English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Steroids with local enteric action in IgA nephropathy and the association between kidney and bowel disease Sir, The interesting paper by Smerud et al. [1] showed a significant beneficial effect of a 6-month treatment with enteric budesonide targeted to the ileocaecal region on urine albumin excretion, along with a minor reduction of serum creatinine and a modest increase of Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rate (eGFR), in patients with IgA nephropathy (IgAN). The authors suggested that such targeted release of budesonide, specifically designed to act in the ileocaecal region , exerts a local effect by suppressing the mucosal immune response to gastrointestinal antigens supposedly involved in the pathogenesis of IgAN. We have recently published a case report and review of the literature on the association between IgAN and inflammatory bowel disease [2], and we would like to add some comments on the therapeutic targeting of the intestinal mucosa by corticosteroids as an effective local immunosuppression. A pathophysiological link between inflammatory bowel disease and IgAN might offer an additional argument for such a local immunosuppressive effect. Immune complex glomerulonephritis, particularly IgAN, is a rarely described extraintestinal manifestation of inflam-matory bowel disease, particularly Crohn's disease, that occurs in the setting of active bowel inflammation [2]. In most cases, the relapse of bowel disease is associated with the onset or exacerbation of renal manifestations, mainly microscopic haematuria, mild proteinuria and renal impairment. Systemic steroid treatment of the bowel disease results in significant improvement in renal manifestations , although there is no clear evidence of concomitant renal histological remission [2, 3]. Although there is increasing literature reporting associations between IgAN and inflammatory bowel disease, whether these reports represent chance associations or pathophysiologically related conditions still remains a matter of debate [2, 4]. We always have to take into consideration the relatively high frequency of subclinical IgAN in supposedly healthy populations and the issue of a chance association between IgAN and other frequent, pathophysiologically unrelated conditions. Furthermore, at present, there is no evidence supporting a link between immune mechanisms operating in inflammatory bowel disease and IgAN. However, a potential common mechanism in these conditions can be speculated through the possible association of a bowel disease exacerbation, at least in part, with the loss of mucosal antigen exclusion, due to impaired integrity of mucosal barriers. This results in increased systemic antigenaemia and subsequent increased immune activation which drives the synthesis of …