Immune Complex Tubulointerstitial Nephritis Due to Autoantibodies to the Proximal Tubule Brush Border.
Immune complex tubulointerstitial nephritis due to antibodies to brush border antigens of the proximal tubule has been demonstrated experimentally and rarely in humans. Our patient developed ESRD and early recurrence after transplantation. IgG and C3 deposits were conspicuous in the tubular basement membrane of proximal tubules, corresponding to deposits observed by electron microscopy. Rare subepithelial deposits were found in the glomeruli. The patient had no evidence of SLE and had normal complement levels. Serum samples from the patient reacted with the brush border of normal human kidney, in contrast with the negative results with 20 control serum samples. Preliminary characterization of the brush border target antigen excluded megalin, CD10, and maltase. We postulate that antibodies to brush border antigens cause direct epithelial injury, accumulate in the tubular basement membrane, and elicit an interstitial inflammatory response.
Department of Pathology and irosales@mgh.harvard.edu.
Ivy A
IA
Rosales
Department of Pathology and.
A Bernard
AB
Collins
Centro Especializado em Anatomia Patologica, Belo Horizonte, Minas Gerais, Brazil.
Paula Alves S
PA
do Carmo
Division of Nephrology, Renal Transplantation Program, Massachusetts General Hospital, Boston, Massachusetts; and.
Nina
N
Tolkoff-Rubin
Department of Pathology and.
R Neal
RN
Smith
Department of Pathology and.
Robert B
RB
Colvin
D000368:Aged; D000936:Antigen-Antibody Complex; D001323:Autoantibodies / Q000276:immunology*; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D007687:Kidney Tubules, Proximal / Q000276:immunology* / Q000473:pathology; D008297:Male; D009395:Nephritis, Interstitial / Q000276:immunology* / Q000473:pathology
D000936:Antigen-Antibody Complex; D001323:Autoantibodies
brush border; immune complex; tubulointerstitial