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Mesangial proliferation and deposition of immunoglobulins and complement components within glomerular mesangium was one of the important pathological features of lupus nephritis. Autoantibodies against human mesangial cells could be detected in the sera of patients with IgA nephropathy (IgAN) and Henoch-Schöenlein nephritis. We speculated that autoantibodies against human glomerular mesangial cells might play a role in the development of lupus nephritis. Objective. To screen autoantibodies against human glomerular mesangial cells in sera from patients with lupus nephritis and to identify their target antigens. Methods. Sera were collected from 96 patients with lupus nephritis as well as 25 patients with IgAN and 20 patients with idiopathic membranous nephropathy (IMN). Cell lysates of in vitro cultured human glomerular mesangial cells were used as antigens in Western-blot analysis to detect autoantibodies against human mesangial cells in sera from patients with lupus nephritis as well as IgAN and IMN. The clinical and pathological significance of the autoantibodies were further investigated. Results. Autoantibodies against human mesangial cells could be detected in 94/96 (97.9%) of the sera from patients with lupus nephritis in Western-blot analysis. Twelve protein bands could be blotted by the sera from patients with lupus nephritis. The prevalence of autoantibodies against human mesangial cells in IgAN was 14/25 (56.0%) and only seven protein bands could be blotted. Five autoantibodies (anti-18, 24, 36, 46, and 91 kD) could be detected only in sera from patients with lupus nephritis. In patients with lupus nephritis, some autoantibodies might have some relationship with gender, hematuria, ANA, anti-dsDNA or anti-ENA antibodies. Conclusions. There are autoantibodies directly against heterogeneous antigens of human glomerular mesangial cells in sera from patients with lupus nephritis, and some of them might be associated with different clinical manifestations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study the clinical and pathological characteristics of patients with microscopic polyangiitis (MPA) with medium artery involvement. METHODS: Hospitalized patients with MPA in recent two years were retrospectively studied. Their clinical and pathological features were compared between patients with and without renal medium artery involvement. RESULTS: Thirty-nine patients had renal pathology confirmed MPA. Nine cases were with medium artery involvement. For the 30 patients without medium artery involvement, 24/30 had crescentic glomerulonephritis and 11/30 also had focal segmental glomerular fibrinoid necrosis; clinically, 21/30 patients were pANCA/MPO-ANCA positive, 26/30 had acute renal failure with an average duration of 14 weeks before MPA was diagnosed, eight cases achieved complete remission after intensive immunosuppressive therapy. Nine MPA patients had medium artery involvement, manifested as segmental fibrinoid necrosis of major branch of arcuate artery, glomerulus ischemia was predominant, but crescentic lesions were mild, none of them reached crescentic glomerulonephritis. Five of the nine were pANCA/MPO-ANCA positive, eight out of the nine patients had acute renal failure with an average duration of eight weeks before diagnosed, seven of the nine achieved complete remission after intensive immunosuppressive therapy. In comparison, MPA with medium artery involvement had a shorter duration (p < 0.05), less crescentic glomerulonephritis in patients with acute renal failure (p<0.01) and more patients achieved complete remission after treatment (p<0.05). CONCLUSION: In present study, about 23% MPA patients had medium artery involvement and their impaired renal function is mainly due to extensive glomerular ischemia. These patients progressed to acute renal failure quicker and responded to therapy better. [ABSTRACT FROM AUTHOR]