IgG4-related Kidney Disease--an Update

Overview

Journal Curr Opin Nephrol Hypertens

Specialties Cardiology & Vascular Diseases
Nephrology

Date 2015 Jan 17

PMID 25594543

Citations 38

Authors

Mitsuhiro Kawano

Takako Saeki

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: IgG4-related disease (IgG4-RD) is a recently recognized systemic inflammatory disorder that can affect most organs/tissues such as sarcoidosis. The kidney is a frequently affected organ with tubulointerstitial nephritis (TIN), the representative lesion of IgG4-RD. This review focuses on the latest knowledge of IgG4-related kidney disease (IgG4-RKD).

Recent Findings: A wide range of renal manifestations of IgG4-RD, that is TIN, membranous glomerulonephritis (MGN) and other glomerular lesions, and pyelitis, are collectively referred to as IgG4-RKD. Clinically, decreased renal function, or characteristic imaging findings such as multiple low-density lesions on contrast-enhanced computed tomography or diffuse thickening of the renal pelvic wall, are typical presenting features. Although a rapid response to corticosteroid therapy is a very important feature of IgG4-TIN, in cases in which renal function is moderately to severely decreased before therapy, only partial recovery of renal function is obtained.

Summary: TIN with characteristic imaging findings is a typical manifestation of IgG4-RKD in the interstitium, while MGN is a representative manifestation of the glomerular lesions. Although IgG4 is a central feature of IgG4-RD, the recent discovery of IgG4-negative IgG4-RD raises questions about the causative role of the IgG4 molecule in this context.

Citing Articles

Phospholipase A2 receptor-negative membranous nephropathy presenting as a rare renal manifestation of IgG4-related disease.

Sama S, Weickhardt A, Subramanian P, Reddy P SAGE Open Med Case Rep. 2024; 12:2050313X241279696.

PMID: 39224761 PMC: 11367585. DOI: 10.1177/2050313X241279696.

Renal Manifestations of IgG4-Related Disease: A Concise Review.

Towheed S, Zanjir W, Ren K, Garland J, Clements-Baker M Int J Nephrol. 2024; 2024:4421589.

PMID: 38957780 PMC: 11217581. DOI: 10.1155/2024/4421589.

A Case of IgG4-Related Disease and Membranous Nephropathy Associated with Thrombospondin Type-1 Domain-Containing 7A.

Hum R, Elyoussfi S, Parker B, Reid G, Kanigicherla D Glomerular Dis. 2023; 2(3):139-144.

PMID: 36751668 PMC: 9710322. DOI: 10.1159/000524014.

Diagnostic Dilemma: Cardiorenal Syndrome As an Unusual Presentation of IgG4-Related Disease.

Singh S, Pokhariyal S, Nandwani A, Duggal R Indian J Nephrol. 2022; 32(5):512-515.

PMID: 36568604 PMC: 9775612. DOI: 10.4103/ijn.ijn_143_21.

Renal biopsy diagnosis of IgG4-related kidney disease with minor hematuria and mild renal dysfunction: lessons for the clinical nephrologist.

Soma Y, Kato M, Shimura G, Kamio M, Iida M J Nephrol. 2022; 36(3):639-642.

PMID: 36441499 DOI: 10.1007/s40620-022-01506-7.

References

Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Burattini M, Kirkali Z . Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer. Eur Urol. 2012; 64(6):865-72. DOI: 10.1016/j.eururo.2012.11.056. View

Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N . Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995; 40(7):1561-8. DOI: 10.1007/BF02285209. View

Kawano M, Mizushima I, Yamaguchi Y, Imai N, Nakashima H, Nishi S . Immunohistochemical Characteristics of IgG4-Related Tubulointerstitial Nephritis: Detailed Analysis of 20 Japanese Cases. Int J Rheumatol. 2012; 2012:609795. PMC: 3415101. DOI: 10.1155/2012/609795. View

Khosroshahi A, Ayalon R, Beck Jr L, Salant D, Bloch D, Stone J . IgG4-Related Disease Is Not Associated with Antibody to the Phospholipase A2 Receptor. Int J Rheumatol. 2012; 2012:139409. PMC: 3357948. DOI: 10.1155/2012/139409. View

Ito K, Yamada K, Mizushima I, Aizu M, Fujii H, Mizutomi K . Henoch-Schönlein purpura nephritis in a patient with IgG4-related disease: a possible association. Clin Nephrol. 2012; 79(3):246-52. DOI: 10.5414/CN107114. View

