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Renal involvement in mixed connective tissue disease. Report of 5 cases
Abstract:
5 cases with the compatible serological criteria of mixed connective tissue disease described earlier are presented. In 1 of them with a moderate degree of proteinuria, the renal biopsy disclosed membranous nephritis. However, despite the absence of overt clinical renal disease in the other 4 cases, biopsies disclosed membranous nephritis in 1 and mild mesangial proliferative glomerulonephritis in the remaining 3 cases. In the follow-up of these 4 cases, 2 subsequently developed abnormal urinalysis. Electron microscopic examinations demonstrated electron-dense deposits in glomeruli, and 4 of these patients also had microtubular structures in the endothelial cytoplasm. Contrarily to the original concept, our findings suggest that mixed connective tissue disease also induces immune complex disease.
Insights
Mixed connective tissue disease (MCTD) can cause immune complex-related kidney disease, including membranous nephritis and glomerulonephritis. Renal biopsies revealed kidney damage even without obvious symptoms, suggesting MCTD
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Mixed connective tissue disease (MCTD) is an autoimmune disorder with overlapping features of other connective tissue diseases.
- The renal manifestations of MCTD are not fully understood, particularly subclinical kidney involvement.
Observation:
- Five patients meeting serological criteria for MCTD were studied.
- Renal biopsies were performed, with some patients showing proteinuria and others lacking overt clinical renal disease.
Findings:
- Membranous nephritis was diagnosed in one patient with proteinuria and another without overt renal disease.
- Mild mesangial proliferative glomerulonephritis was found in three patients.
- Electron microscopy revealed electron-dense deposits and microtubular structures in glomeruli.
- Two patients developed abnormal urinalysis during follow-up.
Implications:
- These findings suggest that MCTD can induce immune complex-mediated kidney disease.
- Subclinical renal involvement in MCTD may be more common than previously recognized.
- Further research is needed to elucidate the pathogenesis of renal disease in MCTD.