Immunoglobulin G4-related Kidney Disease Associated With Autoimmune Hemolytic Anemia

Iran J Kidney Dis. 2018 Jul;12(4):243-246.

Abstract

Awareness of the uncommon associated clinical manifestations of immunoglobulin G4 (IgG4)-related kidney disease is essential for the early diagnosis and effective treatment of patients. To the best of our knowledge, there have been few reports of patients with IgG4-related kidney disease associated with autoimmune hemolytic anemia. We here report a rare case of IgG4-related kidney disease associated with autoimmune hemolytic anemia. A 70-year-old man with kidney dysfunction and severe anemia had been diagnosed with chronic kidney disease and treated without any improvement. On admission, he had a high serum creatinine level, low hemoglobin level, positive direct Coombs test, and mild proteinuria. Serum IgG and IgG4 were elevated. Kidney biopsy showed marked infiltration of IgG4-positive plasma cells and storiform fibrosis in the interstitial compartment, which confirmed the diagnosis of IgG4-related kidney disease. Corticosteroid therapy was initiated, and subsequently, the kidney dysfunction and anemia dramatically improved.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Anemia, Hemolytic, Autoimmune / diagnosis
  • Anemia, Hemolytic, Autoimmune / immunology*
  • Autoimmune Diseases / complications
  • Autoimmune Diseases / diagnosis
  • Autoimmune Diseases / drug therapy
  • Autoimmune Diseases / immunology*
  • Autoimmunity*
  • Biomarkers / blood
  • Biopsy
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin G / immunology*
  • Immunohistochemistry
  • Kidney / drug effects
  • Kidney / immunology*
  • Kidney / pathology
  • Kidney Diseases / complications
  • Kidney Diseases / diagnosis
  • Kidney Diseases / drug therapy
  • Kidney Diseases / immunology*
  • Male
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Biomarkers
  • Immunoglobulin G