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A Case of Concurrent MPO-/PR3-Negative ANCA-Associated Glomerulonephritis and Membranous Glomerulopathy.

Nakada Y, Tsuboi N, Takahashi Y, Yoshida H, Hara Y, Okonogi H, Kawamura T, Arimura Y, Yokoo T - Case Rep Nephrol (2015)

Bottom Line: A renal biopsy showed crescentic glomerulonephritis, together with marked thickening and spike and bubbling formations in the glomerular basement membranes.Indirect immunofluorescence examination of the patient's neutrophils showed a perinuclear pattern.Enzyme-linked immunosorbent assays revealed that the ANCA in this case did not target myeloperoxidase (MPO) or proteinase 3 (PR3) but bactericidal-/permeability-increasing protein, elastase, and lysosome.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.

ABSTRACT
We report a case in which antineutrophil cytoplasmic antibody- (ANCA-) associated glomerulonephritis and membranous glomerulopathy (MGN) were detected concurrently. The patient showed rapidly progressive renal deterioration. A renal biopsy showed crescentic glomerulonephritis, together with marked thickening and spike and bubbling formations in the glomerular basement membranes. Indirect immunofluorescence examination of the patient's neutrophils showed a perinuclear pattern. Enzyme-linked immunosorbent assays revealed that the ANCA in this case did not target myeloperoxidase (MPO) or proteinase 3 (PR3) but bactericidal-/permeability-increasing protein, elastase, and lysosome. The relationship between these two etiologically distinct entities, MPO-/PR3-negative ANCA-associated glomerulonephritis and MGN, remains unclear.

No MeSH data available.


Related in: MedlinePlus

Indirect immunofluorescence reaction pattern of the patient's serum. (a) Fixed with ethanol, neutrophils showed a perinuclear pattern. (b) Fixed with formalin, neutrophils showed a cytoplasmic pattern.
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fig1: Indirect immunofluorescence reaction pattern of the patient's serum. (a) Fixed with ethanol, neutrophils showed a perinuclear pattern. (b) Fixed with formalin, neutrophils showed a cytoplasmic pattern.

Mentions: The patient was a 70-year-old male with a 20-year history of sick sinus syndrome, for which he had a permanent cardiac pacemaker. He also had a 2-year history of interstitial pneumonia. While under treatment for angina pectoris 2 years before admission, he was found to have kidney dysfunction (serum creatinine, 1.4 mg/dL; blood urea nitrogen, 30 mg/dL; and 4+ protein and 2+ occult blood on urinalysis). In early December 2008, he had orthopnea, which worsened gradually. On December 24, he had a checkup in our hospital and was admitted. The medications he was taking on admission included aspirin, ticlopidine, allopurinol, carvedilol, atorvastatin, and carbocisteine. He was 171 cm tall and weighed 61 kg. His temperature was 37.0°C. His blood pressure was 145/70 mmHg. Lung auscultation revealed bilateral coarse crackles. An abdominal examination was normal. Pretibial pitting edema was evident. Laboratory findings on admission are shown in Table 1. The kidney function test had worsened, compared with 2 years earlier. There were significant hypoalbuminemia and elevation of C-reactive protein. Results of a urinalysis were 3+ positive for protein and 3+ positive for blood, with many red blood cells, 2+ for granular casts, and 1+ for red blood cell casts in the urinary sediment. The amount of proteinuria was 5.12 g/day. Urine culture results were negative on admission. An electrocardiogram showed a ventricular pacing rhythm. A chest X-ray revealed bilateral pleural effusion and pulmonary congestion. MPO and PR3-ANCA were both negative by enzyme-linked immunosorbent assay (ELISA), but P-ANCA was detected by indirect immunofluorescence (IIF; Figure 1). Bactericidal-/permeability-increasing protein (BPI), elastase, and lysozyme antibodies were also positive on ELISA (Wieslab ANCA panel kit) despite negative results for azurocidin, cathepsin G, and lactoferrin.


