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Hattori K, Shimizu R, Tanaka S, Terashima T, Hiramatsu M, Shimomura T, Ito T, Morinaga T, Terasaki M, Shimizu A, Morozumi K, Tamai H. A case of juvenile-onset fibrillary glomerulonephritis diagnosed by mass spectrometry and immunohistochemistry of DNAJB9. CEN Case Rep 2022; 11:412-416. [PMID: 35199316 DOI: 10.1007/s13730-022-00693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/06/2022] [Indexed: 10/19/2022] Open
Abstract
Fibrillary glomerulonephritis (FGN) is a rare glomerular disease. FGN is characterized by the deposition of randomly arranged, nonbranching microfibrils in the mesangium and glomerular basement membrane. The discovery of DNAJ homolog subfamily B member 9 (DNAJB9) in 2017 was a breakthrough, and DNAJB9 has been proven to be extremely useful for the definitive diagnosis of FGN. While FGN often occurs in middle-aged individuals, this case was diagnosed at a relatively young age of 17. We performed renal biopsy, and light microscopic study revealed mesangial proliferation with expansion and subepithelial deposits. Electron microscopic study showed glomerular deposition of randomly oriented nonbranching fibrils with a mean of 20 nm. However, direct first scarlet stain for amyloidosis was weakly positive. Therefore, we confirmed the diagnosis of FGN and eliminated the presence of amyloidosis with mass spectrometry. This is the first case in Japan in which the complication of amyloidosis was ruled out with mass spectrometry and FGN was diagnosed using immunostaining and mass spectrometry of DNAJB9. We began treatment with cyclosporine A. One and a half years after the start of the treatment, kidney function continues to be normal.
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Affiliation(s)
- Keita Hattori
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan.
| | - Ryo Shimizu
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
| | - Shoichiro Tanaka
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
| | - Takashi Terashima
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
| | - Miya Hiramatsu
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
| | - Taishi Shimomura
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
| | - Takeshi Ito
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
| | - Takatoshi Morinaga
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
| | - Mika Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kunio Morozumi
- Department of Nephrology, Masuko Memorial Hospital, 35-28 Takegashicho, Nakamura-ku, Nagoya, Aichi, 453-0016, Japan
| | - Hirofumi Tamai
- Department of Nephrology, Anjo Kosei Hospital, 28, higashihirokute, anjocho, Anjo, Aichi, 446-8602, Japan
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2
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Azevedo A, Cotovio P, Góis M, Nolasco F. Rare diagnosis in a patient with diabetes with nephrotic proteinuria. BMJ Case Rep 2019; 12:bcr-2017-223835. [PMID: 30635300 PMCID: PMC6340571 DOI: 10.1136/bcr-2017-223835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/03/2022] Open
Abstract
We report a 63-year-old man with well-controlled type 2 diabetes mellitus and hypertension, who presented with new onset nephrotic proteinuria and rapid deterioration in renal function. The atypical clinical presentation prompted us to consider a non-diabetic and non-hypertensive cause and to perform a renal biopsy. A diagnosis of fibrillarglomerulonephritis (FGn) was made based on electronic microscopy. Proteinuria remained in nephrotic range despite treatment with prednisolone, and renal function deteriorated. We suggest that other causes of proteinuria should be considered in patients with diabetes who present with the nephrotic syndrome when there is no other evidence of microvascular disease. We review the spectrum of fibrillar glomerulopathies including FGn, primary and secondary amyloidosis and immunotactoid glomerulonephritis.
