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Matthai SM, Hems L, Tsang YW, Aggarwal Y, Mahmoud H, Gopalakrishnan K. Podocyte Infolding Glomerulopathy Masquerading as Membranous Nephropathy - A Shared Pathogenesis? Indian J Nephrol 2024; 34:397-400. [PMID: 39156853 PMCID: PMC11326786 DOI: 10.25259/ijn_209_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/15/2023] [Indexed: 08/20/2024] Open
Abstract
Podocyte infolding glomerulopathy (PIG) is a rare pathological entity, diagnosed by electron microscopic demonstration of diffuse infolding of the podocytes into the glomerular basement membranes. We report the first case from United Kingdom exhibiting typical ultrastructural features of PIG in a male with Type II diabetes mellitus, hypertension and common variable immune deficiency. Renal biopsy revealed phospholipase A2 receptor (PLA2R) immunostain positive membranous nephropathy (MN) but no serum PLA2R antibodies. Diffuse infolding of the podocytes into the glomerular basement membranes along with pathognomonic microspherular and microtubular intra basement membrane clusters distributed diffusely and globally were noted on electron microscopy, diagnostic of PIG. We postulate a shared pathomechanistic link between PIG and MN, highlighting the overlapping features of both conditions.
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Affiliation(s)
- Smita Mary Matthai
- Central EM Facility, Christian Medical College, Vellore, Tamil Nadu, India
- Department of Cellular Pathology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Liam Hems
- Department of Cellular Pathology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Yee Wah Tsang
- Department of Cellular Pathology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Yogita Aggarwal
- Department of Renal Medicine, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Huda Mahmoud
- Department of Nephrology, Walsall Manor Hospital, Walsall, UK
| | - Kishore Gopalakrishnan
- Department of Cellular Pathology, University Hospital Coventry and Warwickshire, Coventry, UK
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Kudose S, Stokes MB. Diagnosis of Glomerular Disease With Podocyte Infolding, Microspherical, and Microtubular Glomerular Basement Membrane Inclusions. Kidney Int Rep 2023; 8:2507-2510. [PMID: 38106589 PMCID: PMC10719634 DOI: 10.1016/j.ekir.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Affiliation(s)
- Satoru Kudose
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - M. Barry Stokes
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
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3
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Hong L, Wang L, Wang H, Wang Q, Yang S, Tian T, Cui T, Yue S, Hou X, Zheng Z, Chen W. Podocyte Infolding Glomerulopathy: A Special Morphology of Podocyte Injury Caused by Heterogeneous Diseases. Kidney Int Rep 2023; 8:2742-2753. [PMID: 38106587 PMCID: PMC10719646 DOI: 10.1016/j.ekir.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Podocyte infolding glomerulopathy (PIG) is a newly recognized rare glomerular injury. The clinical significance and mechanism of this injury pattern remains unclear. Methods We conducted a retrospective study of renal biopsies from January 2018 to December 2020 in Kingmed Diagnostics. The renal biopsy features and clinical data were reviewed. Laser scanning microdissection and mass spectrometry (LMD/MS) was conducted to analyze the potential mechanism. Results A total of 116 (0.092%) out of 126,086 biopsies were diagnosed as PIG during the period. Of these, 89 (76.7%) cases were found to have PIG coexisting with immune-complex associated glomerulonephritis (IC-PIG) whereas 27 (23.3%) were identified as isolated PIG without immunoglobulin or complement deposition. Systemic lupus erythematosus (SLE), especially with membranous lupus nephritis (LN), was diagnosed in most (70.8%) IC-PIG cases. Of the isolated PIG cases, 51.9% had no known underlying conditions; however, a relatively high positive rate (42.1%) of antinuclear antibody (ANA) was detected. Nearly half (47.5%) of the patients presented with nephrotic syndrome (NS). PIG grade was associated with proteinuria in isolated PIG (P = 0.035). LMD/MS revealed dysregulated cytoskeletal protein α-actinin4 (ACTN4) and tubulin beta-4 chain in PIG compared with normal donor kidney and minimal change disease (MCD). The displacement of ACTN4 into the glomerular basement membrane (GBM) was confirmed by the confocal microscope. Conclusion PIG is a rare podocyte injury that can exist alone without underlying disease or be concurrent with various diseases, especially SLE. Podocyte cytoskeletal protein ACTN4 and tubulin beta-4 chain were dysregulated, which may be involved in the mechanism of PIG.
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Affiliation(s)
- Ling Hong
- Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Wang
- Department of Renal Pathology, Guangzhou Kingmed Diagnostic Laboratory Ltd, Guangzhou International Biological Island, Guangzhou, China
| | - Honglei Wang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qihua Wang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shicong Yang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tian Tian
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianjiao Cui
- Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Shuling Yue
- Department of Renal Pathology, Guangzhou Kingmed Diagnostic Laboratory Ltd, Guangzhou International Biological Island, Guangzhou, China
| | - Xiaotao Hou
- Department of Renal Pathology, Guangzhou Kingmed Diagnostic Laboratory Ltd, Guangzhou International Biological Island, Guangzhou, China
| | - Zhihua Zheng
- Department of Nephrology, Center of Kidney and Urology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wenfang Chen
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Wang Z, Diao Y, Wang Z, Yang X, Zhen J, Liu G. IgA nephropathy with podocytic infolding glomerulopathy. Chronic Dis Transl Med 2023; 9:345-348. [PMID: 37915389 PMCID: PMC10617307 DOI: 10.1002/cdt3.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 11/03/2023] Open
Abstract
(A) Immunofluorescence staining showed moderate immunoglobulin A depositions in the mesangial areas (++) of glomeruli (Bars = 100 μm). (B) Segmentally mild mesangial proliferation and mesangial matrix expansion (arrowhead) with mild thickening of glomerular capillary walls (PAS, ×400).
