Idiopathic non-lupus full-house nephropathy is associated with poor renal outcome

Rijnink, Emilie C.; Teng, Y K Onno; Kraaij, Tineke; Wolterbeek, Ron; Bruijn, Jan A.; Bajema, Ingeborg M.

doi:10.1093/ndt/gfx020

Cited by 41 publications

(63 citation statements)

References 28 publications

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“…The consensus clinicopathologic diagnoses of these 32 patients were membranous nephropathy (antiphospholipase A2 receptor-positive, n ¼ 1; cancer-associated, n ¼ 3), IgA nephropathy (n ¼ 4), infection-related glomerulonephritis (n ¼ 2), antineutrophil cytoplasmic antibodyassociated glomerulonephritis (n ¼ 2), and idiopathic nonlupus full house nephropathy (n ¼ 20). 5 Details on the clinical presentation, biopsy findings, and clinical follow-up of these patients are provided elsewhere. 5…”

Section: Reference Standard Clinical Diagnosis Of Slementioning

confidence: 99%

“…2 This may be particularly relevant to nephrologists, because patients with renal biopsy findings reminiscent of lupus nephritis (LN) would readily be evaluated in light of these criteria to confirm the diagnosis. The recent descriptions of entities including "renal-limited lupus-like nephritis," 3 and idiopathic 4,5 and secondary "nonlupus full house nephropathy" [4][5][6][7][8][9][10] stress the importance of valid SLE classification criteria in the nephrology clinic: to help distinguish LN patients based on clinical and laboratory findings.…”

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confidence: 99%

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Validation of the Systemic Lupus International Collaborating Clinics classification criteria in a cohort of patients with full house glomerular deposits

Rijnink

Teng

Kraaij

et al. 2018

Kidney International

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Section: Reference Standard Clinical Diagnosis Of Slementioning

confidence: 99%

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confidence: 99%

Validation of the Systemic Lupus International Collaborating Clinics classification criteria in a cohort of patients with full house glomerular deposits

Rijnink

Teng

Kraaij

et al. 2018

Kidney International

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“…This condition is referred to as renal‐limited lupus‐like nephritis or full‐house nephropathy . Full‐house nephropathy was defined as concurrent positive staining in glomeruli for IgG, IgA, IgM, C3, and C1q with ≥1+ intensity on a 0–3+ scale …”

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confidence: 99%

Fate of full‐house immunofluorescence staining in renal allograft: A case report

Sawada

Unagami

Horita

et al. 2019

Pathology International

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Here, we report the case of a patient with renal allograft with full‐house immunofluorescence staining in the zero‐hour biopsy. Full‐house immunofluorescence staining is a well‐known characteristic of lupus nephritis. Previous studies have reported patients with full‐house immunofluorescence staining, but without other symptoms or serological findings; this condition is referred to as full‐house nephropathy. We identified only one case out of 2203 zero‐hour biopsies over 13 years. Zero‐hour biopsy presented no glomerular changes but showed full‐house immunofluorescence staining. Electron microscopy revealed a nonorganized electron‐dense deposit mainly in the mesangial lesion. Systemic lupus erythematosus (SLE)‐associated antibodies were negative, and complement deficiency was not observed in the donor patients. Deposition of immunoglobulin and complement levels markedly decreased within 1–3 years post transplantation. Neither donor nor recipient developed clinical or biological features of SLE; they showed good renal prognosis.

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“…Another nonarchetypical phenotype is that of nonlupus full-house nephropathy, defined as full-house immunofluorescence (IF) staining (i.e., positive staining for IgA, IgG, IgM, C3, and C1q) in the absence of other clinical or immunologic features of systemic lupus erythematosus. Nonlupus full-house nephropathy has been associated with poor clinical outcomes when affecting the native kidney, 4,5 although outcomes in the transplanted kidney have not been described. C1q-dominant cases include those with variable amounts of IgG, IgM, and C3 (along with C1q) immune deposition, and have generally been associated with benign clinical outcomes when occurring in the transplanted kidney.…”

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confidence: 99%

Histologic Case Definition of an Atypical Glomerular Immune-Complex Deposition Following Kidney Transplantation

Chin

Charu

O’Shaughnessy

et al. 2020

Kidney International Reports

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Introduction: Immune-complex deposition in the transplanted kidney can present as well-phenotyped recurrent or de novo glomerular disease. However, a subset, herein termed immune-complex glomerulopathy not otherwise specified (ICG-NOS), defies classification. We quantified, categorized, and characterized cases of transplant ICG-NOS occurring at a single US academic medical center. Methods: We retrospectively reviewed our single-institution pathology database (July 2007-July 2018) to identify and categorize all cases of immune-complex deposition in kidney allografts (based on immunofluorescence microscopy). We extracted clinicopathologic and outcome data for ICG-NOS (i.e., immune complex deposition not conforming to any well-characterized glomerular disease entity). Results: Of 104 patients with significant immune deposits, 28 (27%) were classified as ICG-NOS. We created 5 mutually exclusive ICG-NOS categories: Full-house, Quasi-full-house, IgA-rich, C1q-rich, and C1q-poor. Overall, 16 (57%) patients met criteria for definite or possible allograft rejection, including 9 (32%) with antibody-mediated rejection (ABMR), 3 (11%) suspicious for ABMR, 1 (4%) with T-cell-mediated rejection (TCMR), and 9 (32%) with borderline TCMR. After a median follow-up of 2.3 (range, 0.1-14.0) years after biopsy, 7 (25%) allografts had failed and an additional 8 (29%) had persistent renal dysfunction (hematuria, 14%; proteinuria, 21%; and estimated glomerular filtration rate <60 ml/min per 1.73 m 2 , 11%). Conclusion: In contrast to prior studies, our findings suggest that ICG-NOS is not necessarily a benign glomerular process and that there may be an association between ICG-NOS and alloimmunity. Our immunofluorescence-based classification provides a framework for future studies aiming to further elucidate ICG-NOS pathogenesis and prognosis.

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Idiopathic non-lupus full-house nephropathy is associated with poor renal outcome

Abstract: Our results show that the clinical recognition of idiopathic non-lupus FHN as a diagnostic category is critical.

Cited by 41 publications

References 28 publications

Validation of the Systemic Lupus International Collaborating Clinics classification criteria in a cohort of patients with full house glomerular deposits

Validation of the Systemic Lupus International Collaborating Clinics classification criteria in a cohort of patients with full house glomerular deposits

Fate of full‐house immunofluorescence staining in renal allograft: A case report

Histologic Case Definition of an Atypical Glomerular Immune-Complex Deposition Following Kidney Transplantation

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