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Affiliation(s)
- Ariana Azevedo
- Nephrology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Patrícia Cotovio
- Nephrology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Mário Góis
- Nephrology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Fernando Nolasco
- Nephrology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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Andeen NK, Yang HY, Dai DF, MacCoss MJ, Smith KD. DnaJ Homolog Subfamily B Member 9 Is a Putative Autoantigen in Fibrillary GN. J Am Soc Nephrol 2017; 29:231-239. [PMID: 29097624 DOI: 10.1681/asn.2017050566] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022] Open
Abstract
Fibrillary GN is a rare form of GN of uncertain pathogenesis that is characterized by the glomerular accumulation of randomly arranged, nonbranching fibrils (12-24 nm) composed of Ig and complement proteins. In this study, we used mass spectrometry to comprehensively define the glomerular proteome in fibrillary GN compared with that in controls and nonfibrillary GN renal diseases. We isolated glomeruli from formalin-fixed and paraffin-embedded biopsy specimens using laser capture microdissection and analyzed them with liquid chromatography and data-dependent tandem mass spectrometry. These studies identified DnaJ homolog subfamily B member 9 (DNAJB9) as a highly sampled protein detected only in fibrillary GN cases. The glomerular proteome of fibrillary GN cases also contained IgG1 as the dominant Ig and proteins of the classic complement pathway. In fibrillary GN specimens only, immunofluorescence and immunohistochemistry with an anti-DNAJB9 antibody showed strong and specific staining of the glomerular tufts in a distribution that mimicked that of the immune deposits. Our results identify DNAJB9 as a putative autoantigen in fibrillary GN and suggest IgG1 and classic complement effector pathways as likely mediators of the destructive glomerular injury in this disease.
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Affiliation(s)
| | - Han-Yin Yang
- Genome Sciences, University of Washington, Seattle, Washington
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4
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Ciocchini M, Arbelbide J, Musso CG. Monoclonal gammopathy of renal significance (MGRS): the characteristics and significance of a new meta-entity. Int Urol Nephrol 2017; 49:2171-2175. [DOI: 10.1007/s11255-017-1594-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
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Payan Schober F, Jobson MA, Poulton CJ, Singh HK, Nickeleit V, Falk RJ, Jennette JC, Nachman PH, Pendergraft Iii WF. Clinical Features and Outcomes of a Racially Diverse Population with Fibrillary Glomerulonephritis. Am J Nephrol 2017; 45:248-256. [PMID: 28161700 DOI: 10.1159/000455390] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/10/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fibrillary glomerulonephritis is characterized by randomly arranged fibrils, approximately 20 nm in diameter by electron microscopy. Patients present with proteinuria, hematuria and kidney insufficiency, and about half of the reported patients progress to end-stage kidney disease within 4 years. The dependence of patient characteristics and outcomes on race has not been explored. In this study, we describe a cohort of patients with fibrillary glomerulonephritis and compare their clinical characteristics and outcomes with those of patients previously described. METHODS The University of North Carolina (UNC) Nephropathology Database was used to retrospectively identify patients diagnosed with fibrillary glomerulonephritis between 1985 and 2015. Of these patients, those treated at UNC were selected. Their demographic and clinical characteristics - including signs and symptoms, comorbidities, laboratory values, treatments and outcomes - were compared with those of patients described earlier. RESULTS Among the 287 patients identified, 42 were treated at the UNC Kidney Center. When compared to earlier cohorts, a higher frequency of black race, hepatitis C virus (HCV) infection and use of hemodialysis were noted in both black and HCV-positive patients. Autoimmune diseases, infections and malignancies were frequently observed, present in over half of all cases. CONCLUSION According to this study, fibrillary glomerulonephritis represents a secondary glomerular disease process (associated with autoimmune disease, infection or malignancy) in many cases and hence screening is essential. As the screening for comorbidities increased over time, more underlying causes were identified. We noted a high frequency of HCV among black patients, suggesting a possible causative association. Treatment of underlying disease is essential for patients for the best outcome.
