Membranoproliferative glomerulonephritis with predominant IgG2 and IgG3 deposition in a patient with IgG4-related disease.
BACKGROUND
IgG4-related disease is a novel disease entity characterized by elevated serum IgG4 and tissue infiltration by IgG4-positive plasma cells. Typical renal pathology is tubulointerstitial nephritis with storiform fibrosis, although the co-existence of various glomerular lesions has been described. Here, we present the first report of a case of IgG4-related kidney disease and membranoproliferative glomerulonephritis showing the discrepancy in IgG subclasses between the kidney interstitium and glomeruli.


METHODS
A 70-year-old Japanese woman was diagnosed with membranoproliferative glomerulonephritis and focal tubulointerstitial nephritis with IgG4-positive plasma cells. Immunofluorescence studies revealed predominant deposition of IgG3 and IgG2, but not IgG4 in the glomeruli. We administered oral prednisolone at 30 mg/day, and the abnormalities in urine and blood tests gradually resolved.


CONCLUSIONS
In this case, different patterns of IgG subclasses detected in the glomeruli and interstitial plasma cells suggest overlapping immunologic abnormalities. The favorable clinical course in our patient suggests that steroid therapy is promising in cases of IgG4-related kidney disease accompanied by glomerulonephritis.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. ken810@tkz.bbiq.jp.
Kenji
K
Ueki
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. ym09045180792@yahoo.co.jp.
Yuta
Y
Matsukuma
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. masutani@kcu.med.kyushu-u.ac.jp.
Kosuke
K
Masutani
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tucimoto@intmed2.med.kyushu-u.ac.jp.
Akihiro
A
Tsuchimoto
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kiichiro.fujisaki@nifty.ne.jp.
Kiichiro
K
Fujisaki
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. torisuk@kcu.med.kyushu-u.ac.jp.
Kumiko
K
Torisu
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. sigella1975@gmail.com.
Shigeru
S
Tanaka
Department of Oral Pathology, Graduate School of Dental Sciences, Kyushu University, Fukuoka, Japan. kiyo@dent.kyushu-u.ac.jp.
Tamotsu
T
Kiyoshima
Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. hisanos1@cis.fukuoka-u.ac.jp.
Satoshi
S
Hisano
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kitazono@intmed2.med.kyushu-u.ac.jp.
Takanari
T
Kitazono
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tsuruya@intmed2.med.kyushu-u.ac.jp.|Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. tsuruya@intmed2.med.kyushu-u.ac.jp.
Kazuhiko
K
Tsuruya
D000368:Aged; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism*; D007678:Kidney Glomerulus / Q000473:pathology*; D009395:Nephritis, Interstitial / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D010950:Plasma Cells / Q000378:metabolism
D007074:Immunoglobulin G