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Fatima H, Siew ED, Dwyer JP, Paueksakon P. Membranous glomerulopathy with superimposed pauci-immune necrotizing crescentic glomerulonephritis. Clin Kidney J 2012; 5:587-90. [PMID: 26069808 PMCID: PMC4400567 DOI: 10.1093/ckj/sfs145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 09/14/2012] [Indexed: 11/13/2022] Open
Abstract
We describe a 61-year-old woman with acute kidney injury, nephrotic range proteinuria and hematuria. Kidney biopsy showed membranous glomerulopathy (MG) with superimposed pauci-immune necrotizing crescentic glomerulonephritis (PNCGN). Coexistent MG and PNCGN is a rare occurrence. The diagnosis of such an exceptionally rare combination relies on the combination of renal biopsy findings and serologic testing. We also review previous reported cases and discuss possible pathogenesis of this rare dual glomerulopathy.
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Affiliation(s)
- Huma Fatima
- Department of Pathology, Microbiology and Immunology (MCN C2318B) , Vanderbilt University Medical Center , Nashville, TN , USA
| | - Edward D Siew
- Division of Nephrology and Hypertension , Vanderbilt University Medical Center , Nashville, TN , USA
| | - Jamie P Dwyer
- Division of Nephrology and Hypertension , Vanderbilt University Medical Center , Nashville, TN , USA
| | - Paisit Paueksakon
- Department of Pathology, Microbiology and Immunology (MCN C2318B) , Vanderbilt University Medical Center , Nashville, TN , USA
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GEETHA DUVURU, SEO PHILIP, ELLIS CARLA, KUPERMAN MICHAEL, LEVINE STUARTM. Persistent or New Onset Microscopic Hematuria in Patients with Small Vessel Vasculitis in Remission: Findings on Renal Biopsy. J Rheumatol 2012; 39:1413-7. [DOI: 10.3899/jrheum.111608] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective.Hematuria is considered a sign of active renal disease in patients with small-vessel vasculitis. In patients who are in apparent clinical remission, presence of persistent or new-onset microscopic hematuria may reflect active vasculitis, damage, or other glomerular pathology.Methods.We identified 74 patients from the Johns Hopkins Renal Pathology database between 1995 and 2009 with the diagnosis of pauciimmune glomerulonephritis (GN). Among them we identified 9 who were in clinical remission and underwent a renal biopsy for evaluation of persistent or new-onset hematuria.Results.Nine patients with small-vessel vasculitis, 8 antineutrophil cytoplasmic antibody (ANCA)-positive and 1 ANCA-negative, underwent a renal biopsy at variable time periods after remission of vasculitis (6 to 164 months) for persistent microscopic hematuria (n = 6) or new-onset microscopic hematuria (n = 3). All patients were in apparent clinical remission at the time of renal biopsy. Of the 3 patients presenting with new-onset hematuria, 2 had crescentic IgA nephropathy and 1 had healed crescentic pauciimmune GN. Of the 6 patients with persistent hematuria, 2 had arteriosclerosis, 2 had focal segmental glomerulosclerosis, and 2 had global and segmental glomerulosclerosis and healed crescentic GN, and none had active vasculitis.Conclusion.Microscopic hematuria in patients with renal vasculitis otherwise in remission could represent chronic glomerular injury from prior episode of vasculitis or may represent new glomerular pathology. Renal biopsy should be considered in these patients to guide therapy.
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Morizane R, Konishi K, Hashiguchi A, Tokuyama H, Wakino S, Kawabe H, Hayashi M, Hayashi K, Itoh H. MPO-ANCA associated crescentic glomerulonephritis with numerous immune complexes: case report. BMC Nephrol 2012; 13:32. [PMID: 22656245 PMCID: PMC3470990 DOI: 10.1186/1471-2369-13-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/17/2012] [Indexed: 11/30/2022] Open
Abstract
Background Antineutrophil cytoplasmic antibody (ANCA)-associated crescentic glomerulonephritis (CGN) is a major cause of rapidly progressive glomerulonephritis (RPGN). ANCA-associated CGN is generally classified into pauci-immune RPGN, in which there are few or no immune complexes. Case Presentation A 78-year-old man presented with RPGN after a 7-year course of chronic proteinuria and hematuria with stable renal function. A blood examination showed a high titer of myeloperoxidase (MPO)-ANCA. A renal biopsy showed crescentic glomerulonephritis with abundant subepithelial, intramenbranous and subendothelial deposits by electron microscopy, leading to the diagnosis of ANCA-associated CGN superimposed on type 3 membranoproliferative glomerulonephritis (MPGN). Conclusions This case is unique in that type 3 MPGN and MPO-ANCA-associated CGN coexisted, and no similar case has been reported to date. Because ANCA-associated CGN has a predilection for elderly individuals and primary type 3 MPGN is rarely seen in this age group, coincidental existence appears less likely. This case may confer valuable information regarding the link between immune complex and ANCA-associated CGN.
