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Kung VL, Avasare R, Friedman MA, Koon SM, Neff TL, Protzek S, Corless C, Krajbich V, Setthavongsack N, Ditmore R, Woltjer R, Andeen NK. Targeted Transcriptional Analysis of IgA Vasculitis, IgA Nephropathy, and IgA-Dominant Infection-Related Glomerulonephritis Reveals Both Distinct and Overlapping Immune Signatures. KIDNEY360 2023; 4:e759-e768. [PMID: 37036681 PMCID: PMC10371378 DOI: 10.34067/kid.0000000000000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023]
Abstract
Key Points Skin IL-9, calprotectin, and KIR gene expression may be predictive of subsequent kidney involvement in patients with IgAV. Histologically similar patients with IgAN, IgAV, and IgA-IRGN can be distinguished by their immune transcriptomes. Kidney biopsies from patients with IgA-IRGN are enriched for transcripts involved in granulocyte chemotaxis. Background IgA vasculitis (IgAV), IgA nephropathy (IgAN), and IgA-dominant infection-related glomerulonephritis (IgA-IRGN) have shared histopathologic features, but differences in clinical management and prognosis. The most serious IgAV organ involvement is in the kidneys (IgAV nephritis). In this study, we hypothesized that targeted immune transcript profiling could aid in (1 ) predicting the development of IgAV nephritis in patients with cutaneous IgAV and (2 ) differentiating IgAN, IgAV, and IgA-IRGN. Methods RNA was extracted from 24 formalin-fixed paraffin-embedded tissue specimens (16 kidney, 8 skin) from 21 patients with IgAV nephritis (n=7), IgAN (n=5), and IgA-IRGN (n=4), and IgAV skin biopsies from patients with (n=3) and without (n=5) IgAV nephritis. Differential gene expression and gene set enrichment analysis were performed on a total of 594 transcripts (Nanostring immunology panel) profiled using the nCounter system. Results Skin biopsies in patients with IgAV who develop kidney involvement exhibit reduced S100A8/S100A9 , IL9 , and killer cell immunoglobulin-like receptor expression. The kidney tissue immune transcriptomes of IgAN, IgAV, and IgA-IRGN are largely overlapping. IgA-IRGN kidney biopsies are, however, uniquely enriched for transcripts involved in granulocyte chemotaxis. Conclusion This study identifies immune transcript signatures that may predict IgAV nephritis in skin biopsies and distinguish IgA-IRGN from IgAN and IgAV in kidney biopsies.
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Affiliation(s)
- Vanderlene L. Kung
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
| | - Rupali Avasare
- Department of Medicine, Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon
| | - Marcia A. Friedman
- Department of Medicine, Division of Rheumatology, Oregon Health & Science University, Portland, Oregon
| | | | - Tanaya L. Neff
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
- Knight Diagnostic Laboratories, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sara Protzek
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
- Knight Diagnostic Laboratories, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Christopher Corless
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
- Knight Diagnostic Laboratories, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Victoria Krajbich
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
| | - Naly Setthavongsack
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
| | - Rebecca Ditmore
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
| | - Randall Woltjer
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
| | - Nicole K. Andeen
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Oregon Health & Science University, Portland, Oregon
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Kitamura M, Almaani S, Challa B, Doraiswamy M, Ayoub I, Biederman L, Parikh SV, Molovic-Kokovic A, Benedict J, Mhaskar N, Khitan ZJ, Brodsky SV, Nadasdy T, Satoskar AA. The Diagnostic Conundrum of Glomerular Crescents With IgA Deposits. Kidney Int Rep 2023; 8:507-518. [PMID: 36938067 PMCID: PMC10014387 DOI: 10.1016/j.ekir.2022.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Glomerulonephritis (GN) with crescents and IgA deposits in kidney biopsy poses a frequent diagnostic and therapeutic dilemma because of multiple possibilities. Methods Native kidney biopsies showing glomerular IgA deposition and crescents (excluding lupus nephritis) were identified from our biopsy archives between 2010 and 2021. Detailed clinicopathologic features were assessed. One-year clinical follow-up on a subset of cases was obtained. Results A total of 285 cases were identified, and these clustered into IgA nephropathy (IgAN, n = 108), Staphylococcus or other infection-associated GN/infection-related GN (SAGN/IRGN, n = 43), and antineutrophil cytoplasmic antibody-associated GN (ANCA-GN, n = 26) based on a constellation of clinicopathologic features, but 101 cases (group X) could not be definitively differentiated. The reasons have been elucidated, most important being atypical combination of clinicopathologic features and lack of definitive evidence of active infection. Follow-up (on 72/101 cases) revealed that clinicians' working diagnosis was IgAN in 43%, SAGN/IRGN in 22%, ANCA-GN in 28%, and others in 7% of the cases, but treatment approach varied from supportive or antibiotics to immunosuppression in each subgroup. Comparing these cases as "received immunosuppression" versus "non-immunosuppression," only 2 features differed, namely C3-dominant staining, and possibility of recent infection (both higher in the no-immunosuppression group) (P < 0.05). Renal loss was higher in the non-immunosuppression subgroup, but not statistically significant (P = 0.11). Conclusion Diagnostic overlap may remain unresolved in a substantial number of kidney biopsies with glomerular crescents and IgA deposits. A case-by-case approach, appropriate antibiotics if infection is ongoing, and consideration for cautious immunosuppressive treatment for progressive renal dysfunction may be needed for best chance of renal recovery.