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Affiliation(s)
- Zhouyang Wang
- Department of NephrologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Yujie Diao
- Department of NephrologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Zhendong Wang
- Department of NephrologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Xiangdong Yang
- Department of NephrologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Junhui Zhen
- Department of Pathology, School of Basic Medical SciencesShandong UniversityJinanShandongChina
| | - Guangyi Liu
- Department of NephrologyQilu Hospital of Shandong UniversityJinanShandongChina
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5
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Kim C, Tan RYP, Tan J, Otto S, Nolan J, Brealey J, Rao NN. Patterns of podocyte infolding glomerulopathy and collapsing glomerulopathy seen in a patient with systemic lupus erythematosus: a case study. Pathology 2023; 55:886-890. [PMID: 37100667 DOI: 10.1016/j.pathol.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/16/2022] [Accepted: 02/07/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Chankyung Kim
- Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
| | - Rachel Yi Ping Tan
- Renal Unit, Flinders Medical Centre, Bedford Park, SA, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Janice Tan
- Renal Unit, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Sophia Otto
- Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia
| | - James Nolan
- Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia
| | - John Brealey
- Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia
| | - Nitesh N Rao
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; Renal Unit, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia; Adelaide Medical School, University of Adelaide, SA, Australia
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Chang MY, Zhang Y, Li MX, Xuan F. Integrated Chinese and Western medicine in the treatment of a patient with podocyte infolding glomerulopathy: A case report. World J Clin Cases 2023; 11:4684-4691. [PMID: 37469726 PMCID: PMC10353505 DOI: 10.12998/wjcc.v11.i19.4684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Podocyte infolding glomerulopathy (PIG) is a newly described and rare glomerular disease. To date, only approximately 40 cases have been reported globally.
CASE SUMMARY A 26-year-old female patient presented to our hospital with a complaint of intermittent edema of both lower limbs over the past 2 years. The patient was diagnosed with PIG. She was prescribed corticosteroid therapy in other hospitals during the initial stage, to which she had responded poorly and had developed femoral head necrosis. Therefore, we administered immunosuppressants, renin-angiotensin system inhibitors, combined with traditional Chinese medicine. The patient was followed for 1 year, during which her clinical condition improved.
CONCLUSION Integrated Chinese and Western medicine may be effective for PIG treatment, which requires active intervention to improve prognosis.
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Affiliation(s)
- Mei-Ying Chang
- Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yu Zhang
- Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Ming-Xu Li
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Fang Xuan
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
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7
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Podocyte Infolding Glomerulopathy: A Case Series Report and Literature Review. J Clin Med 2023; 12:jcm12031088. [PMID: 36769735 PMCID: PMC9918010 DOI: 10.3390/jcm12031088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Podocyte infolding glomerulopathy (PIG) is a peculiar and very rare manifestation in renal pathology. Its underlying pathogenesis mechanism and clinical characteristics remain unclear due to sparse reports. OBJECTIVE To further elucidate the clinical profile of PIG by carefully reporting our four cases and a comprehensive review of cases in the literature. METHODS This study retrospectively reviewed four cases of PIG from 2010 to 2022 in our centre. Clinical and pathological profiles were reported. PIG cases in the literature were searched in the MEDLINE database and analysed together with our cases. RESULTS Four cases of PIG identified from our centre and 40 cases from the current literature were reported. The pooled analysis of these 44 cases indicated 79.5% (35/44) were females, 93.2% (41/44) were East Asians, and 63.6% (28/44) were reported in Japan. The average age was 42.0 ± 12.5 years old. The average amount of proteinuria at the time of renal biopsy was 3.06 ± 3.2 g/day. The most reported comorbidities were connective tissue diseases, mainly systemic lupus erythematosus, and 20.5% (9/44) of the cases did not have any contaminant disease. Most of the cases (81.8%, 36/44) had been treated with immunosuppressants, of which a combination of corticosteroids and one other type of immunosuppressant was most commonly reported. In addition, 45.4% (20/44) and 34.1% (15/44) of the cases had achieved complete response and partial response, respectively, after treatment. Whole exosome sequencing indicated mutations in the INF2 gene. CONCLUSIONS PIG is a rare condition and seen in relatively younger populations, often associated with connective tissue diseases clinically and one or two other glomerulopathies histologically. The outcomes following immunosuppressive treatment are relatively good. Mutations in INF2 might be involved in the development of PIG; however, the implications of these results need to be investigated.