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Affiliation(s)
- Ryuji Morizane
- Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Ronco P, Debiec H. Pathophysiological lessons from rare associations of autoimmune diseases. Clin Kidney J 2012; 5:91-93. [PMID: 29497510 PMCID: PMC5783216 DOI: 10.1093/ckj/sfs016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 02/06/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- Pierre Ronco
- INSERM UMR_S702, AP-HP, Tenon Hospital, Paris, France
- UPMC Univ-Paris 6, Tenon Hospital, Paris, France
- AP-HP, Tenon Hospital, Paris, France
| | - Hanna Debiec
- INSERM UMR_S702, AP-HP, Tenon Hospital, Paris, France
- UPMC Univ-Paris 6, Tenon Hospital, Paris, France
- AP-HP, Tenon Hospital, Paris, France
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57
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Surindran S, Ayalon R, Hasan N, Beck LH, Salant DJ, Barisoni L, Skolnik EY, Beara-Lasic L. Coexistence of ANCA-associated glomerulonephritis and anti-phospholipase A(2) receptor antibody-positive membranous nephropathy. Clin Kidney J 2012. [PMID: 22833809 PMCID: PMC3341840 DOI: 10.1093/ckj/sfr149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Antibodies to myeloperoxidase (MPO) and proteinase 3 (PR3) have been demonstrated to mediate anti-neutrophil cytoplasmic antibody (ANCA)-associated disease. For membranous nephropathy, antibodies to the podocyte-expressed phospholipase A2 receptor (anti-PLA2R) are highly associated with disease activity and have been reported in at least 70% of patients with idiopathic membranous nephropathy (IMN). We present a case of a 56-year-old male with a 1 year history of hypertension, leg edema, and proteinuria, who presented with advanced renal failure and was found to have both ANCA-associated glomerulonephritis (GN) and IMN on kidney biopsy. Consistent with the idea that this is due to the chance occurrence of two independent diseases, we found both anti-MPO and anti-PLA2R antibodies in the patient's sera. Treatment with methylprednisolone, plasmapheresis, and cyclophosphamide resulted in improvement in kidney function and proteinuria, together with the simultaneous decrease in both autoantibodies. This is the first demonstration of two pathogenic antibodies giving rise to ANCA-associated GN and IMN in the same patient. It confirms the importance of classifying disease based upon the underlying mechanism, in addition to renal histopathology, to both optimize therapy and predict prognosis.
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Affiliation(s)
- Sheena Surindran
- Division of Nephrology, Department of Medicine, NYU Langone Medical Center, New York, NY, USA
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58
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Surindran S, Ayalon R, Hasan N, Beck LH, Salant DJ, Barisoni L, Skolnik EY, Beara-Lasic L. Coexistence of ANCA-associated glomerulonephritis and anti-phospholipase A(2) receptor antibody-positive membranous nephropathy. Clin Kidney J 2012; 5:162-165. [PMID: 22833809 DOI: 10.1093/ndtplus/sfr149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 09/14/2011] [Indexed: 11/13/2022] Open
Abstract
Antibodies to myeloperoxidase (MPO) and proteinase 3 (PR3) have been demonstrated to mediate anti-neutrophil cytoplasmic antibody (ANCA)-associated disease. For membranous nephropathy, antibodies to the podocyte-expressed phospholipase A(2) receptor (anti-PLA(2)R) are highly associated with disease activity and have been reported in at least 70% of patients with idiopathic membranous nephropathy (IMN). We present a case of a 56-year-old male with a 1 year history of hypertension, leg edema, and proteinuria, who presented with advanced renal failure and was found to have both ANCA-associated glomerulonephritis (GN) and IMN on kidney biopsy. Consistent with the idea that this is due to the chance occurrence of two independent diseases, we found both anti-MPO and anti-PLA(2)R antibodies in the patient's sera. Treatment with methylprednisolone, plasmapheresis, and cyclophosphamide resulted in improvement in kidney function and proteinuria, together with the simultaneous decrease in both autoantibodies. This is the first demonstration of two pathogenic antibodies giving rise to ANCA-associated GN and IMN in the same patient. It confirms the importance of classifying disease based upon the underlying mechanism, in addition to renal histopathology, to both optimize therapy and predict prognosis.
