Renal Granulomas Research Articles

Nocardia seriolae mediates granulomatous chronic inflammation of spleen in Micropterus salmoides through necroptosis

Granulomatous chronic inflammation is a typical pathological characteristic of largemouth bass (Micropterus salmoides) infected by Nocardia seriolae, and it is also an important breakthrough to solve the problem of pathogen prevention and treatment.Spleen, the target organ of N. seriolae infection, is significant for studying pathogenic mechanism. However, histopathological characteristics and immunological molecular mechanisms of the development of splenic granulomas in fish have not been extensively studied. In the initial process of exploring the molecular mechanism of N. seriolae infectious splenic granuloma formation, we accidentally found positive signals of necroptosis-related gene by immunohistochemical staining, suggesting that necroptosis may be involved in the formation of granulomas.Nevertheless, the role of necroptosis in the formation of splenic granuloma is still unclear. In this study, we established a granuloma model in the spleen of largemouth bass infected by N. seriolae. Through multiple tissue staining, we compared splenic granulomas with hepatic and renal granulomas, and preliminarily clarified the histopathological characteristics of splenic granulomas and the formation pattern of fibrosis, calcium salt deposition and other lesions. Notably, we found that the expression of inflammatory factors and necroptosis-related molecules in spleen were significantly upregulated during N. seriolae infection. Further immunohistochemical staining showed that the splenic granulomas were accompanied by extensive and intense p-MLKL-positive signals in the peripheral tissue. In addition, western blot and immunofluorescence results showed that N. seriolae could induce necroptosis in primary spleen cells of largemouth bass in vitro. Our data indicated that necroptosis is closely related to the formation of splenic granulomas in largemouth bass, and provide some ideas for the study of the formation mechanism of fish granuloma.

Asymptomatic renal granuloma diagnosed 3 years after Bacillus Calmette–Guérin intravesical injection: A case report and a literature review

IntroductionIntravesical Bacillus Calmette–Guérin immunotherapy is an effective treatment for non‐muscle‐invasive bladder cancer, which is occasionally associated with side effects and complications. The incidence of significant renal complications after intravesical Bacillus Calmette–Guérin immunotherapy is less than 2%. We report a case of renal granuloma after intravesical Bacillus Calmette–Guérin immunotherapy for bladder cancer, which radiologically resembled a papillary renal cell carcinoma.Case presentationA 65‐year‐old man, who had a medical history of urothelial carcinoma and received intravesical Bacillus Calmette–Guérin therapy, was referred to our Urology Department with a right renal tumor. Imaging findings suggested papillary renal cell carcinoma. Robot‐assisted partial nephrectomy was performed, and the histopathological examination revealed epithelioid cell granuloma, which were considered to be Bacillus Calmette–Guérin‐related renal granuloma.ConclusionBacillus Calmette–Guérin‐related renal granuloma mimicking papillary renal cell carcinoma have been reported. We should consider the possibility of renal granulomas when encountering image abnormalities for patients treated with intravesical Bacillus Calmette–Guérin therapy.

Renal granuloma misdiagnosed as renal papillary carcinoma: a case report

Renal granuloma misdiagnosed as renal papillary carcinoma: a case report

Identification of a novel Neorickettsia species in a Kemp's ridley sea turtle with granulomatous nephritis and development of a quantitative PCR assay.

An adult male Kemp's ridley turtle was found dead on the coast of Kenedy County, Texas, in August 2019 with bilateral severe, diffuse granulomatous nephritis. Pan-bacterial 16S rRNA gene polymerase chain reaction (PCR) and amplicon sequencing of affected tissue indicated the presence of a Neorickettsia. Neorickettsia is a genus of obligate intracellular Alphaproteobacteria that are transmitted by digenean trematodes. For further characterization, primers were designed to amplify and sequence the groEL gene. Phylogenetic analysis found that the organism was distinct from other known species to a degree consistent with a novel species. Immunohistochemistry using an antibody directed against a Neorickettsia surface protein showed bacterial clusters within the renal granulomas. A species-specific quantitative PCR was designed and detected the organism within the liver and colon of the index case. A quantitative PCR survey of grossly normal kidneys opportunistically collected from additional stranded sea turtle kidneys detected this organism in five of 15 Kemp's ridley turtles, two of nine green turtles, and neither of two loggerhead turtles. Recognition of this novel organism in an endangered species is concerning; additional work is underway to further characterize the potential of this organism as a pathogen of sea turtles.