A Case of Concurrent MPO-/PR3-Negative ANCA-Associated Glomerulonephritis and Membranous Glomerulopathy.

Nakada Y, Tsuboi N, Takahashi Y, Yoshida H, Hara Y, Okonogi H, Kawamura T, Arimura Y, Yokoo T - Case Rep Nephrol (2015)

Indirect immunofluorescence reaction pattern of the patient's serum. (a) Fixed with ethanol, neutrophils showed a perinuclear pattern. (b) Fixed with formalin, neutrophils showed a cytoplasmic pattern.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4306403&req=5

fig1: Indirect immunofluorescence reaction pattern of the patient's serum. (a) Fixed with ethanol, neutrophils showed a perinuclear pattern. (b) Fixed with formalin, neutrophils showed a cytoplasmic pattern.
Mentions: The patient was a 70-year-old male with a 20-year history of sick sinus syndrome, for which he had a permanent cardiac pacemaker. He also had a 2-year history of interstitial pneumonia. While under treatment for angina pectoris 2 years before admission, he was found to have kidney dysfunction (serum creatinine, 1.4 mg/dL; blood urea nitrogen, 30 mg/dL; and 4+ protein and 2+ occult blood on urinalysis). In early December 2008, he had orthopnea, which worsened gradually. On December 24, he had a checkup in our hospital and was admitted. The medications he was taking on admission included aspirin, ticlopidine, allopurinol, carvedilol, atorvastatin, and carbocisteine. He was 171 cm tall and weighed 61 kg. His temperature was 37.0°C. His blood pressure was 145/70 mmHg. Lung auscultation revealed bilateral coarse crackles. An abdominal examination was normal. Pretibial pitting edema was evident. Laboratory findings on admission are shown in Table 1. The kidney function test had worsened, compared with 2 years earlier. There were significant hypoalbuminemia and elevation of C-reactive protein. Results of a urinalysis were 3+ positive for protein and 3+ positive for blood, with many red blood cells, 2+ for granular casts, and 1+ for red blood cell casts in the urinary sediment. The amount of proteinuria was 5.12 g/day. Urine culture results were negative on admission. An electrocardiogram showed a ventricular pacing rhythm. A chest X-ray revealed bilateral pleural effusion and pulmonary congestion. MPO and PR3-ANCA were both negative by enzyme-linked immunosorbent assay (ELISA), but P-ANCA was detected by indirect immunofluorescence (IIF; Figure 1). Bactericidal-/permeability-increasing protein (BPI), elastase, and lysozyme antibodies were also positive on ELISA (Wieslab ANCA panel kit) despite negative results for azurocidin, cathepsin G, and lactoferrin.

Bottom Line: A renal biopsy showed crescentic glomerulonephritis, together with marked thickening and spike and bubbling formations in the glomerular basement membranes.Indirect immunofluorescence examination of the patient's neutrophils showed a perinuclear pattern.Enzyme-linked immunosorbent assays revealed that the ANCA in this case did not target myeloperoxidase (MPO) or proteinase 3 (PR3) but bactericidal-/permeability-increasing protein, elastase, and lysosome.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.

ABSTRACT
We report a case in which antineutrophil cytoplasmic antibody- (ANCA-) associated glomerulonephritis and membranous glomerulopathy (MGN) were detected concurrently. The patient showed rapidly progressive renal deterioration. A renal biopsy showed crescentic glomerulonephritis, together with marked thickening and spike and bubbling formations in the glomerular basement membranes. Indirect immunofluorescence examination of the patient's neutrophils showed a perinuclear pattern. Enzyme-linked immunosorbent assays revealed that the ANCA in this case did not target myeloperoxidase (MPO) or proteinase 3 (PR3) but bactericidal-/permeability-increasing protein, elastase, and lysosome. The relationship between these two etiologically distinct entities, MPO-/PR3-negative ANCA-associated glomerulonephritis and MGN, remains unclear.

No MeSH data available.


Related in: MedlinePlus