Advertisement

Characteristic Tubulointerstitial Nephritis in IgG4-Related Kidney Disease

  • Michio NagataEmail author
  • Satoshi Hara
Chapter

Abstract

IgG4-related kidney disease (IgG4-RKD), a progressive renal disorder, often leads to renal dysfunction. Tubulointerstitial nephritis (TIN) is the particular pathophysiology of IgG4-RKD responsible for progression and IgG4-related TIN is a distinct entity of IgG4-RKD. Renal biopsy is the gold standard for diagnosis in IgG4-related TIN, and a characteristic pattern of histology has been identified. A large IgG4 (+) plasma cell population, characteristic fibrotic pattern (storiform or “bird’s eye” fibrosis), and immune complex deposition within the tubulointerstitial compartment are the particular lesions associated with IgG4-related TIN. However, not every case of IgG4-RKD is associated with striking fibrosis, and some are difficult to distinguish from other renal processes that may have TIN. Because full details of the pathogenesis of IgG4-related TIN remain to be elucidated, the diagnosis does not yet have a molecular basis but rather is made through a synthesis of clinical, radiological and histological findings.

Keywords

Tubulointerstitial nephritis Bird’s eye pattern Storiform fibrosis Immune deposit 

Notes

Acknowledgement

We thank Yutaka Yamaguchi and Takako Saeki for providing beautiful micrographs.

References

  1. 1.
    Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366:539–51.CrossRefPubMedGoogle Scholar
  2. 2.
    Kamisawa T, Zen Y, Pillai S, Stone JH. IgG4-related disease. Lancet. 2015;385:1460–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Yamamoto M, Takahashi H, Shinomura Y. Mechanisms and assessment of IgG4-related disease: lessons for the rheumatologist. Nat Rev Rheumatol. 2014;10:148–59.CrossRefPubMedGoogle Scholar
  4. 4.
    Kawano M, Saeki T, Nakashima H, et al. Proposal for diagnostic criteria for IgG4-related kidney disease. Clin Exp Nephrol. 2011;15:615–26.CrossRefPubMedGoogle Scholar
  5. 5.
    Saeki T, Kawano M. IgG4-related kidney disease. Kidney Int. 2014;85:251–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Cortazar FB, Stone JH. IgG4-related disease and the kidney. Nat Rev Nephrol. 2015;11:599–609.CrossRefPubMedGoogle Scholar
  7. 7.
    Saeki T, Kawano M, Mizushima I, et al. The clinical course of patients with IgG4-related kidney disease. Kidney Int. 2013;84:826–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Raissian Y, Nasr SH, Larsen CP, et al. Diagnosis of IgG4-related tubulointerstitial nephritis. J Am Soc Nephrol. 2011;22:1343–52.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Saeki T, Nishi S, Imai N, et al. Clinicopathological characteristics of patients with IgG4-related tubulointerstitial nephritis. Kidney Int. 2010;78:1016–23.CrossRefPubMedGoogle Scholar
  10. 10.
    Kawano M, Saeki T. IgG4-related kidney disease—an update. Curr Opin Nephrol Hypertens. 2015;24:193–201.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    Yamaguchi Y, Kanetsuna Y, Honda K, et al. Characteristic tubulointerstitial nephritis in IgG4-related disease. Hum Pathol. 2012;43:536–49.CrossRefPubMedGoogle Scholar
  13. 13.
    Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25:1181–92.CrossRefPubMedGoogle Scholar
  14. 14.
    Kawano M, Mizushima I, Yamaguchi Y, et al. Immunohistochemical characteristics of IgG4-related tubulointerstitial nephritis: detailed analysis of 20 Japanese cases. Int J Rheumatol. 2012;2012:609795.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Aalberse RC, Stapel SO, Schuurman J, et al. Immunoglobulin G4: an odd antibody. Clin Exp Allergy. 2009;39:469–77.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Houghton DC, Troxell ML. An abundance of IgG4+ plasma cells is not specific for IgG4-related tubulointerstitial nephritis. Mod Pathol. 2011;24:1480–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Jeong HJ, Shin SJ, Lim BJ. Overview of IgG4-related tubulointerstitial nephritis and its mimickers. J Pathol Transl Med. 2015. doi: 10.4132/jptm.2015.11.09 [Epub ahead of print].Google Scholar
  19. 19.
    François H, Mariette X. Renal involvement in primary Sjӧgren syndrome. Nat Rev Nephrol. 2015. doi: 10.1038/nrneph.20150174 [Epub ahead of print].PubMedGoogle Scholar
  20. 20.
    Kawano M, Suzuki Y, Yamada K, et al. Primary Sjӧgren syndrome with chronic tubulointerstitial nephritis and lymphadenopathy mimicking IgG4-related disease. Mod Rheumatol. 2015;25:637–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Nakabayashi K, Sumiishi A, Sano K, et al. Tubulointerstitial nephritis without glomerular lesions in three patients with myeloperoxidase-ANCA-associated vasculitis. Clin Exp Nephrol. 2009;13:605–13.CrossRefPubMedGoogle Scholar
  22. 22.
    Chang SY, Keogh KA, Lewis JE, et al. IgG4-positive plasma cells in granulomatosis with polyangiitis (Wegenerii): a clinicopathologic and immunohistochemical study on 43 granulomatosis with polyangiitis and 20 control cases. Hum Pathol. 2013;44:2432–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28:255–77.CrossRefPubMedGoogle Scholar
  24. 24.
    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 Nov 20. [Epub ahead of print].Google Scholar
  25. 25.
    Singh AK, Ucci A, Madias NE. Predominant tubulointerstitial lupus nephritis. Am J Kidney Dis. 1996;27:273–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2016

Authors and Affiliations

  1. 1.Kidney and Vascular PathologyUniversity of TsukubaTsukuba-CityJapan
  2. 2.Division of Rheumatology, Department of Internal MedicineKanazawa University HospitalKanazawaJapan

Personalised recommendations