Ishimori Shingo, Horinouchi Tomoko, Yamamura Tomohiko, Fujimura Junya, Kamiyoshi Naohiro, Kaito Hiroshi, Tanaka Yuriko, Matsukura Hiroyoshi, Shimabukuro Wataru, Shima Yuko, Kawaguchi Azusa, Araki Yoshinori, Nakanishi Koichi, Hara Shigeo, Nozu Kandai
Department of Pediatrics, Takatsuki General Hospital, Takatsuki, Japan.
Department of Pediatrics, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan.
Kidney Int Rep. 2024 Mar 9;9(6):1664-1673. doi: 10.1016/j.ekir.2024.03.003. eCollection 2024 Jun.
The role of iron in, and the prognosis of, pediatric Immunoglobulin A nephropathy (IgAN) with macrohematuria (MH)-induced acute kidney injury (AKI) (MH-AKI) have not been evaluated. Thirty percent of adults with MH-AKI, and especially those who are older, show progression to chronic kidney disease.
We evaluated the immunohistopathologic characteristics of renal biopsy samples from pediatric patients with MH-AKI IgAN and controls, using Berlin Blue to identify iron, CD163 (a hemoglobin-scavenging receptor), and CD68 (a total macrophage marker), then compared the findings against the clinical characteristics of the patients.
We enrolled 44 children as follows: 19 with IgAN but no MH or AKI; 5 with IgAN and MH but no AKI (MHAKI IgAN); 11 with MH-AKI IgAN; and 9 with no IgAN, MH, or AKI, according to a renal biopsy. Berlin Blue staining was detected predominantly at the injured tubulointerstitium, and the areas of staining in children with MHAKI and MH-AKI IgAN were significantly more extensive. The areas of Berlin Blue and CD163 staining did not perfectly match; however, areas of Berlin Blue were surrounded by immunopositivity for CD163. No children with MH-AKI IgAN showed decreased renal function at their last visit.
Children with IgAN and MH, with or without AKI, showed considerable iron deposition in their renal tubules. CD163-positive cells might scavenge hemoglobin in patients with MH-AKI IgAN, but not their roles as macrophages. The renal prognosis of pediatric MH-AKI IgAN is good.
铁在小儿免疫球蛋白A肾病（IgAN）伴肉眼血尿（MH）所致急性肾损伤（AKI）（MH-AKI）中的作用及预后尚未得到评估。30%的成人MH-AKI患者，尤其是年龄较大者，会进展为慢性肾脏病。
我们评估了小儿MH-AKI IgAN患者及对照组肾活检样本的免疫组织病理学特征，使用柏林蓝鉴定铁，使用CD163（一种血红蛋白清除受体）和CD68（一种总巨噬细胞标志物），然后将结果与患者的临床特征进行比较。
我们纳入了44名儿童，如下：根据肾活检结果，19名患有IgAN但无MH或AKI；5名患有IgAN和MH但无AKI（MHAKI IgAN）；11名患有MH-AKI IgAN；9名无IgAN、MH或AKI。柏林蓝染色主要在受损的肾小管间质中检测到，MHAKI和MH-AKI IgAN患儿的染色区域明显更广泛。柏林蓝和CD163染色区域并不完全匹配；然而，柏林蓝区域被CD163免疫阳性所包围。没有MH-AKI IgAN患儿在最后一次就诊时出现肾功能下降。
患有IgAN和MH的儿童，无论有无AKI，其肾小管中均有大量铁沉积。CD163阳性细胞可能在MH-AKI IgAN患者中清除血红蛋白，但并非作为巨噬细胞发挥作用。小儿MH-AKI IgAN的肾脏预后良好。
