AP-VAS 2012 case report: a case of lupus nephritis with predominant synchronous cellular crescent formation and myeloperoxidase-antineutrophil cytoplasmic antibody seropositivity

CEN Case Reports
Tetsuya MakiishiSayako Maeda

Abstract

Several cases with an overlap of antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN) and lupus nephritis (LN) features have been reported in recent years. However, the clinical and the pathologic features of this condition, including mode of development, histology, and response to treatment, are not fully understood. We report a 77-year-old woman who was diagnosed with Sjögren syndrome 15 years previously. The patient presented with acute worsening of renal function and was diagnosed with new-onset systemic lupus erythematosus. A renal biopsy specimen revealed proliferative LN with synchronous cellular crescents. She was also seropositive for myeloperoxidase-ANCA. Together with the positive staining for immunoglobulins and complement factors on immunofluorescence microscopy and scant subendothelial deposits by electron microscopy, we reached a diagnosis of ANCA-associated crescentic GN overlapping with LN. Although immunosuppressive treatment with methylprednisolone pulse therapy and intravenous cyclophosphamide followed by oral predonisolone was initiated, along with intermittent hemodialysis, these treatments did not induce remission of her GN. Therefore, she continued regular intermittent hemodialys...Continue Reading

References

Jan 1, 1997·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·S MarshallV D'Agati
Mar 13, 2003·Kidney International·J Charles Jennette
Jan 14, 2004·Kidney International·Jan J WeeningUNKNOWN Renal Pathology Society Working Group on the Classification of Lupus Nephritis
Apr 30, 2005·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Naveed N MasaniGlen S Markowitz
Aug 9, 2007·JAMA : the Journal of the American Medical Association·Xavier BoschEduard Mirapeix
Feb 22, 2008·Clinical Journal of the American Society of Nephrology : CJASN·Samih H NasrGlen S Markowitz
May 10, 2008·Clinical and Experimental Nephrology·Yuki HiraiTadao Akizawa
Jan 19, 2010·Modern Rheumatology·Shinji MorimotoYoshinari Takasaki
Jan 13, 2011·Clinical and Experimental Nephrology·Motohide IsonoYoshinori Tsujimura

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