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Ren KYM, Hou J. Characterization of Membranous Nephropathy with Microspherular Deposits. GLOMERULAR DISEASES 2023; 3:197-210. [PMID: 37901699 PMCID: PMC10601910 DOI: 10.1159/000529700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/04/2023] [Indexed: 10/31/2023]
Abstract
Introduction Membranous nephropathy (MN) is a common cause of adult nephrotic syndrome in the USA. The typical ultrastructural finding is of global uniformly dense subepithelial electron-dense immune complex deposits along glomerular basement membranes. However, early reports described deposits with a unique microspherular substructure. There was variability in what was identified as microspherular, sometimes overlapping with other entities such as podocyte infolding glomerulopathy. Currently, the nature, composition, and clinical significance of these microspherular deposits (MSDs) remain unknown. Method We report the clinicopathologic features of a series of MN cases with MSD, with detailed ultrastructural characterization as well as PLA2R and THSD7A immunohistochemical and IgG subclass-staining characteristics. The proportion of MSD to overall deposits is segregated into two groups: global MSD with >50% MSD (n = 14) and segmental MSD with <50% (n = 5). Results The size and appearance of the microspherules were nearly identical in global and segmental MSD groups (mean diameter of 77.9 nm and 77.2 nm, respectively), with subepithelial (n = 19) or intramembranous (n = 12) distributions in all cases. Mesangial MSDs (n = 5) were only found in the global MSD group. The majority of biopsies (86% of global MSD and 100% of segmental MSD) were Ehrenreich-Churg stage 2 or above; early stage 1 was only observed in the global MSD group. All but 3 cases were PLA2R/THSD7A double negative; 1 THSD7A positive in global MSD and 2 PLA2R positive in segmental MSD. IgG1 was the dominant subclass in the global MSD group, and IgG4 was dominant in the segmental MSD group, including the 2 PLA2R-positive cases. Conclusion The findings suggest that MSDs are more commonly associated with secondary MN. This case series is the largest to date, and the findings may yield etiologic and prognostic information on this rare but unique subset of MN and provide a well-characterized cohort of cases for future studies.
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Affiliation(s)
- Kevin Yi Mi Ren
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, ON, Canada
| | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Hijazi M, Aboursheid T, Al Termanini M, Khanjar IAM. Podocyte infolding glomerulopathy after 25 years of clinical remission of lupus nephritis in a patient with systemic lupus erythematosus: A case report and review of literature. Clin Case Rep 2022; 10:e6756. [PMID: 36545554 PMCID: PMC9764042 DOI: 10.1002/ccr3.6756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Podocyte infolding glomerulopathy (PIG) is a rare pathological finding that has gained more recognition recently. Most of the reported cases have been associated with connective tissue diseases especially systemic lupus erythematosus (SLE). Here we report the first case of Infolding Glomerulopathy associated with SLE in the Middle East.
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Affiliation(s)
- Mohamad Hijazi
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Tarek Aboursheid
- Department of Internal MedicineHamad Medical CorporationDohaQatar
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10
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Choung HYG, Jean-Gilles J, Goldman B. Subepithelial deposits with microspherular structures in membranous glomerulonephritis. Ultrastruct Pathol 2022; 46:377-387. [PMID: 35709324 DOI: 10.1080/01913123.2022.2090646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rare cases of membranous glomerulopathy (MGN) with subepithelial deposits consisting of microspherular structures identified by electron microscopy have been described in the literature as either MGN with spherules or podocyte infolding glomerulopathy (PIG). The paucity of available studies shows a strong association with underlying autoimmune disease. To further understand the significance of subepithelial microspherular deposits, we retrospectively identified native kidney biopsies from 10 patients diagnosed as MGN with subepithelial microspherular structures identified by ultrastructural examination at the University of Rochester Medical Center (URMC) during an 11-year period. The majority were Caucasian (80%) with a mean age of 51.3 (±12.9) years. 50% had an autoimmune disorder, of which 80% were SLE. Two SLE cases had concomitant rheumatoid arthritis and Sjogren's syndrome. One additional case had antiphospholipid syndrome and showed lupus-like features on biopsy. 40% were idiopathic and negative for PLA2R, NELL1, and THSD7A. MGN with subepithelial microspherular structures is frequently associated with an underlying autoimmune disease. The majority are negative for markers of primary MGN (PLA2R, THSD7A, and NELL1) and show features suggestive of secondary MGN.
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Affiliation(s)
- Hae Yoon Grace Choung
- Department of Pathology and Laboratory Medicine, Division of Renal Pathology and Electron Microscopy, University of Rochester Medical Center, Rochester, NY, USA
| | - Jerome Jean-Gilles
- Department of Pathology and Laboratory Medicine, Division of Renal Pathology and Electron Microscopy, University of Rochester Medical Center, Rochester, NY, USA
| | - Bruce Goldman
- Department of Pathology and Laboratory Medicine, Division of Renal Pathology and Electron Microscopy, University of Rochester Medical Center, Rochester, NY, USA
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11
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Liu X, Huang J, Zhang K, Niu Y, Liu Y, Cui C, Yu C. A case of Podocytic Infolding Glomerulopathy with SLE and literature review. BMC Nephrol 2021; 22:410. [PMID: 34895156 PMCID: PMC8665562 DOI: 10.1186/s12882-021-02615-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Podocytic infolding glomerulopathy (PIG) is a rare pathological change which was characterized by the microspheres or microtubular structures in the thickened glomerular basement membrane (GBM). Only a few dozen cases have been reported worldwide so far. Here we present a case of PIG with systemic lupus erythematosus. Case presentation A 61-year-old Chinese female was diagnosed with systemic lupus erythematosus with clinical manifestations of proteinuria, pleural effusion, seroperitoneum, anemia, leukopenia, thrombocytopenia, antinuclear antibody positive, and hypocomplementemia. She also had benign ovarian tumor and Epstein-Barr virus infection. Renal biopsy immunofluorescent staining showed IgM and C3 were granularly deposited along the capillary wall instead of typical “full house” features. Electron microscopy showed lots of microspheres structures were seen in the thickened GBM. Conclusion We present a case of PIG in a patient with systemic lupus erythematosus. The mechanisms of PIG are unknown, but may be associated with connective tissue disease and podocyte injury.
