Membranous Nephropathy With MPO-ANCA-Associated Crescentic GN

Nephro-urology Monthly
Kamal KanodiaHargovind Trivedi

Abstract

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. 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. Coexistence of MN with MPO-ANCA crescentic GN is very rare and should be managed aggressively.

References

May 1, 1997·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·W Y TseJ Michael
May 20, 2004·Kidney International·Mark Haas, Joseph A Eustace
Jan 23, 2009·Clinical Journal of the American Society of Nephrology : CJASN·Samih H NasrGlen S Markowitz
Feb 18, 2011·The New England Journal of Medicine·Horia C StanescuRobert Kleta
Sep 10, 2011·Journal of the American Society of Nephrology : JASN·Amanda Walton BasfordAgnes B Fogo
Feb 28, 2014·Indian Journal of Nephrology·R RamK V Dakshinamurty
Dec 1, 2012·Clinical Kidney Journal·Huma FatimaPaisit Paueksakon

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Methods Mentioned

BETA
biopsy
Fluorescence
biopsies

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