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Immunohistochemical Characteristics of IgG4-Related Tubulointerstitial Nephritis: Detailed Analysis of 20 Japanese Cases
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- Mitsuhiro Kawano
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan
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- Ichiro Mizushima
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan
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- Yutaka Yamaguchi
- Yamaguchi's Pathology Laboratory, Matsudo, Chiba 270-2231, Japan
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- Naofumi Imai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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- Hitoshi Nakashima
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
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- Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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- Satoshi Hisano
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
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- Nobuaki Yamanaka
- Tokyo Kidney Research Institute, Tokyo 113-0023, Japan
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- Motohisa Yamamoto
- First Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan
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- Hiroki Takahashi
- First Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan
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- Hisanori Umehara
- Department of Hematology and Immunology, Kanazawa Medical University, Kanazawa 920-0293, Ishikawa, Japan
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- Takao Saito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
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- Takako Saeki
- Department of Internal Medicine, Nagaoka Red Cross Hospital, Nagaoka 940-2085, Japan
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Description
<jats:p>Although tubulointerstitial nephritis with IgG4+ plasma cell (PC) infiltration is a hallmark of IgG4-related kidney disease (IgG4-RKD), only a few studies are available about the minimum number of IgG4+ PC needed for diagnosis along with IgG4+/IgG+ PC ratio in the kidney. In addition, the significance of the deposition of IgG or complement as a reflection of humoral immunity involvement is still uncertain. In this study, we analyzed 20 Japanese patients with IgG4-RKD to evaluate the number of IgG4+ PCs along with IgG4+/IgG+ PC ratio and involvement of humoral immunity. The average number of IgG4+ PCs was 43.8/hpf and the average IgG4+/IgG+ or IgG4+/CD138+ ratio was 53%. IgG and C3 granular deposits on the tubular basement membrane (TBM) were detected by immunofluorescence microscopy in 13% and 47% of patients, respectively. Nine patients had a variety of glomerular lesions, and 7 of them had immunoglobulin or complement deposition in the glomerulus. In conclusion, we confirmed that infiltrating IgG4+ PCs > 10/hpf and/or IgG4/IgG (CD138)+ PCs > 40% was appropriate as an item of the diagnostic criteria for IgG4-RKD. A relatively high frequency of diverse glomerular lesions with immunoglobulin or complement deposits and deposits in TBM may be evidence of immune complex involvement in IgG4-related disease.</jats:p>
Journal
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- International Journal of Rheumatology
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International Journal of Rheumatology 2012 1-9, 2012
Hindawi Limited
