'Renal hypersensitivity' to inulin and IgA nephropathy
Justine Bacchetta1, Florence Villard, Thierry Vial
1Centre de Référence des Maladies Rénales Rares, Hospices Civils de Lyon et Université Lyon 1, Lyon, France.
Pediatric Nephrology (Berlin, Germany)
|June 7, 2008
Summary
Hypersensitivity to inulin, a polyfructan, is rare. In a patient with immunoglobulin A nephropathy (IgAN), inulin infusion triggered anaphylaxis and a relapse of the kidney disease, suggesting a link between inulin and IgAN exacerbation.
Area of Science:
- Immunology
- Nephrology
- Allergy
Background:
- Inulin (polyfructan) hypersensitivity is infrequently reported.
- Immunoglobulin A nephropathy (IgAN) is a primary glomerulonephritis characterized by IgA deposition in the glomeruli.
Observation:
- An 11-year-old boy with IgAN experienced anaphylaxis and a nephropathy relapse after inulin infusion for glomerular filtration rate (GFR) measurement.
- Initial tests for inulin allergy were negative, but subsequent infusion led to acute renal failure, initially suspected as drug-induced interstitial nephritis.
Findings:
- Renal biopsy confirmed an acute proliferative relapse of IgAN, not interstitial nephritis.
- The patient exhibited symptoms of anaphylaxis including pruritus, wheezing, and cough, followed by systemic signs like pallor, asthenia, and oliguria.
Implications:
- This case suggests inulin may trigger IgAN relapse in susceptible individuals, potentially by activating the innate immune system.
- Inulin's role as an immune-modulating agent warrants further investigation, especially in patients with pre-existing immune dysregulation like IgAN.
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