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Wang B, Xiaoyu J, Yu X, Cui Z, Zhao M. The clinical and immunological features of the post-extracorporeal shock wave lithotripsy anti-glomerular basement membrane disease. Ren Fail 2021; 43:149-155. [PMID: 33435789 PMCID: PMC7808748 DOI: 10.1080/0886022x.2020.1869042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive modality to treat urolithiasis, with complications including tissue damage and hematoma of kidney parenchyma. Anti-glomerular basement membrane (GBM) disease is suggested to be a rare complication of ESWL since it was reported in several cases to occur after ESWL. However, the clinical and immunological features of the ESWL-associated anti-GBM disease have not been fully investigated so far. Case Presentation Here, we present the clinical, pathological, and immunological characteristics of three patients with the post-ESWL anti-GBM disease in our hospital. Anti-GBM disease occurred within a median of 22 months after ESWL treatment. It presented with similar clinical features to the classic anti-GBM disease, including fever, gross hematuria, and rapidly progressive glomerulonephritis (RPGN) with poor renal prognosis. Sera from all patients recognized the α3(IV)NC1 in GBM, but with IgG2 and IgG4 as the dominant IgG subclasses. Conclusion Although further exploration is required to prove the causal relationship in this rare condition, our study reminds physicians that patients developing acute renal insufficiency after ESWL should lead to the suspicion of anti-GBM disease and in-time diagnosis and treatment.
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Affiliation(s)
- Beining Wang
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Xiaoyu
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojuan Yu
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Minghui Zhao
- Renal Division, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
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Cheungpasitporn W, Zacharek CC, Fervenza FC, Cornell LD, Sethi S, Herrera Hernandez LP, Nasr SH, Alexander MP. Rapidly progressive glomerulonephritis due to coexistent anti-glomerular basement membrane disease and fibrillary glomerulonephritis. Clin Kidney J 2015; 9:97-101. [PMID: 26798468 PMCID: PMC4720204 DOI: 10.1093/ckj/sfv126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/01/2015] [Indexed: 01/01/2023] Open
Abstract
Anti-glomerular basement membrane (anti-GBM) disease is a major cause of rapidly progressive glomerulonephritis (RPGN). On the other hand, fibrillary glomerulonephritis (GN) typically presents as proteinuria, hematuria and renal insufficiency, but rarely as RPGN. Without electron microscopy, the diagnosis of fibrillary GN can be missed. We report a 68-year-old white woman who presented with RPGN with kidney biopsy demonstrating diffuse crescentic GN on light microscopy. By immunofluorescence, there was bright linear staining of the GBMs and smudgy mesangial staining for immunoglobulin G, C3, and kappa and lambda light chain. Electron microscopy revealed fibrillary deposits in the GBM and mesangium. A serum test for anti-GBM antibody was positive. To our knowledge, this is the first report of coexistence of fibrillary GN in a patient with anti-GBM disease. Electron microscopy is critical to identify the coexistence of other GN in patients presenting with crescentic GN.
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Affiliation(s)
| | | | | | - Lynn D Cornell
- Division of Anatomic Pathology , Mayo Clinic , Rochester, MN , USA
| | - Sanjeev Sethi
- Division of Anatomic Pathology , Mayo Clinic , Rochester, MN , USA
| | | | - Samih H Nasr
- Division of Anatomic Pathology , Mayo Clinic , Rochester, MN , USA
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Sugiyama M, Yamada Y, Nozaki Y, Kinoshita K, Funauchi M. Anti-glomerular basement membrane glomerulonephritis after radiotherapy for early prostate cancer. Clin Kidney J 2015; 7:90-1. [PMID: 25859363 PMCID: PMC4389167 DOI: 10.1093/ckj/sft154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Masafumi Sugiyama
- Department of Nephrology , Hashima Municipal Hospital , Hashima-city, Gifu , Japan ; Department of Hematology and Rheumatology , Kinki University Faculty of Medicine , Osakasayama city, Osaka , Japan
| | - Yoshiteru Yamada
- Department of Urology , Hashima Municipal Hospital , Hashima-city, Gifu , Japan
| | - Yuji Nozaki
- Department of Hematology and Rheumatology , Kinki University Faculty of Medicine , Osakasayama city, Osaka , Japan
| | - Koji Kinoshita
- Department of Hematology and Rheumatology , Kinki University Faculty of Medicine , Osakasayama city, Osaka , Japan
| | - Masanori Funauchi
- Department of Hematology and Rheumatology , Kinki University Faculty of Medicine , Osakasayama city, Osaka , Japan