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Affiliation(s)
- Fernanda Payan Schober
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA
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Treatment of fibrillary glomerulonephritis by corticosteroids and tripterygium glycoside tablets: A case report. Chin J Integr Med 2016; 22:390-3. [DOI: 10.1007/s11655-016-2098-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 11/26/2022]
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Narita I, Shimada M, Fujita T, Murakami R, Nakamura M, Nakamura N, Yamabe H, Okumura K. A case of membranoproliferative glomerulonephritis associated with curved fibril deposition. BMC Nephrol 2015; 16:151. [PMID: 26370133 PMCID: PMC4570744 DOI: 10.1186/s12882-015-0147-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
Background It is sometimes challenging to diagnose unsusual cases of fibrillary glomerulonephritis (FGN) and immunotactoid glomerulopathy (ITG), the rare causes of nephrotic syndrome. Case presentation A 75-year-old Japanese woman presented with nephrotic syndrome, microhematuria and renal insufficiency. Renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) with IgM and weak C3 deposition. Congo red stain was negative. Electron microscopy demonstrated massive fibrils in the subendothelium, mesangium and subepithelium. The fibrils were partially parallel, partially curved and 17 nm in diameter. Cryoglobulin, hepatitis B virus (HBV) antigen, hepatitis C virus (HCV) antibody or antinuclear antibody were negative. Conclusion We report a case of MPGN associated with peculiar non-amyloid fibril deposition corresponding to neither FGN nor ITG.
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Affiliation(s)
- Ikuyo Narita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Michiko Shimada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Takeshi Fujita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Reiichi Murakami
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Masayuki Nakamura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Norio Nakamura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan. .,Community Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Hideaki Yamabe
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Ken Okumura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
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Golitsyna EP, Bocharnikova AV, Varshavskiĭ VA. [Glomerulopathy with fibrillary and tubular deposits]. Arkh Patol 2015; 76:70-77. [PMID: 25842930 DOI: 10.17116/patol201476670-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The advent of up-to-date electron microscopes and molecular biological methods for the examination of renal puncture biopsies could define earlier undetectable and unworthy cellular structures and stromas. There is a diversity of diseases that can be diagnosed exclusively at the ultrastructural level, thus the literature has identified the concept of glomerular diseases with organized deposits. The current classifications based only on the ultrastructual deposits are imperfect as they fail to account for the etiological and pathogenetic features included in these diseases.
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Affiliation(s)
- E P Golitsyna
- Kafedra patologicheskoĭ anatomii im. A.I. Strukova GBOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.M. Sechenova" Minzdrava Rossii, Rossiĭskaia Federatsiia
| | - A V Bocharnikova
- Kafedra patologicheskoĭ anatomii im. A.I. Strukova GBOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.M. Sechenova" Minzdrava Rossii, Rossiĭskaia Federatsiia
| | - V A Varshavskiĭ
- Kafedra patologicheskoĭ anatomii im. A.I. Strukova GBOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.M. Sechenova" Minzdrava Rossii, Rossiĭskaia Federatsiia
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9
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Momose A, Nakajima T, Chiba S, Kumakawa K, Shiraiwa Y, Sasaki N, Watanabe K, Kitano E, Hatanaka M, Kitamura H. A case of fibrillary glomerulonephritis associated with thrombotic microangiopathy and anti-glomerular basement membrane antibody. NEPHRON EXTRA 2015; 5:30-8. [PMID: 25873933 PMCID: PMC4376932 DOI: 10.1159/000371802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We present the first report of a case of fibrillary glomerulonephritis (FGN) associated with thrombotic microangiopathy (TMA) and anti-glomerular basement membrane antibody (anti-GBM antibody). A 54-year-old man was admitted to our hospital for high fever and anuria. On the first hospital day, we initiated hemodialysis for renal dysfunction. Laboratory data revealed normocytic-normochromic anemia with schistocytes in the peripheral smear, thrombocytopenia, increased serum lactate dehydrogenase, decreased serum haptoglobin, and negative results for both direct and indirect Coombs tests. Based on these results, we diagnosed TMA. Assays conducted several days later indicated a disintegrin-like and metalloprotease with a thrombospondin motif 13 (ADAMTS13) activity of 31.6%, and ADAMTS13 inhibitors were negative. We started plasma exchange using fresh frozen plasma and steroid pulse therapy. Anti-GBM antibody was found to be positive. Renal biopsy showed FGN. Blood pressure rose on the 46th hospital day, and mild convulsions developed. Based on magnetic resonance imaging of the head, the patient was diagnosed with reversible posterior leukoencephalopathy syndrome. Hypertension persisted despite administration of multiple antihypertensive agents, and the patient experienced a sudden generalized seizure. Computed tomography of the head showed multiple cerebral hemorrhages. However, his blood pressure subsequently decreased and the platelet count increased. TMA remitted following 36 plasma exchange sessions, but renal function was not restored, and maintenance hemodialysis was continued. The patient was discharged on the 119th day of hospitalization. In conclusion, it was shown that TMA, FGN and anti-GBM antibody were closely related.
