Abstract
A 72-year-old woman exhibited elevated serum myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) levels since 2006. Her serum creatinine (sCr) levels increased from 0.5 to 1.62 mg/dl in a stepwise pattern with proteinuria and hematuria up to January 2011. Renal biopsy indicated global sclerosis (14 %), fibrocellular crescents (28 %), and Swiss cheese-like appearance of the glomerular basement membrane (GBM) on light microscopy. IgG4 staining was negative. Immunofluorescent examination indicated granular staining with IgG and C3 along the GBM. MPO-ANCA-associated glomerulonephritis with membranous nephropathy (MN) was diagnosed. As chronic changes were relatively evident in the renal biopsy specimen without acute augmentation of renal function, immunosuppressive therapy was not administered. Thereafter, rapidly progressive renal dysfunction occurred (sCr, 3.67 mg/dl in May 2011) with proteinuria (~2 g/day), hematuria, and elevated serum MPO-ANCA levels. Therefore, a second renal biopsy was performed in May 2011, indicating global sclerosis (42 %) and cellular crescents (35 %) on light microscopy. Electron microscopy indicated electron-dense deposits in the GBM and mesangial lesions. Steroid therapy was subsequently in...Continue Reading
References
Jan 26, 1989·The New England Journal of Medicine·D C CattranS Ritchie
Jun 1, 1995·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·S L HoganR J Falk
Feb 1, 1993·American Journal of Clinical Pathology·L W GaberC R Cooke
May 1, 1996·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·S M KorbetM M Schwartz
May 1, 1997·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·W Y TseJ Michael
Dec 10, 1997·Internal Medicine·K KanaharaM Yamakido
Jul 21, 1998·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·A A HarrisJ C Jennette
Jun 29, 2002·Journal of the American Society of Nephrology : JASN·Lavanya KameshCaroline O S Savage
Dec 19, 2002·Internal Medicine·Aki KurokiTetsuzo Sugisaki
Mar 4, 2003·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Alenka VizjakDusan Ferluga
Sep 15, 2005·Internal Medicine·Tatsuya SuwabeKenmei Takaichi
Apr 27, 2007·Allergology International : Official Journal of the Japanese Society of Allergology·Shoichi Ozaki
Jan 23, 2009·Clinical Journal of the American Society of Nephrology : CJASN·Samih H NasrGlen S Markowitz
Feb 5, 2011·Human Pathology·Kikuno HanamuraToshiro Fujita
Dec 1, 2009·NDT Plus·Kei MatsumotoTadao Akizawa