Immunotactoid glomerulonephritis in a patient with cold agglutinins: causal association or mere coincidence?
Immunotactoid glomerulonephritis in a patient with cold agglutinins: causal association or mere coincidence?
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冷凝集素患者发生免疫类肾小球肾炎：因果关系还是纯粹的巧合？
DOI：
10.1007/s13730-021-00600-2
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发表时间：
2021
期刊：
影响因子：
1
通讯作者：
Tanaka Hiroyuki
中科院分区：
文献类型：
--
作者：
Morimoto Nobuhisa;Nagahama Kiyotaka;Oyama Sakino;Tsuura Yukio;Fukutomi Toshiyuki;Terai Ayumi;Tanabe Madoka;Otani Megumi;Shioji Shingo;Hirasawa Suguru;Aki Shota;Aoyagi Makoto;Tanaka Hiroyuki
我们报告一例冷凝集素患者的免疫乳样性肾小球肾炎。一位86岁的日本男性，有高血压、血脂异常和胃恶性肿瘤的病史，因蛋白尿和血尿而到本院就诊。他的血压升高了200/77毫米汞柱，并有双腿浮肿。最初的血液测试结果显示肾功能受损(肌酐，1.37 mg/dL)和低蛋白血症(白蛋白，2.6 mg/dL)。他估计每天的尿蛋白为5.89微克/克肌酐，符合肾病综合征的诊断标准。对蛋白尿的选择性指数较低(0.329)。我们进行了肾脏活检以确定肾病综合征的原因。免疫荧光显微镜下可见IgM、C4、C1q染色阳性。电子显微镜下可见系膜扩张伴炎性细胞和小叶结构，提示膜增生性肾小球肾炎。发现含有直径约30-200 nm的微管结构的内皮下沉积物，与ITG的诊断标准一致。对淋巴增生性疾病和免疫异常的筛查显示，直接库姆斯试验结果呈阳性，并存在冷凝集素。无副蛋白血症。冷凝集素疾病与ITG的相似之处，包括自身抗体的产生和补体途径的参与，增加了冷凝集素在ITG发生发展中发挥作用的可能性；然而，由于肾组织学检测冷凝集素的困难，我们无法证明这一点。考虑到先前关于肾病综合征可能与冷凝集素相关的报道，我们讨论了可能的发病机制。
We report a case of immunotactoid glomerulonephritis (ITG) in a patient with cold agglutinins. An 86-year-old Japanese male with a history of hypertension, dyslipidemia, and gastric malignancy presented to our hospital for the evaluation of proteinuria and hematuria. He had an elevated blood pressure of 200/77 mmHg and edema of the lower extremities. Initial blood test results revealed an impaired renal function (creatinine, 1.37 mg/dL) and hypoalbuminemia (albumin, 2.6 g/dL). His estimated daily urinary protein was 5.89 g/g creatinine, meeting the diagnostic criteria for nephrotic syndrome. The selectivity index for proteinuria indicated low selectivity (0.329). We conducted a renal biopsy to identify the cause of nephrotic syndrome. Immunofluorescence microscopy demonstrated positive staining of IgM, C4, and C1q. Electron microscopy exhibited mesangial expansion with inflammatory cells and a lobular structure, suggesting membranoproliferative glomerulonephritis. Subendothelial deposits containing microtubular structures with a diameter of approximately 30–200 nm were found, concurrent with the criteria for the diagnosis of ITG. Screening for lymphoproliferative diseases and immunological abnormalities revealed a positive direct Coombs test result and the presence of cold agglutinins. Paraproteinemia was absent. The similarities between cold agglutinin disease and ITG, including the production of autoantibodies and involvement of complement pathways, raise the possibility that cold agglutinins played a role in the development of ITG; however, we were unable to prove it due to difficulties in detecting cold agglutinins on renal histology. We discuss the possible implications for pathogenesis considering prior reports on nephrotic syndrome being potentially associated with cold agglutinins.
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免疫性肾小球病
DOI：
10.32388/fhjbmt
发表时间：
2020
期刊：
Definitions
影响因子：
--
作者：
Michael Collins;S. Navaneethan;Miriam Chung;J. Sloand;B. Goldman;G. Appel;B. Rovin
通讯作者：
B. Rovin
一名男性患有慢性肾小球肾炎，具有抗 I 特异性 IgM 冷自身抗体和冷淋巴细胞毒性抗体
影响因子：
3.4
作者：
R. Bailey;M. el;I. Balfour;T. Mitchell
通讯作者：
T. Mitchell
影响因子：
6.1
作者：
Nasr, Samih H.;Fidler, Mary E.;Sethi, Sanjeev
通讯作者：
Sethi, Sanjeev
DOI：
10.2215/cjn.07030712
发表时间：
2013-06-01
影响因子：
9.8
作者：
Sethi, Sanjeev;Theis, Jason D.;Nasr, Samih H.
通讯作者：
Nasr, Samih H.
肺炎支原体感染导致慢性肾功能衰竭并发冷凝集素一例。
影响因子：
2.5
作者：
T. Shibasaki;H. Gomi;I. Ohno;F. Ishimoto;O. Sakai
通讯作者：
O. Sakai