Histology of human tubulo-interstitial nephritis associated with antibodies to renal basement membranes

Abstract

Twenty-seven patients with diffuse "crescentic" glomerulonephritis (CSGN) were identified in 1,174 renal biopsies from nephritic patients. Patients were assigned to three groups on the basis of the immunofluorescent study of renal biopsy specimens and serologic findings. Group I included eight patients with antibodies to glomerular (anti-GBM) and tubular (anti-TBM) basement membranes; group II had eight patients with only anti-GBM antibodies; and group III had eleven patients with CSGN unassociated with antibodies to either GBM or TBM. Patients with anti-GBM/anti-TBM antibodies (group I) had severe tubulointerstitial (TI) nephritis, as characterized by the infiltration of polymorphonuclear leukocytes and macrophages along the TBM and peritubular vessels. In some patients, focal proliferation of epithelial cells of proximal convoluted tubules (PCT), gaps or extensive destruction of TBM, lesions in the walls of small peritubular vessels, and interstitial giant cells were also observed. Patients with anti-GBM antibodies (group II) had mild to moderate interstitial cellular infiltration and mild tubular changes. Five patients with CSGN not associated with antibodies to renal basement membranes (group III) had mild to moderate interstitial cellular infiltration and tubular changes. A sixth patient, with Wegener's disease had severe granulomatous TI lesions. The results of this study show that TI nephritis is most frequent and severe with anti-TBM antibodies are demonstrable and suggest that anti-TBM antibodies contribute to the development of TI lesions.

Circulating Anti-Tubular Basement Membrane Antibody in a Variety of Human Renal Diseases

“…Only recently, Andres et al [2] have suggested that the clinical pattern is unique in those patients who have antibody against both TBM and GBM. They described a more extensive tubulointerstitial nephritis, when anti-TBM anti body was present.…”

Specificity and Nephrotoxicity of Heterologous Antibodies Directed Against Renal Basement Membranes

“…In human pathology, a linear fixation of immunoglobulins on TBM has been re ported in about 70% of patients with anti-GBM nephropathy [9], The nephrotoxicity of TBM-bound antibodies has never been clearly established in humans, However, Andres et al [23] in a recent review of human crescentic glomerulonephritis, dem onstrated that tubulointerstitial lesions were more frequent and severe when anti-TBM antibodies were present.…”

Anti-Glomerular Basement Membrane Disease

“…Irregular staining for fibrin is observed in portions of glomerular necrosis and cellular crescents. Linear staining of tubular basement membranes for IgG sometimes occurs (Lehman et al, 1975;Andres et al, 1978).…”