Perirenal capsule involvement in IgG4-related chronic interstitial nephritis: a case report and literature review
10.3760/cma.j.issn.1001-7097.2019.11.004
- VernacularTitle: IgG4相关慢性间质性肾炎并肾包膜纤维化一例报告暨文献复习
- Author:
Yagui QIU
1
,
2
;
Xi XIA
;
Yanyang CHEN
;
Qinghua LIU
;
Dihua ZHANG
;
Haiping MAO
;
Fengxian HUANG
Author Information
1. Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University
2. Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou 510080, China
- Publication Type:Clinical Trail
- Keywords:
Immunoglobulin G;
Nephritis, interstitial;
Fibrosis;
IgG4-related disease;
IgG4-related kidney disease;
Perirenal capsule
- From:
Chinese Journal of Nephrology
2019;35(11):822-827
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinicopathological features and the renal biopsy process of a case of IgG4-related chronic interstitial nephritis with perirenal capsule involved and review associated literature to improve the clinician's understanding for this disease and to perform a better renal biopsy.
Methods:The onset, diagnosis and treatment course of the disease were described and associated literature were reviewed to summary the clinicopathologic features and key points in renal biopsy.
Results:The data of the patient showed that the urine specific gravity was 1.011, with urine protein ± and urine sugar 3+. The concentration of hemoglobin was 53 g/L, serum creatinine was 1665 μmol/L, and IgG4 was 9.39 g/L. Computed tomography showed that both kidneys enlarged slightly with decreased density and low density shadow around the kidneys. On contrast-enhanced scan, irregular low-density enhancement areas were found in both kidneys, and the edge of the boundary was not clear. For the first renal biopsy, no renal parenchyma was found except mainly hyaline collagen fibrils. At the second time, 3 pieces of tissues were obtained, which showed chronic interstitial glomerulonephritis. The IgG4 positive plasma cells were about 60/HPF and the IgG4+/IgG+cells ratio was more than 40%. The diagnosis of IgG4-related chronic interstitial glomerulonephritis was confirmed. After corticosteroid treatment, the serum creatinine decreased to 502 μmol/L after the patient got rid of dialysis.
Conclusions:There are various manifestations of renal damage caused by IgG4-related disease. It is necessary to pay attention to the involvement of the perirenal capsule, and to balance the risk of bleeding and poor sampling in renal biopsy.
