Clinicopathological findings of immunoglobulin G4-related kidney disease

Clin Exp Nephrol. 2011 Dec;15(6):810-9. doi: 10.1007/s10157-011-0526-x. Epub 2011 Aug 26.

Abstract

Immunoglobulin (Ig) G4-related kidney disease characterizing tubulointerstitial nephritis (TIN) is an organ complication recognized in IgG4-related systemic diseases that has some unique aspects compared to other types of TIN. TIN lesions in the kidney can be tumor-like, focal or diffuse. Abnormal urinalysis is usually mild or absent even in the cases with deteriorated renal dysfunction. Some cases are accidentally diagnosed from radiological findings without renal dysfunction and/or abnormal urinalysis. The typical pathological findings of TIN are unique fibrosis and infiltration of massive lymphocytes and IgG4-positive plasma cells. Glomerular lesions are rare but the complication of mesangial proliferative glomerulonephritis and membranous nephropathy is occasionally reported. Pathogenic mechanisms are unclear until now; however, auto-immune and allergic mechanisms have been suspected from laboratory data. The initial response to steroid agents is generally favorable; however, recurrence is possible after the discontinuation of steroid treatment. Long-term follow-up is necessary with continuous systemic checks for organ disorders due to IgG4-related systemic diseases.

Publication types

  • Review

MeSH terms

  • Animals
  • Fibrosis
  • Glomerulonephritis, Membranous / immunology
  • Humans
  • Immunoglobulin G / metabolism*
  • Kidney / drug effects
  • Kidney / immunology*
  • Kidney / pathology
  • Kidney / physiopathology
  • Lymphocytes / immunology
  • Nephritis, Interstitial / diagnosis
  • Nephritis, Interstitial / drug therapy
  • Nephritis, Interstitial / immunology*
  • Nephritis, Interstitial / physiopathology
  • Plasma Cells / immunology*
  • Predictive Value of Tests
  • Steroids / therapeutic use
  • Treatment Outcome

Substances

  • Immunoglobulin G
  • Steroids