Monoclonal and polyclonal immunoglobulin G deposits on tubular basement membranes of native and pretransplant kidneys: A retrospective study
Monoclonal and polyclonal immunoglobulin G deposits on tubular basement membranes of native and pretransplant kidneys: A retrospective study
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DOI：
10.1111/pin.13092
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发表时间：
2021-03-30
影响因子：
2.2
通讯作者：
Shimizu，Akira
中科院分区：
文献类型：
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作者：
Sawada，Anri;Okumi，Masayoshi;Shimizu，Akira
单克隆肾小管基底膜免疫沉积物（TBMID）与移植肾间质损伤的进展有关。然而，单克隆和多克隆TBMID在天然肾脏中的意义仍不清楚。我们回顾性分析了2008年至2018年在我们机构进行的1894例自体肾活检和1724例零时活检。免疫球蛋白G（IgG）TBMID的发生率在自体肾活检中为8.4%，在零时活检中为0.4%。多克隆TBMID常见于IgG 4相关肾小管间质性肾炎（37.5%）、糖尿病肾病（31.3%）和狼疮性肾炎（25.5%）。在7例病例中鉴定出单克隆IgG TBMID，包括3例零时活检。在2例病例中观察到IgG 1 κ的结合，3例病例中观察到IgG 1 λ，2例病例中观察到IgG 2 κ。所有病例的电子显微镜检查均显示粉末状电子致密沉积物。1例诊断为意义不明的单克隆丙种球蛋白病。虽然有1例局灶节段性肾小球硬化症患者发生肾功能衰竭，但所有其他患者均表现出稳定的肾功能。天然肾中的单克隆IgG TBMID与肾脏预后无关。然而，这可能是一个有趣的免疫病理学发现，将有助于阐明TBM免疫沉积物的发病机制。未来需要对单克隆和多克隆TBMID进行进一步研究。
Monoclonal tubular basement membrane immune deposits (TBMID) are associated with progression of interstitial injury in renal allograft. However, the significance of monoclonal and polyclonal TBMID in the native kidney remains unclear. We retrospectively analyzed 1894 native kidney biopsies and 1724 zero‐hour biopsies performed between 2008 and 2018 in our institution. The rate of immunoglobulin G (IgG) TBMID was found to be 8.4% among native kidney biopsies and 0.4% among zero‐hour biopsies. Polyclonal TBMID is common in IgG4‐related tubulointerstitial nephritis (37.5%), diabetic nephropathy (31.3%) and lupus nephritis (25.5%). Monoclonal IgG TBMID was identified in seven cases, including three zero‐hour biopsies. The combination of IgG1κ was observed in two cases, IgG1λ in three, and IgG2κ in two. Electron microscopy revealed powdery electron‐dense deposits in all cases. Monoclonal gammopathy of undetermined significance was diagnosed in one case. Although one patient with focal segmental glomerulosclerosis developed renal failure, all others exhibited stable renal function. Monoclonal IgG TBMID in the native kidney is not associated with renal prognosis. However, this may be an interesting immunopathological finding that would help clarify the pathogenesis of TBM immune deposits. Further study for both monoclonal and polyclonal TBMID is required in the future.