Tertiary lymphoid tissue in early‐stage IgG4-related tubulointerstitial nephritis incidentally detected with a tumor lesion of the ureteropelvic junction: a case report

Miyanaga, Tatsuhito; Mizuguchi, Keishi; Hara, Satoshi; Zoshima, Takeshi; Inoue, Dai; Nishioka, Ryo; Mizushima, Ichiro; Ito, Kiyoaki; Fuji, Hiroshi; Yamada, Kazunori; Sato, Yuki; Yanagita, Motoko; Kawano, Mitsuhiro

doi:10.1186/s12882-021-02240-1

Cited by 14 publications

(6 citation statements)

References 30 publications

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“…However, the accumulation of somatic hypermutations in the IgA variable region genes cloned from these PBs suggests that they were generated via GCs in a T cell–dependent manner. Although tertiary lymphoid tissues containing GC B cells are known to be generated at inflammation sites in various pathologic conditions, such as autoimmunity, cancer, and allograft rejection ( 40 ), as well as in inflamed kidneys of several kidney diseases ( 34 , 41 , 42 ), we could not detect GC B cells in the kidney of 8-wo gddY mice, when IgA + PBs had already appeared. Therefore, IgA + PBs are possibly generated in GCs in some lymphoid organs or differentiated from their precursors, namely, memory B cells, which have undergone somatic hypermutation.…”

Section: Discussioncontrasting

confidence: 58%

Identification of IgA autoantibodies targeting mesangial cells redefines the pathogenesis of IgA nephropathy

et al. 2023

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Immunoglobulin A (IgA) nephropathy (IgAN) is the most common type of primary glomerulonephritis, often progressing to renal failure. IgAN is triggered by IgA deposition in the glomerular mesangium by an undefined mechanism. Here, we show that grouped ddY (gddY) mice, a spontaneous IgAN model, produce serum IgA against mesangial antigens, including βII-spectrin. Most patients with IgAN also have serum anti–βII-spectrin IgA. As in patients with IgAN, IgA + plasmablasts accumulate in the kidneys of gddY mice. IgA antibodies cloned from the plasmablasts carry substantial V-region mutations and bind to βII-spectrin and the surface of mesangial cells. These IgAs recognize transfected and endogenous βII-spectrin exposed on the surface of embryonic kidney–derived cells. Last, we demonstrate that the cloned IgA can bind selectively to glomerular mesangial regions in situ. The identification of IgA autoantibody and its antigen in IgAN provides key insights into disease onset and redefines IgAN as a tissue-specific autoimmune disease.

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Section: Discussioncontrasting

confidence: 58%

Identification of IgA autoantibodies targeting mesangial cells redefines the pathogenesis of IgA nephropathy

et al. 2023

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“…Several studies have reported that TLTs are induced in various kidney diseases [62][63][64][65]. Additionally, we reported that TLTs developed not only in murine kidneys but also in human kidneys in an age-dependent manner [8].…”

Section: Clinical Significance Of Tertiary Lymphoid Tissues In Ckd and The Elderlymentioning

confidence: 66%

Heterogeneity of Fibroblasts in Healthy and Diseased Kidneys

Yoshikawa¹,

Sato²,

Yanagita³

2021

Biochemistry

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Chronic kidney disease (CKD) is a worldwide health problem affecting 9.1% of the world’s population. The treatments to prevent the progression of CKD remain limited, however. Resident fibroblasts in the kidneys play crucial roles in the pathological conditions commonly recognized in CKD, such as renal fibrosis, renal anemia, and peritubular capillary loss. Fibroblasts in the kidney provide structural backbone by producing extracellular matrix proteins and produce erythropoietin for normal hematopoiesis under physiological conditions. In the diseased condition, however, fibroblasts differentiate into myofibroblasts that produce excessive extracellular matrix proteins at the cost of the inherent erythropoietin-producing abilities, resulting in renal fibrosis and renal anemia. Pericytes, which are mesenchymal cells that enwrap peritubular capillaries and highly overlap with resident fibroblasts, detach from peritubular capillary walls in response to kidney injury, resulting in peritubular capillary loss and tissue hypoxia. Several reports have demonstrated the beneficial roles of fibroblasts in the regeneration of renal tubules Renal fibroblasts also have the potential to differentiate into a proinflammatory state, producing various cytokines and chemokines and prolonging inflammation by forming tertiary lymphoid tissues, functional lymphoid aggregates, in some pathological conditions. In this article, we describe the heterogenous functions of renal fibroblasts under healthy and diseased conditions.

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“…We searched PubMed for literature review and summarized clinical characteristics of 8 patients, including our case, in Table 1. [9][10][11][12][13][14][15] The average was 66 years old. There were 62.5% male patients.…”

Section: Discussionmentioning

confidence: 99%

IgG4-Related Disease Mimicking Unilateral Urothelial Carcinoma: A Rare Case Report and Literature Review

Cheng

Chiang

Huang

2023

Clin Med Insights Case Rep

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Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune-mediated disorder with heterogeneous multiorgan manifestations. Early identification and treatment of IgG4-RD are crucial for organ function recovery. Rarely, IgG4-RD manifests as a unilateral renal pelvic soft tissue mass that may be misdiagnosed as urothelial malignancy, resulting in invasive surgical intervention and organ damage. Here we present a 73-year-old man who had a right ureteropelvic mass with hydronephrosis detected by enhanced computed tomography. Right upper tract urothelial carcinoma and lymph node metastasis was highly suggested based on the image findings. However, IgG4-RD was suspected due to his past history of bilateral submandibular lymphadenopathy, nasolacrimal duct obstruction, as well as a high serum IgG4 level of 861 mg/dL. The ureteroscopy with tissue biopsy showed no evidence of urothelial malignancy. His lesions and symptoms improved after glucocorticoid treatment. Hence, a diagnosis of IgG4-RD was made, with the phenotype of classic Mikulicz syndrome with systemic involvement. The manifestation of IgG4-RD as a unilateral renal pelvic mass is rare and should be kept in mind. A ureteroscopic biopsy and serum IgG4 level measurement can help in the diagnosis of IgG4-RD in patients with a unilateral renal pelvic lesion.

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Tertiary lymphoid tissue in early‐stage IgG4-related tubulointerstitial nephritis incidentally detected with a tumor lesion of the ureteropelvic junction: a case report

Cited by 14 publications

References 30 publications

Identification of IgA autoantibodies targeting mesangial cells redefines the pathogenesis of IgA nephropathy

Identification of IgA autoantibodies targeting mesangial cells redefines the pathogenesis of IgA nephropathy

Heterogeneity of Fibroblasts in Healthy and Diseased Kidneys

IgG4-Related Disease Mimicking Unilateral Urothelial Carcinoma: A Rare Case Report and Literature Review

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