echeverria CM, Gu Y, Karunaratne M, Reyes Servin O. Body region involvement and quality of life in psoriasis: analysis of a randomized controlled trial of adalimumab. Am J Clin Dermatol. 2016;17(6):691–9.CrossRefGoogle Scholar
  7. 7.
    Suzuki H, Yasutake J, Makita Y, Tanbo Y, Yamasaki K, Sofue T, et al. IgA nephropathy and IgA vasculitis with nephritis have a shared feature involving galactose-deficient IgA1-oriented pathogenesis. Kidney Int. 2018;93(3):700–5.CrossRefGoogle Scholar
  8. 8.
    Ahuja TS, Funtanilla M, de Groot JJ, Velasco A, Badalamenti J, Wilson S. IgA nephropathy in psoriasis. Am J Nephrol. 1998;18(5):425–9.CrossRefGoogle Scholar
  9. 9.
    Zadrazil J, Tichý T, Horák P, Nikorjaková I, Zíma P, Krejcí K, et al. IgA nephropathy associated with psoriasis vulgaris: a contribution to the entity of’psoriatic nephropathy’. J Nephrol. 2006;19(3):382–6.Google Scholar
  10. 10.
    Turner JE, Krebs C, Tittel AP, Paust HJ, Meyer-Schwesinger C, Bennstein SB, et al. IL-17A production by renal gammadelta T cells promotes kidney injury in crescentic GN. J Am Soc Nephrol JASN. 2012;23(9):1486–95.CrossRefGoogle Scholar
  11. 11.
    Papotto PH, Ribot JC, Silva-Santos B. IL-17 + gammadelta T cells as kick-starters of inflammation. Nat Immunol. 2017;18(6):604–11.CrossRefGoogle Scholar
  12. 12.
    Cai Y, Shen X, Ding C, Qi C, Li K, Li X, et al. Pivotal role of dermal IL-17-producing gammadelta T cells in skin inflammation. Immunity. 2011;35(4):596–610.CrossRefGoogle Scholar
  13. 13.
    Falk MC, Ng G, Zhang GY, Fanning GC, Roy LP, Bannister KM, et al. Infiltration of the kidney by alpha beta and gamma delta T cells: effect on progression in IgA nephropathy. Kidney Int. 1995;47(1):177–85.CrossRefGoogle Scholar
  14. 14.
    Bonnet F, Deprele C, Sassolas A, Moulin P, Berthezène F, Berthoux F. Excessive body weight as a new independent risk factor for clinical and pathological progression in primary IgA nephritis. Am J Kidney Dis. 2001;37(4):720–7.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • Masahiko Ochi
    • 1
    • 3
  • Tadashi Toyama
    • 1
    • 3
    Email author
  • Mai Ando
    • 1
    • 3
  • Koichi Sato
    • 1
    • 3
  • Yasutaka Kamikawa
    • 1
    • 3
  • Akihiro Sagara
    • 1
    • 3
  • Shinji Kitajima
    • 1
    • 3
  • Akinori Hara
    • 1
    • 3
  • Yasunori Iwata
    • 1
    • 3
  • Norihiko Sakai
    • 1
    • 3
  • Miho Shimizu
    • 1
    • 3
  • Kengo Furuichi
    • 1
    • 3
  • Yasuhito Hamaguchi
    • 2
  • Shuichi Kaneko
    • 3
  • Takashi Wada
    • 1
    • 4
  1. 1.Division of NephrologyKanazawa University HospitalKanazawaJapan
  2. 2.Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
  3. 3.Department of System BiologyKanazawa University Graduate School of Medical SciencesKanazawaJapan
  4. 4.Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan

Personalised recommendations