Membranoproliferative glomerulonephritis with predominant IgG2 and IgG3 deposition in a patient with IgG4-related disease

BMC Nephrology

Kazuhiko Tsuruya³  Takanari Kitazono¹  Satoshi Hisano²  Tamotsu Kiyoshima⁴  Shigeru Tanaka¹  Kumiko Torisu¹  Kiichiro Fujisaki¹  Akihiro Tsuchimoto¹  Kosuke Masutani¹  Yuta Matsukuma¹  Kenji Ueki¹ 

[1] Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan;Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan;Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;Department of Oral Pathology, Graduate School of Dental Sciences, Kyushu University, Fukuoka, Japan

关键词: Salivary gland;    Kidney biopsy;    IgG subclasses;    Full-house immunofluorescence;    Corticosteroid;   

Others  :  1231143
DOI  :  10.1186/s12882-015-0164-8

 received in 2015-05-04, accepted in 2015-10-14,  发布年份 2015

【 摘 要 】

Background

IgG4-related disease is a novel disease entity characterized by elevated serum IgG4 and tissue infiltration by IgG4-positive plasma cells. Typical renal pathology is tubulointerstitial nephritis with storiform fibrosis, although the co-existence of various glomerular lesions has been described. Here, we present the first report of a case of IgG4-related kidney disease and membranoproliferative glomerulonephritis showing the discrepancy in IgG subclasses between the kidney interstitium and glomeruli.

Case presentation

A 70-year-old Japanese woman was diagnosed with membranoproliferative glomerulonephritis and focal tubulointerstitial nephritis with IgG4-positive plasma cells. Immunofluorescence studies revealed predominant deposition of IgG3 and IgG2, but not IgG4 in the glomeruli. We administered oral prednisolone at 30 mg/day, and the abnormalities in urine and blood tests gradually resolved.

Conclusion

In this case, different patterns of IgG subclasses detected in the glomeruli and interstitial plasma cells suggest overlapping immunologic abnormalities. The favorable clinical course in our patient suggests that steroid therapy is promising in cases of IgG4-related kidney disease accompanied by glomerulonephritis.

【 授权许可】

   
2015 Ueki et al.

【 图 表 】

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【 参考文献 】

• [1]Umehara H, Okazaki K, Masaki Y, Kawano M, Yamamoto M, Saeki M et al.. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol. 2012; 22:21-30.
• [2]Alexander MP, Larsen CP, Gibson IW, Nasr SH, Sethi S, Fidler ME et al.. Membranous glomerulonephritis is a manifestation of IgG4-related disease. Kidney Int. 2013; 83:455-62.
• [3]Saeki T, Kawano M. IgG4-related renal disease. Kidney Int. 2014; 85:251-7.
• [4]Nishi S, Imai NM, Yoshida K, Ito Y, Saeki T. Clinicopathological findings of immunoglobulin G4-related kidney disease. Clin Exp Nephrol. 2011; 15:810-9.
• [5]Morimoto J, Hasegawa Y, Fukushima H, Uesugi N, Hisano S, Saito T et al.. Membranoproliferative glomerulonephritis-like glomerular disease and concurrent tubulointerstitial nephritis complicating IgG4-related autoimmune pancreatitis. Intern Med. 2009; 48:157-62.
• [6]Katano K, Hayatsu Y, Matsuda T, Miyazaki R, Yamada K, Kawano M et al.. Endocapillary proliferative glomerulonephritis with crescent formation and concurrent tubulointerstitial nephritis complicating retroperitoneal fibrosis with a high serum level of gG4. Clin Nephrol. 2007; 68:308-14.
• [7]Ito K, Yamada K, Mizushima I, Aizu M, Fujii H, Mizutomi K et al.. Henoch–Schönlein purpura nephritis in a patient with IgG4-related renal disease: A possible association. Clin Nephrol. 2013; 79:246-52.
• [8]Saeki T, Nishi S, Imai N, Ito T, Yamazaki H, Kawano M et al.. Clinicopathological characteristics of patients with IgG4-related tubulointerstitial nephritis. Kidney Int. 2010; 78:1016-23.
• [9]Yamaguchi Y, Kanetsuna Y, Honda K, Yamanaka N, Kawano M, Nagata M et al.. Characteristic tubulointerstitial nephritis in IgG4-related disease. Hum Pathol. 2012; 43:536-49.
• [10]Müller T, Beutler C, Picó AH, Otten M, Dürr A, Al-Abadi H et al.. Increased T-helper 2 cytokines in bile from patients with IgG4-related cholangitis disrupt the tight junction-Associated biliary epithelial cell barrier. Gastroenterology. 2013; 144:1116-28.
• [11]Tanaka A, Moriyama M, Nakashima H, Miyake K, Hayashida JN, Maehara T et al.. Th2 and regulatory immune reactions contribute to IgG4 production and the initiation of Mikulicz disease. Arthritis Rheum. 2012; 64:254-63.
• [12]Tipping PG, Holdsworth SR. T cells in glomerulonephritis. Springer Semin Immunopathol. 2003; 24:377-93.
• [13]Imai H, Hmai K, Komatsuda A, Ohtani H, Mura AB. IgG subclasses in patients with membranoproliferative glomerulonephritis, membranous nephropathy, and lupus nephritis. Kidney Int. 1997; 51:270-6.
• [14]Masutani K, Tokumoto M, Nakashima H, Tsuruya K, Kashiwagi M, Kudoh Y et al.. Strong polarization toward Th1 immune response in ANCA-associated glomerulonephritis. Clin Nephrol. 2003; 59:395-405.
• [15]Masutani K, Taniguchi M, Nakashima H, Yotsueda H, Kudoh Y, Tsuruya K et al.. Up-regulated interleukin-4 production by peripheral t-helper cells in idiopathic membranous nephropathy. Nephrol Dial Transplant. 2004; 19:580-6.
• [16]Rodriguez EF, Nasr SH, Larsen CP, Sethi S, Fidler ME, Cornell LD. Membranous nephropathy with crescents: a series of 19 cases. Am J Kidney Dis. 2014; 64:66-73.
• [17]Shimada M, Fujita T, Nakamura N, Narita I, Shimaya Y, Murakami R et al.. A case of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis and concurrent membranous nephropathy. BMC Nephrol. 2013; 14:73. BioMed Central Full Text
• [18]Wang Y, Ito S, Chino Y, Goto D, Matsumoto I, Murata H et al.. Laser microdissection-based analysis of cytokine balance in the kidneys of patients with lupus nephritis. Clin Exp Immunol. 2009; 159:1-10.