Organisation of lymphocytic infiltrates in ANCA‐associated glomerulonephritis

Aims Renal involvement in anti‐neutrophil cytoplasmic antibody (ANCA)‐associated vasculitis contributes to significant morbidity and mortality in patients. In chronic inflammation, B cells are recruited to the inflamed tissue and organised lymphoid structures have been described in several autoimmun...

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Published in:Histopathology 2018-06, Vol.72 (7), p.1093-1101
Main Authors: Brix, Silke R, Noriega, Mercedes, Herden, Elisabeth M, Goldmann, Birgit, Langbehn, Ulrike, Busch, Martin, Jabs, Wolfram J, Steinmetz, Oliver M, Panzer, Ulf, Huber, Tobias B, Stahl, Rolf A K, Wiech, Thorsten
Format: Article
Language:English
Subjects:
ANCA‐associated vasculitis
Antineutrophil cytoplasmic antibodies
Atrophy
Autoimmune diseases
Biopsy
crescentic glomerulonephritis
Fibrosis
Glomerulonephritis
Immunosuppressive agents
Inflammation
Lymphocytes B
Lymphocytes T
lymphocytic organisation
Morbidity
Renal failure
Renal function
renal outcome
Vasculitis
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Summary:Aims Renal involvement in anti‐neutrophil cytoplasmic antibody (ANCA)‐associated vasculitis contributes to significant morbidity and mortality in patients. In chronic inflammation, B cells are recruited to the inflamed tissue and organised lymphoid structures have been described in several autoimmune diseases. The aim of this study was to correlate the lymphoid organisation in renal biopsies with renal outcome in ANCA‐associated glomerulonephritis (GN). Methods and results We investigated 112 renal biopsies from patients with newly diagnosed ANCA‐associated necrotising GN. We identified four different levels of the intrarenal organisation of lymphocytes: T cells without B cells, scattered B and T cells, clustered lymphocytic infiltrates and nodular compartmentally arranged B and T cell aggregates. Almost half the patients showed clusters of B and T lymphocytes in their biopsies. In 15 of these biopsies, a higher degree of organisation with lymphocytic compartments was detected. Inflammatory cell organisation was associated with renal failure, but not with tubular atrophy and interstitial fibrosis. Patients with organised lymphocytic infiltrates in their biopsy had worse renal function during follow‐up and were more likely to develop end stage renal disease. Conclusions In the present study, we show that the renal lymphocytic organisation is associated with renal outcome in ANCA‐associated GN. The organisation of the lymphocytic infiltrate may be a morphological correlate of a perpetual and exaggerated inflammation in renal ANCA disease. Classifying the lymphocytic infiltrate could help to predict renal outcome, and might therefore be used for individualised adjustments in the intensity and duration of immunosuppressive therapy.
ISSN:0309-0167
1365-2559
DOI:10.1111/his.13487