ONE CASES OF IgA NEPHROPATHY TREATED WITH A COMBINATION OF TELITACICEPT AND HALF-DOSE GLUCOCORTICOIDS IN PATIENT WITH ABNORMAL SERIES OF ANTI NUCLEAR ANTIBODIES

Immunoglobulin A nephropathy (IgAN) is a common primary glomerular disease characterized by the deposition of IgA based immune complexes in the mesangial area of the glomerulus, as shown by renal immunopathology. Its etiology is complex, clinical manifestations are diverse, and drug treatment responses vary greatly. The anti nuclear antibody series is a general term for a group of autoantibodies that target components of their own eukaryotic cells as antigens. Their target antigens include nucleic acids, histones, non histones, phospholipids, and various proteases, which exist in the nucleus, cytoplasm, and organelles of cells. They have important clinical value in the diagnosis of autoimmune diseases, and therefore their detection is often used as a preliminary screening test for autoimmune diseases. Telitaciceptis a TACI–Fc fusion protein with APRIL‐and BLyS‐dual targeting capacity. It suppresses the differentiation of mature B cells into plasma cells and influences the secretion of auto antibodies by reactive plasma cells. There are studies showing that IgA nephropathy has a certain proportion of positive anti nuclear antibody series, which is similar to various autoimmune diseases; At the same time, there are many autoimmune diseases that can be combined with IgA nephropathy, such as rheumatoid arthritis, polymyositis, and dermatomyositis, SLE, Primary Sjogren's syndrome. Some researchers believe that ANA positivity is related to enhanced immune function and increased production of autoantibodies in patients with IgA nephropathy. We once encountered a patient with IgA nephropathy who developed positive anti neutrophil cytoplasmic antibodies after years of dialysis and she was diagnosed with ANCA related vasculitis before.

This time we encountered a 46 year old female IgA patient with abnormal antibody series. She presented with proteinuria for half a month and underwent laboratory tests for urinary protein 4+, occult blood 3+, urinary microalbumin/creatinine 1039mg/g, creatinine 138.09umoμmol/L. The anti nuclear antibody series showed positive anti-U1-nRNP/Sm, positive anti Sm, weakly positive ANA, granular type, 1:100. Renal puncture pathology report: Consistent with focal proliferative sclerosing IgA nephropathy, equivalent to Lee grade IV, Oxford classification: M1 E0 S1 T1 C1. Administer methylprednisolone 24mg orally per day and Telitacicept 160mg subcutaneously once a week. After six months of treatment, the dosage was reduced to 4mg methylprednisolone once daily and 160mg Telitacicept subcutaneously injected once every two weeks for maintenance therapy.

One year later, urine protein was negative, anti nuclear antibody series was negative, and urine microalbumin/creatinine was 246.83mg/g; Creatinine is 88.89μmol/L.

This case of treating IgA nephropathy patients with abnormal anti nuclear antibody series with the combination of Telitacicept and  half-dose Glucocorticoid therapy achieved good therapeutic effects, avoiding the side effects of sufficient hormones, and providing a new reference treatment plan for such patients.