Immunoglobulin G deposition on proximal tubules and the tubular basement membrane in acute tubular injury complicated with focal segmental glomerulosclerosis (FSGS): A possible prediction tool for subclinical FSGS

Satoko Kurata; Aya Nawata; Takuya Morinishi; Keisuke Ohta; Eisuke Katafuchi; Satoshi Hisano; Seiji Tanaka; Masanori Hisaoka; Junki Koike; Ryuta Nishikomori; Toshiyuki Nakayama

doi:10.1016/j.anndiagpath.2023.152154

Immunoglobulin G deposition on proximal tubules and the tubular basement membrane in acute tubular injury complicated with focal segmental glomerulosclerosis (FSGS): A possible prediction tool for subclinical FSGS

Ann Diagn Pathol. 2023 Oct:66:152154. doi: 10.1016/j.anndiagpath.2023.152154. Epub 2023 May 15.

Authors

Affiliations

¹ Department of Pediatrics and Child Health, School of Medicine, Kurume University, 67, Asahimachi, Kurume 830-0011, Japan; Department of Pathology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
² Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan. Electronic address: aya.y0116@gmail.com.
³ Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.
⁴ Advanced Imaging Research Center, School of Medicine, Kurume University, 67, Asahimachi, Kurume 830-0011, Japan.
⁵ Department of Pathology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
⁶ Department of Pediatrics and Child Health, School of Medicine, Kurume University, 67, Asahimachi, Kurume 830-0011, Japan.
⁷ Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
⁸ Department of Pathology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.

PMID: 37216712
DOI: 10.1016/j.anndiagpath.2023.152154

Abstract

Immunofluorescent deposition of immunoglobulin G (IgG) in the tubular basement membrane (TBM) has been evaluated in the diagnosis of various diseases; however, few studies have investigated the immunofluorescence of acute tubular injury (ATI). Herein, we attempted to clarify IgG expression in the proximal tubular epithelium and TBM in ATI due to various causes. Patients with ATI with nephrotic-range proteinuria, including focal segmental glomerulosclerosis (FSGS, n = 18) and minimal change nephrotic syndrome (MCNS, n = 8), ATI with ischemia (n = 6), and drug-induced ATI (n = 7), were enrolled. ATI was evaluated by light microscopy. CD15 and IgG double staining and IgG subclass staining were performed to evaluate immunoglobulin deposition in the proximal tubular epithelium and TBM. IgG deposition was identified in the proximal tubules only in the FSGS group. Furthermore, IgG deposition in the TBM was observed in the FSGS group showing severe ATI. IgG3 was predominantly deposited by the IgG subclass study. Our results indicate that IgG deposition in the proximal tubular epithelium and TBM suggests the leaking of IgG from the glomerular filtration barrier and its reabsorption by proximal tubules, which may predict disruption of the glomerular size barrier, including subclinical FSGS. FSGS with ATI should be included as a differential diagnosis when IgG deposition in TBM is observed.

Keywords: Acute tubular injury; Focal segmental glomerulosclerosis; IgG subclass deposition; Tubular basement membrane; Tubular basement membrane IgG deposits.

MeSH terms

Basement Membrane
Glomerulosclerosis, Focal Segmental* / complications
Glomerulosclerosis, Focal Segmental* / diagnosis
Humans
Immunoglobulin G
Kidney Glomerulus
Proteinuria

Substances

Immunoglobulin G