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Affiliation(s)
- Xi Liu
- The Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jieli Huang
- The Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kun Zhang
- The Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yangyang Niu
- The Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuting Liu
- The Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunli Cui
- The Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chen Yu
- The Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
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12
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Ting JA, Hung W, McRae SA, Barbour SJ, Copland M, Riazy M. Podocyte Infolding Glomerulopathy, First Case Report From North America. Can J Kidney Health Dis 2021; 8:20543581211048357. [PMID: 34659774 PMCID: PMC8516371 DOI: 10.1177/20543581211048357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale Podocyte infolding glomerulopathy (PIG) is a newly described condition with only 37 cases reported worldwide. Due to its rarity, the pathogenesis and evolution of this disease is unclear. This case report contributes to our collective knowledge about the clinical and histological progression of this disease. Presenting concerns of the patient Over the course of a year, a 52-year-old Malaysian woman with no known prior medical history developed progressively worsening edema and other findings consistent with nephrotic syndrome. Diagnosis Unlike most patients with PIG, this patient did not have any autoimmune disease. She was Hepatitis B core antibody positive with a Hepatitis B surface antibody >1000, suggesting prior Hepatitis B infection with immunity. A renal biopsy was performed which was consistent with PIG. A second renal biopsy was done 2 years later which again showed characteristic findings of PIG with worsened podocyte effacement but no interval change in chronicity. Interventions The patient was treated with blood pressure control and renin-angiotensin-aldosterone system (RAAS) blockade with irbesartan and spironolactone. She was also treated with prednisone at 1 mg/kg for 2 months followed by a taper for a total of 7 months of prednisone treatment. Outcomes The patient had a partial response to a course of prednisone. However, since stopping steroids, her proteinuria and renal function has been gradually worsening. Teaching points PIG is mostly found in patients of East Asian descent. It presents as proteinuria and is often associated with autoimmune disease but can be idiopathic. It is characterized on renal biopsy by infolding or protrusion of podocyte cytoplasm into glomerular basement membrane, as well as intramembranous cytoplasmic microspherules or microtubules. Atypical membranous nephropathy should be ruled out prior to diagnosis. Unlike membranous nephropathy, PIG usually responds at least partially to steroid monotherapy. To our knowledge, this is the first reported case of PIG from North America. Furthermore, it is the first case of PIG with repeat biopsy showing interval worsening of PIG rather than either resolution of PIG or transformation of PIG to a different diagnosis.
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Affiliation(s)
- Julie Anne Ting
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Wayne Hung
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Susanna A McRae
- Division of Nephrology, The University of British Columbia, Vancouver, Canada.,Department of Pathology, The University of British Columbia, Vancouver, Canada
| | - Sean J Barbour
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Michael Copland
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Maziar Riazy
- Division of Nephrology, The University of British Columbia, Vancouver, Canada.,Department of Pathology, The University of British Columbia, Vancouver, Canada.,Department of Pathology, St. Paul's Hospital, Vancouver, BC, Canada
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13
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Manabe S, Sato M, Kataoka H, Taneda S, Mochizuki T, Nitta K. Cell invasion in glomerular basement membrane: infolding glomerulopathy. Kidney Int 2021; 98:1623. [PMID: 33276871 DOI: 10.1016/j.kint.2020.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/05/2020] [Accepted: 04/13/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masayo Sato
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Clinical Research Division for Polycystic Kidney Disease, Department of Medicine, Kidney Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Sekiko Taneda
- Department of Experimental Pathology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Clinical Research Division for Polycystic Kidney Disease, Department of Medicine, Kidney Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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14
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Pandit AP, Rennke HG, Denker BM. Podocytic Infolding Glomerulopathy in a Patient with Phospholipase A2 Receptor-Positive Membranous Nephropathy and Review of the Literature. Nephron Clin Pract 2021; 145:496-502. [PMID: 33965947 DOI: 10.1159/000515769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Podocytic infolding glomerulopathy (PIG) is a rare diagnosis based on characteristic histopathologic findings on renal biopsy and was proposed as a new entity about a decade ago. It is a type of podocytic injury, characterized by invagination of the podocyte cell membrane (cytoplasmic projections from podocytes) into the glomerular basement membrane. The presence of microspheres and/or microtubules on electron microscopy is the characteristic finding. PIG is most often associated with autoimmune conditions like systemic lupus erythematosus. We report pathologic findings typical of PIG in a patient with phospholipase A2 receptor antibody-positive membranous nephropathy. She was treated with rituximab and responded well with decrease in proteinuria to the sub-nephrotic range.
