Immunotactoid glomerulopathy is a rare entity with monoclonal and polyclonal variants
| Autor: | Satoru Kudose, Sanjeev Sethi, Vivette D. D'Agati, Mary E. Fidler, Sibel Erdogan Damgard, Dominick Santoriello, Glen S. Markowitz, Samih H. Nasr, Nelson Leung, Samar M. Said, Sean R Williamson |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Pathology medicine.medical_specialty business.industry Glomerular basement membrane Chronic lymphocytic leukemia 030232 urology & nephrology Glomerulonephritis medicine.disease Lymphoma 03 medical and health sciences 030104 developmental biology 0302 clinical medicine medicine.anatomical_structure Nephrology Glomerulopathy Monoclonal Membranoproliferative glomerulonephritis medicine business Multiple myeloma |
| Zdroj: | Kidney International. 99:410-420 |
| ISSN: | 0085-2538 |
| DOI: | 10.1016/j.kint.2020.07.037 |
| Popis: | Immunotactoid glomerulopathy (ITG) is a rare form of glomerulonephritis for which our understanding is limited to case reports and small case series. Herein we describe the clinical, pathologic, and outcome characteristics of 73 patients with ITG who typically presented with proteinuria, hematuria, and renal insufficiency. Hematologic disorders were present in 66% of patients, including lymphoma in 41% (mainly chronic lymphocytic leukemia/small lymphocytic lymphoma), monoclonal gammopathy in 20%, and multiple myeloma in 6%. Light microscopy revealed endocapillary proliferative (35%), membranoproliferative (29%) and membranous (29%) patterns of glomerular involvement. Electron microscopy revealed characteristic microtubular deposits with a diameter of 14-60 nm, hollow cores, frequent parallel alignment, and a predominant distribution outside of the lamina densa of the glomerular basement membrane. Importantly, immunofluorescence revealed IgG-dominant staining which was light chain and IgG subclass restricted in 67% of cases, indicating monoclonal composition. This finding was used to distinguish monoclonal and polyclonal variants of ITG. As compared to polyclonal, monoclonal ITG had a higher incidence of lymphoma (53% vs. 11%), multiple myeloma (8% vs. 0), and monoclonal gammopathy (22% vs. 16%). Monoclonal ITG was more commonly treated with clone-directed therapy, which was associated with more frequent remission and less frequent end stage kidney disease. Thus, a third of ITG cases are polyclonal but a quarter of these cases are associated with hematologic conditions, underscoring the need for hematologic evaluation in all patients with ITG. Hence, based on these distinctions, ITG should be subclassified into monoclonal and polyclonal variants. Prognosis of ITG is good if the underlying hematologic condition is treated. |
| Databáze: | OpenAIRE |
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