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Nishioka R, Zoshima T, Hara S, Suzuki Y, Ito K, Yamada K, Nakashima A, Tani Y, Kawane T, Hirata M, Mizushima I, Kawano M. Urinary abnormality in mixed connective tissue disease predicts development of other connective tissue diseases and decrease in renal function. Mod Rheumatol 2022; 32:155-162. [PMID: 33706652 DOI: 10.1080/14397595.2021.1899602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To clarify the clinical significance of development of urinary abnormality in mixed connective tissue disease (MCTD). METHODS Forty-one patients with an initial diagnosis of MCTD, followed at five hospitals between April 1, 2000 and December 31, 2013, were included. The relationship between urinary abnormality and various clinical parameters were retrospectively analyzed. Urinary abnormality was defined as proteinuria and/or hematuria detected by urinalysis. Development of other connective tissue diseases (CTDs) was defined as satisfaction of the criteria of each respective disease. RESULTS Of 41 patients (34 females, 7 males, mean age at diagnosis 42.2 ± 15.2 years), 16 developed urinary abnormality (UrA(+) patients). The total incidences of development of other CTDs were higher in the UrA(+) patients than UrA(-) (62.5% versus 16.0%, p = .01). In the comparison between UrA(+) and UrA(-) patients, there were no significant differences in follow-up duration or last determined estimated glomerular filtration rate (eGFR), although eGFR decreased more significantly in the UrA(+) patients than UrA(-). (-20.2 ± 17.2 vs -6.1 ± 13.8 ml/min/1.73m2, p = .01; -21.0 ± 18.9 vs -6.7 ± 14.1%, p = .03). CONCLUSION Urinary abnormality during the clinical course in MCTD is predictive of a higher incidence of developing other CTDs. Furthermore, it might also predict long-term renal prognosis in patients with an initial diagnosis of MCTD.
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Affiliation(s)
- Ryo Nishioka
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takeshi Zoshima
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Satoshi Hara
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Yasunori Suzuki
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Kiyoaki Ito
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Kazunori Yamada
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Akikatsu Nakashima
- Department of Rheumatology and Nephrology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yukiko Tani
- Department of Nephrology, Komatsu Municipal HospitalKomatsu, Japan
| | - Takashi Kawane
- Department of Nephrology, Rheumatology, Infectious Disease Medicine, Toyama Red Cross Hospital, Toyama, Japan
| | - Masayoshi Hirata
- Department of Nephrology, Takaoka City Hospital, Takaokarr, Japan
| | - Ichiro Mizushima
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
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Sato S, Yashiro M, Matsuoka N, Uematsu M, Asano T, Kobayashi H, Watanabe H, Ohira H. Successful Immunosuppressive Treatment of Mixed Connective Tissue Disease Complicated by Microscopic Polyangiitis. TOHOKU J EXP MED 2016; 239:111-6. [DOI: 10.1620/tjem.239.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shuzo Sato
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Makiko Yashiro
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Naoki Matsuoka
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Manabu Uematsu
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
| | - Tomoyuki Asano
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Hiroko Kobayashi
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Hiroshi Watanabe
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Hiromasa Ohira
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
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Yuste C, Rapalai M, Pritchard BA, Jones TJ, Amoasii C, Al-Ansari A, Ramakrishna SB. Overlap between dermatomyositis and ANCA vasculitides. Clin Kidney J 2014; 7:59-61. [PMID: 25859353 PMCID: PMC4389158 DOI: 10.1093/ckj/sft142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/02/2013] [Indexed: 11/13/2022] Open
Abstract
We present the second report of the association between antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis with dermatomyositis (DM). A 47-year-old woman suddenly developed rapidly progressive renal failure in the context of (DM). The kidney biopsy showed focal and segmental necrotizing glomerulonephritis with crescent formation. Cyclophosphamide treatment was commenced resulting in a significant recovery of kidney function and maintenance of recovery at 6 months. Although the pathophysiology is unknown, we hypothesize that CD8-T-deficient cells and MPO+ neutrophils in the DM lesions play an important role in the disease process.
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Nakabayashi K, Fujioka Y, Nagasawa T, Kimura T, Kojima K, Arimura Y, Arimura Y, Yamada A. Dual myeloperoxidase-antineutrophil cytoplasmic antibody- and antiglomerular basement membrane antibody-positive cases associated with prior pulmonary fibrosis: a report of four cases. Clin Exp Nephrol 2011; 15:226-34. [PMID: 21246240 DOI: 10.1007/s10157-010-0390-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Both myeloperoxidase-associated antineutrophil cytoplasmic antibody (MPO-ANCA) and antiglomerular basement membrane antibody (anti-GBM Ab) positivity have been demonstrated in patients with rapidly progressive glomerulonephritis (RPGN), either with or without pulmonary hemorrhage; however, the implications of these antibodies in such patients have not yet been elucidated. The cases with dual positive antibodies were studied clinically, serologically, and pathologically, and the implications of antibodies are discussed here. PATIENTS AND METHODS Four patients with prior pulmonary fibrosis, who subsequently developed RPGN and pulmonary hemorrhage, were studied clinically, serologically, and pathologically. The clinical data were reviewed extensively and the dual positive antibodies were detected by enzyme-linked immunosorbent assays. Pathological studies were performed with a renal biopsy in one patient, a gastric biopsy in another patient, and autopsy materials in the remaining 2 patients. RESULTS All 4 patients had prior pulmonary fibrosis before the symptoms of RPGN when the dual positivity of MPO-ANCA and anti-GBM Ab was detected. Three cases were accompanied by pulmonary hemorrhage around the time of RPGN whereas the remaining case demonstrated pulmonary hemorrhage a few years later. Renal tissue specimens in 3 cases showed circumferential crescents and linear immunoglobulin G deposits along the glomerular capillary loops in glomeruli. Two autopsy specimens revealed vasculitis of the small arteries and arterioles of the kidney, and one of them showed similar vasculitic findings in both the gastrointestinal tract walls and the adipose tissues of the adrenal glands. Additionally, a case with pulmonary hemorrhage occurring after remission was associated with re-elevated MPO-ANCA levels but without anti-GBM Ab positivity. A gastric biopsy was unremarkable and non-contributory for the diagnosis, but this case showed vasculitic symptoms of peripheral neuritis and retinal hemorrhage. Taken together, all 4 cases demonstrated prior pulmonary fibrosis and dual positivity of MPO-ANCA as well as anti-GBM Abs at the time of RPGN, and were associated with either pulmonary hemorrhage or its occurrence thereafter. CONCLUSION Four cases that showed prior pulmonary fibrosis as well as subsequent RPGN and pulmonary hemorrhage were both MPO-ANCA- and anti-GBM Ab-positive at the time of RPGN. The glomeruli disclosed features compatible with anti-GBM Ab disease, but the clinical and pathological vasculitic manifestations, including prior pulmonary fibrosis that might be an early manifestation of ANCA disease, suggested the occurrence of MPO-ANCA-associated vasculitis. Furthermore, 1 case subsequently showed repetitive pulmonary hemorrhage with re-elevated MPO-ANCA positivity but without anti-GBM Ab positivity, and this event was possibly due to MPO-ANCA-associated alveolar capillaritis. As anti-GBM Ab disease is generally thought not to manifest the clinical and pathological features of vasculitis excluding the kidney, MPO-ANCA might be a key factor regarding the occurrence of this dual positive disease.
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Affiliation(s)
- Kimimasa Nakabayashi
- First Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
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Murakami T, Endo S, Moriki T, Doi T, Matsumoto Y. Mixed connective tissue disease developing into MPO-ANCA-positive polyangiitis. Intern Med 2011; 50:591-5. [PMID: 21422684 DOI: 10.2169/internalmedicine.50.3958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Renal involvement of mixed connective tissue disease (MCTD) shows systemic lupus erythematosus (SLE)-like immune complex glomerulonephritis. The prognosis of this condition is generally good. We report the case of an elderly female patient with MCTD who developed autoimmune pleurisy and rapidly progressive glomerulonephritis. Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) was positive with a titer of 59.0 EU. Anti-DNA antibody and complement levels were normal. Renal biopsy revealed crescentic glomerulonephritis and mild mesangial proliferation. However, immunofluorescence examination revealed immune-complex glomerulonephritis. These findings suggest that the renal involvement of MCTD developed concurrently with MPO-ANCA-related glomerulonephritis.
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Affiliation(s)
- Taichi Murakami
- Department of Nephrology, Tokushima University Hospital, Japan.
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Kobayashi S, Inokuma S. Intrapulmonary hemorrhage in collagen-vascular diseases includes a spectrum of underlying conditions. Intern Med 2009; 48:891-7. [PMID: 19483357 DOI: 10.2169/internalmedicine.48.1760] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To elucidate the background and clinical features of intrapulmonary hemorrhage in collagen-vascular diseases (CVD) patients. PATIENTS AND METHODS The charts of collagen-vascular diseases patients who were hospitalized and had intrapulmonary hemorrhages between 1981 and 2006 were retrospectively examined for underlying diseases, clinical and laboratory features, and treatments and outcomes. RESULTS Of 4,017 patients, 11 females aged 52.1+/-12 had total of 17 episodes of diffuse or non-diffuse intrapulmonary hemorrhage. Fourteen episodes of diffuse alveolar hemorrhage (DAH) developed in 4 microscopic polyangiitis (MPA) patients having a high MPO-ANCA level, 4 systemic lupus erythematosus (SLE) patients having a high SLEDAI score, and 1 SLE/MPA patient having a high MPO-ANCA level. Among the 9 DAH patients, 2 had complicated Goodpasture syndrome, 3 had thrombotic thrombocytopenic purpura (TTP), and 1 had disseminated intravascular coagulation. In DAH the peripheral blood hemoglobin level decreased from 9.3+/-2.2 (n=13) to 6.8+/-1.5 g/dL (n=14, p<0.0001) at 0.5+/-0.7 g/dL/day, and the lymphocyte count decreased from 854+/-424 to 462+/-376 /microL. No patient died of DAH, including 1 who spontaneously remitted. The 3 episodes of non-DAH included 2 pulmonary aneurysm ruptures in 1 SLE patient, and 1 thromboembolism that developed in 1 SLE patient who had anti-phospholipid antibody; their SLEDAI scores were low and these remitted spontaneously. CONCLUSION Of intrapulmonary hemorrhage in CVD patients, DAH developed with active MPA or SLE, upon which Goodpasture syndrome or TTP was occasionally superimposed. With DAH, the magnitude of peripheral blood Hb level decrease was approximately 0.5 g/dL/day, and the lymphocyte count decreased. No patient died of DAH.
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Affiliation(s)
- Shoko Kobayashi
- Department of Allergy and Immunological Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo.
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Haraguchi K, Gunji K, Ito Y, Yokomori N, Kawaguchi A, Ohomori M, Inoue H, Shimura H, Saito T, Kobayashi T. Extensive pancreatic necrosis in microscopic polyangiitis. Clin Exp Nephrol 2006; 9:326-331. [PMID: 16362161 DOI: 10.1007/s10157-005-0378-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 08/01/2005] [Indexed: 12/14/2022]
Abstract
We encountered an 84-year-old woman with microscopic polyangiitis who was found to have pancreatitis on autopsy. The patient was admitted to Yamanashi University Hospital because of fever and progressive renal failure. She was diagnosed with anti-myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA)-related microscopic polyangiitis (MPA) and was treated successfully with prednisolone pulse therapy. Two months later, she was found unconscious at home and was transferred to hospital, where she died of cardiac arrest after 6 days. Autopsy revealed systemic vasculitis with fibrinoid necrosis (with the most severe form found in the pancreas), interstitial pneumonia, and crescentic glomerulonephritis. A review of the literature revealed that pancreatic involvement in vasculitis, although rare, is one of the complications of MPA; however, the present study is the first report to focus on the pancreatic involvement of MPA. We recommend that nephrologists consider the possibility of pancreatic involvement in this disease.
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Affiliation(s)
- Kazutaka Haraguchi
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan.
| | - Kazuaki Gunji
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Yuko Ito
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Nobuhiko Yokomori
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Akio Kawaguchi
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Masayuki Ohomori
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Hironobu Inoue
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Hiroki Shimura
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Tsukasa Saito
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
| | - Tetsuro Kobayashi
- Third Department of Internal Medicine, University of Yamanashi, 1110 Tamaho, Nakakoma, Yamanashi, 409-3898, Japan
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Picard C, Parrot A, Mayaud C, Cadranel J. Hémorragies intra-alvéolaires de l’adulte d’origine immunitaire. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)73417-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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