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Affiliation(s)
- Amar P Pandit
- Renal Division, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bradley M Denker
- Renal Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Xiong S, Shuai L, Li X, Dang X, Wu X, He Q. Podocytic infolding in Schimke immuno-osseous dysplasia with novel SMARCAL1 mutations: a case report. BMC Nephrol 2020; 21:170. [PMID: 32393263 PMCID: PMC7216528 DOI: 10.1186/s12882-020-01809-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Schimke immuno-osseous dysplasia (SIOD) is a rare autosomal recessive disorder characterized by spondyloepiphyseal dysplasia, progressive renal insufficiency and defective cellular immunity. Podocytic infolding glomerulopathy (PIG) is a newly proposed disease entity characterized by microspheres or microtubular structures associated with podocytes infolding into the glomerular basement membrane (GBM) on electron microscopy (EM). Case presentation A 4-year-old boy was admitted to our ward due to proteinuria and edema lasting 1 month. He had a short trunk and demonstrated subtle dysmorphology, with a triangular shape, a broad nasal bridge and a bulbous nasal tip. The laboratory findings were as follows: lymphocytes, 0.5 × 109/L; urine protein, 3.67 g/d; albumin, 9.8 g/L; and cholesterol, 11.72 mmol/L. Skeletal X rays showed small iliac wings, small ossification centers of the capital femoral epiphyses, shallow dysplastic acetabular fossae and mildly flattened vertebrae. The specimen for light microscopy (LM) suggested focal segmental glomerulosclerosis (FSGS). EM revealed a focal thickness of the GBM with some cytoplasmic processes of podocyte infolding into the GBM. Gene sequencing showed novel compound heterozygous mutations in the SMARCAL1 gene (c.2141 + 5G > A; c.2528 + 1G > A) that were inherited from his parents. Finally, we established the diagnosis of SIOD and treated him with diuretics and angiotensin-converting enzyme inhibitors (ACEIs). Conclusion The pathogenic mechanism of PIG has not been clarified. Further studies are required to understand whether gene mutations, especially those related to podocytes, contribute to the pathogenesis of podocytic infolding.
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Affiliation(s)
- Shiqiu Xiong
- Department of Pediatrics, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lanjun Shuai
- Department of Pediatrics, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiaoyan Li
- Department of Pediatrics, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiqiang Dang
- Department of Pediatrics, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiaochuan Wu
- Department of Pediatrics, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Qingnan He
- Department of Pediatrics, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Shi J, Zheng R, Gao H, Zhao Z, Wu H, Zhang Z. Podocyte infolding glomerulopathy with undifferentiated connective tissue disease: a case report. Ultrastruct Pathol 2020; 44:245-248. [PMID: 32172632 DOI: 10.1080/01913123.2020.1739791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Podocyte infolding glomerulopathy (PIG) is a special type of glomerular disease that has been proposed in recent years and has attracted considerable attention. PIG is characterized by the formation of microspheres and microtubules in thickened glomerular basement membrane (GBM) on electron microscopy (EM), which is recognized as podocyte cytoplasmic infolding to the GBM. However, to date, only a few cases of PIG have been reported. Herein, we report a case of a 33-year-old female with PIG with undifferentiated connective tissue disease (UCTD) in China and review the literature.
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Affiliation(s)
- Jiaoyu Shi
- Department of Pathology, School of Basic Medical Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rong Zheng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongyang Gao
- Department of Electron Microscope, School of Basic Medical Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhonghua Zhao
- Department of Electron Microscope, School of Basic Medical Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huijuan Wu
- Department of Pathology, School of Basic Medical Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhigang Zhang
- Department of Pathology, School of Basic Medical Science, Shanghai Medical College, Fudan University, Shanghai, China
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Malvar A, Davila P, Ferrari M, Delgado P, Iscoff P, Lococo B, Alberton V. Podocyte infolding glomerulopathy; report of the first case in Latin America and review of the literature. Nefrologia 2020; 40:469-473. [PMID: 31952852 DOI: 10.1016/j.nefro.2019.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Podocyte infolding glomerulopathy (PIG) is a condition of uncertain origin, frequently associated with autoimmune diseases. Its specific treatment and clinical course are unknown. It is characterised by thickening of the capillary walls due to the presence of non-argyrophilic intramembranous bubbles similar to those found in membranous glomerulopathy, but without electron-dense deposits of immune complexes in the ultrastructure, where translucent microspheres generated by invagination of the podocyte cytoplasm into the basement membranes are observed. OBJECTIVES Generally reported in young females patients. To date, few cases in Asian patients have been reported. Our case is the first to be reported in a Latin American Caucasian patient. METHODS A 38-year-old woman with SLE. In 2014 she presented with nephrotic syndrome empirically treated with corticosteroids (CO) and intravenous cyclophosphamide with good response. She had a relapse in April 2015 with normal renal function and no extrarenal lupus activity, so she was referred to our hospital to be biopsied. RESULTS The biopsy reported focal segmental glomerular sclerosis without deposits of immune complexes in the immunofluorescence. However, methenamine silver staining revealed clear spaces in the capillary walls accompanied by marked podocyte alterations. On electron microscope study, numerous aggregates of microvesicular and cylindrical ultrastructures bound to the membranes were observed, without evidence of dense deposits, and diffuse effacement of pedicel foot processes, confirming the suspected diagnosis. CONCLUSIONS This is the first reported case of what can be considered a new pathological glomerular entity in a Latin American Caucasian patient, whose clinical course and therapy are still unknown.
