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Monoclonal antibody analysis of crescentic membranous glomerulonephropathy
P Arrizabalaga1, A Sans Boix, A Torras Rabassa
1Department of Medicine, University of Barcelona, Spain.
Abstract:
Idiopathic membranous glomerulonephropathy (MG) has a rather benign prognosis. Acute renal failure with cellular crescents superimposed on MG is unusual and its pathogenesis is not fully understood. We report 3 patients with crescentic MG who showed strong glomerular and interstitial infiltration of leukocytes (CD45), T lymphocytes (CD3), helper/inducer T cells (CD4), cytotoxic/suppressor T cells (CD8), and monocyte-macrophages (CD14). A similar number of CD4+ and CD8+ cells contributed to T cellularity within the glomerular tuft, whereas CD4+ cells were predominant over CD8+ cells in the crescents. Intercellular adhesion molecule-1 (ICAM-1) antigens (CD54) were found on renal vascular endothelium, interstitial cellular aggregates and proximal tubular epithelial cells. The case reports illustrate the contribution of macrophages and T cells bearing predominantly CD4+ phenotype to cellular crescents, and the abnormal expression of ICAM-1 antigens on proximal tubular epithelial cells. Both features suggest that cell-mediated immunity may play a role in the transformation of crescentic MG.
Insights
Idiopathic membranous glomerulonephropathy (MG) rarely causes acute renal failure. This study reveals that T cells and macrophages contribute to crescent formation in MG, suggesting a role for cell-mediated immunity.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Idiopathic membranous glomerulonephropathy (MG) typically has a favorable prognosis.
- Acute renal failure with cellular crescents in MG is uncommon and its mechanisms are unclear.
Observation:
- Three patients with crescentic MG exhibited significant infiltration of leukocytes (CD45), T lymphocytes (CD3), helper T cells (CD4), cytotoxic T cells (CD8), and monocyte-macrophages (CD14) in glomeruli and interstitium.
- CD4+ and CD8+ T cells were equally present in glomerular tufts, but CD4+ cells predominated in crescents.
- Intercellular adhesion molecule-1 (ICAM-1, CD54) was expressed on renal vascular endothelium, interstitial cells, and proximal tubular epithelial cells.
Findings:
- Macrophages and T cells, particularly CD4+ cells, contribute to the formation of cellular crescents in MG.
- Abnormal expression of ICAM-1 was observed on proximal tubular epithelial cells.
Implications:
- These findings suggest that cell-mediated immunity plays a significant role in the progression of crescentic MG.
- Understanding these immune mechanisms may lead to novel therapeutic strategies for crescentic MG.