Tubulointerstitial Nephritis Associated With IgG4-Related Autoimmune Disease

Yoneda, Kentaro; Murata, Kazumoto; Katayama, Kan; Ishikawa, Eiji; Fuke, Hiroyuki; Yamamoto, Norio; Ito, Keiichi; Shiraki, Katsuya; Nomura, Shinsuke

doi:10.1053/j.ajkd.2007.05.018

Cited by 52 publications

(41 citation statements)

References 24 publications

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“…In IgG4-TIN, renal biopsy is usually contemplated to evaluate an asymptomatic rise in serum creatinine, proteinuria, renal enlargement, and/or focal renal parenchymal lesions. [6][7][8][9][10][11] As with other forms of IgG4-SD, IgG4-TIN is often accompanied by serological findings consistent with an immune complex disorder, including marked elevation of serum IgG, particularly IgG4, 6,[8][9][10][11] the presence of ANA and other autoantibodies, 6,8,11 and hypocomplementemia. 6,8,10,11 When examined by enhanced CT, the renal parenchymal lesions are typically focal or multifocal and expansile, sometimes mimicking cancer.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11] As with other forms of IgG4-SD, IgG4-TIN is often accompanied by serological findings consistent with an immune complex disorder, including marked elevation of serum IgG, particularly IgG4, 6,[8][9][10][11] the presence of ANA and other autoantibodies, 6,8,11 and hypocomplementemia. 6,8,10,11 When examined by enhanced CT, the renal parenchymal lesions are typically focal or multifocal and expansile, sometimes mimicking cancer. 5,6 Histologically, IgG4-TIN is characterized by the presence of IgG4 þ PC-rich lymphoplasmacytic infiltrates, obliterative, expansile sclerosis, 6,7,8 and often by peritubular and/or interstitial immune deposits, including IgG4 deposits.…”

Section: Discussionmentioning

confidence: 99%

“…In published reports, most cases of IgG4-TIN accompany other lesions of IgG4-SD [5][6][7][8][9][10][11] (Table 1), particularly those in pancreas, hepatobiliary system, lymph nodes, and/or salivary glands. This has been our experience as well, but in all of the IgG4-TIN reference biopsy samples reviewed in this study, IgG4-SD first came to light as a result of the kidney biopsy.…”

Section: Discussionmentioning

confidence: 99%

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An abundance of IgG4+ plasma cells is not specific for IgG4-related tubulointerstitial nephritis

Houghton

Troxell

2011

Modern Pathology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An abundance of IgG4+ plasma cells is not specific for IgG4-related tubulointerstitial nephritis

Houghton

Troxell

2011

Modern Pathology

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“…An association with a hypoparathyroidism [33]; lymphoid interstitial lung disease with alveolitis [34]; hyperthyroidism [35]; Cogan's syndrome [36] and IgG 4 related syndrome [37] has been reported. There are few reports of patients with TINU syndrome who had family members suffering from autoimmune diseases, including a father with Vogt-Koyanagi-Harada syndrome and sister with ulcerative colitis.…”

Section: Discussionmentioning

confidence: 99%

Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome, Two New Cases and Review of the Literature