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Affiliation(s)
- Ana Malvar
- Unidad de Nefrología, Hospital Juan A. Fernández, Buenos Aires, Argentina.
| | - Pedro Davila
- Unidad de Nefrología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Matías Ferrari
- Unidad de Nefrología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Pamela Delgado
- Unidad de Nefrología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Paula Iscoff
- Unidad de Nefrología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Bruno Lococo
- Unidad de Nefrología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Valeria Alberton
- División de Patología, Hospital Juan A. Fernández, Buenos Aires, Argentina
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Wöstmann F, Müller RU, Göbel H, Benzing T, Becker JU, Bartram MP. Case report: a peculiar glomerulopathy in a patient suffering from nephrotic syndrome. BMC Nephrol 2019; 20:326. [PMID: 31438874 PMCID: PMC6704495 DOI: 10.1186/s12882-019-1478-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background Podocyte infolding glomerulopathy (PIG) is a rare histopathologic finding with global infolding of the podocytes into the glomerular basement membrane (GBM), accompanied by microstructures underneath. Described in 2002 for the first time, PIG was proposed as a new pathological entity in 2008 based on the largest case series so far. Yet all of the described cases derive from Asian countries. We report a case from Germany fulfilling the diagnostic criteria of PIG. Considering the scarcity of data on this entity especially in Western countries, collecting cases like ours and multicentric meta-analyses will be crucial to obtain a better understanding of PIG, its causes, clinical course and potential treatment options. Case presentation A 56-year-old Caucasian woman with a history of rheumatoid arthritis (RA), no other comorbidities and no known renal disease was admitted to the hospital with acute kidney injury (AKI) and nephrotic syndrome. Physical examination was unremarkable except for anasarca. Renal ultrasound revealed no abnormalities. Laboratory and urine analyses were consistent with the nephrotic syndrome and renal failure. Serological studies regarding ANA, ANCA, anti-PLA2R autoantibodies, complement, virus infections, immunofixation and quantitative light chain analysis were unremarkable. A renal biopsy was performed. Light microscopic examination showed flattened tubular epithelium consistent with acute tubular damage, no infiltrates and unremarkable glomeruli except diffuse and global holes in the GBM (Fig. 1a) and negative staining for immunoglobulin heavy-chains, light-chains and complement split products. Electron microscopy revealed a rare correlate for these holes: global peculiar infolding of podocyte cytoplasm into the GBM. Most of these infoldings were accompanied by condensation of the GBM underneath. No such condensation or electron dense deposits were found without these infoldings or outside the GBM. Conclusion Here we report the first case of PIG outside of Asia. Since there are only few reports about this specific finding, we feel there is a need to share information in an attempt to accumulate knowledge about this possible new entity and potential treatment options.
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Affiliation(s)
- Fabian Wöstmann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Heike Göbel
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Thomas Benzing
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jan U Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany.
| | - Malte P Bartram
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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Podocytic infolding glomerulopathy: two new cases with connective tissue disease and literature review. Clin Rheumatol 2019; 38:1521-1528. [PMID: 30879204 DOI: 10.1007/s10067-019-04504-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/17/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
Podocytic infolding glomerulopathy (PIG) is a newly proposed disease entity, and only 29 cases have been reported worldwide so far, characterized by microspheres or microtubular structures or both associated with podocytic infolding into the glomerular basement membrane (GBM) on electron microscopy. We present two new cases of PIG with connective tissue disease (CTD), one with primary Sjögren's syndrome and the other with systemic lupus erythematosus (SLE), and make a systemic review of the literature. In the entire 31 patients of PIG, 24 (77.42%) were women and seven (22.58%) were men, with an average age of 41.2 ± 15.2 (ranging from 14 to 79) years old. Almost two-thirds of patients (67.74%) were diagnosed with CTD, in which 76.19% were SLE. All patients presented with proteinuria and six (19.35%) patients were accompanied with hematuria. Serum creatinine was elevated in six (19.35%) patients. Pathological findings of all patients were consistent with PIG characteristics, and four patients with repeated renal biopsies further provided profound insights.
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20
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Fang JY, Song AH, Shen B, Liu YL. A Case of Podocytic Infolding Glomerulopathy with Primary Sjögren's Syndrome and Hashimoto's Thyroiditis. Chin Med J (Engl) 2019; 131:2747-2748. [PMID: 30425203 PMCID: PMC6247595 DOI: 10.4103/0366-6999.245276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jun-Yan Fang
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - A-Hui Song
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bo Shen
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Ying-Li Liu
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Takaki T, Ohno N, Saitoh S, Nagai M, Joh K. Podocyte penetration of the glomerular basement membrane to contact on the mesangial cell at the lesion of mesangial interposition in lupus nephritis: a three-dimensional analysis by serial block-face scanning electron microscopy. Clin Exp Nephrol 2019; 23:773-781. [PMID: 30734164 DOI: 10.1007/s10157-019-01701-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The interaction among the glomerular components plays an important role in the development of glomerular lesions; thus, investigation of the ultrastructural three-dimensional (3D) configuration of the human glomerular cells and extracellular matrix (ECM) is important for understanding the pathogenesis of glomerulosclerosis, especially glomerulonephritis. METHODS We applied a new technique of serial block-face scanning electron microscopy (SBF-SEM), which helps to acquire serial electron microscopic images to reconstruct a 3D ultrastructure, to a human kidney biopsy specimen obtained from a 25-year-old woman with lupus nephritis. RESULTS SBF-SEM demonstrated that the cytoplasmic processes of the podocyte penetrated into the lamina densa of the glomerular basement membrane, and was in direct contact with the cytoplasm of mesangial cells at the site of mesangial interposition. CONCLUSION Although this is a single-case observational study, SBF-SEM revealed a unique 3D configuration, suggesting a novel mechanism of direct intercellular cross-communication between podocytes and mesangial cells, aside from the presumed paracrine communication.
