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Pediatric Nephrology

, Volume 7, Issue 1, pp 6–10 | Cite as

Glomerular injury in end-stage liver disease — role of circulating IgG and IgM immune complexes

  • Lawrence S. Milner
  • Mark T. Houser
  • Peter C. Kolbeck
  • Dean L. Antonson
  • Thomas L. McDonald
  • Rodney S. Markin
  • Byers W. ShawJr.
Original Article

Abstract

The relationship of IgG- and IgM-bound circulating immune complexes and immune dysfunction to glomerular injury was evaluated in 15 children with end-stage liver disease (ESLD) awaiting liver transplantation. Compared with age-matched controls, children with ESLD had significantly (P<0.01) increased serum IgG, IgA, and IgM levels, as well as IgG- and IgM-bound circulating immune complexes. Furthermore, they showed a significant (P<0.05) depression of C3 and C4 levels compared with controls. Hematuria occurred in 66% of children with ESLD, and the urinary protein/creatinine ratio was also significantly (P<0.01) increased compared with controls (4.65±2.56 vs. 0.16±0.04mg/mg). Light microscopy of renal biopsy tissue obtained from 6 children with ESLD at the time of transplantation demonstrated mesangial proliferation and expansion with basement membrane splitting. This was associated with subendothelial deposits on electron-microscopic examination, compatible with a diagnosis of membranoproliferative glomerulonephritis. By immunofluorescence, deposition of IgG, IgA, and IgM occurred in various combinations with co-deposition of complement fragments. We conclude that membrano-proliferative glomerulonephritis is a common finding in children with ESLD, probably due to entrapment of circulating IgG- and IgM-bound immune complexes.

Key words

End-stage liver disease Circulating immune complexes Immunoglobulins Membranoproliferative glomerulonephritis 

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Copyright information

© IPNA 1993

Authors and Affiliations

  • Lawrence S. Milner
    • 1
  • Mark T. Houser
    • 1
  • Peter C. Kolbeck
    • 2
  • Dean L. Antonson
    • 1
  • Thomas L. McDonald
    • 3
  • Rodney S. Markin
    • 2
  • Byers W. ShawJr.
    • 4
  1. 1.Department of PediatricsUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Department of PathologyUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.Department of MicrobiologyUniversity of Nebraska Medical CenterOmahaUSA
  4. 4.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA

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