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Progress in understanding the pathogenesis of IgA nephropathy has shown that probably there is no a single IgA nephropathy with the same pathogenic mechanism, clinical course and response to therapy. The evidence currently available suggests the existence of at least two possible mechanisms of IgA deposition in the renal mesangium. In a small percentage of patients, mesangial deposition of IgA1 colocalizes with secretory component, indicating that the deposited IgA1 in glomeruli originates completely or partly in the mucose-associated lymphoid tissue. This deposition pattern has been associated with activation of complement by the lectin pathway and has been associated with a worse prognosis, although this last statement needs to be confirmed in long-term studies. The mechanisms responsible for secretory IgA deposition are not known. In the majority of patients with IgA nephropathy secretory component is not detectable in the mesangium. In these cases, the presence of elevated circulating levels of galactose-deficient IgA, produced by bone marrow plasma cells would be a predisposing factor but not sufficient to induce nephropathy. To produce kidney disease, galactose-deficient IgA1 must be deposited in the renal mesangium, and once there, either by interaction with specific receptors (CD71?), by direct activation of complement or by being the target of an IgG autoimmune response anti-IgA, induce activation, proliferation and increased mesangial matrix synthesis and eventually cell injury. In parallel, galactose-deficient IgA, through interaction with the RR Fc alpha/gamma, may activate circulating lymphocytes and monocytes and enhance their response to chemoattractants produced by the mesangial cell, causing, thus, the inflammatory infiltrate to initiate and maintain the interstitial injury. In the next few years, advances recently added to the knowledge of the pathogenesis of nephropathy IgA1 could provide new variables that allow walking in the direction of having a classification of patients based not only in clinical and morphological criteria but also having a greater pathogenic basis.

L-selectin is an adhesion molecule that is responsible for the initial attachment of leukocytes to endothelium. After leukocyte activation L-selectin is endoproteolytically released from the cell surface. In order to analyze the relationship between soluble L-selectin (sL-selectin) and parameters of immune activation and disease progression, 51 HIV infected children and 15 healthy controls were studied. Serum L-selectin concentrations were significantly higher in HIV infected children than in the control group. Levels of sL-selectin were higher in HIV infected patients with severe immunologic suppression than in those with moderate or no evidence of suppression. A positive correlation between sL-selectin levels and LTCD8 counts, sL-selectin and soluble intercellular adhesion molecule-1 (sICAM-1) and immunogobulin A (IgA) levels was detected. On the contrary sL-selectin concentration did not correlate with plasmatic viral load. The correlation with parameters of immune activation may implicate involvement of sL-selectin in the immunopathogenesis of HIV infection.

Several immunologic changes, both humoral and cellular, have been described in patients with post-alcoholic cirrhosis. One of these changes was a polyclonal hypergammaglobulinemia which can be produced by a failure in the immunoregulation dynamics. The number of leukocytes, as well as lymphocytic population and subpopulation, did not prove significant differences between healthy people and patients. The seric immunoglobulin showed an increase of IgG in cirrhotics. The synthesis of immunoglobulins "in vitro" showed increased productions in cirrhotics; this being spontaneous in IgA and induced by pokeweed in the case of IgG and IgA.