1
|
ANCA-Negative Vasculitis in Eosinophilic Granulomatosis with Polyangiitis Complicated with Membranous Nephropathy: A Case Report and Brief Literature Review. Case Rep Nephrol 2022; 2022:8110940. [PMID: 35573079 PMCID: PMC9106512 DOI: 10.1155/2022/8110940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/20/2022] [Indexed: 01/23/2023] Open
Abstract
Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA) typically occurs in anti-neutrophil cytoplasmic autoantibody (ANCA)-positive cases presenting with rapidly progressive renal insufficiency and urinary abnormalities induced by primarily necrotizing crescentic glomerulonephritis (NCGN). Recently, ANCA-negative EGPA has also been reported to manifest with renal involvement, such as NCGN or non-NCGN, including membranous nephropathy (MN). Herein, we report a 70-year-old female who presented with purpura on the lower legs, upper limb numbness, renal dysfunction (eGFR, 20.5 ml/min/1.73 m2), and eosinophilia (eosinophils, 37,570/μl). MPO-and PR3-ANCA were negative, and urinalysis revealed urine protein (0.63 g/day) but without red blood cells in the urine sediment. Thus, she was diagnosed with ANCA-negative EGPA with rapidly progressive renal dysfunction. A renal biopsy revealed vasculitis in the interlobular arteries without NCGN, with the vasculitis being complicated by MN. Micrograph findings on fluorescence immunostaining contained both primary and secondary characteristics of MN (dominance of IgG subclass 4 more than subclass 1 vs. negativity of PLA2R and THSD7A). After treatment with prednisolone, her eosinophil counts normalized, and renal dysfunction improved. Furthermore, urine protein did not increase above 1.0 g/day during the clinical course. This is a rare case of ANCA-negative EGPA presenting with acute renal dysfunction without NCGN and subclinical MN with unknown etiology. It is important to recognize that EGPA pathology varies widely throughout the disease course, and the clinical course of subclinical MN should be carefully assessed in further follow-ups.
Collapse
|
2
|
Mahmood SB, Ahmad H, Wu J, Haselby D, LeClaire MM, Nasr R. Anti-neutrophil cytoplasmic antibody-positive eosinophilic granulomatosis with polyangiitis: can it cause membranous nephropathy? Scand J Rheumatol 2019; 48:256-257. [PMID: 30907692 DOI: 10.1080/03009742.2019.1580765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S B Mahmood
- a Department of Internal Medicine , Hennepin County Medical Center , Minneapolis , MN , USA
| | - H Ahmad
- a Department of Internal Medicine , Hennepin County Medical Center , Minneapolis , MN , USA
| | - J Wu
- b Department of Internal Medicine, Division of Nephrology , Hennepin County Medical Center , Minneapolis , MN , USA
| | - D Haselby
- b Department of Internal Medicine, Division of Nephrology , Hennepin County Medical Center , Minneapolis , MN , USA
| | - M M LeClaire
- c Department of Internal Medicine, Division of Pulmonary and Critical Care , Hennepin County Medical Center , Minneapolis , MN , USA
| | - R Nasr
- d Department of Internal Medicine Division of Rheumatology , Hennepin County Medical Center , Minneapolis , MN , USA
| |
Collapse
|
3
|
Kanodia K, Vanikar A, Patel R, Suthar K, Nigam L, Kute V, Trivedi H. Membranous Nephropathy With MPO-ANCA-Associated Crescentic GN. Nephrourol Mon 2015; 6:e20701. [PMID: 25738112 PMCID: PMC4330666 DOI: 10.5812/numonthly.20701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/16/2014] [Accepted: 06/26/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction: Antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (GN) is characterized by necrotizing and crescentic GN with paucity of immunoglobulin (Ig) and complement deposition, which is also known as pauci-immune crescentic GN. Membranous nephropathy (MN) is characterized by the formation of subepithelial immune deposit with resultant changes in glomerular basement membrane (GBM), most notably spike formation. Case Presentation: A 48-year-old man presented with marked proteinuria, hypoalbuminemia, and renal dysfunction with positive results for myeloperoxidase (MPO) and ANCA. Renal biopsy revealed crescents and thick GBM with subepithelial spikes along with IgG deposition on immunofluorescent staining. The condition was diagnosed as MN with MPO-ANCA-associated crescentic GN. He was treated with intravenous methylprednisolone and cyclophosphamide. After one-month follow-up, antibody level and renal function did not improve. Conclusions: Coexistence of MN with MPO-ANCA crescentic GN is very rare and should be managed aggressively.
Collapse
Affiliation(s)
- Kamal Kanodia
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedaba, India
- Corresponding author: Kamal Kanodia, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, India. Tel: +91-7922687162; +91-7922687000, Fax: +91-7922685454, E-mail:
| | - Aruna Vanikar
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedaba, India
| | - Rashmi Patel
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedaba, India
| | - Kamlesh Suthar
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedaba, India
| | - Lovelesh Nigam
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedaba, India
| | - Vivek Kute
- Department of Nephrology and Transplantation Medicine, Ahmedabad, India
| | - Hargovind Trivedi
- Department of Nephrology and Transplantation Medicine, Ahmedabad, India
| |
Collapse
|