Renal Neoformation: A Diagnosis to Consider

Renal granulomas related to suture material are rare and usually accidental findings in imagiological studies. A 12-year-old boy, followed-up after Anderson-Hynes pyeloplasty 7 years before, was submitted to an ultrasonography that described a solid nodular lesion, possibly in the dependence of the left kidney. Subsequently, magnetic resonance imaging was performed, which reported a lesion with non-specific features, suggesting neoformation with predominant fibrous peripheric component and myxomatous center. Percutaneous biopsy was morphologically compatible with chronic xanthogranulomatous inflammatory process. Anatomopathological examination of the surgical excised lesion described histiocytic cells with frequent participation of foreign body type giant cells and granulomatous reaction in relation to exogenous suture-like material. He remains asymptomatic since then. Foreign body granulomatous pseudotumors are difficult to diagnose regarding the absence of specific imagiological features distinctive from neoplasms, requiring histological examination to confirm the diagnosis.

Atteinte rénale au cours de la sarcoïdose : facteurs pronostiques et prédictifs

IntroductionSarcoidosis is a systemic granulomatous disease that primarily affects the respiratory system and lymphatic vessels. Renal involvement is rare, poorly studied and found in less than 10% of cases. The objective of our study was to identify factors of poor renal prognosis and predictive factors of renal involvement during sarcoidosis. MethodsIt's a retrospective study including patients hospitalized in our department for sarcoidosis with renal involvement over a period of 40 years. To study renal survival, we identified two groups of patients with renal manifestations of sarcoidosis by following their evolution: group A (n=26) represents those with renal remission or deterioration of renal function but without progression to end-stage renal disease and group B (n=8) those with progression to end-stage renal disease. To detect the predictive factors of end-stage renal disease in patients with sarcoidosis, we compared the clinical and paraclinical characteristics of our patients (group 1) to those of 44 patients with sarcoidosis without renal impairment followed in our department during the same period (group 2). ResultsRenal involvement was observed in 34 patients hospitalized for sarcoidosis (43.6%). There were 28 women and 6 men with a sex ratio of 0,21. The mean age at diagnosis of sarcoidosis was 47.1 years. The median time from sarcoidosis diagnosis to renal disease was 2 months (range 1–72). Tubulointerstitial nephropathy was the most frequent renal manifestation observed in 24 patients (70.6%). Hypercalcemia and hypercalciuria were found in 52.9% and 46.4% respectively. Renal failure was noted in 25 patients (73.5%). Corticosteroid therapy was initiated in 33 patients (97%) associated with immunosuppressive therapy in 3 cases. Predictive factors of end-stage renal disease were advanced age at diagnosis of nephropathy (P=0.007), comorbidities (P=0.002), multi-organ involvement (P=0.041), initial renal failure (P=0.013), interstitial fibrosis (P=0.006) and renal granulomas (P=0.007). Predictive factors of renal impairment during sarcoidosis were multi-organ involvement, inflammatory syndrome and hypercalcemia. ConclusionRenal envolvement, although rare during sarcoidosis, can influence the prognosis hence the great interest of its early detection to prevent progression to end-stage renal failure.

The Use of Hematological and Histopathological Biomarkers to Assess the Health of Aquatic Ecosystems in Koh Sichang, Thailand

Abstract Koh Sichang area in Thailand is a sink for a wide variety of contaminants such as heavily polluted water from industry and oil spills. This situation may affect the health status of fish living in the area, but such information remains scarce. In this study, we evaluated the health status of java rabbitfish Siganus javus, an important marine fish in Koh Sichang, using hematological and histopathological biomarkers. All fish samples were collected from the Koh Sichang area during December 2017 and January 2018. Although the salinity, pH, and dissolved oxygen levels at sampling points were all within the normal range, abnormal nuclei were observed in erythrocytes (up to ~6% of all erythrocytes) and in some leucocytes (neutrophil, lymphocyte and monocyte). Visceral organs (gill, kidney and liver) were apparently normal in terms of gross morphology, but a wide variety of the histopathological alterations were found at the microscopic level: epithelial hyperplasia and aneurysm in gills; blood congestion and melanomacrophage centers (MMCs) in the liver; renal degeneration, granuloma and MMCs together with unidentified parasites in kidney. Calculation of semi-quantitative parameters [histological alteration index (HAI) and the average value of alteration (AVA)] demonstrated the highest frequency of histopathological alterations in kidney, suggesting that kidney is a sensitive organ. Overall, our observations suggest that S. javus in Koh Sichang is under the pathological state and warrants conservation efforts. Keywords: Erythrocytes, Fish Health, Hematology, Histopathology, Kidney