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Affiliation(s)
- Akishi Momose
- Department of Urology, Jusendo General Hospital, Koriyama, Japan
| | - Taku Nakajima
- Department of Urology, Jusendo General Hospital, Koriyama, Japan
| | - Shigetoshi Chiba
- Department of Urology, Jusendo General Hospital, Koriyama, Japan
| | | | - Yasuo Shiraiwa
- Department of Urology, Jusendo General Hospital, Koriyama, Japan
| | - Nobuhiro Sasaki
- Department of Nephrology, Jusendo General Hospital, Koriyama, Japan
| | - Kazuo Watanabe
- Department of Pathology, Jusendo General Hospital, Koriyama, Japan
| | - Etsuko Kitano
- Department of Medical Technology, Kobe Tokiwa College, Kobe, Japan
| | - Mitiyo Hatanaka
- Department of Medical Technology, Kobe Tokiwa College, Kobe, Japan
| | - Hajime Kitamura
- Department of Medical Technology, Kobe Tokiwa College, Kobe, Japan
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The occurrence or fibrillary glomerulonephritis in patients with diabetes mellitus may not be coincidental: a report of four cases. Case Rep Med 2013; 2013:935172. [PMID: 23762079 PMCID: PMC3671515 DOI: 10.1155/2013/935172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 04/15/2013] [Accepted: 04/28/2013] [Indexed: 12/03/2022] Open
Abstract
Although clinical presentation of fibrillary glomerulonephritis is similar to most forms of glomerulonephritis, it is usually difficult to make the diagnosis. Clinical manifestations include proteinuria, microscopic haematuria, nephrotic syndrome, and impairment of renal function. A diagnosis of fibrillary glomerulonephritis is only confirmed by renal biopsy and it must comprise electronmicroscopy-verified ultrastructural findings. We report four cases between 45–50 years old with documented type 2 diabetes mellitus (T2DM) and arterial hypertension. All patients were found to have fibrils on kidney biopsy. The differential diagnosis of fibrils in the setting of diabetes mellitus is also discussed.
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Liu X, Liu H, Zhao Z, Zhang Z, Ding X. Fibrillary glomerulonephritis complicated by membranous nephropathy in a patient with tuberculosis. Int Urol Nephrol 2012; 45:1501-4. [PMID: 22826141 DOI: 10.1007/s11255-012-0236-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
Fibrillary glomerulonephritis (FGN) is a morphologically defined entity characterized by glomerular accumulations of non-branching, randomly arranged fibrils; these differ from amyloid fibrils by their larger size and lack of reactivity with Congo red and other amyloid-specific dyes. FGN is a rare disease and may mimic membranous nephropathy under routine light microscopy and immunohistochemistry. However, electron microscopy shows the fibrillary nature of these glomerular deposits. We report a rare case of membranous nephropathy complicated by fibrillary deposits in a 60-year-old man with a history of bone tuberculosis.
