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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">nid</journal-id><journal-title-group><journal-title xml:lang="ru">Нефрология и диализ</journal-title><trans-title-group xml:lang="en"><trans-title>Nephrology and Dialysis</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1680-4422</issn><issn pub-type="epub">2618-9801</issn><publisher><publisher-name>Российское диализное общество</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.28996/2618-9801-2024-1-35-54</article-id><article-id custom-type="elpub" pub-id-type="custom">nid-143</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И ЛЕКЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEWS AND LECTURES</subject></subj-group></article-categories><title-group><article-title>Современные представления о патогенезе IgA нефропатии</article-title><trans-title-group xml:lang="en"><trans-title>Current concepts of the pathogenesis IgA nephropathy</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Зубкин</surname><given-names>М. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Zubkin</surname><given-names>M. L.</given-names></name></name-alternatives><email xlink:type="simple">m-zubkin@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Солдатов</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Soldatov</surname><given-names>D. A.</given-names></name></name-alternatives><email xlink:type="simple">danil.soldatov.1996@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фролова</surname><given-names>Н. Ф.</given-names></name><name name-style="western" xml:lang="en"><surname>Frolova</surname><given-names>N. F.</given-names></name></name-alternatives><email xlink:type="simple">nadiya.frolova@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Червинко</surname><given-names>В. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Chervinko</surname><given-names>V. I.</given-names></name></name-alternatives><email xlink:type="simple">dok534@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Крюков</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kryukov</surname><given-names>E. V.</given-names></name></name-alternatives><email xlink:type="simple">evgeniy.md@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Федеральное бюджетное учреждение науки «Московский научно-исследовательский институт эпидемиологии и микробиологии имени Г.Н. Габричевского» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека; Филиал федерального государственного бюджетного военного образовательного учреждения высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации; Государственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница № 52 Департамента здравоохранения г. Москвы»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology; Branch of the S.M. Kirov Military Medical Academy; Moscow City Hospital No. 52</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Государственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница № 52 Департамента здравоохранения г. Москвы»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Moscow City Hospital No. 52</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Федеральное государственного бюджетного военное образовательное учреждение высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>S.M. Kirov Military Medical Academy</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>21</day><month>06</month><year>2024</year></pub-date><volume>26</volume><issue>1</issue><fpage>35</fpage><lpage>54</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Зубкин М.Л., Солдатов Д.А., Фролова Н.Ф., Червинко В.И., Крюков Е.В., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Зубкин М.Л., Солдатов Д.А., Фролова Н.Ф., Червинко В.И., Крюков Е.В.</copyright-holder><copyright-holder xml:lang="en">Zubkin M.L., Soldatov D.A., Frolova N.F., Chervinko V.I., Kryukov E.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://journal.nephro.ru/jour/article/view/143">https://journal.nephro.ru/jour/article/view/143</self-uri><abstract><p>Введение: иммуноглобулин А нефропатия является самым распространенным в мире и в России первичным хроническим гломерулонефритом и одной из наиболее значимых причин развития терминальной стадии хронической болезни почек, требующей применения заместительной почечной терапии. Заболевание дебютирует у людей преимущественно молодого и трудоспособного возраста (от 20 до 40 лет), что определяет его социальную значимость. Также известно о высокой частоте рецидивов IgA нефропатии после трансплантации донорской почки. Спектр клинических проявлений и морфологической картины заболевания чрезвычайно разнообразен, варьируя от изолированного мочевого синдрома (асимптоматическая микрогематурия/протеинурия) до нефритической активности, нефротического синдрома и даже быстропрогрессирующего гломерулонефрита. Цель настоящего обзора представить современный взгляд на патогенез IgA нефропатии. Основные сведения: в настоящее время сформировалось принципиальное понимание природы этого заболевания, а также