Zen Y, Fujii T, Harada K, Kawano M, Yamada K, Takahira M . Th2 and regulatory immune reactions are increased in immunoglobin G4-related sclerosing pancreatitis and cholangitis. Hepatology. 2007; 45(6):1538-46. DOI: 10.1002/hep.21697. View

Mizushima I, Yamada K, Fujii H, Inoue D, Umehara H, Yamagishi M . Clinical and histological changes associated with corticosteroid therapy in IgG4-related tubulointerstitial nephritis. Mod Rheumatol. 2012; 22(6):859-70. PMC: 3496477. DOI: 10.1007/s10165-011-0589-2. View

Masaki Y, Dong L, Kurose N, Kitagawa K, Morikawa Y, Yamamoto M . Proposal for a new clinical entity, IgG4-positive multiorgan lymphoproliferative syndrome: analysis of 64 cases of IgG4-related disorders. Ann Rheum Dis. 2008; 68(8):1310-5. DOI: 10.1136/ard.2008.089169. View

Vaglio A, Strehl J, Manger B, Maritati F, Alberici F, Beyer C . IgG4 immune response in Churg-Strauss syndrome. Ann Rheum Dis. 2011; 71(3):390-3. DOI: 10.1136/ard.2011.155382. View

10.

Katano K, Hayatsu Y, Matsuda T, Miyazaki R, Yamada K, Kawano M . Endocapillary proliferative glomerulonephritis with crescent formation and concurrent tubulointerstitial nephritis complicating retroperitoneal fibrosis with a high serum level of IgG4. Clin Nephrol. 2007; 68(5):308-14. DOI: 10.5414/cnp68308. View

11.

Cravedi P, Abbate M, Gagliardini E, Galbusera M, Buelli S, Sabadini E . Membranous nephropathy associated with IgG4-related disease. Am J Kidney Dis. 2011; 58(2):272-5. DOI: 10.1053/j.ajkd.2011.05.002. View

12.

Saeki T, Imai N, Ito T, Yamazaki H, Nishi S . Membranous nephropathy associated with IgG4-related systemic disease and without autoimmune pancreatitis. Clin Nephrol. 2009; 71(2):173-8. DOI: 10.5414/cnp71173. View

13.

Crumley S, Ge Y, Zhou H, Shen S, Ro J . Interstitial cystitis: another IgG4-related inflammatory disease?. Ann Diagn Pathol. 2013; 17(5):403-7. DOI: 10.1016/j.anndiagpath.2013.03.004. View

14.

Hart P, Smyrk T, Chari S . Lymphoplasmacytic sclerosing pancreatitis without IgG4 tissue infiltration or serum IgG4 elevation: IgG4-related disease without IgG4. Mod Pathol. 2014; 28(2):238-47. DOI: 10.1038/modpathol.2014.91. View

15.

Mattoo H, Della-Torre E, Mahajan V, Stone J, Pillai S . Circulating Th2 memory cells in IgG4-related disease are restricted to a defined subset of subjects with atopy. Allergy. 2014; 69(3):399-402. PMC: 3944385. DOI: 10.1111/all.12342. View

16.

Marando A, DAmbrosio G, Catanzaro F, La Rosa S, Sessa F . IgG4-related disease of the ureter: report of two cases and review of the literature. Virchows Arch. 2013; 462(6):673-8. DOI: 10.1007/s00428-013-1421-5. View

17.

Takahashi N, Kawashima A, Fletcher J, Chari S . Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology. 2007; 242(3):791-801. DOI: 10.1148/radiol.2423060003. View

18.

Deshpande V, Zen Y, Chan J, Yi E, Sato Y, Yoshino T . Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012; 25(9):1181-92. DOI: 10.1038/modpathol.2012.72. View

19.

Kamisawa T, Okazaki K, Kawa S, Ito T, Inui K, Irie H . Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 III. Treatment and prognosis of autoimmune pancreatitis. J Gastroenterol. 2014; 49(6):961-70. DOI: 10.1007/s00535-014-0945-z. View

20.

Miyata K, Kihira H, Haneda M, Nishio Y . IgG4-Related Tubulointerstitial Nephritis Associated with Membranous Nephropathy in Two Patients: Remission after Administering a Combination of Steroid and Mizoribine. Case Rep Nephrol. 2014; 2014:678538. PMC: 4089550. DOI: 10.1155/2014/678538. View