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Tubulointerstitial B-cell infiltration and tertiary lymphoid tissue in adult-onset immunoglobulin A vasculitis with nephritis

  • Nephrology - Original Paper
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Abstract

Purpose

This study aimed to examine tubulointerstitial B-cell infiltration in patients with adult-onset immunoglobulin A vasculitis (IgAV) and nephritis (IgAV-N), and to evaluate whether B-cell infiltration correlated with clinicopathological variables at kidney biopsy and with short-term renal outcomes.

Methods

Twenty patients with adult-onset IgAV-N and 10 control patients with thin basement membrane nephropathy (TBMN) were retrospectively examined. The lymphatic organization was graded based on B-cell infiltration and was classified into 4 groups: 0—T cells without B cells, 1—scattered B and T cells, 2—clustered B and T cells, and 3—nodular compartmentally arranged B- and T-cell aggregates, equivalent to tertiary lymphoid tissue (TLT).

Results

The B-cell infiltration grade was significantly higher in patients with IgAV-N than in patients with TBMN, and no age differences were observed. The B-cell infiltration grade in patients with IgAV-N was significantly correlated with age, serum IgA level, renal dysfunction, and tubulointerstitial injury parameters, but was not correlated with duration after purpura or glomerular injury parameters. Most patients with IgAV-N were treated with corticosteroids. The proteinuria level was significantly decreased, but renal function was not improved in 12 patients after the 24-month follow-up compared with the values at baseline. The B-cell infiltration grade was significantly correlated with renal dysfunction after 24 months of follow-up.

Conclusions

The B-cell infiltration grade in patients with IgAV-N was associated with renal dysfunction and tubulointerstitial injuries but not with glomerular injury parameters. B-cell infiltration and TLT might have a pathologically significant role in irreversible renal dysfunction in patients with early phase adult-onset IgAV-N.

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Authors and Affiliations

  1. Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan

    Ryo Togashi, Yoshifuru Tamura, Shigeyuki Arai, Shinichiro Asakawa, Osamu Yamazaki, Shunya Uchida, Shigeru Shibata & Yoshihide Fujigaki

  2. Department of Health Care, Teikyo Heisei University, 2-51-4 Higashi Ikebukuro, Toshima-ku, Tokyo, Japan

    Shunya Uchida

Authors
  1. Ryo Togashi
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  2. Yoshifuru Tamura
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  3. Shigeyuki Arai
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  4. Shinichiro Asakawa
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  5. Osamu Yamazaki
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Correspondence to Yoshihide Fujigaki.

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The authors have declared that no conflicts of interest exist.

Ethical approval

The study protocol was approved by the Institutional Review Board (IRB) of Teikyo University (IRB approval number #19-039) and executed in accordance with the principles of the Declaration of Helsinki. Written informed consent was waived after obtaining IRB approval. Instead, a detailed disclosure of the contents of this study was published on the research ethics committee website.

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Togashi, R., Tamura, Y., Arai, S. et al. Tubulointerstitial B-cell infiltration and tertiary lymphoid tissue in adult-onset immunoglobulin A vasculitis with nephritis. Int Urol Nephrol 55, 749–758 (2023). https://doi.org/10.1007/s11255-022-03373-4

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  • DOI: https://doi.org/10.1007/s11255-022-03373-4

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