появились отдельные данные о более тонких механизмах его развития. Стало очевидным, что IgA нефропатия является аутоиммунной болезнью, в основе которой лежит образование иммунных комплексов (ИК). В роли аутоантигена выступает галактозо-дефицитный IgA1 (Gd-IgA1), образующийся в результате ослабленного гликозилирования отдельных участков шарнирной области тяжелых цепей этого иммуноглобулина. Его продукция осуществляется клетками MALT-системы (mucosa-associated lymphoid tissue), а именно лимфоидной ткани миндалин ротоглотки NALT (nasal-associated lymphoid tissue) и дистального отдела тонкого кишечника GALT (gut-associated lymphoid tissue). Однако в последние годы значительную роль в патогенезе IgA нефропатии отводят так называемой оси «кишечник-почка». ИК, связываясь с особыми рецепторами, расположенными на мезангиоцитах почечного клубочка, запускают процесс его повреждения. В представленном научном обзоре приводится информация о структуре и продукции IgA как в норме, так и в условиях, способствующих развитию патологии. Рассматриваются триггеры недогликозилирования IgA1, в частности, роль хронических заболеваний носоглотки и кишечника, значение состояния микробиоты этих отделов желудочно-кишечного тракта и пищевых антигенов. Новые данные о патогенезе IgA нефропатии лежат в основе разрабатываемых и уже апробируемых методов лечения заболевания и поэтому могут представлять интерес для клиницистов. Например, крупное международное многоцентровое рандомизированное двойное слепое плацебо-контролируемое клиническое исследование NefigArd продемонстрировало эффективность глюкокортикостероидного препарата (будесонид/Nefecon) с таргетным высвобождением в дистальном отделе тонкого кишечника при существенно меньшей частоте нежелательных явлений, свойственных системным кортикостероидам.</p></abstract><trans-abstract xml:lang="en"><p>Introduction: immunoglobulin A (IgA) nephropathy is the most common primary chronic glomerulonephritis worldwide and in Russia. IgA nephropathy is one of the most significant causes of the development of end-stage chronic kidney disease, which requires renal replacement therapy. The disease occurs in people of predominantly young and working age (from 20 to 40 years), which determines its social significance. A high rate of relapse of IgA nephropathy after donor kidney transplantation was reported. The spectrum of clinical manifestations and morphological picture of the disease is diverse, ranging from isolated urinary syndrome (asymptomatic microhematuria/proteinuria) to nephritic activity, nephrotic syndrome, and even rapidly progressive glomerulonephritis. The review aimed to present current view on the pathogenesis of IgA nephropathy Main information: at present, a fundamental understanding of the nature of this disease has been formed, and some data have appeared on the more subtle mechanisms of its development. It has become obvious that IgA nephropathy is an autoimmune disease based on the immune complexes (IC) formation. Galactose-deficient IgA1 (Gd-IgA1) acts as an autoantigen and is formed as a result of underglycosylation in the hinge region of this immunoglobulin heavy chains. Its production is carried out by cells of the mucosa-associated lymphoid tissue, namely nasal-associated lymphoid tissue (NALT) and gut-associated lymphoid tissue (GALT). However, in recent years, the so-called “gut-kidney” axis has played a significant role in the pathogenesis of IgA nephropathy. IC, binding to special receptors located on the mesangiocytes of the renal glomerulus, trigger the process of its damage. The presented scientific review provides information on the structure and production of IgA both under normal and contributing to pathology conditions. The study examines the triggers of IgA1 underglycosylation, in particular, chronic nasopharynx and intestines diseases, the heterogeneity of the microbiota of these parts of the gastrointestinal tract, and food antigens. New data on the pathogenesis of IgA nephropathy underlie the developed and already tested methods of treating the disease and therefore may be of interest to clinicians. For example, a large international multi-center, randomized, double-blind, placebo-controlled NefigArd trial has demonstrated the effectiveness of a glucocorticoid drug (budesonide/Nefecon) with a targeted release in the ileum with a significantly lower incidence of adverse events in comparison to systemic corticosteroids.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>IgA нефропатия</kwd><kwd>галактозо-дефицитный IgA1</kwd><kwd>иммунные комплексы</kwd><kwd>триггеры</kwd><kwd>IgA nephropathy</kwd><kwd>galactose-deficient IgA1</kwd><kwd>immune complexes</kwd><kwd>triggers</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Schena F.P., Nistor I. Epidemiology of IgA Nephropathy: A Global Perspective. Semin Nephrol. 2018. 38:435-442. doi: 10.1016/j.semnephrol.2018.05.013</mixed-citation><mixed-citation xml:lang="en">Schena F.P., Nistor I. 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