T. Ootaka et al., MECHANISM OF INFILTRATION AND ACTIVATION OF GLOMERULAR MONOCYTES MACROPHAGES IN IGA NEPHROPATHY/, American journal of nephrology, 17(2), 1997, pp. 137-145
Glomerular deposits of fibrin-related antigens (FRA), C3c, membrane at
tack complex (MAC) were examined by the immunoperoxidase method on 176
renal biopsy specimens from 120 cases with IgA nephropathy including
56 cases with sequential biopsies. On 47 sets of repeated renal biopsy
specimens, the glomerular infiltration. of the following immune cells
was examined by the indirect immunoperoxidase method; immune cells po
sitive for C3bi receptor (C3biR; CR3/CD11b, CR4/CD11c), HLADR antigen
and several leukocyte surface markers (CD45R, CD3, CD15 and CD68). Twe
nty-four-hour urine protein (UP) at the renal biopsy was also evaluate
d. The glomerular deposition of FRA was inversely correlated with C3c/
MAC deposition (p < 0.00001). Most cases (163 of 176) were classified
into the following two types; type C with dominant deposition of C3c (
97 cases) and type F with dominant deposition of FRA (66 cases), excep
t for 13 cases with equivalent deposits of C3c and FRA (7 cases, type
B) and without C3 or FRA deposits (6 cases, type O). In 56 rebiopsied
cases, apparent conversion from type F or C into the other was observe
d only in one case though a few cases in type C lost or reduced C3c de
position to an equivocal type at the follow-up biopsy, which were incl
uded in type C', an expanded category of type C. In the whole cases, t
he glomerular infiltration of immune cells was significantly correlate
d with FRA deposition (p < 0.0002) but not with C3c. Glomerular CD11c cells were significantly correlated with C3c deposition in type C' (p
< 0.0001), but not in type F. Glomerular HLADR positive immune cells
were significantly correlated with glomerular CD3+ T cells in type F (
p < 0.001), but not in type C'. In type C', UP was significantly corre
lated with glomerular CD11c+ cells (p < 0.0001) but not with CD15+ or
HLADR+ cells. On the other hand, in type F, UP was significantly corre
lated with CD15+ and HLADR+ cells (p < 0.001) but not with CD11c+ cell
s. These results suggested that there are multiple pathways in inducin
g glomerular infiltration of immune cells in IgA nephropathy. In type
C, local activation of complements might primarily induce immune cell
infiltration through C3biR and these C3biR+ cells are involved in indu
cing proteinuria. On the other hand, in type F, in which complement ac
tivation is weak, immune cells might infiltrate directly through their
Fc receptor or MHC class II antigens, and might be activated by T-cel
l/macrophage interaction to induce proteinuria.