Clinical significance and pathological features of ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis
10.3760/cma.j.issn.1001-7097.2019.09.001
- VernacularTitle: IgG4相关肾小管间质性肾炎肾间质异位淋巴组织的病理学特征及其临床意义
- Author:
Hui WANG
1
;
Tao SU
2
,
3
;
Danyang LI
1
;
Xu ZHANG
1
;
Jin XU
1
;
Xiaojuan YU
2
,
3
;
Suxia WANG
1
;
Minghui ZHAO
2
,
3
Author Information
1. Laboratory of Electron Microscopy, Peking University First Hospital, Beijing 100034, China
2. Renal Division, Department of Medicine, Peking University First Hospital
3. Renal Pathological Center, Institute of Nephrology, Peking University, Beijing 100034, China
- Publication Type:Clinical Trail
- Keywords:
Immunoglobulin G;
Nephritis, interstitial;
Tertiary lymphoid structures;
IgG4-related diseases;
Russell body
- From:
Chinese Journal of Nephrology
2019;35(9):641-647
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical significance and pathological features of lymphocytes and plasma cells infiltration and related ectopic lymphoid-like structures in IgG4-related tubulointerstitial nephritis (IgG4-TIN).
Methods:Complete data was collected from 24 patients with IgG4-TIN confirmed by pathology in the Peking University First Hospital. The renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy examination. In addition, immunohistochemistry was used to detect the distribution of CD20+ B lymphocytes, CD3+ T lymphocytes and CD138+ plasma cells.
Results:A total of 24 patients were enrolled in the study, including 21 males (87.5%), 3 females (12.5%). The age was (58.0±10.8) years (38-75 years). Pathology analysis showed ectopic lymphoid-like structures were located in 16 (66.7%) cases and Russell bodies were detected in infiltrative plasma cells of 19(79.2%) cases with IgG4-TIN. Compared with cases without Russell body formation, cases with Russell body formation in renal interstitial plasma cells were more prone to show ectopic germinal center-like structure formation (P=0.001), tubular basement membrane (TBM) electron dense deposits (P=0.040) and reduced blood C3 levels (P=0.028).
Conclusions:Abnormal tubulointerstitial infiltration of ectopic lymphoid-like structures and plasma cells with prominent Russell body exist in IgG4-TIN patients, which suggests the persistent activation of lymphocytes and plasma cells in renal interstitium may contribute to the pathogenesis of IgG4-TIN.
