Kidney Week

Abstract: FR-PO0510

Cellular and Molecular Features and Clinical Significance of Tertiary Lymphoid Structures in Diabetic Kidney Disease

Session Information

• CKM: Clinical - Trials, Epidemiology, and Biomarkers
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Lee, Yu ho, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Yu ho Lee, MD, PhD

• Moon, Youngyoon, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Youngyoon Moon, MD, MS

• Jung, Su Woong, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Su Woong Jung, MD, PhD

• Kim, Yang Gyun, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Yang Gyun Kim, MD

• Lee, Sangho, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Sangho Lee, DrMed

• Hwang-Bo, Jeon, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jeon Hwang-Bo, PhD

• Lee, Tae Hoon, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Tae Hoon Lee, PhD

• Lee, Jeong-Yeun, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jeong-Yeun Lee, MD

• Yoon, Soo-Young, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Soo-Young Yoon, MD, PhD

• Kim, Jinsug, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Jinsug Kim, MD

• Hwang, Hyeon Seok, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Hyeon Seok Hwang, MD, PhD

• Jeong, Kyunghwan, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Kyunghwan Jeong, MD, PhD

• Jang, Hye Ryoun, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Moon, Ju young, Kyung Hee University, Dongdaemun-gu, Seoul, Korea (the Republic of)

Ju young Moon, MD, PhD

Background

Tertiary lymphoid structures (TLSs) are inducible ectopic lymphoid tissues that arise in chronic inflammatory conditions. Herein, we investigated the clinical and molecular characteristics of TLSs and their clinical impacts on kidney function decline in patients with diabetic kidney disease (DKD).

Methods

We retrospectively enrolled 180 patients with biopsy-proven DKD. TLSs were defined as T and B cell infiltrations with signs of proliferation, and their stages were classified by the absence (stage I) or the presence (stage II) of follicular dendritic cells. Spatial transcriptomic analysis using the Xenium platform was performed to characterize the cellular and molecular architecture of TLSs.

Results

TLSs were observed in 54.4% of patients with DKD, with stage II TLSs identified in 18.3% of DKD tissues. Patients with stage II TLSs had significantly higher risks of progression to end-stage kidney disease (adjusted hazard ratio, 2.66 and 95% confidence interval, 1.39 to 5.09) than those without. Stage II TLSs were also associated with more severe tubulointerstitial inflammation and fibrosis, but not with the severity of glomerular injury. Spatial transcriptomic analysis revealed that kidney TLSs were enriched with fibroblasts, myofibroblasts, and B cells, with prominent CXCL12 expression in fibroblasts and enhanced stromal–immune interactions within TLS regions. Increases in intra-TLS CXCL12 expression were further confirmed in an independent Visium dataset.

Conclusion

TLSs are prevalent and the presence of stage II TLSs are associated with worse tubulointerstitial injury and rapid decline in kidney function in patients with DKD. CXCL12-expressing fibroblasts and their interactions with B cells represent key features of the TLS microenvironment in DKD.