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Spatola L, Ravera F, Sghirlanzoni MC, Verdesca S, Menegotto A, Querques M, Camozzi ML, Colombo V, Minetti EE. An enigmatic case of IgG4-related nephropathy and an updated review of the literature. Clin Exp Med 2021; 21:493-500. [PMID: 33683496 DOI: 10.1007/s10238-021-00696-x] [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: 10/29/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
IgG4-related disease (IgG4-RD) is still an underestimated disorder which affects multiple organs, and its recognition as a distinct clinical disease has been only proved in the recent decades. The renal involvement has been documented in approximately 15% of patients with IgG4-RD, and the typical manifestation is a tubulo-interstitial nephritis. The main histological findings in IgG4-RD are typically a dense tissue infiltration of IgG4-positive plasma cells, storiform fibrosis, obliterative phlebitis, and frequently elevated IgG4 serum levels. Herein we report our atypical and peculiar clinical presentation of an IgG4-related nephropathy (IgG4-RN) and the remarkable response to rituximab (RTX) treatment at the renal imaging with computerized tomography assessment. The current nephrological evidences support the renal function recovery after steroids or steroids plus RTX therapy, even if the renal imaging data are not always shown. In a complex and enigmatic clinical scenario such as the IgG4-RN, both the renal biopsy and the renal imaging before and after the immunosuppressive therapy become mandatory tools to thoroughly define the diagnosis, the management and the response to the immunological therapy.
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Affiliation(s)
- Leonardo Spatola
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy.
| | - Federica Ravera
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Maria Chiara Sghirlanzoni
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Simona Verdesca
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Alberto Menegotto
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Marialuisa Querques
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Mario Livio Camozzi
- Division of Pathology, ASST Grande Ospedale Territoriale Niguarda, 20162, Milan, Italy
| | - Valeriana Colombo
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Enrico Eugenio Minetti
- Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
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Gopalakrishnan N, Abraham A, Balasubramaniyan T, Dineshkumar T, Dhanapriya J, Malathy N, Haris M, Prasad NDS. IgG4 related interstitial nephritis: A case report and review of literature. Indian J Nephrol 2013; 23:308-11. [PMID: 23960352 PMCID: PMC3741980 DOI: 10.4103/0971-4065.114489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IgG4 interstitial nephritis is a recently described entity. A middle-aged gentleman with bilateral parotid enlargement, hepatosplenomegaly and generalized lymphadenopathy was referred to us for evaluation of renal failure. He had trace proteinuria and large kidneys. Kidney biopsy revealed interstitial nephritis with characteristic storiform fibrosis. Immunohistochemistry demonstrated intense staining for IgG4-secreting plasma cells in the interstitium.
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Affiliation(s)
- N Gopalakrishnan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
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Immunohistochemical Characteristics of IgG4-Related Tubulointerstitial Nephritis: Detailed Analysis of 20 Japanese Cases. Int J Rheumatol 2012; 2012:609795. [PMID: 22899937 PMCID: PMC3415101 DOI: 10.1155/2012/609795] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 06/11/2012] [Indexed: 12/18/2022] Open
Abstract
Although tubulointerstitial nephritis with IgG4+ plasma cell (PC) infiltration is a hallmark of IgG4-related kidney disease (IgG4-RKD), only a few studies are available about the minimum number of IgG4+ PC needed for diagnosis along with IgG4+/IgG+ PC ratio in the kidney. In addition, the significance of the deposition of IgG or complement as a reflection of humoral immunity involvement is still uncertain. In this study, we analyzed 20 Japanese patients with IgG4-RKD to evaluate the number of IgG4+ PCs along with IgG4+/IgG+ PC ratio and involvement of humoral immunity. The average number of IgG4+ PCs was 43.8/hpf and the average IgG4+/IgG+ or IgG4+/CD138+ ratio was 53%. IgG and C3 granular deposits on the tubular basement membrane (TBM) were detected by immunofluorescence microscopy in 13% and 47% of patients, respectively. Nine patients had a variety of glomerular lesions, and 7 of them had immunoglobulin or complement deposition in the glomerulus. In conclusion, we confirmed that infiltrating IgG4+ PCs > 10/hpf and/or IgG4/IgG (CD138)+ PCs > 40% was appropriate as an item of the diagnostic criteria for IgG4-RKD. A relatively high frequency of diverse glomerular lesions with immunoglobulin or complement deposits and deposits in TBM may be evidence of immune complex involvement in IgG4-related disease.
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Kotera N, Isogawa A, Uchida L, Ishimoto Y, Tanaka M, Tanaka S, Kishi S, Mise N, Sugimoto T, Shiba T. IgG4-related Hypophysitis Presenting with Secondary Adrenal Insufficiency and Central Diabetes Insipidus in a Type 1 Diabetes Patient. ACTA ACUST UNITED AC 2011; 100:1044-7. [DOI: 10.2169/naika.100.1044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Akihiro Isogawa
- Division of Diabetes and Metabolism, Department of Medicine, Mitsui Memorial Hospital
| | - Lisa Uchida
- Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
| | - Yu Ishimoto
- Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
| | - Mototsugu Tanaka
- Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
| | - Shinji Tanaka
- Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
| | - Satoru Kishi
- Division of Diabetes and Metabolism, Department of Medicine, Mitsui Memorial Hospital
| | - Naobumi Mise
- Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital
| | | | - Teruo Shiba
- Division of Diabetes and Metabolism, Department of Medicine, Mitsui Memorial Hospital
- Department of Diabetes, Toho University Ohashi Medical Center
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