Light-microscopic characteristics of IgG4-related tubulointerstitial nephritis: distinction from non-IgG4-related tubulointerstitial nephritis
Light-microscopic characteristics of IgG4-related tubulointerstitial nephritis: distinction from non-IgG4-related tubulointerstitial nephritis
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DOI：
10.1093/ndt/gfr761
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发表时间：
2012-07-01
影响因子：
6.1
通讯作者：
Saeki, Takako
中科院分区：
文献类型：
--
作者：
Yoshita, Kazuhiro;Kawano, Mitsuhiro;Saeki, Takako
IgG4相关疾病是一种以血清中高水平的IgG4和密集的IgG4阳性细胞渗入受累器官为特征的多脏器疾病。然而，在常规研究中，不会估计免疫球蛋白亚类。在本研究中，我们试图阐明IgG4相关性小管间质性肾炎(TIN)的光镜特征，以便于在常规肾活检标本中区分与非IgG4相关的TIN。在34例TIN(13例与IgG4相关，21例与非IgG4相关)中，9名肾科医生独立地回顾了间质病变的下列组织学特征：(1)细胞浸润至肾被膜，(2)细胞浸润至肾髓质，(3)局部病变分布，(4)淋巴滤泡炎，(5)肉芽肿性病变，(6)坏死性血管，(Vii)嗜酸性粒细胞浸润，(Viii)中性粒细胞浸润，(Ix)小管炎，(X)管周毛细管炎，(Xi)管状纤维化，(Xii)间质纤维化阶段。应用改进的标称组技术在病理解释中取得共识，除了一个病理特征(区域病变分布)外，所有的诊断人员都成功地获得了共识。在13例与IgG4相关的TIN中有12例(92.3%)表现为条状纤维化，但在其他类型的TIN中均未见。此外，仅在与IgG4相关的TIN中可观察到细胞渗入肾被膜。相反，只有非IgG4相关的TIN才有中性粒细胞浸润、严重的小管炎、严重的管周毛细管炎、肉芽肿性病变和坏死性脉管炎。本研究揭示了在光镜下鉴别IgG4相关和非IgG4相关TIN的一些有用的特征。
IgG4-related disease is a multi-organ disorder characterized by a high level of serum IgG4 and dense infiltration of IgG4-positive cells into affected organs. In routine studies, however, IgG subclasses are not estimated. In the present study, we attempted to clarify the light-microscopic characteristics of IgG4-related tubulointerstitial nephritis (TIN) to facilitate distinction from non-IgG4-related TIN in specimens obtained by renal biopsy using routine staining.In specimens from 34 cases of TIN (13 IgG4-related and 21 non-IgG4-related), 9 nephrologists independently reviewed the following histological features of interstitial lesions: (i) cell infiltration extending into the renal capsule, (ii) cell infiltration into the renal medulla, (iii) regional lesion distribution, (iv) lymphoid follicles, (v) granulomatous lesions, (vi) necrotizing angiitis, (vii) eosinophil infiltration, (viii) neutrophil infiltration, (ix) tubulitis, (x) peritubular capillaritis, (xi) storiform fibrosis and (xii) the stage of interstitial fibrosis. The modified nominal group technique was applied to obtain a consensus in the pathological interpretation.Consensus was successfully attained among the diagnosticians for all but one pathological feature (regional lesion distribution). Storiform fibrosis was demonstrated in 12 of 13 (92.3) cases of IgG4-related TIN but in none of the cases of other types of TIN. Cell infiltration extending into the renal capsule was also observed only in IgG4-related TIN. Conversely, neutrophil infiltration, severe tubulitis, severe peritubular capillaritis, granulomatous lesions and necrotizing angiitis were evident only in non-IgG4-related TIN.This study revealed some useful and characteristic features for distinguishing IgG4-related from non-IgG4-related TIN on the basis of light-microscopic observation.