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Antineutrophil cytoplasmic antibody-associated glomerulonephritis with immunoglobulin deposition

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Abstract

Background

Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis is commonly classified as pauci-immune glomerulonephritis; however, some cases have granular immunoglobulin deposition along the glomerular capillary. The pathogenesis of immune deposits is poorly studied.

Methods

Of 66 patients diagnosed with ANCA-associated glomerulonephritis on renal biopsy, cases with immunoglobulin deposition along the glomerular capillary were identified and their clinicopathological characteristics were analyzed. We also performed myeloperoxidase (MPO) and double immunofluorescence (IF) stainings to determine the presence of immune complex antigens.

Results

Granular IgG deposition, IgG plus IgM deposition, and IgM deposition were observed in 15 (22.1%), 8 (11.2%), and 17 (25.0%) cases, respectively. In cases with granular IgG deposition, MPO-IgG double IF staining revealed co-localization of MPO and IgG. In cases with granular IgM deposition, MPO-IgM double IF staining did not co-localize. By electron microscopy, subepithelial deposition as well as intramembranous, subendothelial, and mesangial deposition was detected in the patients with IgG deposition. In addition, renal survival curves were not significantly different between the immunoglobulin deposition and non-deposition groups.

Conclusions

Granular IgG and/or IgM deposition was observed in 60.6% of patients with ANCA-associated glomerulonephritis. In cases with IgG deposition, electron-dense deposits (EDDs) were observed at various sites in the glomerulus, and MPO and IgG immunocomplex deposition was frequently observed along the glomerular capillary. With IgM deposition, EDDs were not obvious in the glomerular basement membrane, and MPO and IgM immunocomplex was not detected. These data suggest differential mechanism between IgG deposition and IgM deposition.

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Acknowledgements

The authors thank Minako Koike (Tokyo Women’s University Yachiyo Medical Center), Jun Ino (Toda Chuo General Hospital), and Michihiro Mitobe (Saiseikai Kurihashi Hospital), who performed renal biopsy and provided patient follow-up data. The authors thank Shigeru Horita (Tokyo Women's Medical University) for histological support.

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Authors and Affiliations

  1. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Orie Hirose, Mitsuyo Itabashi, Takashi Takei & Kosaku Nitta

  2. Department of Pathology, Tokyo Women’s Medical University, Tokyo, Japan

    Kazuho Honda

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  1. Orie Hirose
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  2. Mitsuyo Itabashi
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  3. Takashi Takei
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  4. Kazuho Honda
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  5. Kosaku Nitta
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Correspondence to Mitsuyo Itabashi.

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The authors report no disclosures or conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number #3556) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent for renal biopsy was obtained from all individual participants included in the study.

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Hirose, O., Itabashi, M., Takei, T. et al. Antineutrophil cytoplasmic antibody-associated glomerulonephritis with immunoglobulin deposition. Clin Exp Nephrol 21, 643–650 (2017). https://doi.org/10.1007/s10157-016-1341-1

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  • DOI: https://doi.org/10.1007/s10157-016-1341-1

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