Laidoudi¹,

Hakem²

2016

J Nephrol Ther

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Case 1: A 25 year-old woman, presented with asthenia; weight loss; severe hypertension and acute unilateral anterior uveitis. She had also proteinuria; hematuria; aciduria; kidney failure and grade I hypertensive retinopathy. Kidney biopsy showed a non caseating granuloma in the interstitial tissue, and tubulointerstitial nephritis (TIN) with granulomatous lesions in the medullary parenchyma. All explorations were negative but QuantiFERON was 10 times normal without koch's bacillus. No other sites of granulomas. The patient partially responded to corticoid treatment. She replased after untimely stopping corticosteroids. Corticosteroid-sparing was provided by mycophenolate mofetil.Case 2: A 46 year-old patient, with family history of mother who died of CKD, presented with recurrent anterior uveitis, kidney failure, proteinuria, and inflammatory syndrome, research of infectious agents or auto-immunity origin was negative. Renal biopsy showed TIN lesions in subacute stage; biopsy of the salivary glands showed stage III chronic lymphocytic sialadenitis without Sjogren syndrome or sarcoidosis. The patient received corticosteroid treatment. Discussion:The presence of TIN, recurrent anterior uveitis, no notion of drug intake, response to corticosteroids and exclusion of other diagnoses leads to TINU syndrome. Positivity of Quantiferon is explained by the fact that TINU syndrome is associated with high serological markers in the absence of their corresponding diseases, and presence of chronic lymphocytic sialadenitis explained by these immunological disorders without Sjogren syndrome, Both patients remained well without recurrence of uveitis 2 and 6 years later respectively. Conclusion:TINU syndrome is secondary to immunological disorders as evidenced interstitial infiltrate of the renal parenchyma, the inflammatory disease of the uvea and good response to corticosteroid therapy.

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“…5) In 2001, Type 1 AIP with elevated serum IgG4 level and abundant IgG4-positive lymphoplasmacyte infiltration in the pancreas was reported and the concept of IgG4-related disease was proposed. 6) Then, it was gradually discovered that IgG4-related disease involves inflammation and sclerosing in many other organs, 7) especially exocrine organs: 8) bile ducts, 9) lacrimal and salivary glands, 10) retroperitoneum, 11) urinary organs, [12][13][14] pituitary gland, 15) prostate, 16) arteries, [17][18][19][20] veins, [21][22][23] heart, [24][25][26] lung, 25,27,28) eye, 24,29) mesenterium, 30) mammary gland, 31) central nervous system, 32) esophagus, 33) stomach, 34) liver, 35) gastrointestinal tract, 36) thyroid, 37,38) nose, 39) blood, 40,41) skin, 42) and pseudotumors in various organs 9,14,25,[43][44]…”

Section: History Of Igg4-related Diseasementioning

confidence: 99%

IgG4-Related Cardiovascular Disorders

2014

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SummaryImmunoglobulin4 (IgG4)-related disease is a systemic inflammatory disease characterized by elevation of serum IgG4. It involves various organs such as the pancreas (autoimmune pancreatitis), lacrimal gland (Mikulicz's disease), retroperitoneum (retroperitoneal fibrosis), aorta (aortic aneurysm and aortitis), heart (constrictive pericarditis), and pseudotumors around the coronary arteries. These disorders often coexist in accordance with progression of the disease. Because IgG4-related cardiovascular disorder affects the patient's prognosis, early detection and treatment is important. Coronary CT imaging and echocardiography accidentally detect IgG4-related disorders and 18 FDG-PET imaging can identify active inflammation in the lesions. Measurement of serum IgG4 levels and tissue biopsy are necessary for diagnosis. Minor salivary gland biopsy is recommended even though 18 FDG uptake is not detected when it is difficult to obtain a biopsy specimen from IgG4-related cardiovascular lesions. The first-line treatment is high-dose corticosteroid therapy, however, relapse is often reported. Corticosteroids suppress the development of active inflammatory diseases such as aortitis, pericarditis, and pseudotumors, but already-developed lesions do not respond. A large developed aneurysm can rupture even during or after corticosteroid therapy, therefore, additional surgical treatment may be needed. Treatment of IgG4-related cardiovascular disorders might require higher doses of corticosteroids than IgG4-related extracardiovascular disorders. The adequate dose of corticosteroid, type and dose of immunosuppressant, and surgical intervention should be carefully considered on a case-by-case basis. (Int Heart J 2014; 55: 287-295)

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Tubulointerstitial Nephritis Associated With IgG4-Related Autoimmune Disease

Cited by 52 publications

References 24 publications

An abundance of IgG4+ plasma cells is not specific for IgG4-related tubulointerstitial nephritis

An abundance of IgG4+ plasma cells is not specific for IgG4-related tubulointerstitial nephritis

Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome, Two New Cases and Review of the Literature

IgG4-Related Cardiovascular Disorders

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