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Affiliation(s)
- Sheena Surindran
- Division of Nephrology, Department of Medicine, NYU Langone Medical Center, New York, NY, USA
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59
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Couser WG. Basic and translational concepts of immune-mediated glomerular diseases. J Am Soc Nephrol 2012; 23:381-99. [PMID: 22282593 DOI: 10.1681/asn.2011030304] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Genetically modified immune responses to infections and self-antigens initiate most forms of GN by generating pathogen- and danger-associated molecular patterns that stimulate Toll-like receptors and complement. These innate immune responses activate circulating monocytes and resident glomerular cells to release inflammatory mediators and initiate adaptive, antigen-specific immune responses that collectively damage glomerular structures. CD4 T cells are needed for B cell-driven antibody production that leads to immune complex formation in glomeruli, complement activation, and injury induced by both circulating inflammatory and resident glomerular effector cells. Th17 cells can also induce glomerular injury directly. In this review, information derived from studies in vitro, well characterized experimental models, and humans summarize and update likely pathogenic mechanisms involved in human diseases presenting as nephritis (postinfectious GN, IgA nephropathy, antiglomerular basement membrane and antineutrophil cytoplasmic antibody-mediated crescentic GN, lupus nephritis, type I membranoproliferative GN), and nephrotic syndrome (minimal change/FSGS, membranous nephropathy, and C3 glomerulopathies). Advances in understanding the immunopathogenesis of each of these entities offer many opportunities for future therapeutic interventions.
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Affiliation(s)
- William G Couser
- Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
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Ito A, Miura N, Kimura Y, Maeda S, Suzuki K, Kitagawa W, Morita H, Banno S, Imai H. Myeloperoxidase anti-cytoplasmic antibody related crescentic glomerulonephritis in a patient with IgG3λ monoclonal immunoglobulin deposition disease with membranous features. Intern Med 2012; 51:2393-7. [PMID: 22975555 DOI: 10.2169/internalmedicine.51.7900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old woman showed rapidly progressive glomerulonephritis based on the fact that she had 1+ proteinuria (1.1 g/day), a 3+ occult blood reaction, blood urea nitrogen of 32.4 mg/dL, serum creatinine of 2.96 mg/dL, and myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibodies (ANCA) at 52 ELISA Unit (normal range: below 10). A renal biopsy demonstrated a bubbling appearance associated with cellular crescent formation with segmental necrosis. Immunofluorescence studies showed granular IgG3λ deposition along the basement membrane and in the mesangial area. This is the first English-language case report describing MPO-ANCA positive crescentic glomerulonephritis in a patient demonstrating monoclonal immunoglobulin deposition disease with mainly membranous features.
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Affiliation(s)
- Ayano Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Japan
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61
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Etter C, Gaspert A, Regenass S, Wüthrich RP, Kistler T, Kain R, Cohen CD. Anti-hLAMP2-antibodies and dual positivity for anti-GBM and MPO-ANCA in a patient with relapsing pulmonary-renal syndrome. BMC Nephrol 2011; 12:26. [PMID: 21651778 PMCID: PMC3127995 DOI: 10.1186/1471-2369-12-26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 06/08/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pulmonary-renal syndrome associated with anti-glomerular basement membrane (GBM) antibodies, also known as Goodpasture's syndrome, is a rare but acute and life-threatening condition. One third of patients presenting as anti-GBM antibody positive pulmonary-renal syndrome or rapidly progressive glomerulonephritis are also tested positive for anti-neutrophil cytoplasmic antibodies (ANCA). Whilst anti-GBM disease is considered a non-relapsing condition, the long-term course of double-positive patients is less predictable. CASE PRESENTATION We report a patient with such dual positivity, who presented with pulmonary hemorrhage, crescentic glomerulonephritis and membranous nephropathy. Plasmapheresis in combination with immunosuppressive therapy led to a rapid remission but the disease relapsed after two years. The serum of the patient was tested positive for antibodies to human lysosomal membrane protein 2 (hLAMP2), a novel autoantigen in patients with active small-vessel vasculitis (SVV). The anti-hLAMP2 antibody levels correlated positively with clinical disease activity in this patient. CONCLUSION We hypothesize that this antibody may indicate a clinical course similar to ANCA-associated vasculitis in double-positive patients. However, this needs to be confirmed on comprehensive patient cohorts.
