Clinical And Pathological Study Of Special Types Of ANCA Associated Glomerulonephritis

?Objective?1.To observe the clinical features of 36 ANCA associated glomerulonephritis with an abundance of Ig G4+ plasma cells(Ig G+ANCA-GN), and to compare the pathological morphology and prognosis of 64 ANCA associated glomerulonephritis without Ig G4+ plasma cells(Ig G-ANCA-ANCA).2.To analyze the clinical and pathological features of 1 ANCA-GN combined with Ig G4-TIN cases.3.To analyze the clinical and pathological features of 3 ANCA-GN combined with Ig A nephropathy.?Methods?1.The clinical data of Ig G+ANCA-GN and Ig G-ANCA-ANCA were collected.Their renal biopsy specimens was studied with light microscopy, immunehistochemistry staining. Analyze their clinical features and compare pathological morphology and prognostic features in Ig G+ANCA-GN and Ig G-ANCA-GN.2.The clinical and pathologyical characteristics of the renal biopsy from ANCAGN combined with Ig G4-TIN were collected.3.The clinical and pathologyical characteristics of the renal biopsy from ANCAGN combined with Ig A nephropathy.?Results?1.It was found that compared with those Ig G-ANCA-GN, patients with Ig G+ ANCA-GN had significantly higher prevalence of gastrointestinal involvement, CRP as well as better renal outcome, patients, survivals. We also found that Ig G-ANCA-GN patients had more severe animia and heart involvement than those with Ig G+ANCA-GN patients.2.The pathological features characteristics of ANCA-GN with Ig G4-TIN: there were renal mass in imaging; serum Ig G4 was elevated; and there were much lymphoplasmacytic cell infiltration under the membrane, with obliteration of the tubules, glomurular sclerosis and fibroplastic proliferation, the interface between shallow cortex and deep cortex tissue forms a sharp margin, only a few inflammatory cells extend into the intact parenchyma.3.All appeared renal damage, follow-up study showed that the second case had gastrointestinal involvement and presented with acid reflux, diarrhea, and the third presented with atelectasis, pleural effusion and pericardial effusion. All showed relatively strong deposits of Ig A in mesangial. One achieved complete remission and other partial remission after been treated with hormone combined with cycloph-osphamide and glucocorticoids; the second and third showed chronic renal failure lately.?Conclusions?1.We found that Ig G+ANCA-GN may be a special subtybe of ANCA-GN, and the prognosis is better than Ig G-ANCA-GN.2.A large number of Ig G4+ plasma cells is not enough to diagnose Ig G4-TIN, but also to combined with imaging, elevated serum Ig G4 and pathological characteristi-cs. We should to avoid misdiagnosis when there are many Ig G4+ plasma cells in the renal interstitial.3.ANCA-GN has poor prognosis and also lead to progressive renal damage. It has important significance for clinical outcome if the pathologist report it to the clinician because the treatment of ANCA-GN is different from the others.