title: IgG4-related tubulointerstitial nephritis and hepatic inflammatory pseudotumor without hypocomplementemia.
abstract: Immunoglobulin G4 (IgG4)-related tubulointerstitial nephritis (TIN) is often accompanied by autoimmune pancreatitis (AIP) or chronic sclerosing dacryoadenitis and sialoadenitis. However, IgG4-related TIN without AIP or lacrimal and/or salivary gland lesions has not been well recognized. Here, we report a case of IgG4-related TIN associated with hepatic inflammatory pseudotumor without AIP or lacrimal and/or salivary gland lesions. A 58-year-old Japanese man with epigastralgia underwent contrast-enhanced computed tomography (CT), which revealed multiple low-density lesions in both kidneys and a low density hepatic mass. Laboratory tests showed an extremely high level of serum IgG4. Percutaneous renal and hepatic biopsies showed diffuse infiltration of lymphocytes and IgG4-positive plasma cells with fibrosis in both tissues. Two months after administration of oral prednisolone, both lesions decreased in size on follow-up CT, and the serum creatinine level also improved. No recurrence has been detected for two years with a maintenance dose of prednisolone.
authors.affiliation: Department of Internal Medicine, Kanazawa University, Japan.
authors.forename: Fae
authors.initials: F
authors.lastname: Kim
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yamada
authors.forename: Dai
authors.initials: D
authors.lastname: Inoue
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nakajima
authors.forename: Ichiro
authors.initials: I
authors.lastname: Mizushima
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kakuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujii
authors.forename: Kenta
authors.initials: K
authors.lastname: Narumi
authors.forename: Masami
authors.initials: M
authors.lastname: Matsumura
authors.forename: Hisanori
authors.initials: H
authors.lastname: Umehara
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kawano
mesh_terms: D001706:Biopsy; D015897:Comorbidity; D015432:Glomerulonephritis, Membranoproliferative; D005938:Glucocorticoids / Q000627:therapeutic use; D006104:Granuloma, Plasma Cell / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology*; D011239:Prednisolone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G; D011239:Prednisolone