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Affiliation(s)
- Xueguang Liu
- Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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12
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Kim HJ, Kang SW, Park SJ, Kim TH, Kang MS, Kim YH. Fibrillary glomerulonephritis associated with Behçet's syndrome. Ren Fail 2012; 34:637-9. [PMID: 22417126 DOI: 10.3109/0886022x.2012.664507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fibrillary glomerulonephritis (FGN) is a rare cause of progressive renal dysfunction resulting in fibrillary deposits in the mesangium and/or glomerular basement membrane (GBM). Some case reports have shown FGN in patients with rheumatoid arthritis and other autoimmune diseases. This is the first case report of FGN in a patient with Behçet's syndrome. The most common renal histological finding in Behçet's syndrome is secondary amyloidosis. A 46-year-old woman with a 4-year history of Behçet's syndrome was referred to the nephrology clinic with foamy urine with non-selective proteinuria (urine protein-to-creatinine ratio was 1400 mg protein/g creatinine) and microscopic hematuria. Serum and urine protein electrophoresis showed no evidence of monoclonal gammopathy. A renal biopsy was performed. Light microscopy showed mesangial widening and nodular expansion with hyaline deposits. Immunofluorescence microscopy revealed immunoglobulin M deposits in the mesangium. Congo red staining was negative. Electron microscopy showed fibrillary deposits on the GBM. Pathological findings were consistent with FGN. She had been taking 50 mg azathioprine and 3000 mg mesalazine per day for 4 years due to Behçet's syndrome, so we did not add any other immunosuppressive agents or corticosteroids. Treatment of this glomerulopathy is not promising. It has been noted that none of the various approaches, including corticosteroid, plasmapheresis, and cytotoxic therapy, improves prognosis.
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Affiliation(s)
- Hyun Ju Kim
- Department of Nephrology, College of Medicine, Pusan Paik Hospital, Inje University, Busan, Republic of Korea
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Park JH, Kim BR, Chun BG, Kim MH, Shin HS, Jung YS, Rim H. Coexistence of fibrillary glomerulonephritis in a patient with multiple myeloma. Intern Med 2012; 51:1379-81. [PMID: 22687846 DOI: 10.2169/internalmedicine.51.6638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old man was admitted to our hospital for two weeks due to edema in both legs. A bone marrow aspiration test confirmed a diagnosis of multiple myeloma. The result of the patient's renal biopsy showed fibrillary glomerulonephritis (FGN). FGN is a rare form of glomerulopathy that is diagnosed using electron microscopy when deposits of amyloid-like fibrils are observed on the mesangium and microvascular wall. These fibrils do not respond to Congo red staining and are generally 12-30 nm in diameter. This is a report of an unusual case of fibrillary glomerulonephritis in a patient with multiple myeloma.
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Affiliation(s)
- Jin Hee Park
- Department of Internal Medicine, Kosin University College of Medicine, Korea
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Grosch S, Van Overmeire L, Krzesinski JM, Bovy C. [Fibrillary nonamyloid glomerulonephritis: a rare etiology of nephrotic syndrome]. Nephrol Ther 2011; 7:494-8. [PMID: 21498141 DOI: 10.1016/j.nephro.2011.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 03/03/2011] [Accepted: 03/05/2011] [Indexed: 10/28/2022]
Abstract
The fibrillary nonamyloïd glomerulonephritis is a glomerulopathy with fibrillar, nonamyloid deposits of predominantly polyclonal immunoglobulin G. It is an idiopathic glomerulopathy responsible for heavy proteinuria, generally in the nephrotic range, and renal failure up to end stage in 40 % of the cases after five years. The histologic pattern is variable, correlating with renal prognosis. The Congo red-negativity of the deposits and the size of the fibrils on electron microscopy make the differential diagnosis with amyloid deposits. There is no specific efficient therapy. Recurrence in the transplant is frequent, but with better renal prognosis.
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Affiliation(s)
- Stéphanie Grosch
- Service de néphrologie du CHU de Liège, université de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique.
