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Tubulointerstitial Nephritis as Manifestations of IgG4- Related Disease: A New Emerging Disease Entity
並列摘要
IgG4-related disease (IgG4-RD) is an unrecognized disease entity until recently. The termed ＂IgG4-RD＂ was first proposed in 2011, comprising a wide variety of diseases, such as Mikulicz's disease, autoimmune pancreatitis, tubulointerstitial nephritis, retroperitoneal fibrosis, etc. The most commonly involved organs are salivary gland, lacrimal gland, pancreas, kidney, and retroperitoneum. It affects a wide range of age with a peak in the sixth to seventh decades. The characteristic features of this new emerging disease are elevated serum IgG4 level and tumefactive lesions with organ enlargement, infiltrated by IgG4-positive plasma cells accompanying tissue fibrosis and sclerosis. Pancreatic tumorous lesion is a common presentation of IgG4-related autoimmune pancreatitis (IgG4-related AIP) and should be differentiated from malignant neoplasm. Kidney is frequently involved with renal insufficiency, termed IgG4-related kidney disease (IgG4-RKD). IgG4-positive plasma cells-rich tubulointerstitial nephritis with characteristic storiform fibrosis is the hallmark pathology in IgG4-RKD. Besides, glomerular involvements have rarely been reported, and membranous nephropathy is most commonly described. The pathogenesis of IgG4-RD is not fully clarified and has been speculated that it is a complicated process possibly involving B cell and T cell collaboration orchestrates a chronic and self-perpetuating immune response against a putative antigen. The disease shows good response to corticosteroid therapy. However, without timely treatment, advanced tissue fibrosis and atrophy may occur with permanent organ dysfunction. This review will aim to introduce this novel disease in regard to its nomenclature, diagnosis, pathology, pathogenesis, treatment and prognosis. Early diagnosis of IgG4-RD by high clinical suspicion to avoid unnecessary surgical procedure is warranted.
延伸閱讀
- Moinuddin, I., Bracamonte, E., Thajudeen, B., Sussman, A., Madhrira, M., & Costello, J. (2015). Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram. Case Reports in Medicine, 2015(), 103-106-026. https://doi.org/10.1155/2015/250530
- Chen, C. H., Yang, Y., Huang, S. H., & Chen, W. L. (2016). A Case of Disseminated Tuberculosis in a Renal Transplant Recipient: A Multidisciplinary Approach. Acta Nephrologica, 30(1), 52-57. https://doi.org/10.6221/AN.2015022
- Chen, Y. L., Sung, J. M., Cheng, M. F., Wu, A. B., Chen, F. F., & Huang, J. J. (2006). Mycobactrium Tuberculosis Induced Granulomatous Tubulointerstitial Nephritis in the Renal Allograft: A Case Report. Acta Nephrologica, 20(3), 215-219. https://www.airitilibrary.com/Article/Detail?DocID=10131671-200607-20-3-215-219-a
- Sunderkrishnan, R., Bodukam, V., Tiwana, M., Tadi, P., & Okechukwu, N. C. (2013). An Unusual Presentation of Classic Idiopathic Polyarteritis Nodosa as Acute Interstitial Nephritis. Clinical Medicine Insights: Case Reports, (2013), 125-129. https://doi.org/10.4137/CCRep.S11520
- Alnasrallah, B., Collins, J. F., & Zwi, L. J. (2017). Malignancy in Membranous Nephropathy: Evaluation of Incidence. International Journal of Nephrology, 2017(), 1-7-024. https://doi.org/10.1155/2017/8409829