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IgG4-Related Kidney Disease with Retroperitoneal Fibrosis in a Patient with Diabetes Mellitus

  • Takako Saeki
  • Tomoyuki Ito
  • Ryo Onishi
  • Masamichi Komatsu
  • Akira Iguchi
  • Hajime Yamazaki
Chapter

Abstract

A 74-year-old man with type 2 diabetes mellitus, in whom persistent proteinuria and renal dysfunction had been noted for several years, developed a rapid increase in his serum creatinine concentration and was referred to our hospital because of concern about a potential exacerbation of diabetic nephropathy. Laboratory findings revealed high levels of serum IgG and IgG4. Computed tomography examination showed right hydronephrosis with retroperitoneal fibrosis. Although the hydronephrosis resolved with ureteral stent placement, the serum creatinine level further increased and renal biopsy was performed. Renal histology revealed tubulointerstitial nephritis with an abundant IgG4-positive plasma cell infiltrate and marked fibrosis, compatible with IgG4-related kidney disease (IgG4-RKD). The patient was treated with glucocorticoids and his serum creatinine level decreased to 1.5 mg/dL. This experience suggests that IgG4-RKD should be considered in cases of chronic kidney disease in which the renal dysfunction progresses rapidly without apparent cause, and that IgG4-RKD may be accompanied by retroperitoneal fibrosis in IgG4-related disease.

Keywords

Chronic Kidney Disease Diabetic Nephropathy Diabetic Retinopathy Minor Salivary Gland Retroperitoneal Fibrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Corradi D, Maestri R, Palmisano A, et al. Idiopathic retroperitoneal fibrosis: clinicopathologic features and differential diagnosis. Kidney Int. 2007;72:742–53.PubMedCrossRefGoogle Scholar
  2. 2.
    Parving HH, Mauer M, Ritz E. Diabetic nephropathy. In: Brenner BM, editor. Brenner and Rector's the kidney, vol. 2. 7th ed. Philadelphia: WB Saunders; 2004. p. 1777–818.Google Scholar
  3. 3.
    Umehara H, Okazaki K, Masaki Y, et al. A novel clinical entity, IgG4-related disease (IgG4RD): general concept and details. Mod Rheumatol. 2012;22:1–14.PubMedCrossRefGoogle Scholar
  4. 4.
    Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366:539–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Kawano M, Saeki T, Nakashima H, et al. Proposal for diagnostic criteria for IgG4-related kidney disease. Clin Exp Nephrol. 2011;25:810–9.Google Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Takako Saeki
    • 1
  • Tomoyuki Ito
    • 1
  • Ryo Onishi
    • 1
  • Masamichi Komatsu
    • 1
  • Akira Iguchi
    • 1
  • Hajime Yamazaki
    • 1
  1. 1.Department of Internal MedicineNagaoka Red Cross HospitalNagaoka CityJapan

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