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15
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Menon S, Zeng X, Valentini R. Fibrillary glomerulonephritis and renal failure in a child with systemic lupus erythematosus. Pediatr Nephrol 2009; 24:1577-81. [PMID: 19308460 DOI: 10.1007/s00467-009-1168-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 02/24/2009] [Accepted: 02/27/2009] [Indexed: 11/25/2022]
Abstract
Fibrillary glomerulonephritis (FGN) is a rare immune-mediated glomerulopathy characterized by randomly arranged immunoglobulin (Ig) deposits on electron microscopy. Only seven pediatric cases have been reported, and the incidence in adults is about 1.5%. A 12-year-old boy presented with systemic lupus erythematosus (SLE) with World Health Organization Class IV lupus nephritis. A repeat biopsy carried out due to a poor response to standard immunosuppressive therapy and worsening renal functions revealed diffuse proliferative glomerulonephritis with fibrillary deposits. Despite aggressive immunosuppression with plasmapheresis and rituximab, the patient developed end stage renal disease. This is an atypical pediatric case characterized by SLE-associated FGN and a poor prognosis.
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Affiliation(s)
- Shina Menon
- Pediatric Nephrology, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201, USA.
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Ray S, Rouse K, Appis A, Novak R, Haller NA. Fibrillary Glomerulonephritis with Hepatitis C Viral Infection and Hypocomplementemia. Ren Fail 2009; 30:759-62. [DOI: 10.1080/08860220802213062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Kinomura M, Maeshima Y, Kodera R, Morinaga H, Saito D, Nakao K, Yanai H, Sada K, Sugiyama H, Makino H. A case of immunotactoid glomerulopathy exhibiting nephrotic syndrome successfully treated with corticosteroids and antihypertensive therapy. Clin Exp Nephrol 2009; 13:378-384. [PMID: 19367362 DOI: 10.1007/s10157-009-0166-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 02/16/2009] [Indexed: 11/25/2022]
Abstract
We report a case of immunotactoid glomerulopathy (ITG) with cerebral hemorrhage and hypocomplementemia, with successful therapeutic outcome following the corticosteroids and antihypertensive treatment. A 70-year-old man presented with facial edema in October 2006. One day prior to his referral, he experienced speech disturbance, headache, and vomiting, and on the next day he was referred to our hospital. The laboratory examination revealed massive proteinuria (11.3 g/day) and hematuria. The total serum hemolytic complement (CH50) was decreased to 23 U/ml and C4 component was decreased to 7.5 mg/dl, whereas C3 component remained within normal limits (82 mg/dl). Brain computed tomography scan showed high-density lesions in the left parieto-occipital area suggesting subcortical cerebral hemorrhage. Renal biopsy revealed diffuse subendothelial PAS-positive depositions. Immunofluorescence studies revealed intensive deposition of IgG, IgA, C3, C1q, Fibrinogen, and kappa light chain with granular pattern in the capillary and mesangial area. Electron microscopic examination revealed regularly arranged microtubular deposits, appearing as 21-33 nm in diameter. Based on these findings, this patient was diagnosed as ITG complicated with cerebral hemorrhage and hypocomplementemia. He received oral prednisolone (30 mg/day), resulting in reduction of proteinuria, improvement of hypocomplementemia, and prevention of renal functional deterioration. This case demonstrates that accurate diagnosis of ITG may result in successful therapeutic outcome.