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Takeuchi Y, Takeuchi E, Kamata K. A possible clue for the production of anti-glomerular basement membrane antibody associated with ureteral obstruction and hydronephrosis. Case Rep Nephrol Dial 2015; 5:87-95. [PMID: 25960997 PMCID: PMC4410589 DOI: 10.1159/000381396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Anti-glomerular basement membrane (anti-GBM) antibody-mediated glomerulonephritis (anti-GBM GN) is an autoimmune disease with rapidly progressive glomerulonephritis. Based on a case report of anti-GBM GN following hydronephrosis, we hypothesized that hydronephrosis may act as a trigger for the development of anti-GBM antibodies. Patients and Methods We evaluated 11 patients who were diagnosed with hydronephrosis. It was measured with serum anti-GBM antibody. These patients’ medical histories as well as risk factors for the development of anti-GBM antibodies and causes of hydronephrosis were reviewed. Renal function and hematuria were also considered. The serum anti-GBM antibody was measured with enzyme-linked immunosorbent assays (ELISA) or chemiluminescent enzyme immunoassays (CLEIA). Histopathological findings of renal biopsy specimens were also evaluated. Results No patient had a medical history of renal disease. Five patients had a history of smoking. Ten of the 11 patients had renal dysfunction as evidenced by serum creatinine levels of 0.85–13.8 mg/dl, while 8 patients had RBCs in their urinary sediment at the time of diagnosis for hydronephrosis. Two of the patients assessed by ELISA and CLEIA were positive for anti-GBM antibodies. In 1 of these 3 patients, anti-GBM antibodies and renal dysfunction improved upon treatment for hydronephrosis. Another of the 3 patients developed anti-GBM GN, but anti-GBM antibodies and renal dysfunction improved dramatically upon treatment. In the 3rd patient without improved hydronephrosis, anti-GBM antibodies and renal dysfunction remained unchanged. Conclusion Our results provide insights into the development of anti-GBM antibodies in patients with ureteral obstruction and hydronephrosis.
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Affiliation(s)
- Yasuo Takeuchi
- Division of Nephrology, Department of Internal Medicine, Sagamihara, Japan
| | - Emiko Takeuchi
- Department of Immunology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouju Kamata
- Division of Nephrology, Department of Internal Medicine, Sagamihara, Japan
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Cranfield A, Mathavakkannan S. Goodpasture's disease following extracorporeal shock wave lithotripsy: a case report & literature review. Clin Case Rep 2015; 3:160-4. [PMID: 25838905 PMCID: PMC4377247 DOI: 10.1002/ccr3.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/01/2014] [Accepted: 10/25/2014] [Indexed: 11/12/2022] Open
Abstract
Shock wave lithotripsy may unmask epitopes within the glomerular basement membrane, leading to the formation of anti-glomerular basement membrane (GBM) antibodies and clinical disease in susceptible individuals. Although rare, our case highlights the need for vigilant monitoring of renal function following extracorporeal shock wave lithotripsy. This may allow for early recognition, treatment and improved outcome of anti-GBM disease.
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Birck R, Van Der Woude FJ. [Rapidly progressive glomerulonephritis:classification, pathogenesis and clinical management]. Internist (Berl) 2003; 44:1107-19. [PMID: 14566464 DOI: 10.1007/s00108-003-1025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Rapidly progressive glomerulonephritides (RPGN) belong to a heterogeneous group of inflammatory kidney diseases which are commonly associated with systemic vasculitic syndromes. Renal histology is characterized by necrotizing lesions within the glomerual tuft and extracapillary proliferation, in most cases leading rapidly to renal failure. The etiology and pathogenesis are only partly elucidated. Since irreversible renal scaring develops within days to weeks, RPGN represent a nephrological emergency necessitating urgent diagnostic evaluation and rapid institution of effective therapy. New onset nephritic sediment combined with concomitantly deteriorating excretory renal function should lead to immediate nephrological consultation. Autoimmune serology and particularly renal biopsy are of the utmost importance for rapid diagnosis. Most forms of RPGN are treated with immunosuppressive regimens which generally consist of high dose steroids in combination with the alkylating agent cyclophosphamide. Some forms also require the use of plasma exchange therapy. Rapid diagnosis and early therapy improves both renal and overall outcome in the affected patients.
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Affiliation(s)
- R Birck
- V. Medizinische Klinik-Universitätsklinikum Mannheim, Fakultät für Klinische Medizin der Universität Heidelberg, Mannheim, Germany.
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