Discordant Phenotypes of Nephritis in Patients with X-linked Agammaglobulinemia
August 8, 2024
Abstract
Purpose
To define the clinical and histological characteristics of nephritis in patients with X-linked agammaglobulinemia (XLA) and their immunological profiles.
Methods
The clinical, immunological, and histological findings of nine patients with XLA and nephritis were retrospectively analyzed.
Results
Based on kidney histological findings, patients with XLA and nephritis could be divided into two groups, viz., chronic glomerulonephritis (CGN) and tubulointerstitial nephritis (TIN). The two groups showed different immunological profiles. Patients in the CGN group exhibited an atypical immunological profile of XLA, with pathogenic leaky B cells producing immunoglobulins that may play a role in forming immune complexes and causing immune-mediated glomerulonephritis. In contrast, patients in the TIN group exhibited a typical immunological profile of XLA, suggesting that antibody-independent/other BTK-dependent mechanisms, or immunoglobulin replacement therapy (IgRT)-related immune/nonimmune-mediated nephrotoxicity causes TIN.
Conclusion
Nephritis occurring in patients with XLA could have links between their renal pathology and immunological status. Careful observation is recommended to detect kidney pathology in patients with XLA on IgRT.
To define the clinical and histological characteristics of nephritis in patients with X-linked agammaglobulinemia (XLA) and their immunological profiles.
Methods
The clinical, immunological, and histological findings of nine patients with XLA and nephritis were retrospectively analyzed.
Results
Based on kidney histological findings, patients with XLA and nephritis could be divided into two groups, viz., chronic glomerulonephritis (CGN) and tubulointerstitial nephritis (TIN). The two groups showed different immunological profiles. Patients in the CGN group exhibited an atypical immunological profile of XLA, with pathogenic leaky B cells producing immunoglobulins that may play a role in forming immune complexes and causing immune-mediated glomerulonephritis. In contrast, patients in the TIN group exhibited a typical immunological profile of XLA, suggesting that antibody-independent/other BTK-dependent mechanisms, or immunoglobulin replacement therapy (IgRT)-related immune/nonimmune-mediated nephrotoxicity causes TIN.
Conclusion
Nephritis occurring in patients with XLA could have links between their renal pathology and immunological status. Careful observation is recommended to detect kidney pathology in patients with XLA on IgRT.
Journal Article
JOURNAL：Journal of Clinical Immunology
TITLE：Discordant Phenotypes of Nephritis in Patients with X-linked Agammaglobulinemia
DOI：10.1007/s10875-024-01766-x
TITLE：Discordant Phenotypes of Nephritis in Patients with X-linked Agammaglobulinemia
DOI：10.1007/s10875-024-01766-x
Correspondence to
Hirokazu Kanegane, Professor
Department of Child Health and Development,
Graduate School of Medical and Dental Sciences,
Tokyo Medical and Dental University(TMDU)
E-mail:hkanegane.ped（at）tmd.ac.jp
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