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Affiliation(s)
- Masaru Kinomura
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Yohei Maeshima
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
| | - Ryo Kodera
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Hiroshi Morinaga
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Daisuke Saito
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Kazushi Nakao
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenei Sada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Hitoshi Sugiyama
- Center for Chronic Kidney Disease and Peritoneal Dialysis, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirofumi Makino
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
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Chirunomula V, Kondle V, Vaddey B, Colvin RB, Kambham N. Crescentic glomerulonephritis with ribbon-like immunofluorescence pattern. Am J Kidney Dis 2009; 54:381-4. [PMID: 19121555 DOI: 10.1053/j.ajkd.2008.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 10/29/2008] [Indexed: 11/11/2022]
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Vilayur E, Trevillian P, Walsh M. Monoclonal gammopathy and glomerulopathy associated with chronic lymphocytic leukemia. ACTA ACUST UNITED AC 2008; 5:54-8. [DOI: 10.1038/ncpneph0989] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/17/2008] [Indexed: 11/09/2022]
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Collins M, Navaneethan SD, Chung M, Sloand J, Goldman B, Appel G, Rovin BH. Rituximab treatment of fibrillary glomerulonephritis. Am J Kidney Dis 2008; 52:1158-62. [PMID: 18823685 DOI: 10.1053/j.ajkd.2008.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 07/03/2008] [Indexed: 12/24/2022]
Abstract
Fibrillary glomerulonephritis belongs to a group of disorders characterized by pathogenic deposition of fibrils in glomeruli. This glomerulopathy tends to progress to end-stage kidney disease, and there currently are no treatments of proven benefit, including corticosteroids and cytotoxic agents. Because the glomerular deposits contain an immunoglobulin component, it was postulated that anti-B-cell therapy with rituximab, an anti-CD20 monoclonal antibody, may be effective in the treatment of patients with fibrillary glomerulonephritis. We describe 3 patients with fibrillary glomerulonephritis who were treated with rituximab for nephrotic-range proteinuria. Each patient also received standard antiproteinuria therapy, including blockade of the renin-angiotensin system and strict blood pressure control. All patients showed a decrease in proteinuria to less than 1.5 g/d of protein by 27 months, and kidney function was preserved throughout the duration of therapy and follow-up. No adverse effects were seen with rituximab. These outcomes suggest that treatment with rituximab may be a promising approach to the management of fibrillary glomerulonephritis, an entity previously considered refractory to therapy.
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Affiliation(s)
- Michael Collins
- Ohio State University College of Medicine, Columbus, OH 43210, USA
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Leung N. Making the diagnosis of immunotactoid glomerulonephritis. Ann Hematol 2008; 88:95-6. [PMID: 18648811 DOI: 10.1007/s00277-008-0547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 06/23/2008] [Indexed: 11/25/2022]
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Shim YH, Lee SJ, Sung SH. A case of fibrillary glomerulonephritis with unusual IgM deposits and hypocomplementemia. Pediatr Nephrol 2008; 23:1163-6. [PMID: 18288497 DOI: 10.1007/s00467-008-0765-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 01/09/2008] [Accepted: 01/10/2008] [Indexed: 11/24/2022]
Abstract
Fibrillary glomerulonephritis (FGN) is rare immune-mediated GN with predominant immunoglobulin (Ig) G deposits, normal serum complement levels, and poor prognosis. The incidence of FGN is less than 1% in the adult population, and only six pediatric cases have been reported in the English literature. A 12-year-old girl presented with acute nephrotic-nephritic syndrome mimicking atypical clinical features of acute poststreptococcal GN (APSGN). Clinical features had completely resolved in 2 weeks, but the serum complement levels remained low. Renal biopsy was done 6 months later, and she was diagnosed as having FGN with unusual IgM deposits. Despite persistently low serum complement levels during the subsequent 3 years, clinical relapse did not develop. This case was an atypical form of FGN characterized by unusual IgM deposits, persistent hypocomplementemia, and good prognosis, which suggests that childhood FGN is not necessarily a disease with poor prognosis.
