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Hiroshi Nishi, Akihiro Tojo, Maristela Lika Onozato, Rika Jimbo, Masaomi Nangaku, Hiroshi Uozaki, Kenji Hirano, Hiroyuki Isayama, Masao Omata, Shinya Kaname, Anti-carbonic anhydrase II antibody in autoimmune pancreatitis and tubulointerstitial nephritis, Nephrology Dialysis Transplantation, Volume 22, Issue 4, April 2007, Pages 1273–1275, https://doi.org/10.1093/ndt/gfl672
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Sir,
Autoimmune pancreatitis (AIP) has been characterized by diffuse enlargement of the pancreas, irregular narrowing of the pancreatic duct, high levels of serum IgG4, and lymphoplasmacytic infiltration in the pancreatic parenchyma [ 1 ]. Accumulating evidence suggests that this autoimmune disease could present with diffuse infiltration of IgG4-positive plasmacytes in multiple organs, resulting in sclerosing cholangitis, sialadenitis and retroperitoneal fibrosis [ 1 ]. In 2004, tubulointerstitial nephritis (TIN) associated with AIP was independently reported by two groups [ 2 , 3 ]. Renal biopsy revealed tubulointerstitial inflammatory infiltrates with IgG4-positive plasma cells. However, it remains unknown to which antigenic peptides in the kidney these antibodies bind.
A 66-year-old male was referred to our department because of a rise in serum creatinine concentrations from 0.83 to 1.75 mg/dl during the previous 6 months. The diagnosis of AIP had been made a year previously by high serum IgG4 level of 670 mg/dl, and by the findings of imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography (ERCP). On admission, his laboratory data showed serum IgG4 of 1830 mg/dl. Renal biopsy demonstrated TIN with plasma-cell infiltration, although the glomeruli appeared almost normal ( Figure 1 A). Immunohistochemistry revealed that IgG4 was positive in the infiltrating plasma cells and also in the distal tubular cells ( Figure 1 B). After 8 weeks of treatment with oral prednisolone, his serum creatinine and IgG4 levels decreased to 0.87 mg/dl and 694 mg/dl, respectively.
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