A case of renal sarcoidosis with complement activation via the lectin pathway
A case of renal sarcoidosis with complement activation via the lectin pathway
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DOI：
10.1053/j.ajkd.2004.11.020
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发表时间：
2005-03-01
影响因子：
13.2
通讯作者：
Tomino, Y
中科院分区：
文献类型：
--
作者：
Hagiwara, S;Ohi, H;Tomino, Y
一名57岁女性肺结节病患者因血清肌酐和尿素氮升高而入院。入院时，实验室数据提示无蛋白尿和血尿的间质性肾炎，而肾活检显示肉芽肿性间质性肾炎和轻度系膜增生性肾小球肾炎。免疫球蛋白和C1q沉积呈阴性，但甘露糖结合凝集素、C3、Cod和C5b-9沉积在肾小球系膜区明显。补体激活的凝集素途径可能促进了该患者肾小球损伤的发展。在患者的肾小球系膜细胞中检测到痤疮丙酸杆菌的DNA，现在强烈怀疑是结节病的病原体；小管上皮细胞，参与肉芽肿性炎症；上皮样肉芽肿的单核细胞原位杂交。这些发现可能为肾结节病的发病机制及其与感染的关系提供新的见解，因为甘露糖结合凝集素在宿主防御各种病原体中起着至关重要的作用。从本例肾结节病，推测痤疮P可能参与肉芽肿间质性肾炎的发病机制，并通过凝集素途径参与肾小球补体活化。
A 57-year-old woman with pulmonary sarcoidosis was admitted to the hospital because of an elevation of serum creatinine and blood urea nitrogen. On admission, the laboratory data suggested interstitial nephritis without proteinuria and hematuria, whereas a renal biopsy showed granulomatous interstitial nephritis and mild mesangial proliferative glomerulonephritis. Immunoglobulin and C1q deposits were negative, but mannose-binding lectin, C3, Cod, and C5b-9 deposits were marked in the glomerular mesangial areas. The lectin pathway of complement activation may have contributed to the development of glomerular injury in this patient. DNA of Propionibacterium acnes, which is now strongly suspected as the pathogen of sarcoidosis, was detected in the patient's glomerular mesangial cells; tubular epithelial cells, which were involved in granulomatous inflammation; and mononuclear cells in epithelioid granulomas by in situ hybridization. These findings may add new insights to the pathogenesis of renal sarcoidosis, including its relation to infection, because mannose-binding lectin plays a crucial role in the host defense against various pathogens. From this case of renal sarcoidosis, it is hypothesized that P acnes may be involved in pathogenesis of granulomatous interstitial nephritis and that it plays a role in glomerular complement activation via the lectin pathway.