Light-microscopic characteristics of IgG4-related tubulointerstitial nephritis: distinction from non-IgG4-related tubulointerstitial nephritis.

Abstract

BACKGROUND:

IgG4-related disease is a multi-organ disorder characterized by a high level of serum IgG4 and dense infiltration of IgG4-positive cells into affected organs. In routine studies, however, IgG subclasses are not estimated. In the present study, we attempted to clarify the light-microscopic characteristics of IgG4-related tubulointerstitial nephritis (TIN) to facilitate distinction from non-IgG4-related TIN in specimens obtained by renal biopsy using routine staining.

METHODS:

In specimens from 34 cases of TIN (13 IgG4-related and 21 non-IgG4-related), 9 nephrologists independently reviewed the following histological features of interstitial lesions: (i) cell infiltration extending into the renal capsule, (ii) cell infiltration into the renal medulla, (iii) regional lesion distribution, (iv) lymphoid follicles, (v) granulomatous lesions, (vi) necrotizing angiitis, (vii) eosinophil infiltration, (viii) neutrophil infiltration, (ix) tubulitis, (x) peritubular capillaritis, (xi) storiform fibrosis and (xii) the stage of interstitial fibrosis. The modified nominal group technique was applied to obtain a consensus in the pathological interpretation.

RESULTS:

Consensus was successfully attained among the diagnosticians for all but one pathological feature (regional lesion distribution). Storiform fibrosis was demonstrated in 12 of 13 (92.3%) cases of IgG4-related TIN but in none of the cases of other types of TIN. Cell infiltration extending into the renal capsule was also observed only in IgG4-related TIN. Conversely, neutrophil infiltration, severe tubulitis, severe peritubular capillaritis, granulomatous lesions and necrotizing angiitis were evident only in non-IgG4-related TIN.

CONCLUSIONS:

This study revealed some useful and characteristic features for distinguishing IgG4-related from non-IgG4-related TIN on the basis of light-microscopic observation.

• Authors: Kazuhiro Yoshita, Mitsuhiro Kawano, Ichiro Mizushima, Satoshi Hara, Yumi Ito, Naofumi Imai, Mitsuhiro Ueno, Shinichi Nishi, Hideki Nomura, Ichiei Narita, Takako Saeki
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 27 Issue 7 Pg. 2755-61 (Jul 2012) ISSN: 1460-2385 [Electronic] England
• PMID: 22228836 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunoglobulin G

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Female
• Graft Rejection (metabolism, pathology)
• Humans
• Immunoenzyme Techniques
• Immunoglobulin G (metabolism)
• Male
• Middle Aged
• Nephritis, Interstitial (metabolism, pathology)
• Transplantation, Homologous
• Young Adult