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Case Reports
. 2016 Feb;27(2):380-4.
doi: 10.1681/ASN.2015030334. Epub 2015 Sep 2.

Immune Complex Tubulointerstitial Nephritis Due to Autoantibodies to the Proximal Tubule Brush Border

Ivy A Rosales  1 , A Bernard Collins  2 , Paula Alves S do Carmo  3 , Nina Tolkoff-Rubin  4 , R Neal Smith  2 , Robert B Colvin  2
Affiliations
Case Reports

Immune Complex Tubulointerstitial Nephritis Due to Autoantibodies to the Proximal Tubule Brush Border

Ivy A Rosales et al. J Am Soc Nephrol. 2016 Feb.

Abstract

Immune complex tubulointerstitial nephritis due to antibodies to brush border antigens of the proximal tubule has been demonstrated experimentally and rarely in humans. Our patient developed ESRD and early recurrence after transplantation. IgG and C3 deposits were conspicuous in the tubular basement membrane of proximal tubules, corresponding to deposits observed by electron microscopy. Rare subepithelial deposits were found in the glomeruli. The patient had no evidence of SLE and had normal complement levels. Serum samples from the patient reacted with the brush border of normal human kidney, in contrast with the negative results with 20 control serum samples. Preliminary characterization of the brush border target antigen excluded megalin, CD10, and maltase. We postulate that antibodies to brush border antigens cause direct epithelial injury, accumulate in the tubular basement membrane, and elicit an interstitial inflammatory response.

Keywords: brush border; immune complex; tubulointerstitial.

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Figures

Figure 1.
Figure 1.
Native kidney. (A) Mononuclear inflammatory interstitial infiltrate with few admixed neutrophils and eosinophils, tubular atrophy, and normal-looking glomerulus (hematoxylin and eosin staining). (B) Granular IgG staining of TBMs. (C) Amorphous electron-dense deposits along the TBM. (D) Penetrating subepithelial electron-dense deposits along the GBM. Original magnification, ×400 in A and B; ×8900 in C and D.
Figure 2.
Figure 2.
Indirect IF of the patient’s serum on normal human kidney. (A) IgG staining of proximal tubule brush borders. (B) Proximal tubule brush border IgG staining and negative glomerular staining. (C) Control normal serum on normal human kidney.
Figure 3.
Figure 3.
Patient IgG-megalin on normal human kidney, colocalization by IF. (A) Patient IgG staining on proximal tubule brush borders. (B) Megalin staining on proximal tubule brush borders. (C) No evident IgG-megalin colocalization.
Figure 4.
Figure 4.
Allograft kidney. (A) Tubular epithelial blebs, vacuolization, focal tubulitis, and mononuclear inflammatory interstitial infiltrate, 45 weeks post-transplant (hematoxylin and eosin staining). (B) Granular IgG staining of TBMs, 45 weeks post-transplant. (C) Large amorphous electron-dense deposits along the TBM, 7 weeks post-transplant; similar deposits are present at 45 weeks. (D) Rare amorphous subepithelial electron-dense deposits along the GBM, 45 weeks post-transplant. Original magnification, ×400 in A and B; ×14,000 in C; ×18,000 in D.
See this image and copyright information in PMC

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