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Anti-GBM disease with a mild relapsing course and low levels of anti-GBM autoantibodies.

Segelmark M, Dahlberg P, Wieslander J - Clin Kidney J (2012)

Bottom Line: Here, we report a 71-year-old women diagnosed at a stage of mild renal insufficiency.Over a period of 10 years, she experienced three mild relapses with return of anti-GBM antibodies, haematuria and slight elevations in serum creatinine level.This case shows that long-term follow-up is warranted in patients treated for anti-GBM-mediated disease, but urinary dipsticks may be sufficient for early detection of relapses.

View Article: PubMed Central - PubMed

Affiliation: Division of Drug Research, Department of Medical and Health Sciences , Linköping University , Linköping , Sweden ; Department of Nephrology UHL , County Council of Östergötland , Linköping , Sweden ; Department of Nephrology , Lund University , Lund , Sweden.

ABSTRACT
Anti-glomerular basement membrane disease (anti-GBM) is usually characterized by rapidly progressive glomerulonephritis, and when autoantibody production has ceased, relapses are rare. Here, we report a 71-year-old women diagnosed at a stage of mild renal insufficiency. Over a period of 10 years, she experienced three mild relapses with return of anti-GBM antibodies, haematuria and slight elevations in serum creatinine level. All three relapses responded to immunosuppressive therapy, and all were preceded by peaks of myeloperoxidase-antineutrophil cytoplasm antibodies (MPO-ANCA). This case shows that long-term follow-up is warranted in patients treated for anti-GBM-mediated disease, but urinary dipsticks may be sufficient for early detection of relapses.

No MeSH data available.


Related in: MedlinePlus

The solid line represents levels of anti-GBM antibodies measured by the enzyme-linked immunosorbent assay (ELISA) and expressed in arbitrary ELISA units as indicated by the right vertical axis. The patient exhibited four distinct serological exacerbations separated by intervals with negative tests. The serological relapses coincided with clinical relapses; start (and restart) of immunosuppressive treatment is indicated by arrows. Dotted lines represent MPO-ANCA levels measured by three different ELISA methods. Method* was used until June 2007, then method** was used until November the same year when method***, using international units, was introduced. ELISA units for MPO-ANCA are indicated on the left vertical axis, levels differ between the three assays.
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SFS098F1: The solid line represents levels of anti-GBM antibodies measured by the enzyme-linked immunosorbent assay (ELISA) and expressed in arbitrary ELISA units as indicated by the right vertical axis. The patient exhibited four distinct serological exacerbations separated by intervals with negative tests. The serological relapses coincided with clinical relapses; start (and restart) of immunosuppressive treatment is indicated by arrows. Dotted lines represent MPO-ANCA levels measured by three different ELISA methods. Method* was used until June 2007, then method** was used until November the same year when method***, using international units, was introduced. ELISA units for MPO-ANCA are indicated on the left vertical axis, levels differ between the three assays.

Mentions: She was transferred to the Lund University Hospital, where she received apheresis with Protein A adsorption columns. A renal biopsy showed focal necrotizing glomerulonephritis with crescents in 6 of 16 glomeruli and a typical linear immunofluorescence pattern for IgG, kappa and lambda. After three Protein A sessions, her anti-GBM antibodies were undetectable. She was discharged with oral cyclophosphamide 75 mg per day and prednisolone. After 5 months, the medication was switched to azathioprine 50 mg daily, which was continued for 12 months. Serum creatinine remained stable at a level of 90 µmol/L and anti-GBM antibodies were below the detection limit (Figure 1).Fig. 1.


Anti-GBM disease with a mild relapsing course and low levels of anti-GBM autoantibodies.

Segelmark M, Dahlberg P, Wieslander J - Clin Kidney J (2012)

The solid line represents levels of anti-GBM antibodies measured by the enzyme-linked immunosorbent assay (ELISA) and expressed in arbitrary ELISA units as indicated by the right vertical axis. The patient exhibited four distinct serological exacerbations separated by intervals with negative tests. The serological relapses coincided with clinical relapses; start (and restart) of immunosuppressive treatment is indicated by arrows. Dotted lines represent MPO-ANCA levels measured by three different ELISA methods. Method* was used until June 2007, then method** was used until November the same year when method***, using international units, was introduced. ELISA units for MPO-ANCA are indicated on the left vertical axis, levels differ between the three assays.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400544&req=5

SFS098F1: The solid line represents levels of anti-GBM antibodies measured by the enzyme-linked immunosorbent assay (ELISA) and expressed in arbitrary ELISA units as indicated by the right vertical axis. The patient exhibited four distinct serological exacerbations separated by intervals with negative tests. The serological relapses coincided with clinical relapses; start (and restart) of immunosuppressive treatment is indicated by arrows. Dotted lines represent MPO-ANCA levels measured by three different ELISA methods. Method* was used until June 2007, then method** was used until November the same year when method***, using international units, was introduced. ELISA units for MPO-ANCA are indicated on the left vertical axis, levels differ between the three assays.
Mentions: She was transferred to the Lund University Hospital, where she received apheresis with Protein A adsorption columns. A renal biopsy showed focal necrotizing glomerulonephritis with crescents in 6 of 16 glomeruli and a typical linear immunofluorescence pattern for IgG, kappa and lambda. After three Protein A sessions, her anti-GBM antibodies were undetectable. She was discharged with oral cyclophosphamide 75 mg per day and prednisolone. After 5 months, the medication was switched to azathioprine 50 mg daily, which was continued for 12 months. Serum creatinine remained stable at a level of 90 µmol/L and anti-GBM antibodies were below the detection limit (Figure 1).Fig. 1.

Bottom Line: Here, we report a 71-year-old women diagnosed at a stage of mild renal insufficiency.Over a period of 10 years, she experienced three mild relapses with return of anti-GBM antibodies, haematuria and slight elevations in serum creatinine level.This case shows that long-term follow-up is warranted in patients treated for anti-GBM-mediated disease, but urinary dipsticks may be sufficient for early detection of relapses.

View Article: PubMed Central - PubMed

Affiliation: Division of Drug Research, Department of Medical and Health Sciences , Linköping University , Linköping , Sweden ; Department of Nephrology UHL , County Council of Östergötland , Linköping , Sweden ; Department of Nephrology , Lund University , Lund , Sweden.

ABSTRACT
Anti-glomerular basement membrane disease (anti-GBM) is usually characterized by rapidly progressive glomerulonephritis, and when autoantibody production has ceased, relapses are rare. Here, we report a 71-year-old women diagnosed at a stage of mild renal insufficiency. Over a period of 10 years, she experienced three mild relapses with return of anti-GBM antibodies, haematuria and slight elevations in serum creatinine level. All three relapses responded to immunosuppressive therapy, and all were preceded by peaks of myeloperoxidase-antineutrophil cytoplasm antibodies (MPO-ANCA). This case shows that long-term follow-up is warranted in patients treated for anti-GBM-mediated disease, but urinary dipsticks may be sufficient for early detection of relapses.

No MeSH data available.


Related in: MedlinePlus