Organisation of lymphocytic infiltrates in ANCA-associated glomerulonephritis
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Organisation of lymphocytic infiltrates in ANCA-associated glomerulonephritis. / Brix, Silke R; Noriega, Mercedes; Herden, Elisabeth M; Goldmann, Birgit; Langbehn, Ulrike; Busch, Martin; Jabs, Wolfram J; Steinmetz, Oliver M; Panzer, Ulf; Huber, Tobias B; Stahl, Rolf A K; Wiech, Thorsten.
in: HISTOPATHOLOGY, Jahrgang 72, Nr. 7, 06.2018, S. 1093-1101.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Organisation of lymphocytic infiltrates in ANCA-associated glomerulonephritis
AU - Brix, Silke R
AU - Noriega, Mercedes
AU - Herden, Elisabeth M
AU - Goldmann, Birgit
AU - Langbehn, Ulrike
AU - Busch, Martin
AU - Jabs, Wolfram J
AU - Steinmetz, Oliver M
AU - Panzer, Ulf
AU - Huber, Tobias B
AU - Stahl, Rolf A K
AU - Wiech, Thorsten
N1 - © 2018 John Wiley & Sons Ltd.
PY - 2018/6
Y1 - 2018/6
N2 - AIMS: Renal involvement in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis contributes to significant morbidity and mortality in patients. In chronic inflammation, B cells are recruited to the inflamed tissue and organised lymphoid structures have been described in several autoimmune diseases. The aim of this study was to correlate the lymphoid organisation in renal biopsies with renal outcome in ANCA-associated glomerulonephritis (GN).METHODS AND RESULTS: We investigated 112 renal biopsies from patients with newly diagnosed ANCA-associated necrotising GN. We identified four different levels of the intrarenal organisation of lymphocytes: T cells without B cells, scattered B and T cells, clustered lymphocytic infiltrates and nodular compartmentally arranged B and T cell aggregates. Almost half the patients showed clusters of B and T lymphocytes in their biopsies. In 15 of these biopsies, a higher degree of organisation with lymphocytic compartments was detected. Inflammatory cell organisation was associated with renal failure, but not with tubular atrophy and interstitial fibrosis. Patients with organised lymphocytic infiltrates in their biopsy had worse renal function during follow-up and were more likely to develop end stage renal disease.CONCLUSIONS: In the present study, we show that the renal lymphocytic organisation is associated with renal outcome in ANCA-associated GN. The organisation of the lymphocytic infiltrate may be a morphological correlate of a perpetual and exaggerated inflammation in renal ANCA disease. Classifying the lymphocytic infiltrate could help to predict renal outcome, and might therefore be used for individualised adjustments in the intensity and duration of immunosuppressive therapy.
AB - AIMS: Renal involvement in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis contributes to significant morbidity and mortality in patients. In chronic inflammation, B cells are recruited to the inflamed tissue and organised lymphoid structures have been described in several autoimmune diseases. The aim of this study was to correlate the lymphoid organisation in renal biopsies with renal outcome in ANCA-associated glomerulonephritis (GN).METHODS AND RESULTS: We investigated 112 renal biopsies from patients with newly diagnosed ANCA-associated necrotising GN. We identified four different levels of the intrarenal organisation of lymphocytes: T cells without B cells, scattered B and T cells, clustered lymphocytic infiltrates and nodular compartmentally arranged B and T cell aggregates. Almost half the patients showed clusters of B and T lymphocytes in their biopsies. In 15 of these biopsies, a higher degree of organisation with lymphocytic compartments was detected. Inflammatory cell organisation was associated with renal failure, but not with tubular atrophy and interstitial fibrosis. Patients with organised lymphocytic infiltrates in their biopsy had worse renal function during follow-up and were more likely to develop end stage renal disease.CONCLUSIONS: In the present study, we show that the renal lymphocytic organisation is associated with renal outcome in ANCA-associated GN. The organisation of the lymphocytic infiltrate may be a morphological correlate of a perpetual and exaggerated inflammation in renal ANCA disease. Classifying the lymphocytic infiltrate could help to predict renal outcome, and might therefore be used for individualised adjustments in the intensity and duration of immunosuppressive therapy.
KW - Aged
KW - Antibodies, Antineutrophil Cytoplasmic
KW - Biopsy
KW - Creatinine
KW - Cyclophosphamide
KW - Female
KW - Glomerulonephritis
KW - Humans
KW - Immunosuppressive Agents
KW - Inflammation
KW - Kidney
KW - Kidney Function Tests
KW - Lymphocytes
KW - Male
KW - Middle Aged
KW - Rituximab
KW - Treatment Outcome
KW - Journal Article
U2 - 10.1111/his.13487
DO - 10.1111/his.13487
M3 - SCORING: Journal article
C2 - 29453894
VL - 72
SP - 1093
EP - 1101
JO - HISTOPATHOLOGY
JF - HISTOPATHOLOGY
SN - 0309-0167
IS - 7
ER -
