The immunopathogenesis of membranous nephropathy.
Membranous nephropathy is an important disease: it is one of the leading primary causes of the nephrotic syndrome in adults, and, in up to a third of patients, causes progressive renal impairment resulting in end stage renal failure. Ever since histological techniques demonstrated the presence of glomerular immunoglobulin deposits in this disease the immune system has been implicated in pathogenesis. Initial ideas focussed on the deposition of circulating immune complexes, but the development of an animal model (Heymann nephritis) suggested the alternative mechanism of antibody reacting with an intrinsic glomerular antigen. However, attempts to find evidence for this Heymann type mechanism in the human disease have, in general, been unsuccessful. This article briefly reviews the development of ideas about the pathogenesis of membranous nephropathy, and proposes the hypothesis that the disease is caused by formation of low affinity non-complement fixing IgG4-containing immune complexes.
Oliveira
D B G
DB
Department of Renal Medicine, St. George's Hospital Medical School, Cranmer Terrace, London, United Kingdom. doliveir@sghms.ac.uk
D000818:Animals; D000936:Antigen-Antibody Complex / Q000032:analysis / Q000276:immunology*; D000937:Antigen-Antibody Reactions; D003176:Complement C3 / Q000276:immunology; D015433:Glomerulonephritis, Membranous / Q000276:immunology*; D026541:Heymann Nephritis Antigenic Complex / Q000032:analysis / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D023421:Models, Animal; D009393:Nephritis / Q000276:immunology; D051381:Rats; D012737:Sex Factors
D000936:Antigen-Antibody Complex; D003176:Complement C3; D026541:Heymann Nephritis Antigenic Complex; D007074:Immunoglobulin G