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Affiliation(s)
- Yoon Hee Shim
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, #911-1 Mok-Dong Yangcheon-Ku, Seoul, South Korea
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Chen N, Pan X, Xu Y, Wang Z, Shi H, Yan F, Dong X. Two Brothers in One Chinese Family With Collagen Type III Glomerulopathy. Am J Kidney Dis 2007; 50:1037-42. [DOI: 10.1053/j.ajkd.2007.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 08/07/2007] [Indexed: 11/11/2022]
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Abstract
In routine diagnosis on renal biopsy, one of the confusing fields for pathological diagnoses is the glomerulopathies with fibrillary structure. The primary glomerulopathies with a deposit of ultrastructural fibrillary structure, which are negative for Congo-red stain but positive for immunoglobulins, include fibrillary glomerulonephritis and immunotactoid glomerulopathy. Several paraproteinemias including cryoglobulinemia, monoclonal gammopathy, and light chain deposition disease as well as hematopoietic disorders including plasmacytoma, plasma cell dyscrasia, and B cell lymphoproliferative disorders involve glomerulopathy with an ultrastructural fibrillary structure. A rare glomerulopathy with fibrillary structure that stains negative for Congo-red as well as for immunoglobulins has been also reported. The pathological diagnoses of these glomerulopathies can include either glomerular diseases, or paraproteinemic diseases, or hematopoietic diseases. The terminology is still confusing when glomerular diseases can be combined with paraproteinemic diseases and/or hematopoietic diseases. Therefore, the generic term, 'glomerular deposition disease' (GDD), has been proposed by pathologists with a requirement for clinicians to detect autoantibodies, paraproteins as well as to carry out a bone marrow check. An attempt has been made to rearrange the diseases with related disorders of fibrillary deposits, based on detailed clinical and pathological finding and to elucidate the correlation between GDD, paraproteinemia, and hematopoietic disorder.
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Affiliation(s)
- Kensuke Joh
- Division of Immunopathology, Clinical Research Center, Chiba-East National Hospital, Chuo-ku, Chiba, Japan.
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Javaid MM, Denley H, Tagboto S. Fibrillary glomerulonephritis with small fibrils in a patient with the antiphospholipid antibody syndrome successfully treated with immunosuppressive therapy. BMC Nephrol 2007; 8:7. [PMID: 17490479 PMCID: PMC1885430 DOI: 10.1186/1471-2369-8-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 05/09/2007] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Fibrillary glomerulonephritis is a rare cause of progressive renal dysfunction, often leading to the need for dialysis within a few years. The role of immunosuppressive treatment is still uncertain although this has been tried with variable success. CASE PRESENTATION A 56 year old woman with the antiphospholipid antibody syndrome (IgM anticardiolipin antibodies) was seen in the nephrology clinic with haematuria, proteinuria, and worsening renal function. A renal biopsy demonstrated a mesangial proliferative glomerulonephritis on light microscopy and smaller fibrils (10.6-13.8 nm in diameter) than is usual for fibrillary glomerulonephritis (typically 18-22 nm) on electron microscopy. Amyloidosis was excluded following detailed evaluation. On account of rapidly worsening renal failure she was started on cyclophosphamide and prednisolone which led to the partial recovery and stabilization of her renal function. CONCLUSION This case highlights the need for routine electron microscopy in native renal biopsies, where the differential diagnosis is wide and varied and the light and immunofluorescence microscopic findings may be non specific.
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Affiliation(s)
| | - Helen Denley
- Department of Histopathology, 1st Floor, Clinical Sciences Building 1, Central Manchester and Manchester Childrens University Hospitals NHS Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Senyo Tagboto
- University Hospital of North Staffordshire, Royal Infirmary, Princes Road, Hartshill, Stoke-on-Trent, ST4 7LN, UK
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Bijol V, Agrawal N, Abernethy VE, Rifkin IR, Nosé V, Rennke HG. A 57-year-old woman with recently diagnosed SLE, proteinuria, and microhematuria. Am J Kidney Dis 2007; 48:1004-8. [PMID: 17162159 DOI: 10.1053/j.ajkd.2006.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 09/15/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Vanesa Bijol
- Department of Pathology and Laboratory Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
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Current World Literature. Curr Opin Nephrol Hypertens 2005. [DOI: 10.1097/01.mnh.0000172731.05865.69] [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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