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Affiliation(s)
- Takashi Takaki
- Division of Electron microscopy, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan. .,Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi Aoba-ku, Sendai-shi, Miyagi-ken, 980-8575, Japan.
| | - Nobuhiko Ohno
- Division of Histology and Cell Biology, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken, 329-0431, Japan.,Division of Neurobiology and Bioinformatics, National Institute for Physiological Sciences, 5-1 Higashiyama, Myoudaiji-cho, Okazaki-shi, Aichi-ken, 444-8787, Japan
| | - Sei Saitoh
- Section of Electron Microscopy, Supportive Center for Brain Research, National Institute for Physiological Sciences, Okazaki-shi, Aichi-ken, 444-8787, Japan.,Department of Anatomy II and Cell Biology, Fujita Health University School of Medicine, 1-98 Dengakubo, Kutsukake-cho, Toyoake-shi, Aichi-ken, 470-1192, Japan
| | - Masaaki Nagai
- Division of Nephrology, Narita Memorial Hospital, 134 Haneihonmachi, Toyohashi-shi, Aichi-ken, 441-8029, Japan
| | - Kensuke Joh
- Department of Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi Aoba-ku, Sendai-shi, Miyagi-ken, 980-8575, Japan
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22
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Howell DN. Renal biopsy in patients with systemic lupus erythematosus: Not just lupus glomerulonephritis! Ultrastruct Pathol 2017; 41:135-146. [DOI: 10.1080/01913123.2017.1282068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David N. Howell
- Department of Pathology, Duke University, Durham, NC, USA
- Durham Veterans Affairs Medical Centers, Durham, NC, USA
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23
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Three-dimensional electron microscopy reveals the evolution of glomerular barrier injury. Sci Rep 2016; 6:35068. [PMID: 27725732 PMCID: PMC5057164 DOI: 10.1038/srep35068] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/20/2016] [Indexed: 12/26/2022] Open
Abstract
Glomeruli are highly sophisticated filters and glomerular disease is the leading cause of kidney failure. Morphological change in glomerular podocytes and the underlying basement membrane are frequently observed in disease, irrespective of the underlying molecular etiology. Standard electron microscopy techniques have enabled the identification and classification of glomerular diseases based on two-dimensional information, however complex three-dimensional ultrastructural relationships between cells and their extracellular matrix cannot be easily resolved with this approach. We employed serial block face-scanning electron microscopy to investigate Alport syndrome, the commonest monogenic glomerular disease, and compared findings to other genetic mouse models of glomerular disease (Myo1e−/−, Ptpro−/−). These analyses revealed the evolution of basement membrane and cellular defects through the progression of glomerular injury. Specifically we identified sub-podocyte expansions of the basement membrane with both cellular and matrix gene defects and found a corresponding reduction in podocyte foot process number. Furthermore, we discovered novel podocyte protrusions invading into the glomerular basement membrane in disease and these occurred frequently in expanded regions of basement membrane. These findings provide new insights into mechanisms of glomerular barrier dysfunction and suggest that common cell-matrix-adhesion pathways are involved in the progression of disease regardless of the primary insult.
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25
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Koda R, Yoshino A, Imanishi Y, Kawamoto S, Ueda Y, Kazama JJ, Narita I, Takeda T. A Case of Membranous Glomerulonephropathy Associated with Takayasu's Arteritis. Case Rep Nephrol Dial 2014; 4:60-9. [PMID: 24847348 PMCID: PMC4025153 DOI: 10.1159/000360850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Glomerulonephropathy is a rare complication of Takayasu's arteritis (TA). To date, most glomerulonephropathies associated with TA show the histological feature of mesangial proliferation. Membranous glomerulonephropathy (MG) is a form of glomerulonephropathy in which the mesangial proliferation is not conspicuous and its association with TA is extremely rare. A 54-year-old man was referred to our hospital due to progressive edema in the lower limbs and nephrotic range proteinuria. Five years previously, he underwent percutaneous angioplasty for left subclavian artery stenosis. Kidney biopsy revealed stage II MG. General examination including enhanced CT scan confirmed the presence of TA. He started oral prednisolone therapy at a dose of 40 mg daily. The C-reactive protein level normalized 7 days after the prednisolone therapy. Three months later, proteinuria had remitted. Though the true relationship between MG and TA was not revealed in present case, considering the fact that complete remission of nephrotic syndrome occurred following the improvement of C-reactive protein level in response to steroid therapy, TA might be the secondary cause of MG. To our best knowledge, only two case reports described the association of MG and TA previously. Those two patients, however, also demonstrated the feature of systemic lupus erythematosus in addition to TA. This is the first case report that describes a patient who presented as MG associated with TA, but not complicated by systemic lupus erythematosus.
