Abstract
A variety of diseases cause tubulointerstitial inflammation in the basic structure of the tubulointerstitium. The histological variation differs according to the onset (acute or chronic) and type of immune mechanism (primary or secondary), and some specific findings are of help in surmising the etiology of tubulointerstitial nephritis (TIN).
The histopathological picture in IgG4-related TIN is mixed: some patients present with acute, and others slowly progressive renal insufficiency. IgG4-related TIN is classified appropriately as a secondary cause of TIN because it occurs not in association with a primary glomerular disease but rather as a manifestation of a systemic underlying condition, admixed with tubulointerstitial immune deposition. Although IgG4-related TIN reveals some specific pathological hallmarks, pathologists should differentiate some diseases such as idiopathic hypocomplementemic TIN, nephropathy associated with the diffuse infiltrative lymphocytosis syndrome, Epstein-Barr virus infection of renal proximal tubule cells, predominantly tubulointerstitial lupus nephritis, multicentric Castleman disease, and kidney infiltration by lymphoproliferative disorders.
In this chapter, the basic structure of the tubulointerstitium, various aspects of TIN and its pathology, and the differential diagnosis of IgG4-related TIN are focused on.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bonsib SM. Renal anatomy and histology. In: Jennette JC, Olson JL, Silva FG, D’Agati VD, editors. Heptinstall’s pathology of the Kidney. 7th ed. Philadelphia: Wolters Kluwer; 2015. p. 1–66.
Edwards JG. Efferent arterioles of glomeruli in the juxtamedullary zone of the human kidney. Anat Rec. 1956;125:521–9.
Farquhar MG, Wissig SL, Palade GE. Glomerular permeability I. Ferritin transfer across the normal glomerular capillary wall. 1961. J Am Soc Nephrol. 1999;10:2645–62.
Bohman SO. The ultrastructure of the renal medulla and the interstitial cells. In: Mandal AK, editor. The renal papilla and hypertension. New York: Plenum Medical Book Company; 1980. p. 7.
Bulger RE, Nagle RB. Ultrastructure of the interstitium in the rabbit kidney. Am J Anat. 1973;136:183–203.
Mounier F, Foidart JM, Gubler MC. Distribution of extracellular matrix glycoproteins during normal development of human kidney. An immunohistochemical study. Lab Invest. 1986;54:394–401.
Kriz W. Structural organization of the renal medulla: comparative and functional aspects. Am J Physiol. 1981;241:R3–16.
Kriz W. Structural organization of renal medullary circulation. Nephron. 1982;31:290–5.
Kriz W. Structural organization of the renal medullary counterflow system. Fed Proc. 1983;42:2379–85.
Lemley KV, Kriz W. Cycles and separations: the histotopography of the urinary concentrating process. Kidney Int. 1987;31:538–48.
Lemley KV, Kriz W. Anatomy of the renal interstitium. Kidney Int. 1991;39:370–81.
Brodsky SV, Nadasdy T. Acute and chronic tubulointerstitial nephritis. In: Jennette JC, Olson JL, Silva FG, D’Agati VD, editors. Heptinstall’s pathology of the kidney. 7th ed. Philadelphia: Wolters Kluwer; 2015. p. 1111–65.
Mori Y, Kishimoto N, Yamahara H, et al. Predominant tubulointerstitial nephritis in a patient with systemic lupus nephritis. Clin Exp Nephrol. 2005;9:79–84.
Satoskar AA, Brodsky SV, Nadasdy G, et al. Discrepancies in glomerular and tubulointerstitial/vascular immune complex IgG subclasses in lupus nephritis. Lupus. 2011;20:1396–403.
Yamaguchi Y, Kanetsuna Y, Honda K, et al. Characteristic tubulointerstitial nephritis in IgG4-related disease. Hum Pathol. 2012;43:536–49.
Raissian Y, Nasr SH, Larsen CP, et al. Diagnosis of IgG4-related tubulointerstitial nephritis. J Am Soc Nephrol. 2011;22:1343–52.
Bijol V, Mendez GP, Nosé V, et al. Granulomatous interstitial nephritis: a clinicopathologic study of 46 cases from a single institution. Int J Surg Pathol. 2006;14:57–63.
Robson MG, Banerjee D, Hospster D, et al. Seven cases of granulomatous interstitial nephritis in the absence of extrarenal sarcoid. Nephrol Dial Transplant. 2003;18:280–4.
Joss N, Morris S, Young B, et al. Granulomatous interstitial nephritis. Clin J Am Soc Nephrol. 2007;2:222–30.
Yoshita K, Kawano M, Mizushima I, et al. Light-microscopic characteristics of IgG4-related tubulointerstitial nephritis: distinction from non-IgG4-related tubulointerstitial nephritis. Nephrol Dial Transplant. 2012;27:2755–61.
Mizushima I, Yamada K, Fujii H, et al. Clinical and histological changes associated with corticosteroid therapy in IgG4-related tubulointerstitial nephritis. Mod Rheumatol. 2012;22:859–70.
Houghton DC, Troxell ML. An abundance of IgG4+ plasma cells is not specific for IgG4-related tubulointerstitial nephritis. Mod Pathol. 2011;24:1480–7.
Kambham N, Markowitz GS, Tanji N, et al. Idiopathic hypocomplementemic interstitial nephritis with extensive tubulointerstitial deposits. Am J Kidney Dis. 2001;37:388–99.
Becker JL, Miller F, Nuovo GJ, et al. Epstein-Barr virus infection of renal proximal tubule cells: possible role in chronic interstitial nephritis. J Clin Invest. 1999;104:1673–81.
Zafrani L, Coppo P, Dettwiler S, et al. Nephropathy associated with the diffuse infiltrative lymphocytosis syndrome. Kidney Int. 2007;72:219–24.
Omokawa A, Wakui H, Okuyama S, et al. Predominant tubulointerstitial nephritis in a patient with systemic lupus erythematosus: phenotype of infiltrating cells. Clin Nephrol. 2008;69:436–44.
Zoshima T, Yamada K, Hara S, et al. Multicentric castleman disease with tubulointerstitial nephritis mimicking IgG4-related disease: two case reports. Am J Surg Pathol. 2015;20 [Epub ahead of print].
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Japan
About this chapter
Cite this chapter
Yamaguchi, Y., Hara, S., Kawano, M. (2016). Differential Diagnosis of IgG4-Related Tubulointerstitial Nephritis: An Overview. In: Saito, T., Stone, J., Nakashima, H., Saeki, T., Kawano, M. (eds) IgG4-Related Kidney Disease. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55687-9_21
Download citation
DOI: https://doi.org/10.1007/978-4-431-55687-9_21
Published:
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-55686-2
Online ISBN: 978-4-431-55687-9
eBook Packages: MedicineMedicine (R0)