Special articleHypothesis: dysregulation of immunologic balance resulting from hygiene and socioeconomic factors may influence the epidemiology and cause of glomerulonephritis worldwide
Section snippets
Cell-mediated immunity is regulated by T helper cell subsets
The immune system is controlled largely by T helper (TH) cells (CD4+ cells). The principal function of CD4+ cells expressing the TH1 phenotype is the immune response to infection. These cells are responsible for the induction of cell-mediated organ-specific immunity and the generation of complement-fixing antibody, and the process is orchestrated by the release of interleukin-12 (IL-12) from activated macrophages, interferon-γ (IFN-γ) from natural killer cells, and activation of CD4+ cells to
The Hygiene Hypothesis as a mechanism to explain the increasing frequency of allergies in industrialized nations
The Hygiene Hypothesis originally was proposed as a mechanism to explain the marked increase in allergies observed in industrialized (Westernized) societies.18, 19, 20, 21, 22, 23, 24, 25 Specifically, the hypothesis proposes that early and frequent exposure to bacterial and other antigens, common in developing nations, leads to a normal TH1 response, but that the better public hygiene and less infections observed in industrialized nations may lead to persistence of the TH2 phenotype and
Can the Hygiene Hypothesis explain the epidemiological patterns of glomerular disease observed worldwide?
Studies largely led by Holdsworth et al26 have shown that most proliferative glomerular diseases are driven by a TH1 response. One might then hypothesize that such diseases as MPGN, mesangial proliferative glomerulonephritis (GN; of the non-IgA type), and poststreptococcal GN may be more frequent in developing countries. MPGN is one of the most common glomerular diseases in Africa (such as Nigeria),3, 4 the West Indies (Trinidad),27 eastern Europe (Poland),28 Turkey,29 and east China.30 In
The renal Hygiene Hypothesis: summary, caveats, and future studies
To summarize, we propose a new hypothesis to explain the divergent epidemiological characteristics of glomerular disease worldwide. Specifically, we suggest that the overall hygiene and socioeconomic status of a country may predispose its citizens to either a TH1- or TH2-dominant phenotype that will increase the susceptibility of that population to specific types of glomerular disease. Although recognizing that true incidence data are lacking, we present evidence that TH1-dominant diseases,
Acknowledgements
The authors thank the following physicians for providing data on glomerular disease patterns in their respective countries: Dr E. Kasamatsu (Paraguay), Dr N. Mazzuchi (Uruguay), and Dr A. Pinto (Venezuela).
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Microbiota and glomerulonephritis: An immunological point of view
2022, American Journal of the Medical SciencesEpidemiology and Outcomes of Glomerular Diseases in Low- and Middle-Income Countries
2022, Seminars in NephrologyDoes the pathohistological pattern of renal biopsy change during time?
2018, Pathology Research and PracticeCitation Excerpt :The incidence of MPGN decreased somewhat during the period of observation without reaching statistical significance. This concords with the hypothesis that socioeconomic conditions have an influence on MPGN prevalence [10]. Non-IgAN, IgAN, MPGN and MCD occurred significantly more often in the younger age group than in the elderly one, while MN and CressGN were more prevalent among the older patients.
Role of Mesangial-Podocytic-Tubular Cross-Talk in IgA Nephropathy
2018, Seminars in NephrologyCitation Excerpt :The mechanism for the formation of IgA-IC is highly variable in different patient groups as a result of the following: (1) marked differences in the extent of serum IgA1 O-glycosylation and the hinge-region–specific autoantibodies83-85; (2) the presence or absence of additional components in the process of immune complex formation (these components include soluble CD89 of different molecular weight, complements, and antigliadin antibodies)86-90; and (3) the variation in the size of IgA-IC and light chain composition of the IgA1.91-93 It is likely that both genetic and environmental factors play contributory roles in the process of IgA-IC formation.94-96 All of these elements operate in variable extents, driving the formation of IgA-IC in different subgroups of IgAN patients, and point to a final common end point of mesangial IgA deposition.
Primary glomerulonephritides
2016, The LancetCitation Excerpt :Important regional differences in glomerulonephritis distribution exist; the percentage of IgA nephropathy diagnoses is higher in Asian cohorts, whereas in cohorts from the USA and Canada, focal segmental glomerulosclerosis is more prevalent. Additionally, within one region, the distribution of glomerulonephritis types is associated with socioeconomic factors, with wealthier countries exhibiting more IgA nephropathy and less wealthy countries having more cases of membranoproliferative glomerulonephritis.9 In most glomerulonephritides, only a subgroup of patients experiences progressive glomerular filtration rate (GFR) loss; such high-risk patients should be followed up by a nephrologist.
A higher frequency of CD4<sup>+</sup>CXCR5<sup>+</sup> T follicular helper cells in patients with newly diagnosed IgA nephropathy
2014, Immunology LettersCitation Excerpt :Human T lymphocytes can be divided into two groups: Th1 cells and Th2 cells. Some researchers have suggested that differences in the prevalence of various forms of glomerulonephritis in various areas of the world are based on an imbalance between the Th1 and Th2 systems [30]. However, conflicting results have been reported concerning the Th1/Th2 ratio in IgA nephropathy.