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Affiliation(s)
- Ryo Koda
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Atsunori Yoshino
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Yuji Imanishi
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Shinya Kawamoto
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Junichiro James Kazama
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tetsuro Takeda
- Department of Nephrology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
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26
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Harada M, Kamijo Y, Ehara T, Shimojo H, Shigematsu H, Higuchi M. A case of podocytic infolding glomerulopathy with multiple myeloma. BMC Nephrol 2014; 15:32. [PMID: 24528497 PMCID: PMC3926855 DOI: 10.1186/1471-2369-15-32] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Podocytic infolding glomerulopathy (PIG) is a recently described condition causing rare pathological changes to the glomeruli, and has attracted considerable attention. PIG is characterized by specific changes to the thickened glomerular basement membrane (GBM), including microspheres, microtubular structures, and podocytic infolding. Only a small number of cases of PIG have been reported. The clinical features and pathogenesis of this condition are still unclear. To elucidate the characteristics of this glomerulopathy, it is necessary to accumulate information from reported cases. We present here the first reported case of PIG with multiple myeloma. CASE PRESENTATION A 79-year-old Japanese man was admitted to his local hospital with proteinuria, hypergammaglobulinemia, hypoalbuminemia, and kidney dysfunction. Laboratory tests revealed monoclonal IgG(λ) M proteins in the serum and Bence-Jones proteins in the urine. Bone marrow aspiration showed monoclonal plasma cell proliferation, indicating a diagnosis of multiple myeloma. Renal biopsy was performed to determine the cause of the proteinuria and kidney dysfunction. Histological examination of the biopsy specimen showed glomeruli with an irregularly thickened GBM and bubble-like structures in the capillary walls. Immunofluorescence staining did not show glomerular deposition of immunoglobulins, light chains, or complement components. Congo red staining did not show amyloid deposition. Electron microscopy showed an irregularly thickened GBM with unusual structures in the glomerular capillary walls including podocytic infolding and microspheres, suggesting PIG. There were no electron-dense deposits in the GBM, while various findings indicating podocyte injury were detected. CONCLUSION We present here the first reported case of PIG in a patient with multiple myeloma. The mechanisms underlying the development of PIG in multiple myeloma are unknown, but may be associated with podocyte injury.
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Affiliation(s)
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano 390-8621, Japan.
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A case of a new disease entity: podocytic infolding glomerulopathy. Pathology 2014. [DOI: 10.1097/01.pat.0000454228.44878.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Suzuki K. Remarks on the Asia Pacific Meeting of Vasculitis and ANCA Workshop 2012. Clin Exp Nephrol 2013; 17:599-602. [DOI: 10.1007/s10157-013-0805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 03/22/2013] [Indexed: 11/27/2022]
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Suga N, Miura N, Uemura Y, Nakamura T, Morita H, Banno S, Imai H. A large-sized bubbling appearance of the glomerular basement membrane in a patient with pulmonary limited AL amyloidosis and a past history of lupus nephritis. Clin Exp Nephrol 2011; 15:970-5. [PMID: 21874627 DOI: 10.1007/s10157-011-0528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022]
Abstract
We report an unusual pathological finding, a large-sized bubbling appearance of the glomerular basement membrane (GBM), in a patient with pulmonary limited AL amyloidosis and a past history of lupus nephritis. The first renal biopsy specimen from 10 years ago, when systemic lupus erythematosus was diagnosed, demonstrated mild mesangial proliferation and subepithelial deposits (WHO classification: III + V). Light microscopy of the current biopsy using periodic acid methenamine silver (PAMS) stain demonstrated a large-sized bubbling appearance of the GBM; however, very weak immunoglobulin and complement deposition was observed in immunofluorescence studies. Routine electron microscopy demonstrated partial subendothelial expansion with electron-lucent materials, but no electron-dense deposits or amyloid fibrils. Electron microscopy with PAMS stain revealed electron-lucent endothelial scalloping, including some cellular components and microspheres in the GBM; however, it is not clear if these materials are derived from endothelial cells. One possibility is that these unique findings represent a recovery phase of lupus membranous nephritis; another is that these findings correspond to a new disease entity.
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Affiliation(s)
- Norihiro Suga
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University, School of Medicine, Nagakute, Aichi 480-1195, Japan
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Angioimmunoblastic T-cell lymphoma and membranous nephropathy: a still unreported association. Clin Exp Nephrol 2010; 14:288-93. [PMID: 20177729 DOI: 10.1007/s10157-010-0266-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 01/19/2010] [Indexed: 12/28/2022]
Abstract
A 21-year-old man with lymphadenopathy and Coombs-positive hemolytic anemia had been treated with steroid maintenance therapy. He developed nephrotic syndrome with size increase of lymphadenopathy. Lymph node examination disclosed angioimmunoblastic T-cell lymphoma (AITL). Light microscopy of a renal biopsy specimen showed typical features of membranous nephropathy (MN), such as bubbling appearance and spike formation. Immunofluorescence studies revealed no significant deposition of immunoglobulins. Electron microscopy showed sparse degenerative materials on the epithelial side of the glomerular basement membranes, with intervening spikes. These unique histological findings suggested secondary MN. High-dose steroid therapy followed by six courses of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) therapy improved his symptoms. One-year follow-up revealed the patient in good health without any signs of relapse. Glomerular manifestations have rarely been reported in association with AITL. To our knowledge, this is the first reported case of nephrotic syndrome due to MN associated with AITL.
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Nagayama Y, Morita H, Kawashima E, Yoshimura A. Light microscopic features of membranous nephropathy with unusual changes of the podocytes and glomerular basement membrane in a patient with sudden onset of nephrotic syndrome. Am J Kidney Dis 2010; 55:962-6. [PMID: 20138416 DOI: 10.1053/j.ajkd.2009.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 11/10/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Yoshikuni Nagayama
- Department of Medicine, Division of Nephrology, Showa University Fujigaoka Hospital, Yokohama, Japan.
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Sakai T. Are the cytoplasmic microstructures within GBM pathologically significant? Clin Exp Nephrol 2008; 12:419-20. [PMID: 18998048 DOI: 10.1007/s10157-008-0102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Indexed: 10/21/2022]
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