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Affiliation(s)
- Christoph Etter
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Ariana Gaspert
- Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Regenass
- Division of Clinical Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Kistler
- Division of Nephrology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Clemens D Cohen
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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Hanamura K, Tojo A, Kinugasa S, Asaba K, Onozato ML, Uozaki H, Fukayama M, Fujita T. Detection of myeloperoxidase in membranous nephropathy-like deposits in patients with anti-neutrophil cytoplasmic antibody–associated glomerulonephritis. Hum Pathol 2011; 42:649-58. [DOI: 10.1016/j.humpath.2010.08.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 08/13/2010] [Accepted: 08/20/2010] [Indexed: 11/30/2022]
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Rodamilans MF, Barros LL, Carneiro MM, dos Santos WLC, Rocha PN. Challenges in clinical-pathologic correlations: acute tubular necrosis in a patient with collapsing focal and segmental glomerulosclerosis mimicking rapidly progressive glomerulonephritis. Ren Fail 2011; 32:1005-8. [PMID: 20722570 DOI: 10.3109/0886022x.2010.501931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Herein, we report a case of acute kidney injury (AKI) due to diarrhea-induced acute tubular necrosis (ATN) in a patient with nephrotic syndrome secondary to biopsy-proven collapsing focal and segmental glomerulosclerosis (FSGS). The clinical picture mimicked rapidly progressive glomerulonephritis (RPGN) and motivated pulse therapy with methylprednisolone and cyclophosphamide. The case presentation is followed by a brief overview of the epidemiology of AKI in nephrotic syndrome as well as a discussion of its risk factors and potential mechanisms involved.
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Affiliation(s)
- Mariana Freire Rodamilans
- Departamento de Medicina, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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64
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Granata A, Floccari F. Membranous glomerulonephritis with superimposed ANCA-associated vasculitis: another case report. NDT Plus 2011; 4:80-1. [PMID: 25984116 PMCID: PMC4421644 DOI: 10.1093/ndtplus/sfq198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 10/21/2010] [Accepted: 10/26/2010] [Indexed: 11/14/2022] Open
Affiliation(s)
- Antonio Granata
- Department of Nephrology and Dialysis , "V. Emanuele" Hospital , Catania , Italy
| | - Fulvio Floccari
- Department of Nephrology and Dialysis , "San Paolo" Hospital , Civitavecchia , Italy
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Nasr SH, Fidler ME, Valeri AM, Cornell LD, Sethi S, Zoller A, Stokes MB, Markowitz GS, D'Agati VD. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol 2010; 22:187-95. [PMID: 21051737 DOI: 10.1681/asn.2010060611] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Postinfectious glomerulonephritis (PIGN) is primarily a childhood disease that occurs after an upper respiratory tract infection or impetigo; its occurrence in older patients is not well characterized. Here, we report 109 cases of PIGN in patients ≥65 years old diagnosed by renal biopsy. The male to female ratio was 2.8:1. An immunocompromised background was present in 61%, most commonly diabetes or malignancy. The most common site of infection was skin, followed by pneumonia and urinary tract infection. The most common causative agent was staphylococcus (46%) followed by streptococcus (16%) and unusual gram-negative organisms. Hypocomplementemia was present in 72%. The mean peak serum creatinine was 5.1 mg/dl, and 46% of patients required acute dialysis. The most common light microscopic patterns were diffuse (53%), focal (28%), and mesangial (13%) proliferative glomerulonephritis. IgA-dominant PIGN occurred in 17%. Of the 72 patients with ≥3 months of follow-up (mean, 29 months), 22% achieved complete recovery, 44% had persistent renal dysfunction, and 33% progressed to ESRD. The presence of diabetes, higher creatinine at biopsy, dialysis at presentation, the presence of diabetic glomerulosclerosis, and greater tubular atrophy and interstitial fibrosis predicted ESRD. In summary, the epidemiology of PIGN is shifting as the population ages. Older men and patients with diabetes or malignancy are particularly at risk, and the sites of infection and causative organisms differ from the typical childhood disease. Prognosis for these older patients is poor, with fewer than 25% recovering full renal function.
