Proteinuria of Tubulointerstitial Nephritis: Diagnostic Considerations

Author(s):  
R. A. Zager
2020 ◽  
Vol 103 (11) ◽  
pp. 1230-1235

Immunoglobulin G4-related disease (IgG4-RD) has recently been recognized as an autoimmune disorder involving multiple organs. The kidney is a represented organ with a wide range of renal manifestations. The authors report a case of an 83-year-old Thai male with combined IgG4 tubulointerstitial nephritis and membranous nephropathy coexisting with cholangiocarcinoma. The patient presented with proteinuria, acute renal failure, eosinophilia, hypocomplementemia, and high serum IgG4 concentration. The diagnosis was IgG 4-related tubulointerstitial nephritis and membranous nephropathy on renal biopsy, with negative immunohistochemistry for anti-phospholipase A2 receptor antibodies. Magnetic resonance imaging (MRI) abdomen showed two wedge shaped arterial enhancing lesions of liver. Liver biopsy revealed adenocarcinoma, compatible with cholangiocarcinoma. Proteinuria and renal failure were resolved with initial steroid treatment. Meanwhile, IgG4-related membranous nephropathy should be considered in the differential diagnosis for patients with proteinuria. Potentially, IgG4-RD may be rarely associated with carcinoma development. However, further studies are recommended to ratify and confirm the association between IgG4-RD and incidence of malignancies. Keywords: IgG4-related disease, Membranous nephropathy, Secondary membranous nephropathy, Tubulointerstitial nephritis, Cholangiocarcinoma


2001 ◽  
Vol 59 (3) ◽  
pp. 846-854
Author(s):  
Chin-Yuan Tzen ◽  
Jeng-Daw Tsai ◽  
Tsu-Yen Wu ◽  
Be-Fon Chen ◽  
Mong-Liang Chen ◽  
...  

2019 ◽  
Vol 26 (5) ◽  
pp. 290-294 ◽  
Author(s):  
S. Clavé ◽  
C. Rousset-Rouvière ◽  
L. Daniel ◽  
M. Tsimaratos

2021 ◽  
Vol 6 (4) ◽  
pp. S205
Author(s):  
T. JHIDRI ◽  
M. Ben Salem ◽  
A. Letaief ◽  
M. Hamouda ◽  
M. Ben salah ◽  
...  

2021 ◽  
Vol 10 (13) ◽  
pp. 2986
Author(s):  
Laura Martinez Valenzuela ◽  
Juliana Draibe ◽  
Oriol Bestard ◽  
Xavier Fulladosa ◽  
Francisco Gómez-Preciado ◽  
...  

Background: Acute tubulointerstitial nephritis (ATIN) diagnosis lays on histological assessment through a kidney biopsy, given the absence of accurate non-invasive biomarkers. The aim of this study was to evaluate the accuracy of different urinary inflammation-related cytokines for the diagnostic of ATIN and its distinction from acute tubular necrosis (ATN). Methods: We included 33 patients (ATIN (n = 21), ATN (n = 12)), and 6 healthy controls (HC). We determined the urinary levels of 10 inflammation-related cytokines using a multiplex bead-based Luminex assay at the time of biopsy and after therapy, and registered main clinical, analytical and histological data. Results: At the time of biopsy, urinary levels of I-TAC/CXCL11, CXCL10, IL-6, TNFα and MCP-1 were significantly higher in ATIN compared to HC. A positive correlation between the extent of the tubulointerstitial cellular infiltrates in kidney biopsies and the urinary concentration of I-TAC/CXCL11, MIG/CXCL9, CXCL10, IL17, IFNα, MCP1 and EGF was observed. Notably, I-TAC/CXCL11, IL-6 and MCP-1 were significantly higher in ATIN than in ATN, with I-TAC/CXCL11 as the best discriminative classifier AUC (0.77, 95% CI 0.57–0.95, p = 0.02). A combinatory model of these three urinary cytokines increased the accuracy in the distinction of ATIN/ATN compared to the individual biomarkers. The best model resulted when combining the three cytokines with blood eosinophil and urinary leukocyte counts (LR = 9.76). Follow-up samples from 11ATIN patients showed a significant decrease in I-TAC/CXCL11, MIG/CXCL9 and CXCL10 levels. Conclusions: Urinary I-TAC/CXCL11, CXCL10, IL6 and MCP-1 levels accurately distinguish patients developing ATIN from ATN and healthy individuals and may serve as novel non-invasive biomarkers in this disease.


1994 ◽  
Vol 269 (3) ◽  
pp. 1654-1659 ◽  
Author(s):  
T.A. Kalfa ◽  
J.D. Thull ◽  
R.J. Butkowski ◽  
A.S. Charonis

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