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Affiliation(s)
- Mineaki Kitamura
- Division of Renal and Transplant Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Salem Almaani
- Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bindu Challa
- Division of Renal and Transplant Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Isabelle Ayoub
- Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura Biederman
- Division of Renal and Transplant Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Samir V. Parikh
- Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Jason Benedict
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Zeid J. Khitan
- Marshall University School of Medicine, Huntington, West Virginia, USA
| | - Sergey V. Brodsky
- Division of Renal and Transplant Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tibor Nadasdy
- Division of Renal and Transplant Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anjali A. Satoskar
- Division of Renal and Transplant Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Correspondence: Anjali A. Satoskar, Division of Renal and Transplant Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, M015 Starling Loving Hall, 320 West 10th Avenue, Columbus, Ohio 43210, USA.
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Takayasu M, Hirayama K, Shimohata H, Kobayashi M, Koyama A. Staphylococcus aureus Infection-Related Glomerulonephritis with Dominant IgA Deposition. Int J Mol Sci 2022; 23:ijms23137482. [PMID: 35806487 PMCID: PMC9267153 DOI: 10.3390/ijms23137482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Since 1995, when we reported the case of a patient with glomerulonephritis with IgA deposition that occurred after a methicillin-resistant Staphylococcus aureus (MRSA) infection, many reports of MRSA infection-associated glomerulonephritis have accumulated. This disease is being systematized as Staphylococcus infection-associated glomerulonephritis (SAGN) in light of the apparent cause of infection, and as immunoglobulin A-dominant deposition infection-related glomerulonephritis (IgA-IRGN) in light of its histopathology. This glomerulonephritis usually presents as rapidly progressive glomerulonephritis or acute kidney injury with various degrees of proteinuria and microscopic hematuria along with an ongoing infection. Its renal pathology has shown several types of mesangial and/or endocapillary proliferative glomerulonephritis with various degrees of crescent formation and tubulointerstitial nephritis. IgA, IgG, and C3 staining in the mesangium and along the glomerular capillary walls have been observed on immunofluorescence examinations. A marked activation of T cells, an increase in specific variable regions of the T-cell receptor β-chain-positive cells, hypercytokinemia, and increased polyclonal immune complexes have also been observed in this glomerulonephritis. In the development of this disease, staphylococcal enterotoxin may be involved as a superantigen, but further investigations are needed to clarify the mechanisms underlying this disease. Here, we review 336 cases of IgA-IRGN and 218 cases of SAGN.
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Affiliation(s)
- Mamiko Takayasu
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
- Correspondence: ; Tel.: +81-29-887-1161
| | - Homare Shimohata
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Masaki Kobayashi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Akio Koyama
- Emeritus Professor, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan;
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Grywalska E, Smarz-Widelska I, Korona-Głowniak I, Mertowski S, Gosik K, Hymos A, Ludian J, Niedźwiedzka-Rystwej P, Roliński J, Załuska W. PD-1 and PD-L1 Expression on Circulating Lymphocytes as a Marker of Epstein-Barr Virus Reactivation-Associated Proliferative Glomerulonephritis. Int J Mol Sci 2020; 21:ijms21218001. [PMID: 33121190 PMCID: PMC7663145 DOI: 10.3390/ijms21218001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022] Open
Abstract
Alterations to the programmed cell death protein-1 (PD-1) pathway were previously shown to be involved in a poorer prognosis for patients with proliferative glomerulonephritis (PGN). Here, we investigated the association between several infectious agents and the expression of PD-1 and its ligand (PD-L1) on T and B lymphocytes in patients with PGN and nonproliferative glomerulonephritis (NPGN). A cohort of 45 newly-diagnosed patients (23 with PGN and 22 with NPGN) and 20 healthy volunteers was enrolled. The percentage of peripheral blood mononuclear cells expressing PD-1 and PD-L1 antigens was determined by flow cytometry. We found PD-1 and PD-L1 expression on T and B lymphocytes was higher in PGN patients than in NPGN patients and controls. We also found that reactivation of the Epstein-Barr virus (EBV) correlated with the expression of PD-1/PD-L1 antigens in patients with PGN. Further receiver operating characteristic analysis indicated that PD-1 expression could distinguish EBV-positive PGN patients from those with NPGN or healthy controls. The use of PD-1 expression as a non-invasive marker of PGN should be further investigated.
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Affiliation(s)
- Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
- Correspondence: ; Tel.: +48-8144-86420
| | - Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital in Lublin, 20-718 Lublin, Poland;
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | - Krzysztof Gosik
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | - Anna Hymos
- Department of Otolaryngology and Laryngeal Oncology, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Jarosław Ludian
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | | | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-954 Lublin, Poland;
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