A novel host-adapted strain of Salmonella Typhimurium causes renal disease in olive ridley turtles (Lepidochelys olivacea) in the Pacific

Salmonella spp. are frequently shed by wildlife including turtles, but S. enterica subsp. enterica serovar Typhimurium or lesions associated with Salmonella are rare in turtles. Between 1996 and 2016, we necropsied 127 apparently healthy pelagic olive ridley turtles (Lepidochelys olivacea) that died from drowning bycatch in fisheries and 44 live or freshly dead stranded turtles from the west coast of North and Central America and Hawaii. Seven percent (9/127) of pelagic and 47% (21/44) of stranded turtles had renal granulomas associated with S. Typhimurium. Stranded animals were 12 times more likely than pelagic animals to have Salmonella-induced nephritis suggesting that Salmonella may have been a contributing cause of stranding. S. Typhimurium was the only Salmonella serovar detected in L. olivacea, and phylogenetic analysis from whole genome sequencing showed that the isolates from L. olivacea formed a single clade distinct from other S. Typhimurium. Molecular clock analysis revealed that this novel clade may have originated as recently as a few decades ago. The phylogenetic lineage leading to this group is enriched for non-synonymous changes within the genomic area of Salmonella pathogenicity island 1 suggesting that these genes are important for host adaptation.

Increase of 1,25 dihydroxyvitamin D in sarcoidosis patients with renal dysfunction

In sarcoidosis, renal involvement includes hypercalcemia-related nephrocalcinosis and granulomatous tubulointerstitial nephritis. Hypercalcemia is thought to be due to increased production of 1,25 dihydroxyvitamin D (1-25D), but 1-25D levels have not been evaluated in sarcoidosis patients with renal dysfunction. We enrolled 9 sarcoidosis patients who underwent renal biopsy, and compared the serum 1-25D concentration and eGFR with those in 428 non-sarcoidosis patients who had renal dysfunction (stage 2 or higher CKD with an estimated glomerular filtration rate < 90). Serum calcium and 1-25D levels were significantly higher in the sarcoidosis patients than in the non-sarcoidosis patients (p < 0.01 and p = 0.01, respectively). There was a positive correlation between 1-25D and eGFR in the patients without sarcoidosis (r = 0.693; p < 0.01). As the renal function of sarcoidosis patients was improved by steroid therapy, the serum 1-25D and adjusted serum calcium levels decreased to near the median values in non-sarcoidosis patients. On renal biopsy, CD68 staining was positive for tissue macrophages in all 8 patients who had tubulointerstitial nephritis (with or without typical granulomas), while Von Kossa staining showed calcification of tubules near or inside granulomas in 6 of these 8 patients. While tissue macrophages promote development of tubulointerstitial nephritis and 1-25D overproduction in renal sarcoidosis, hypercalcemia secondary to elevation of 1-25D may be related to renal calcification and granuloma formation.

Mycobacterium marinum is the causative agent of splenic and renal granulomas in half-smooth tongue sole (Cynoglossus semilaevis Günther) in China

The half-smooth tongue sole (Cynoglossus semilaevis Günther) is a major cultivated marine fish species of high economic value. However, splenic and renal granulomas disease is a major disease of C. semilaevis and results in high mortality; its first outbreak was reported in 2009, and the pathogen responsible was believed to be associated with an unidentified virus. In this study, we investigated the prevalence of this disease in three fish farms located in different cities; we isolated homogeneous colonies from affected fish from each farm. Healthy half-smooth tongue sole were subjected to bacterial challenge tests by intraperitoneal injection of 0.5 × 107 cfu/fish of the isolates from each farm. The accumulative mortality rate was >80% within 30 days post infection. Diseased sole displayed symptoms similar to those seen in naturally infected fish. These strains were all identified as Mycobacterium marinum based on bacterial morphology, analytical profile index identification and 16S rDNA sequencing. The results of this study suggest that M. marinum is the causal agent of splenic and renal granulomas disease in half-smooth tongue sole; therefore, more attention should be paid to the occurrence of this bacterium in the flat fish aquaculture industry in China.

Severe tubulointerstitial nephritis: tracking tuberculosis even in the absence of renal granuloma.

ABSTRACTExtra-pulmonary tuberculosis is frequently located in the kidneys and, in such cases, could be associated with a granulomatous interstitial nephritis. Granulomas are not always detected, especially in human immunodeficiency virus (HIV)-positive patients. We report here a case of tubulointerstitial nephritis without granulomas in an HIV-negative patient. Since all laboratory tests failed to isolate Mycobacterium tuberculosis in the kidney, a targeted biopsy guided by positron emission tomography–computed tomography was performed on a mediastinal node, revealing a positive culture. After 6 months of treatment, no recovery of the renal injury has been observed.

Dynamic bacterial colonization and microscopic lesions in multiple organs of tilapia infected with low and high pathogenic Streptococcus agalactiae strains

Streptococcus agalactiae (also known as GBS) is an emerging pathogen of fish and is fatal to tilapia worldwide. However, the differences in pathogens-host interactions among different pathogenic GBS strains remain unclear. In this study, we investigated the dynamic bacterial colonization as well as microscopic lesions in multiple organs of tilapia infected with the low pathogenic TFJ0901 and high pathogenic THN0901 strains. Using the qPCR assay, we revealed that THN0901 can easily invade the spleen at the early stage of infection, and then effectively replicate in the brain and eyes, while bacterial loads are maintained at constant lower levels in all tissues of TFJ0901-infected fish at any time points. Both immunohistochemistry and histopathology showed that the differences in the microscopic lesions caused by the two strains were mainly focused on the blood vessels/sinusoids, and that THN0901 infection was more likely to lead to degenerative lesions within the endothelial cells, with subsequent vascular lesions and local tissue infarction, particularly in the brain, spleen, kidney and gills. THN0901 can also result in typical histopathological changes, including meningitis, epicarditis, and renal granuloma. In contrast, TFJ0901 caused slight or no microscopic lesions in those tissues over time. Interestingly, this study provides direct evidence that THN0901 can adhere to and invade the intestinal epithelial cells through intraperitoneal injection. Furthermore, touch impression smears of the spleen also confirmed that THN0901 can proliferate in macrophages and cause immune cells to collapse, whereas TFJ0901 did not appear to have the ability to do so. In summary, we closed a gap in understanding the differences in pathogen-host interactions between high and low pathogenic GBS strains, which will enhance our ability to develop an attenuated vaccine based on TFJ0901 in the future.

Morbidity and mortality in stranded Cook Inlet beluga whales Delphinapterus leucas.

The endangered Cook Inlet (Alaska, USA) stock of beluga whales Delphinapterus leucas declined 47% between 1994 and 1998, from an estimated 653 whales to 347 whales, with a continued decline to approximately 312 in 2012. Between 1998 and 2013, 164 known dead strandings were reported by the National Marine Fisheries Service. Only 38 of these animals, or 23% of the known stranded carcasses, were necropsied. Carcasses were found between April and October. The majority of animals necropsied were adults (n=25), followed by juveniles (n=6), calves (n=3), and aborted fetuses (n=4). Eight of the 11 mature females were pregnant, post-partum, or lactating. Many (82%) of these belugas were in moderate to advanced autolysis, which hampered determination of a cause of death (COD). Each animal had a single primary COD assigned within a broad set of categories. The CODs were unknown (29%), trauma (18%), perinatal mortality (13%), mass stranding (13%), single stranding (11%), malnutrition (8%), or disease (8%). Other disease processes were coded as contributory or incidental to COD. Multiple animals had mild to moderate verminous pneumonia due to Stenurus arctomarinus, renal granulomas due to Crassicauda giliakiana, and ulcerative gastritis due to Anisakis sp. Each stranding affords a unique opportunity to obtain natural history data and evidence of human interactions, and, by long-term monitoring, to characterize pathologies of importance to individual and population health.

BCG-related renal granulomas managed conservatively: A case series.

The aim of this case series is to present two cases of renal granulomas discovered incidentally post-intravesical Bacillus Calmette-Guerin (BCG) installations and were managed conservatively. The first case is a 68-year-old man with bladder and right ureteral orifice carcinoma in situ. After transurethral resection of the right ureteral orifice and bladder tumours, he received 6 + 3 weekly intravesical installations of BCG and then 6 + 3 weekly intravesical installations of BCG with interferon alpha (IFN) in the presence of an indwelling ureteral stent since he had refused cystoprostatectomy. At the 18-month follow-up, his computed tomography scan showed two right renal masses. Biopsy demonstrated non-necrotizing granulomatosis. Serial follow-up with imaging studies showed complete resolution of these masses without anti-tuberculous medications. The second case is a 74-year old man with left renal high-grade papillary urothelial carcinoma. After ureteral meatotomy and insertion of indwelling ureteral stents, he received 6 weekly intravesical installations of BCG followed by 3 weekly installations of BCG and IFN prior to the definitive management with laparoscopic left nephroureterectomy. Final pathology showed pT1 urothelial carcinoma and an incidental finding of BCG-related renal granulamotosis. The patient has been asymptomatic and did not require anti-tuberculous medications. While these two cases demonstrate the ability of intravesical BCG to reach the renal pelvis, patients with a history of intravesical BCG with incidental renal masses may benefit from renal biopsy. These renal granulomas may resolve without anti-tuberculous medications.

Suture Granuloma Mimicking Renal Cell Carcinoma: Magnetic Resonance Imaging (MRI) and Pathologic Correlation

OZET Solid renal masses are generally distinguished with contrast enhancement and intratumoral fatty foci by radiological examinations. The present of enhancement is most important criteria for diagnosis of malignant lesions. Generally, a contrast enhanced solid mass in kidney is accepted as a neoplasm. Foreign body granuloma is an extraordinary cause of enhanced solid renal mass. This case of a renal suture granuloma demonstrated peripheral enhanced exophytic renal mass mimic renal cell carcinoma, and underwent surgery. At the solid renal mass with different radiological features, biopsy is an option to determining the necessity of surgery as well as the surgical approach.

Diagnóstico imuno-histoquímico e caracterização anatomopatológica de clamidiose em psitacídeos

A clamidiose é causada por Chlamydophila psittaci e representa uma das principais zoonoses de origem aviária. Realizou-se um estudo retrospectivo em psitacídeos do período de 1995 a 2012 e exame imuno-histoquímico (IHQ) anti-Chlamydia. Foram avaliados 111 casos, dos quais 12 foram a óbito devido à clamidiose. As aves eram provenientes de apreensão ou cativeiro (zoológicos, criatórios, centros de triagem e domicílios). À necropsia observou-se fígado aumentado (4/12) com áreas branco-amareladas (3/12), baço aumentado (2/12) e rompido (1/12), saco pericárdico com deposição de fibrina (1/12), polisserosite fibrinosa (1/12) e em três casos não havia lesões. Na avaliação histopatológica evidenciou-se hepatite necrótica mononuclear (7/12), hepatite mononuclear (3/12), hiperplasia de ductos biliares (8/12), esplenite necrótica histiocitária (9/12), hemossiderose em fígado (9/12) e baço (9/12), aerossaculite mononuclear (4/12), pericardite fibrino-heterofílica (2/12), necrose (1/12) e rarefação (1/12) linfoide de bursa de Fabricius, pneumonia fibrinosa (1/12), nefrite mononuclear (1/12) e granulomas renais (1/12). Observaram-se inclusões basofílicas intracitoplasmáticas (corpos elementares) em fígado (2/12), baço e rins (1/12). Evidenciou-se imunomarcação anti-Chlamydia em fígado (11/12), baço (7/9), pulmões (3/9), rins (2/8), intestinos (2/3), sacos aéreos (1/4) e bursa de Fabricius (1/2). A IHQ poderá ser utilizada como forma de diagnóstico definitivo post mortem de clamidiose em psitacídeos no Brasil.

Granulomatosis con poliangeítis, doble positividad de anticuerpos contra el citoplasma de neutrófilos y granuloma renal

Idiopathic systemic vasculitis is characterized by inflammation and necrosis of the vessel walls of unknown origin. Medications and infections have been proposed as potential triggers of these diseases. The case is presented on a patient diagnosed with granulomatosis with polyangiitis with antibodies to neutrophil cytoplasm, as well as anti-proteinase 3 and anti-myeloperoxidase, plus the unusual finding of renal granuloma.

