Diffuse proliferative glomerulonephritis associated with dermatomyositis with nephrotic syndrome

Abstract

We described a 44-year-old man developing dermatomyositis (DM) and nephrotic syndrome (NS). Renal biopsy revealed diffuse proliferative glomerulonephritis (DPGN) with depositions of immunoglobulin and complements. A combination therapy of steroid and cyclophosphamide (CTX) was found very effective for the patient. Chronic glomerulonephritis is rare in DM. In our review of related literature, membranous glomerulonephritis (MN) is the main type of glomerular lesion, another type is mesangial proliferative glomerulonephritis (mesPGN). Here we reported a case of DM associated with DPGN developing NS, which was not found in existing literature. Although glomerulonephritis is uncommon in patients with DM, renal pathology is not as simplex as previously thought, and treatment with steroid or/and cytotoxic drugs is favorable for prognosis.

Anti-MDA5 Antibody Dermatomyositis Overlap with Systemic Lupus Erythematosus: A Case Report and Review of the Literature

“…It has been suggested that there are 2 possible mechanisms for renal damage in these patients: tubular disorder related to myoglobulinemia and myoglobinuria and, less frequently, chronic glomerulonephritis. There are also cases reported with membranous and mesangial proliferative glomerulonephritis [11]. …”

Renal involvement in autoimmune connective tissue diseases

“…First, rhabdomyolysis with release of myoglobin can lead to acute tubular necrosis with deterioration of renal function [14,15]. Second, several reports revealed the occurrence of chronic glomerulonephritis in patients with PM/DM [14,46-49]. In PM, mesangial proliferative glomerulonephritis represents the leading glomerular lesion [46,50,51].…”

“…In contrast, the predominant finding in DM with renal involvement is membranous nephropathy [55-57]. Nevertheless, both mesangial proliferative glomerulonephritis [58] and diffuse proliferative glomerulonephritis [49] have been reported in single case reports.…”

“…Moreover, the addition of immunosuppressive drugs, such as azathioprine (AZA) or cyclophosphamide (CYC), as well as anti-malaria medication in DM and methotrexate, CYC, intravenous immunoglobulins and CSA in PM has been reported to improve the renal outcome in DM/PM [14,49,55-58]. In contrast to these reports, one patient progressed to end-stage renal disease despite immunosuppressive treatment [59].…”

Dermatomyositis Sine Myositis with Membranoproliferative Glomerulonephritis

“…Chronic glomerulonephritis is quite rare in dermatomyositis. To date, based on our search, only 8 cases of documented glomerulonephritis have been reported [3–10]. In four cases dermatomyositis and glomerulonephritis developed concurrently and in the rest of cases glomerulonephritis presented 1.5–9 years after the diagnosis of dermatomyositis.…”