title: Renal involvement in Castleman disease.
abstract: BACKGROUND
  Castleman disease (CD), or angiofollicular lymph-node hyperplasia, is an atypical lymphoproliferative disorder with heterogeneous clinical manifestations. Renal involvement in CD has been described in only single-case reports, which have included various types of renal diseases.
  
  
  METHODS
  Nineteen patients with histologically documented CD and renal biopsies available were included. Clinical features and renal histological findings were reviewed, and the available samples were immunolabelled with anti-vascular endothelial growth factor (VEGF) antibody.
  
  
  RESULTS
  Nineteen CD cases were identified: 89% were multicentric, and 84% were of the plasma-cell or mixed type. Four cases (21%) were associated with human immunodeficiency virus (HIV) infection. Among HIV-negative patients, two main patterns of renal involvement were found: (i) a small-vessel lesions group (SVL) (60%) with endotheliosis and glomerular double contours in all patients and with superimposed glomerular/arteriolar thrombi or mesangiolysis in most; and (ii) AA amyloidosis (20%). Renal histology was more heterogeneous among HIV-positive patients. Decreases in glomerular VEGF were observed only in some patients with SVL, whereas VEGF staining was normal in all other histological groups. Interestingly, glomerular VEGF loss associated with SVL was correlated with plasma C-reactive protein levels, a marker of CD activity.
  
  
  CONCLUSIONS
  Small-vessel lesions are the most frequent renal involvement in CD, whereas loss of glomerular VEGF is correlated with CD activity and could have a role in SVL pathophysiology.
authors.affiliation: Department of Pathology, Hopital Europeen Georges Pompidou, AP-HP-Universite Paris Descartes, Paris, France.
authors.forename: Khalil
authors.initials: K
authors.lastname: El Karoui
authors.forename: Vincent
authors.initials: V
authors.lastname: Vuiblet
authors.forename: Daniel
authors.initials: D
authors.lastname: Dion
authors.forename: Hassan
authors.initials: H
authors.lastname: Izzedine
authors.forename: Joelle
authors.initials: J
authors.lastname: Guitard
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
authors.forename: Michel
authors.initials: M
authors.lastname: Delahousse
authors.forename: Philippe
authors.initials: P
authors.lastname: Remy
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Boffa
authors.forename: Evangéline
authors.initials: E
authors.lastname: Pillebout
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.forename: Laure-Hélène
authors.initials: LH
authors.lastname: Noël
authors.forename: Eric
authors.initials: E
authors.lastname: Daugas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D005871:Castleman Disease / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult