Autoimmune cell-mediated tubulointerstitial nephritis induced in Lewis rats by renal antigens

Inter-molecular epitope spreading does not lead to extension of autoimmunity beyond target tissue in autoimmune glomerulonephritis

Inter-molecular epitope spreading during autoimmune pathogenesis leads to generation of new pathogenic epitopes on other autoantigens beyond the original one. It raises an important question as whether autoimmunity extends beyond the target tissues if new epitopes are on the molecules shared with other tissues. This study is aimed addressing this question in a rat anti-glomerular basement membrane (GBM) glomerulonephritis model induced by a T cell epitope of glomerulus-specific collagen4α3. We have demonstrated inter-molecular B cell epitope spreading. Four novel epitopes were first identified by screening a phage display random peptide library against autoantibodies isolated from the GBM of immunized rats. All four epitopes were derived from GBM proteins with three from laminins and one from collagen4α4. Three out of four synthetic peptides were nephritogenic. Importantly, two peptides from lamininα1 and lamininβ1, respectively, induced severe inflammation in glomeruli but not in the interstitial tissues, despite the presence of more abundant laminins in the tubular basement membranes. Our study suggests that surrounding tissues may display a lower or altered susceptibility to autoimmune inflammation. Thus, preventing extension of autoimmune inflammation beyond the original target tissue.

LDL Receptor-Related Protein 2 (Megalin) as a Target Antigen in Human Kidney Anti-Brush Border Antibody Disease

Primary renal tubulointerstitial disease resulting from proximal tubule antigen-specific antibodies and immune complex formation has not been well characterized in humans. We report a cohort of patients with a distinct, underappreciated kidney disease characterized by kidney antibrush border antibodies and renal failure (ABBA disease). We identified ten patients with ABBA disease who had a combination of proximal tubule damage, IgG-positive immune deposits in the tubular basement membrane, and circulating antibodies reactive with normal human kidney proximal tubular brush border. All but one of the patients also had segmental glomerular deposits on renal biopsy specimen. Patients with ABBA disease were elderly and presented with AKI and subnephrotic proteinuria. Serum from all patients but not controls recognized a high molecular weight protein in renal tubular protein extracts that we identified as LDL receptor-related protein 2 (LRP2), also known as megalin, by immunoprecipitation and mass spectrometry. Immunostaining revealed that LRP2 specifically colocalized with IgG in the tubular immune deposits on the ABBA biopsy specimen but not the control specimen analyzed. Finally, ABBA serum samples but not control samples showed reactivity against recombinantly expressed N-terminal LRP2 fragments on Western blots and immunoprecipitated the recombinantly expressed N-terminal region of LRP2. This case series details the clinicopathologic findings of patients with ABBA disease and shows that the antigenic target of these autoantibodies is LRP2. Future studies are needed to determine the disease prevalence, stimulus for ABBA, and optimal treatment.

Tubulointerstitial Renal Diseases of Children: Pathologic Features and Pathogenetic Mechanisms in Fanconi's Familial Nephronophthisis, Antitubular Basement Membrane Antibody Disease, and Medullary Cyst Disease

The renal lesions of 15 children with tubulointerstitial diseases (TID), originally diagnosed as Fanconi's familial nephronophthisis (FFN), medullary cyst disease (MCD), or antitubular basement membrane (TBM) antibody disease were studied by light, electron, and immunofluorescence microscopy and by peroxidase-antiperoxidase stain for IgG. Kidneys originally considered in all three categories showed similar pathologic findings, with periglomerular fibrosis, interstitial fibrosis and infiltration, TBM thickening, and glomerulopathy. The data suggest that MCD and FFN are not synonyms, but that FFN can lead to medullary cystic disease, as can other tubulointerstitial diseases. Anti-TBM disease appears to be a more frequent cause of TID than is usually recognized. Glomerular involvement in TID may be due to deposition of anti-TBM antibody/TBM antigen complexes.

Autoimmune Responses to Tamm-Horsfall Protein in the Pathogenesis of Chronic Pyelonephritis

Although the role of bacterial infection as the major determinant in the development of acute pyelonephritis has been well documented for years, the nature of the renal scarring typical of chronic "atrophic" pyelonephritis has been a matter of controversy for at least three decades. In the past, recurrent bacterial infection of the kidney was thought to be responsible for the pathologic entity of "chronic pyelonephritis." However, more recent studies suggest that recurrent bacteriuria, in the absence of some form of obstructive uropathy, rarely produces chronic pyelonephritis. The close association between vesicoureteral reflex and chronic pyelonephritis has also been firmly established and has been observed to occur frequently in the absence of urinary tract infection. However, the mechanism by which vesicoureteral reflux injures the kidney has not been firmly established. A number of observations have suggested that some normal component of urine, particularly Tamm-Horsfall protein, might serve as an antigenic determinant involved in the immunopathogenesis of renal scarring in vesicoureteral reflux. The present studies were designed to investigate the immunopathogenic role of Tamm-Horsfall protein in a rabbit model of tubulointerstitial nephritis, and in a swine model of reflux nephropathy. The immune responses to Tamm-Horsfall protein in patients with recurrent nephrolithiasis were also examined, as were the antigenic similarities between Tamm-Horsfall protein and protein-containing components of uropathic bacteria. The results of these studies indicate that autoimmune responses to Tamm-Horsfall protein may occur after exposure to Tamm-Horsfall protein by intravenous challenge in rabbits, and by urinary reflux in pigs, as well as in recurrent nephrolithiasis in man.(ABSTRACT TRUNCATED AT 250 WORDS)

T cell receptor BV gene usage in interstitial cellular infiltrates in active Heymann nephritis

BACKGROUND

Infiltration of the kidney by mononuclear cells is a prominent feature of active Heymann nephritis (HN). These cells could be present as a part of generalized inflammatory response, or could be proliferating in response to specific antigens. To examine these questions, we have analysed the T cell receptor (TCR) BV repertoire of T cells infiltrating the renal interstitium at regular time intervals throughout the course of the disease.

METHODS

HN was induced in Lewis rats by immunization with renal tubular antigen (Fx1A) in complete Freund's adjuvant (CFA). Kidneys were collected 8 and 12 weeks after immunization. Renal tissue was homogenized and RNA extracted. RT-PCR and sequencing were used to characterize expression of TCR BV genes.

RESULTS

Preferential expression of TCR BV2 and BV16 gene families was seen at 8 weeks. By 12 weeks the diversity of the TCR BV gene repertoire had increased and was highly heterogeneous. Sequence analysis of BV2, and BV16 RT-PCR products from 8 week HN kidneys revealed conserved usage of CDR3 regions, and an over-representation of arginine residues in the CDR3 regions at a frequency of between 60 and 100% of clones sequenced in most of BV2 and BV16 subfamilies.

CONCLUSION

The preferential usage of CDR3 region sequences in TCR BV2 and BV 16 families indicates clonal expansion of individual T cells in HN kidneys at 8 weeks. The conserved usage of arginine residues in the CDR3 regions may indicate recognition of select antigenic epitopes. By 12 weeks, the diverse TCR BV repertoire in the kidney may be due to epitope spreading or may represent a non-specific inflammatory response in the late phase of the disease.

Self-regulation of autoreactive kidney-infiltrating T cells in MRL-lpr nephritis

MRL-lpr kidney-infiltrating (KI) T cell clones (CD3+, TCR alpha/beta+, B220+, CD4-, CD8-) are autoreactive, exclusively proliferate to renal tissues, and secrete interferon-gamma (IFN-gamma). We now report that IFN-gamma treatment of tubular epithelial cells (TEC) decreases their ability to induce KI T cell proliferation. The decreased ability of IFN-gamma-treated TEC to induce T cell proliferation is evident by 24 hours and can be restored by re-exposure to TEC not treated with IFN-gamma. IFN-gamma-treated TEC supernatant does not diminish KI T cell proliferation and IFN-gamma-treated TEC fixed with glutaraldehyde remain less capable of inducing KI T cell proliferation. Although we have not identified the TEC surface molecule(s) modified by IFN-gamma, neither class I, class II, ICAM-1 nor IFN-gamma bound to the surface of TEC are responsible. In conclusion, IFN-gamma induces a surface alteration(s) on TEC capable of limiting their ability to induce KI T cell proliferation. The ability of autoreactive KI T cells to release IFN-gamma represents a self-regulatory mechanism for limiting T cell expansion.

Cellular immunity in interstitial nephropathy

Inflammatory tubulointerstitial nephritis (TIN), either as a primary or as a secondary event, plays an essential role in the development of all forms of chronic renal failure. Experimental models of TIN should help in understanding TIN in humans. As in experimental glomerulopathies, the target antigen can be a kidney structural antigen, from the tubular basement membrane (TBM) or not, or a foreign antigen. While some models are due to deposits of free antibodies or circulating immune complexes, many others involve cell-mediated immunity. This last aspect explains the importance and the originality of experimental TIN.

Autoreactive kidney-infiltrating T-cell clones in murine lupus nephritis

T-cells have been implicated in autoimmune renal injury. To examine the role of T-cells in lupus nephritis we propagated T-cell clones from the cortical interstitium of MRL/lpr mice. All isolated kidney-infiltrating (KI) T-cell clones [6] express surface markers identical to the T-cells regulated by the lpr gene (Thy 1.2+, TCR alpha/beta +, Lyt-2-, L3T4-, B220+). Although KI T-cell clones have the same surface markers as lymph node-infiltrating (LNI) T-cells, they differ functionally. KI T-cells, but not LNI T-cells, are autoreactive and kidney-specific, exclusively proliferating to renal tubular epithelial (TEC) and mesangial cells. In addition, unlike LNI T-cell supernatants (SN), KI T-cell clones SN induce class II and ICAM-1 on cultured TEC. When KI T-cell clones are injected under the renal capsule, class II is increased on TEC. All clones transcribe mRNA for cytokines capable of inducing class II and ICAM-1 (IL-4, TNF-alpha, IFN-gamma). Anti-IFN-gamma mAb prevents the induction of class II and ICAM-1 on cultured TEC. Since class II and ICAM-1 expression on TEC precedes renal injury, the ability to propagate autoreactive, kidney-specific T-cell clones that induce these molecules provides evidence for their role in initiating renal injury in MRL/lpr mice.

Detection of nephritogenic antigen from the Lewis rat renal tubular basement membrane

Immunopathogenicity of trypsin-solubilized or non-solubilized renal tubular basement membrane (TBM) of the Lewis (LEW) rat was investigated. Autoimmune tubulointerstitial nephritis (TIN) was induced in BALB/c mice by immunization with trypsin-solubilized LEW rat TBM, while immunization with non-solubilized TBM did not produce the disease. Based on this preliminary experiment we studied the characterization of immunogenic and nephritogenic TBM antigen of the LEW rat. TIN was characterized by severe mononuclear cell infiltrates with multi-nucleated giant cells in the interstitium, tubular destruction and intensive IgG and C3 deposits along the TBM. Anti-TBM antisera and eluate from the nephritic mouse kidneys reacted with the TBM of normal LEW rat kidney by immunofluorescence. LEW rat TBM was also detected immunofluorescently by using antisera from BALB/c mice immunized with autologous trypsin-solubilized TBM. A competitive inhibition test revealed a higher titer of anti-TBM antibody in the eluate than in the adsorption-treated antisera per microgram IgG. Immunoblotting showed one reactive band with a molecular weight of 45,000 daltons, and the blotting patterns in tryptic TBM of the Brown Norway (BN) and LEW rats appeared similar. Amino acid analysis of nephritogenic LEW rat tryptic TBM showed that it contained no hydroxyproline and hydroxylysine, suggesting that this TBM preparation was not collagenous. These findings suggest that tryptic digestion contributes to the release of nephritogenic antigen from the LEW rat TBM and that this antigen system might participate in the immune system involved in the anti-TBM associated TIN that is well known to be induced by non-digested TBM of TBM antigen positive animals.

Tubulointerstitial nephritis induced by Tamm-Horsfall protein sensitization in guinea pigs

Experimental tubulointerstitial nephritis (TIN) was induced in guinea pigs by immunization with homologous Tamm-Horsfall protein (THP). This disease was characterized by focal interstitial mononuclear cell infiltration around the distal nephron segments with degeneration of renal tubular cells. Although concomitant granular immunoglobulin deposition on the tubular basement membrane and a rise of serum anti-THP antibodies were recognized, they were related to the severity of the lesion. Lymphocytes from lymph nodes of animals with TIN showed blast transformation in the presence of THP in vitro. Following the transfer of lymphocytes and spleen cells from guinea pigs with THP-induced TIN to nonimmunized animals, the recipient animals developed TIN 7 days later. These observations suggest that TIN induced in guinea pigs by challenge with homologous THP may, at least in part, be related to a cell-mediated immune response.

Spontaneous immune complex orchitis in brown Norway rats

Immune complexes occur spontaneously in the testis of Brown-Norway (BN) inbred rats between the basal lamina of the seminiferous tubules and the outer lamina of the myoid testicular cells. The deposits can be detected immunohistologically (IgG; C3) and by electron microscopy. The immune complexes appear between the 8th and 12th weeks of life, increase in amount up to the 30th week and decrease thereafter. After about the 20th week, of life, 15% of the animals show destruction of the germinal epithelium accompanied by an infiltration of lymphocytes and plasma cells. The final stage of this disease, which initially shows no signs of inflammation, is characterized by diffuse tubular atrophy. However, up to the 70th week of life, 85% of the animals with immune complexes show no pathological alterations. Antibodies eluated from the testes react with spermatocytes I and structures close to the lumen of the seminiferous tubules, but not with mature sperms. Serum antibodies to sperms occur in about 25% of the BN rats, but the presence of these antibodies shows no correlation with the immunohistological findings. This newly described spontaneous immune complex orchitis is regarded as a further example of an in-situ-induced immune complex disease. The observations made here can be compared with those in (peri-) membraneous glomerulonephritis, another example of a disorder resulting from in-situ-formation of immune deposits.

Leflunomide (HWA 486) inhibits experimental autoimmune tubulointerstitial nephritis in rats

Experimental tubulointerstitial nephritis (TIN), induced in Brown Norway rats, is an autoimmune disorder in which afflicted animals display high levels of serum autoantibodies directed against antigens present on the tubular basement membrane (TBM). Serious functional damage, due to lesions of the kidney cortex, is evident 10 days after disease initiation. In an earlier study, we could show that cyclosporin A (CsA), an immunosuppressive drug, effectively prevented the onset of this illness, although it did not inhibit the formation of TBM autoantibodies. In the present study, the protective effects of CsA in autoimmune TIN was compared to those of drugs currently used to combat inflammatory ailments (i.e. prednisolone, indomethacin, naproxen, azathioprine) and a novel immunomodulating agent, leflunomide (HWA 486). Leflunomide is known to specifically inhibit the formation of T-dependent antibodies and is effective in preventing and curing animal autoimmune diseases, i.e. adjuvant arthritis disease of rats and murine lupus-like disorders. We found that not only could leflunomide inhibit TIN, but the drug-effects seemed to be more effective than those of CsA. Further, leflunomide was extremely effective in inhibiting the formation of autoantibodies to TBM, whereas CsA displayed only partial suppression. Neither prednisolone, indomethacin nor naproxen were effective in reducing the autoantibody titer, and did not offer any protection to the development of this disease. Together with the known effects on other autoimmune diseases we conclude that leflunomide is a novel immunointerventive drug protecting against several types of autoimmunity.

Induction, characterization, and cell transfer of autoimmune tubulointerstitial nephritis

Autoimmune tubulointerstitial nephritis (TIN) was induced in Lewis (LEW) rats by immunization with homologous Brown-Norway (BN) rat renal basement membrane (RBM), complete Freund's adjuvant and Bordetella pertussis vaccine. The BN strain has a tubular basement membrane (TBM) antigen (Ag+) detectable by immunofluorescence which is lacking in unmodified LEW rat TBM. Development of TIN in LEW rats correlated with TBM Ag+ immunogens from homologous and heterologous RBM preparations. By day 14 after immunization TIN developed characterized by elevated serum creatinine levels and by tubular destruction with focal, circumscribed lesions containing epithelioid cells, giant cells and mononuclear cell infiltrates. Approximately 60% of the mononuclear cells bore T cell antigens with most cells expressing Ia markers. Immunofluorescence and elution studies revealed no selective IgG fixation to TBM at day 14 despite high titers of circulating alloantibody reactive with the immunizing TBM. Intravenous transfer of LNC and/or splenic cells (3.5 to 7 X 10(8)) to naive LEW rats resulted in less severe but histologically identical TIN in seven days with T cell subpopulations similar to those seen in the active model. This model strongly suggests an initiating role for cell-mediated immunity in TIN in the rat and may provide a parallel to human TIN.

Cyclosporin A inhibits autoimmune experimental tubulointerstitial nephritis

Tubulointerstitial nephritis, regularly induced in Brown Norway rats by autosensitization with tubular basement membranes, appeared acutely at about 10 days and was completely inhibited by Cyclosporin A (CyA) when this was given before and at the time of onset of the disease. It did not recur after the end of therapy. In spite of this disease inhibition, autoantibodies against tubular basement membranes persisted in the circulation and in the kidney. It is therefore suggested that it is not so much the antibodies that are the decisive factors in the pathogenesis of this and other autoimmune diseases but, rather cellular factors that are directly influenced by CyA. Although in this model CyA application was a preventive measure, the experiments provide a cogent reason for the application of CyA as early as possible in acute and seriously damaging diseases.

Leukocyte analysis using monoclonal antibodies in human glomerulonephritis

The leukocyte subpopulations were analyzed within both the glomeruli and the interstitium in renal biopsies from 145 patients with various forms of glomerulonephritis. Cells were identified by monoclonal antibodies to leukocyte cell-surface antigens and immunoperoxidase labelling. Leukocytes, as defined by a monoclonal antibody to the leukocyte common antigen (PHM1), were present in normal, human renal tissue in both glomeruli (2.8 +/- 0.6 cells/glom. cross section) and interstitium (102 +/- 18 cells/mm2). Monocytes constituted the predominant infiltrating cell type in normal glomeruli (1.3 +/- 0.2) and T cells were rarely found (0.3: range 0 to 0.8), whereas both monocytes (34 +/- 10/mm2) and T lymphocytes (33 +/- 14/mm2) were found in the normal interstitium. In the non-proliferative forms of glomerulonephritis there was no significant increase in the number of glomerular inflammatory cells when compared with normal glomeruli. However, significantly increased numbers of T lymphocytes were seen in the interstitium of biopsies with minor non-specific changes (67 +/- 15/mm2), membranous nephropathy (134 +/- 30/mm2), focal glomerulosclerosis (207 +/- 53/mm2), and diabetic nephropathy (198 +/- 81/mm2). In the proliferative forms of glomerulonephritis only crescentic GN and post-infectious GN demonstrated significantly-increased glomerular monocytes and granulocytes. There was no significant increase in the number of glomerular T cells when compared with normal glomeruli. However, there was a significant increase in the number of interstitial T lymphocytes in all forms of proliferative glomerulonephritis when compared with the normal interstitial cell population.(ABSTRACT TRUNCATED AT 250 WORDS)

Histopathologic evaluation of lupus patients with transient renal failure

Patients with lupus nephritis and severe renal failure progress to end-stage renal disease despite aggressive therapy to suppress immunologic function. Within this group is a small subset presenting with rapid progression of renal failure and requiring dialytic support. We reviewed the clinicopathologic data of four such patients who were able to terminate dialysis after acute renal failure due to lupus nephritis. Three of these patients have remained independent of dialysis up to 4 years, and one patient returned to dialysis 1 month following discontinuation. Although glomerular pathology was variable in the four patients, a lesion common to all at presentation was acute tubular necrosis. It is suggested that tubular necrosis may cause reversible renal failure when part of the nephropathy of disseminated lupus treated with corticosteroids.

Induction of multifocal lesions of the testis by passive transfer of immune cells

Spleen cells obtained from Wistar rats bearing a multifocal damage of the testis that had been induced by an antiserum against a non-collagenous fraction of basement membranes, were able to transfer similar testicular lesions into normal recipients. Damage was characterized by multiple foci of seminiferous tubules with different degrees of cell sloughing and a mild interstitial mononuclear cell infiltrate. The incidence of testicular damage in the transferred recipients was 83%, while in the control group of rats transferred with spleen cells from donors that had been injected with normal rabbit serum only 4% of the animals presented mild lesions. In order to determine which lymphocyte subpopulations were effective in transferring the disease, rat spleen cells were treated with murine monoclonal antibodies W3/25 and OX8 or with a rabbit anti-rat IgG serum and complement, before the transfer. A multifocal damage of the testes, indistinguishable from that obtained with the untreated spleen cells was transferred in 50% and 25% of the rats injected with spleen cells depleted in B or in T lymphocytes, respectively. The most severe lesions were observed in the rats transferred with cell populations depleted in B cells.

Cell-mediated immunity in renal disease

It has been shown in experimental models that cell-mediated immunologic mechanisms can lead to glomerular as well as tubulointerstitial renal injury, with or without concomitant antibody-mediated effects. The glomerular lesions are characterized by varying combinations of monocyte and, to a lesser extent, lymphocyte influx, necrosis, and proliferation of intrinsic glomerular cells. The tubulointerstitial lesions have generally been characterized by interstitial infiltrates containing numerous T lymphocytes and, often, numerous macrophages, sometimes with invasion of tubules and tubular cell damage. Although similar renal abnormalities are seen in several human renal diseases, further evidence is obviously required to establish a pathogenetic role for cellular immunity. Analyses of infiltrating mononuclear cells by immunohistochemical methods, with monoclonal antibodies that identify subsets of T cells, have indirectly supported a role for delayed hypersensitivity reactions in tubulointerstitial nephritis resulting from drugs or associated with anti-TBM antibodies, as well as a role for both delayed hypersensitivity and cytolytic lymphocyte effects in renal allografts. However, only with the development of methods that permit the identification of subsets of lymphocytes with unique functions, as well as the identification of the antigen specificity of the cells, will it be possible to understand fully the renal lesions that are now suspected of being cell-mediated.

Unusual transformations of renal involvement in systemic lupus erythematosus

The clinical course of a woman with systemic lupus erythematosus demonstrated that renal involvement in this disease can change, both in the predominant site of renal injury and in the pattern of glomerular lesions. Over 50 months she had first tubulo-interstitial lupus nephritis with no glomerular change, then a membranous nephropathy with disappearance of tubulo-interstitial inflammation, and finally crescentic glomerulonephritis. This case emphasizes the need for close follow-up of all lupus patients regardless of their initial renal manifestations and pathology.

Diphenylhydantoin-induced hypersensitivity reaction with interstitial nephritis

A 10-year-old black girl had an episode of diphenylhydantoin(DPH)-induced exfoliative dermatitis, lymphadenopathy, hepatitis, peripheral eosinophilia, and transient renal failure. The findings of specific lymphocyte sensitization of DPH, a clinically typical delayed hypersensitivity reaction, multinucleated histiocytes in the renal interstitium, and negative renal immunofluorescence studies for immune reactants indicate that the child's renal injury was at least partially cell-mediated.

Idiopathic acute interstitial nephritis: characterization of the infiltrating cells in the renal interstitium as T helper lymphocytes

A previously healthy 39-year-old man presented with acute renal failure. There was no history of exposure to drugs nor was there any infection. Renal biopsy revealed interstitial nephritis with extensive acute degenerative changes in the tubules and extensive interstitial infiltration with mononuclear cells and no eosinophils. Monoclonal antibody staining studies identified the cells in the renal interstitium to be a helper/inducer subset of T lymphocytes. We suggest that a delayed hypersensitivity mechanism played a pathogenetic role in this patient's idiopathic acute interstitial nephritis.

Mononuclear cell subsets in human renal disease. Enumeration in tissue sections with monoclonal antibodies

Mononuclear inflammatory cells (MIC) in renal biopsies from 37 patients with renal disease were studied by avidin--biotin--immunoperoxidase complex (ABC) technique, utilizing monoclonal antibodies to cell surface antigens: T11 (total T), T4 (inducer/helper), T8 (suppressor/cytotoxic), B1 (B cells), M1 (monocytes), and Leu-7 (natural killer, NK cells). Renal MIC consisted mostly of T cells and monocytes. T cells were a predominating cell type in the renal interstitium of all patients studied (64-88% of MIC). The T4:T8 ratios ranged from 0.4 +/- 0.3 (mean +/- SEM) in interstitial nephritis to 2.5 +/- 0.9 in membranous glomerulonephritis. M1+ cells constituted from 10 to 62% of glomerular MIC and from 5 to 24% of interstitial MIC. Glomerular MIC were rare or absent in patients with IgA nephropathy (IgA N). These results support the concept that in situ interactions of T lymphocytes and monocytes may modulate the events leading to the development of human renal disease. The striking absence of glomerular MIC in IgA N could be related to persistence of immune deposits in the glomeruli of patients with this renal disorder.

Immunopathogenesis of chronic pyelonephritis

Immunopathologic responses to urinary Tamm-Horsfall protein in the development of chronic pyelonephritis were examined by four different approaches. First, in a rabbit model, tubulointerstitial nephritis developed in 64 of 102 rabbits injected intravenously with urine or rabbit Tamm-Horsfall protein as compared with only one of 17 rabbits in two control groups. Circulating cytotoxic lymphocytes plus immunoglobulin G (IgG) antibodies against Tamm-Horsfall protein were found in 51 percent of challenged (urine or Tamm-Horsfall protein) rabbits with tubulointerstitial nephritis as compared with only 8 percent of those without it (p less than 0.001). Second, in a porcine model of reflux nephropathy, 16 of 21 pigs with pyelographic findings indicative of reflux had elevated serum titers of anti-Tamm-Horsfall protein antibody as compared with 0 of 13 with normal pyelograms. Five of 10 refluxing pigs tested also had circulating lymphocytes that were cytotoxic in the presence of Tamm-Horsfall protein as compared with 0 of 13 with normal pyelograms. Third, in human studies, 12 of 49 patients with recurrent nephrolithiasis demonstrated abnormal elevations in anti-Tamm-Horsfall protein antibody; 13 of 49 had an abnormality in one of two assays of cell-mediated immunity to Tamm-Horsfall protein as compared with 0 of the normal control subjects. These abnormalities were not associated with overt obstruction or bacteriuria, but appeared to be more common in patients with recent onset and active recurrent nephrolithiasis. Lastly, an inhibitor of the binding reaction between human Tamm-Horsfall protein and its IgG antibody was detected in extracts of three uropathic coliforms. The inhibitors were partially purified by chromatographic means. Preliminary immunoautoradiographic studies revealed three or less protein-containing subunits of Escherichia coli that cross-reacted with anti-Tamm-Horsfall protein antibody. These studies suggest that autoimmune responses to Tamm-Horsfall protein may occur after exposure to Tamm-Horsfall protein by intravenous challenge, urinary reflux, or recurrent nephrolithiasis. This autoimmune response to Tamm-Horsfall protein may be the pathogenetic mechanism by which these factors, including bacteriuria, contribute to chronic pyelonephritis.

Characterization of inflammatory cells in autoimmune tubulointerstitial nephritis in rats

Brown Norway rats immunized with bovine tubular basement membrane (TBM) antigens develop tubulointerstitial nephritis. The composition of the inflammatory cell infiltrate was characterized in kidney tissue sections and cell suspensions obtained from affected kidneys. Anti-TBM antibody deposition in the kidney began 8 days after immunization and was followed on days 8 to 10 by C3 deposits and infiltration of polymorphonuclear leukocytes (PMN). After day 13, the infiltrate became almost exclusively mononuclear in character. On day 13, the inflammatory mononuclear cells recovered by Ficoll-Hypaque centrifugation contained 10% Ig+ cells (B cells), 60% W3/25+ cells (T helper cells), 9% OX8+ cells (T suppressor cells), 9% esterase+ cells (monocytes/macrophages), 4% renal cells, and 8% other unidentified cells. Monocytes/macrophages were prominent only at the latest stages of the disease. The ratio of W3/25+ to OX8+ cells was higher in the kidney than in the spleen or peripheral blood. The sequential accumulation of T cells and then monocytes/macrophages after an initial antibody, complement, and PMN lesion suggests a role for the T cells (selective prevalence of the helper T cell population over that of suppressor T cells) both as inflammatory cells and in progression and regulation of the subsequent stages of injury.

Drug-induced acute interstitial nephritis with granulomas

To shed more light on the immunopathogenesis of drug-induced acute interstitial nephritis, a combined histologic, immunopathologic, and ultrastructural study of renal biopsy specimens from nine patients with drug-induced renal disease was performed. None of the patients had pre-existing renal disease or evidence of sarcoidosis or tuberculosis. The principal drugs included a hydrochlorothiazide-triamterene combination (Dyazide), hydrochlorothiazide, fenoprofen, and furosemide and triamterene. Renal insufficiency developed approximately four to ten weeks after initiation of drug therapy. In all cases, withdrawal of the drug(s) with or without steroid therapy resulted in restoration of normal or near-normal renal function. Histologically, all biopsy specimens showed acute interstitial nephritis characterized by an intense but patchy mononuclear cell interstitial infiltrate consisting of lymphocytes, monocytes, and plasma cells, modest numbers of eosinophils, patchy tubular atrophy, interstitial edema, and normal glomeruli. All biopsy specimens contained interstitial (and, in two cases, perivascular) non-caseating granulomas, which were numerous in one case, moderate in four cases, and rare in the remainder. Direct immunofluorescence was negative for IgG, IgM, IgA, C1q, C4, and C3 along glomerular and tubular basement membranes. Immunoperoxidase staining for lysozyme (performed in three cases) demonstrated many positive cells in the infiltrate. In two cases in which granulomas were present in prepared sections, the epithelioid and multinucleated giant cells did not stain for lysozyme. Electron microscopy of the granulomas in two cases revealed that the epithelioid and giant cells had "secretory" features characteristic of hypersensitivity granulomas. These findings provide further evidence for the participation of cell-mediated immunity in the pathogenesis of at least some cases of drug-induced acute interstitial nephritis.

Antigens of the basement membranes of the seminiferous tubules induce autoimmunity in Wistar rats

A preparation enriched in basement membranes from seminiferous tubules was isolated from rat testes (STBM) and injected with complete Freund's adjuvant into Wistar rats. In 60% of animals a mild multifocal orchitis was observed. In damaged areas, perivascular and peritubular mononuclear cell infiltrates and different degrees of cell sloughing of some seminiferous tubules were observed. Electron microscopy revealed focal thickenings and delamination of the basement membrane of the seminiferous tubules as well as vacuolization of Sertoli cell cytoplasm. Using immunofluorescence discontinuous linear deposits of IgG were detected along the seminiferous tubular wall. Moreover, the same pattern of immunofluorescence was observed when the IgG eluted from the testes of the immunized rats was layered on sections of normal rat testis. Circulating antibodies to STBM were detected using passive haemagglutination in approximately 45% of the immunized rats, with titers ranging from 1:20 to 1:80. Leukocyte migration was inhibited when the spleen cells of the immunized rats were incubated with antigens from the basement membrane of seminiferous tubules, whilst a negative reaction was obtained when the soluble fraction of testis homogenate was used.

Experimental induction of glomerulonephritis mediated by anti-glomerular basement membrane and anti-brush border antibodies in a single rat

This report describes induction of nephritis, which was concurrently mediated by [anti-glomerular basement membrane antibody (anti-GBM) and anti-brush border antibody, in the Wistar rat immunized with a solubilized renal antigen (S-RA). The antigen was prepared by digestion of rat cortical tissue with trypsin and pronase. Ouchterlony test using antisera to the rat GBM and brush border showed that the S-RA contained both antigens. From the S-RA the brush border antigen was isolated by affinity chromatography. At the 8th week rats injected with the S-RA showed a linear or combined linear and granular distribution of rat IgG and C3 along the GBM in immunofluorescence. The capillary granular pattern was only observed at the 16th week. In contrast rats injected with the brush border antigen remained in a capillary granular pattern throughout the experimental course. It was suggested that the rat nephritis injected with the S-RA was mediated by the antibodies capable of reacting with at least two different antigens, namely the GBM and the brush border. The possibility was confirmed by demonstrating the coexistence of these two kinds of antibodies in the serum and kidney eluate from the nephritic rats.

Fenoprofen nephropathy: lipoid nephrosis and interstitial nephritis. A possible T-lymphocyte disorder

Five patients are presented, each of whom had an acute idiosyncratic reaction to fenoprofen calcium (Nalfon) characterized by acute renal failure and marked proteinuria. Renal pathology was similar in all patients. Light microscopy revealed marked lymphocytic inflammatory infiltrates and normal glomeruli. Immunofluorescent staining was minimal or absent. Electron microscopy showed fusion of podocytes in otherwise normal glomeruli. Two patients were studied using T-cell and B-cell specific fluorescent staining, which revealed that the interstitial infiltrates were composed exclusively of T-lymphocytes. This finding is considered in relation to prior experimental and theoretic work. It is suggested that the various clinical and pathologic findings in fenoprofen nephropathy are all manifestations of a disordered cell-mediated immunity.