A Refractory Case of Secondary Membranous Nephropathy Concurrent with IgG4-related Tubulointerstitial Nephritis

Arai, Hiroyuki; Toda, Naohiro; Kamimatsuse, Ryo; Nishioka, Keisuke; Endo, Shuichiro; Akiyama, Shin–ichi; Maruyama, Shoichi; Matsubara, Takeshi; Yokoi, Hideki; Yanagita, Motoko

doi:10.2169/internalmedicine.0836-18

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Idiopathic MN was previously described as PLA2R-positive in approximately 70% of MN cases ( 17 ), while MN associated with active sarcoidosis was reported to be positive in 56% (5/9 cases) ( 16 ). In contrast, PLA2R staining was negative in all 13 cases of MN with IgG4-RKD ( 15 , 18 ). Therefore, the negative PLA2R staining observed in the present case was not decisive for a diagnosis of secondary MN.…”

Section: Discussionmentioning

confidence: 88%

Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease

Yoshida¹,

Takahashi

Horiguchi³

et al. 2021

Intern. Med.

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A 78-year-old man presented with hypercalcemia and renal disease with high serum IgG4 and positive myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), exhibiting sarcoidosis-like chest findings. A renal biopsy revealed tubulointerstitial nephritis, membranous nephropathy (MN), and sub-capsular lymphoid aggregates without fulfilling the diagnostic criteria of IgG4-related disease or sarcoidosis. Steroid therapy ameliorated the serological and renal abnormalities. After 5 years, following gradual increases in the neutrophil count and upper respiratory infection (URI), necrotizing crescentic glomerulonephritis (NCGN) developed with an increased serum MPO-ANCA level. These results suggest that in the presence of MPO-ANCA in immune senescence, the persistent neutrophil increase with URI may lead to the development of NCGN.

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Section: Discussionmentioning

confidence: 88%

Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease

Yoshida¹,

Takahashi

Horiguchi³

et al. 2021

Intern. Med.

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“…The predominant subclass of IgG deposited in the glomerular capillary wall is IgG4, although deposition of other IgG subclasses has also been reported. [15,[21][22][23][24][25][26] Several studies have proposed the involvement of galectin-3, [27] laminin-511, [28] and annexin-A11 [29] in the pathogenesis of IgG4-RD. IgG4 galectin-3 autoantibodies have been found in a subset of IgG4-RD patients and are correlated with plasma levels of galectin-3.…”

Section: Discussionmentioning

confidence: 99%

IgG4-Related Disease with IgG1-Dominant Membranous Nephropathy: A Rare Case Report

Duan,

Qu,

Zhuang

et al. 2023

Integr Med Nephrol Androl

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Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder affecting various organs and tissues. Kidney involvement in IgG4-RD commonly manifests as IgG4-related tubulointerstitial nephritis or IgG4-related membranous nephropathy, with the latter occurring less frequently. The identification of the phospholipase A2 receptor (PLA2R) antigen has improved our understanding of primary membranous nephropathy. Here, we present the case of a 60-year-old Chinese man initially diagnosed with IgG4-related pancreatitis, who achieved clinical remission with glucocorticoid therapy followed by low-dose glucocorticoid maintenance therapy. Two years later, the patient developed nephrotic syndrome. A kidney biopsy revealed membranous nephropathy characterized by glomerular subepithelial deposition of IgG1 and positive PLA2R staining. Rituximab (RTX) treatment resulted in complete clinical remission of nephrotic syndrome, and no recurrence was observed during the 24-month follow-up period. IgG4-RD complicated by membranous nephropathy is a rare pathological feature characterized by glomerular subepithelial IgG1 deposition and positive PLA2R antigen staining. In the present case, RTX treatment was effective in achieving clinical remission. These findings contribute to the evolving understanding of the relationship between IgG4-RD and membranous nephropathy.

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“…In addition, positive deposition of IgG4 has been observed in IgG4-MN, either predominantly or together with other IgG subclasses [24][25][26][27][28]. Thus, immunoprofile of IgG subclasses would likely not distinguish between primary MN and IgG4-MN [29]. It is worth noting that TBM immune complex deposits are less common in IgG4-MN than in IgG4-TIN.…”

Section: ) Tubulointerstitial Nephritis (Tin)mentioning

confidence: 99%

“…In contrast, glomerular lesions of IgG4-RKD are usually refractory to corticosteroid monotherapy [28,29]. Most cases required combination therapy with immunosuppressive agents to 9 achieve a complete or partial response.…”

Section: Treatment and Outcomementioning

confidence: 99%

Renal involvement in IgG4-related disease

2020

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A Refractory Case of Secondary Membranous Nephropathy Concurrent with IgG4-related Tubulointerstitial Nephritis

Cited by 6 publications

References 26 publications

Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease

Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease

IgG4-Related Disease with IgG1-Dominant Membranous Nephropathy: A Rare Case Report

Renal involvement in IgG4-related disease

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