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Erschienen in: Clinical and Experimental Nephrology 12/2019

04.09.2019 | Original article

Clinicopathological analysis of ANCA-associated glomerulonephritis focusing on plasma cell infiltrate

verfasst von: Naoko Masuzawa, Ayako Nishimura, Yu Mihara, Keiichi Tamagaki, Eiichi Konishi

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 12/2019

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Abstract

Background

When we encounter glomerulonephritis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides demonstrating many plasma cell infiltrations, histological overlapping of immunoglobulin G4-related disease (IgG4-RD) often comes into the differential diagnosis. No previous study has focused on the degree of plasma cells in the kidney infiltrate in ANCA-associated glomerulonephritis (ANCA-GN), and the significance of massive plasma cell infiltrate has not been investigated.

Methods

To clarify the plasma cell ratio in renal biopsy specimens of ANCA-GN and the histological characteristic of “plasma cell-rich” ANCA-GN, 20 cases of ANCA-GN were reviewed and clinicopathologically analyzed.

Results

Plasma cell ratio was widely distributed between 1.4 and 81%, and the median ratio was 10%. Three patients were categorized in “plasma cell-rich” ANCA-GN, defined as over 45% plasma cell ratio. They tended to include many active glomerular lesions compared to chronic lesions and to display severe tubulointerstitial inflammation. It is suggested that plasma cell-rich ANCA-GN may be acute onset of the disease, and the target of early inflammation may also be in the tubulointerstitial region. Two of the three plasma cell-rich ANCA-GN cases demonstrated numerous IgG4+ cells, but no bird’s-eye pattern fibrosis or obliterative phlebitis.

Conclusions

Plasma cell-rich ANCA-GN is not rare and demonstrates distinct clinicopathological characteristics. This study also reminds us that the presence of the significant number of plasma cells in ANCA-GN, as such, is not a histological diagnostic basis for overlap ANCA-GN and IgG4-related disease.
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Metadaten
Titel
Clinicopathological analysis of ANCA-associated glomerulonephritis focusing on plasma cell infiltrate
verfasst von
Naoko Masuzawa
Ayako Nishimura
Yu Mihara
Keiichi Tamagaki
Eiichi Konishi
Publikationsdatum
04.09.2019
Verlag
Springer Singapore
Erschienen in
Clinical and Experimental Nephrology / Ausgabe 12/2019
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-019-01785-8

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