Membranoproliferative Glomerulonephritis-Like Glomerular Disease and Concurrent Tubulointerstitial Nephritis Complicating IgG4-Related Autoimmune Pancreatitis

Abstract

Abstract

Proposal for diagnostic criteria for IgG4-related kidney disease

“…Therefore, lymphoplasmacytic TIN with fibrosis and prominent IgG4-positive plasma cells seems to be a representative histopathologic feature of IgG4-RKD. Several kinds of glomerular lesions have been reported that overlap with those of typical lymphoplasmacytic TIN [11,23,24]. The most frequently reported lesion is membranous nephropathy (MN), and three patients had this type of glomerulopathy in this study.…”

“…IgG4-RKD is a new clinical entity in the field of nephrology, unrecognized before 2004, when the notion gradually emerged of it being an extrapancreatic manifestation of AIP [2][3][4][5][6][7][8][9][10][11][20][21][22][23][24][25]. This disease has many features helping to distinguish it from other types of TIN radiographically [26][27][28][29][30] and pathologically [11,21], and early detection provides the best chance for preservation of renal function because of its good responsiveness to corticosteroid therapy [2][3][4][5][6][7][8][9][10][11].…”

Autoimmune Pancreatitis Associated with Various Extrapancreatic Lesions during a Long-term Clinical Course Successfully Treated with Azathioprine and Corticosteroid Maintenance Therapy

“…Renal biopsy reveals diffuse lymphoplasmacytic infiltration of the renal interstitium, and the lesions vary from diffuse tubulointerstitial nephritis to tumor-like masses according to the distribution patterns of the infiltrating cells (21). On the other hand, glomerulonephritis associated with AIP is rare (22,23). Katano et al (23) …”

Possible IgG4-Related Kidney Disease Requiring a Differential Diagnosis of Membranous Lupus Nephritis

“…Glomerular changes were evident in a quarter of the reported cases of IgG4-related tubulointerstitial nephritis (2). Among them, membranous nephropathy was dominant (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Membranous nephropathy, concomitant with IgG4-related tubulointerstitial nephritis, is considered linked to IgG4-related disease, but not a primary glomerular disease, because circulating anti-phospholipase A2 receptor antibodies, the most common autoantibodies in idiopathic membranous nephropathy (30), were undetected (11,12).…”

“…Hypocomplementemia and elevated antinuclear antibody (ANA) are frequently observed, whereas anti-SS-A, anti-SS-B, anti-Sm, anti-RNP and anti-double-stranded DNA (dsDNA) antibodies are generally negative (1). Occasionally, IgG 4-related tubulointerstitial nephritis accompanies glomerular diseases such as membranous nephropathy, mesangial proliferative glomerulonephritis and membranoproliferative glomerulonephritis; however, membranous nephropathy is dominant (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). We report a case, initially considered to be IgG4-related tubulointerstitial nephritis with membranous nephropathy requiring a differential diagnosis of membranous lupus nephritis (Class V) with severe tubulointerstitial changes.…”