TUBULOINTERSTITIAL NEPHRITIS WITH IGM-POSITIVE PLASMA CELLS SUCCESSFULLY TREATED WITH CYCLOSPORINE MONOTHERAPY: A CASE REPORT

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TUBULOINTERSTITIAL NEPHRITIS WITH IGM-POSITIVE PLASMA CELLS SUCCESSFULLY TREATED WITH CYCLOSPORINE MONOTHERAPY: A CASE REPORT

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Co-author 1

Shuntaro Kita kyokui150031@gmail.com Asahikawa Medical University Division of Cardiology and Nephrology, Department of Internal Medicine Asahikawa Japan *

Co-author 2

Momoko Nambu moco@asahikawa-med.ac.jp Asahikawa Medical University Division of Cardiology and Nephrology, Department of Internal Medicine Asahikawa Japan -

Co-author 3

Saeko Uchida-Miura saekou@asahikawa-med.ac.jp Kitasaito Hospital Department of Internal Medicine Asahikawa Japan -

Co-author 4

Reina Suetsugu-Ishizawa kyokui120084@gmail.com Asahikawa Medical University Division of Cardiology and Nephrology, Department of Internal Medicine Asahikawa Japan -

Co-author 5

Megumi Matsumoto kyokui110100@gmail.com Asahikawa Medical University Division of Cardiology and Nephrology, Department of Internal Medicine Asahikawa Japan -

Co-author 6

Hirofumi Sakuma hsakuma210@asahikawa-med.ac.jp Asahikawa Medical University Division of Cardiology and Nephrology, Department of Internal Medicine Asahikawa Japan -

Co-author 7

Motoki Matsuki motoki@asahikawa-med.ac.jp Asahikawa Medical University Division of Cardiology and Nephrology, Department of Internal Medicine Asahikawa Japan -

Co-author 8

Naoki Takahashi ntakahas@u-fukui.ac.jp University of Fukui Hospital Department of Clinical Laboratory Fukui Japan - University of Fukui Department of Nephrology, Faculty of Medical Sciences Fukui Japan

Co-author 9

Tadashi Toyama ttoyama@u-fukui.ac.jp University of Fukui Hospital Department of Clinical Laboratory Fukui Japan - University of Fukui Department of Nephrology, Faculty of Medical Sciences Fukui Japan

Co-author 10

Naoki Nakagawa naka-nao@asahikawa-med.ac.jp Asahikawa Medical University Division of Cardiology and Nephrology, Department of Internal Medicine Asahikawa Japan -

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Tubulointerstitial nephritis (TIN) with IgM-positive plasma cells (IgMPC-TIN) is an inflammatory disease characterized by the infiltration of IgM and CD138 dual-positive plasma cells into the renal interstitium. Although steroid treatment is effective in many cases of IgMPC-TIN, we report the case of a patient with IgMPC-TIN that managed with cyclosporine monotherapy.

Methods

Case report that was presented at Asahikawa Medical University hospital.

Results

58-year-old woman was diagnosed with primary biliary cirrhosis by liver biopsy due to liver dysfunction and positive anti-mitochondrial M2 antibody in 2019. Although her liver function remained stable with conservative treatment, proteinuria was detected in 2022. In 2023, the patient was referred to the Nephrology Department of our hospital for persistent proteinuria. The patient’s vital signs were unremarkable, and physical examination revealed dry eyes. Upon admission, urinalysis revealed proteinuria and glucosuria without hematuria or monoclonal proteins. Laboratory findings showed serum creatinine of 1.07 mg/dL, estimated glomerular filtration rate (eGFR) 41.9 ml/min/1.73m2, hypokalemia (serum potassium of 2.8 mEq/L), hypouricemia (serum uric acid of 1.5 mg/dL), and metabolic acidosis. Serological workup revealed positivity for antinuclear antibodies and anti-SS-A antibodies, with elevated IgM levels (970.6 mg/dL). Renal biopsy revealed severe infiltration of IgMPC in the renal interstitium without glomerular abnormalities, leading to a diagnosis of IgMPC-TIN. Based on the ophthalmological findings, the patient was diagnosed with Sjogren's syndrome. Because she refused steroid treatment, monotherapy with cyclosporine (100 mg/day) was initiated. Following treatment, proteinuria decreased from 1.26 g/gCr to 0.33 g/gCr, renal function improved as evidenced by a decrease in serum creatinine of 1.07 to 0.78 mg/dL, and an increase in the eGFR from 41.9 to 58.7 ml/min/1.73 m² and glucosuria resolved. Her disease activity was managed well with cyclosporine monotherapy without steroid treatment.

Conclusion

Cyclosporine monotherapy might stabilize the disease activity in a patient with IgMPC-TIN.

Kewords