Discordant Phenotypes of Nephritis in Patients with X-linked Agammaglobulinemia

期刊论文
发表日期：

2024年7月25日

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Toru Kanamori,
Tomohiro Udagawa,
Takayuki Fujii,
Hiroyoshi Matsukura,
Yuka Iwaya,
Motoshi Sonoda,
Keisuke Sugimoto,
Masahiro Takeguchi,
Atsunori Yoshino,
I-Feng Wang,
Daw-Yang Hwang,
Harry W. Schroeder,
Masaki Shimizu,
Hans D. Ochs,
Tomohiro Morio,
Hirokazu Kanegane

摘要

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.