High mobility group box protein-1 crossing cell borders may incite an inflammatory “tornado” in renal disease

High mobility group box 1 (HMGB-1) protein has been widely studied as a DNA-binding nuclear protein that regulates gene transcription, maintains nucleosome structure and modulates the activity of steroid hormone receptors [1]. Besides these classical functions as transcription factor, HMGB-1 may also be released by the cells into the extracellular milieu. This release process may be clearly distinguished from a passive process occurring with profound cell damage, e.g., necrosis or apoptosis, and has been elucidated as an active process in monocytes and macrophages after pro-inflammatory stimulation with LPS, IFN-c, TNFa or IL-1b. ‘‘Outside’’ cells, HMGB-1 serves as an inflammatory mediator affecting synthesis of TNFa, monocyte chemotactic protein (MCP)-1 and expression of cell adhesion molecules ICAM-1 and VCAM-1 [2]. A recent publication by Oyama et al. [3] sheds light on the potent role of HMGB-1 in an experimental nephritis model caused by adenine excess. Adenine-rich diet (2,8-dihydroxyadenine (DHA)induced nephritis) provokes interstitial nephritis [3]. Oyama and colleagues set up the hypothesis that activated infiltrating macrophages, which are abundantly found in renal granulomas, may release HMGB-1 and thereby perpetuate disease, e.g., by enhancing MCP-1 expression and secretion. Furthermore, the study addressed the question whether secreted MCP-1 may attract more macrophages, which also release HMGB-1. Thus, the authors postulated the existence of a dangerous self-amplifying vicious circle in the interstitial nephritis model [3]. As a result, Oyama et al. demonstrate elevated levels of HMGB-1 and MCP-1 in renal tissue, urine and serum samples of adenine-fed rats. Moreover, receptors of extracellular HMGB-1, i.e., receptor for advanced glycation end products (RAGE) and tolllike receptor-4 (TLR4), were up-regulated in kidney tissue from rats fed with adenine. Intraperitoneal injection of HMGB-1 in the course of adenineinduced nephritis resulted in functional impairment, as indicated by enhanced serum blood urea nitrogen (BUN) and creatinine levels. When HMGB-1?/mice were investigated in the same disease model, MCP-1 expression was reduced, and accumulation of macrophages in the kidneys was decreased. In vitro, renal tubular epithelial cells were found to enhance MCP-1 secretion upon HMGB-1 stimulation. V. Shpacovitch P. R. Mertens (&) Nephrology and Hypertension & Endocrinology and Metabolic Diseases, Otto-von-Guericke University Magdeburg, Leipziger Str. 40, 39120 Magdeburg, Germany e-mail: peter.mertens@med.ovgu.de

High-mobility group box-1 protein promotes granulomatous nephritis in adenine-induced nephropathy

Granulomatous nephritis can be triggered by diverse factors and results in kidney failure. However, despite accumulating data about granulomatous inflammation, pathogenetic mechanisms in nephritis remain unclear. The DNA-binding high-mobility group box-1 protein (HMGB1) initiates and propagates inflammation when released by activated macrophages, and functions as an ‘alarm cytokine' signaling tissue damage. In this study, we showed elevated HMGB1 expression in renal granulomas in rats with crystal-induced granulomatous nephritis caused by feeding an adenine-rich diet. HMGB1 levels were also raised in urine and serum, as well as in monocyte chemoattractant protein-1 (MCP-1), a mediator of granulomatous inflammation. Injection of HMGB1 worsened renal function and upregulated MCP-1 in rats with crystal-induced granulomatous nephritis. HMGB1 also induced MCP-1 secretion through mitogen-activated protein kinase (MAPK) and phosphoinositide-3-kinase (PI3K) pathways in rat renal tubular epithelial cells in vitro. Hmgb1+/− mice with crystal-induced nephritis displayed reduced MCP-1 expression in the kidneys and in urine and the number of macrophages in the kidneys was significantly decreased. We conclude that HMGB1 is a new mediator involved in crystal-induced nephritis that amplifies granulomatous inflammation in a cycle where MCP-1 attracts activated macrophages, resulting in excessive and sustained HMGB1 release. HMGB1 could be a novel target for inhibiting chronic granulomatous diseases.

Renal granuloma and immunoglobulin M-complex glomerulonephritis: a case of common variable immunodeficiency?

Common variable immunodeficiency (CVID) is characterized by reduced serum immunoglobulin levels and recurrent bacterial infections. Granulomatous infiltrations are occasionally found in the lymphoid or solid organs of affected patients, but renal involvement is rare. We present a case of possible CVID with interstitial noncaseating granuloma and immunoglobulin (IgM)-complex glomerulonephritis with a membranoproliferative pattern and with a favorable response to corticosteroids, intravenously administered immunoglobulins (IVIGs) and rituximab. CVID must be included in the differential diagnosis of renal granuloma and should be differentiated from sarcoidosis to ensure appropriate therapy.