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Glomerular injury in end-stage liver disease — role of circulating IgG and IgM immune complexes

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Abstract

The relationship of IgG- and IgM-bound circulating immune complexes and immune dysfunction to glomerular injury was evaluated in 15 children with end-stage liver disease (ESLD) awaiting liver transplantation. Compared with age-matched controls, children with ESLD had significantly (P<0.01) increased serum IgG, IgA, and IgM levels, as well as IgG- and IgM-bound circulating immune complexes. Furthermore, they showed a significant (P<0.05) depression of C3 and C4 levels compared with controls. Hematuria occurred in 66% of children with ESLD, and the urinary protein/creatinine ratio was also significantly (P<0.01) increased compared with controls (4.65±2.56 vs. 0.16±0.04mg/mg). Light microscopy of renal biopsy tissue obtained from 6 children with ESLD at the time of transplantation demonstrated mesangial proliferation and expansion with basement membrane splitting. This was associated with subendothelial deposits on electron-microscopic examination, compatible with a diagnosis of membranoproliferative glomerulonephritis. By immunofluorescence, deposition of IgG, IgA, and IgM occurred in various combinations with co-deposition of complement fragments. We conclude that membrano-proliferative glomerulonephritis is a common finding in children with ESLD, probably due to entrapment of circulating IgG- and IgM-bound immune complexes.

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Authors and Affiliations

  1. Department of Pediatrics, University of Nebraska Medical Center, 600 South 42nd Street, 68198-2165, Omaha, Nebraska, USA

    Lawrence S. Milner, Mark T. Houser & Dean L. Antonson

  2. Department of Pathology, University of Nebraska Medical Center, Omaha, Nebraska, USA

    Peter C. Kolbeck & Rodney S. Markin

  3. Department of Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA

    Thomas L. McDonald

  4. Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA

    Byers W. Shaw Jr.

Authors
  1. Lawrence S. Milner
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  2. Mark T. Houser
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  3. Peter C. Kolbeck
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  4. Dean L. Antonson
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  5. Thomas L. McDonald
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  6. Rodney S. Markin
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  7. Byers W. Shaw Jr.
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Milner, L.S., Houser, M.T., Kolbeck, P.C. et al. Glomerular injury in end-stage liver disease — role of circulating IgG and IgM immune complexes. Pediatr Nephrol 7, 6–10 (1993). https://doi.org/10.1007/BF00861550

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  • DOI: https://doi.org/10.1007/BF00861550

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