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Affiliation(s)
- Samih H Nasr
- Mayo Clinic, Division of Anatomic Pathology, Hilton 10-20, 200 First Street, SW, Rochester, MN 55905, USA.
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Kaneko K, Nanki T, Hosoya T, Mizoguchi F, Miyasaka N. Etanercept-induced necrotizing crescentic glomerulonephritis in two patients with rheumatoid arthritis. Mod Rheumatol 2010; 20:632-6. [PMID: 20617355 DOI: 10.1007/s10165-010-0333-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 06/15/2010] [Indexed: 12/01/2022]
Abstract
We present two patients with rheumatoid arthritis (RA) who developed necrotizing crescentic glomerulonephritis (NCGN) during etanercept therapy. Both patients developed proteinuria and hematuria, and one progressed to renal failure. Renal biopsy revealed NCGN. In both patients, nephritis improved following discontinuation of etanercept and administration of prednisolone. Physicians should be aware of etanercept-induced GN in patients with RA on anti-tumor necrosis factor therapy.
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Affiliation(s)
- Kayoko Kaneko
- Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, Neumann I, Noël LH, Pusey CD, Waldherr R, Bruijn JA, Bajema IM. Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol 2010; 21:1628-36. [PMID: 20616173 DOI: 10.1681/asn.2010050477] [Citation(s) in RCA: 568] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is the most common cause of rapidly progressive glomerulonephritis worldwide, and the renal biopsy is the gold standard for establishing the diagnosis. Although the prognostic value of the renal biopsy in ANCA-associated glomerulonephritis is widely recognized, there is no consensus regarding its pathologic classification. We present here such a pathologic classification developed by an international working group of renal pathologists. Our classification proposes four general categories of lesions: Focal, crescentic, mixed, and sclerotic. To determine whether these lesions have predictive value for renal outcome, we performed a validation study on 100 biopsies from patients with clinically and histologically confirmed ANCA-associated glomerulonephritis. Two independent pathologists, blinded to patient data, scored all biopsies according to a standardized protocol. Results show that the proposed classification system is of prognostic value for 1- and 5-year renal outcomes. We believe this pathologic classification will aid in the prognostication of patients at the time of diagnosis and facilitate uniform reporting between centers. This classification at some point might also provide means to guide therapy.
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Affiliation(s)
- Annelies E Berden
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
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Matsumoto K, Honda H, Shibata T, Sanada D, Wada Y, Ashikaga E, Kuroki A, Kitazawa K, Akizawa T. MPO-ANCA crescentic glomerulonephritis complicated by membranous nephropathy: MPO demonstrated in epimembranous deposits. NDT Plus 2009; 2:461-5. [PMID: 25949380 PMCID: PMC4421330 DOI: 10.1093/ndtplus/sfp112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 07/29/2009] [Indexed: 11/12/2022] Open
Abstract
An elderly woman presented with haematuria and proteinuria accompanied by elevated serum myeloperoxidase (MPO)-specific anti-neutrophil cytoplasmic antibodies (MPO-ANCA). A renal biopsy revealed mild mesangial proliferation with fibrocellular crescent formation and a membranous glomerular lesion. Immunofluorescence microscopy using FITC-labelled rabbit anti-human MPO antibodies revealed granular MPO deposition along the glomerular capillary walls (GCW) with a staining profile similar to that of glomerular IgG deposition. The one-year follow-up renal biopsy revealed minimal IgG and undetectable MPO deposition. Both MPO and MPO-ANCA might have been responsible for the IgG immune depositions along the GCW in this patient.
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Affiliation(s)
- Kei Matsumoto
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Takanori Shibata
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Daisuke Sanada
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Yukihiro Wada
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Eijin Ashikaga
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Aki Kuroki
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Kozo Kitazawa
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine , Showa University School of Medicine , 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666 , Japan
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