MPO-ANCA crescentic glomerulonephritis complicated by membranous nephropathy: MPO demonstrated in epimembranous deposits

Matsumoto, Keīichi; Honda, Hirokazu; Shibata, Takanori; Sanada, Daisuke; Wada, Yukihiro; Ashikaga, Eijin; Kuroki, Aki; Kitazawa, Kozo; Akizawa, Tadao

doi:10.1093/ndtplus/sfp112

Cited by 13 publications

(12 citation statements)

References 14 publications

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“…In fact, EDDs in the mesangium were observed in 6 of 13 cases in a case series [7] and also in another case report [6]. Although EDDs in the mesangium are frequently observed in lupus nephritis without membranous lesions, they are not generally observed in AAG.…”

Section: Discussionmentioning

confidence: 93%

“…In a case reported by Matsumoto et al, there was MPO deposition along the GCW in the first biopsy, which disappeared in the second biopsy and was accompanied by a decreased MPO-ANCA titer after treatment. They concluded that MPO and MPO-ANCA might have been responsible for the IgG immune depositions along the GCW in their patient [6].…”

Section: Discussionmentioning

confidence: 97%

“…There are some reports of AAG with MN [6][7][8]. In a case reported by Matsumoto et al, there was MPO deposition along the GCW in the first biopsy, which disappeared in the second biopsy and was accompanied by a decreased MPO-ANCA titer after treatment.…”

Section: Discussionmentioning

confidence: 99%

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Antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis with membranous nephropathy treated using thiamazole

et al. 2013

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A 21-year-old woman with nephrotic syndrome was referred to our hospital. She had congenital diaphragmatic hernia, hypoxic ischemic encephalopathy, and mental retardation, and had been treated for hyperthyroidism with thiamazole in another hospital. Serum creatinine was 37.8 lmol/L and antineutrophil cytoplasmic antibody against myeloperoxidase (MPO-ANCA) was 39 EU. Urinalyses were 3? for proteins and 3? for occult blood. A renal biopsy was performed. An examination using light microscopy (LM) revealed necrotizing glomerulonephritis with crescent formation. Immunofluorescence microscopy showed granular staining with immunoglobulin G and complement component 3 along the capillary walls. Electron microscopy (EM) disclosed subepithelial dense deposits. A renal biopsy suggested necrotizing glomerulonephritis with membranous nephropathy (MN) in stages I or II. Since many cases of drug-induced ANCA-associated glomerulonephritis (AAG) have been reported, we stopped thiamazole and treated with corticosteroid. The MPO-ANCA titer became negative 49 days after the initiation of treatment. Two years after the first treatment, the MPO-ANCA titer became elevated again and was 82 EU. The patient was administered cyclophosphamide and prednisone. However, the MPO-ANCA titer did not decrease. A renal biopsy was performed again 3 years after the first renal biopsy. LM revealed no crescentic formation but demonstrated spike formations along the glomerular basement membrane. EM also disclosed subepithelial dense deposits, but less than the first biopsy. The renal biopsy suggested MN in stages II or III. AAG was regarded as inactive after corticosteroid treatment. Therefore, ciclosporin administration was started. In conclusion, we experienced a rare case of AAG complicated with MN. The histopathologic results showed that immunosuppressive therapy seemed to be effective in treating crescentic glomerulonephritis; furthermore, it reduced proteinuria but could not reduce the MPO-ANCA titer.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 97%

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Antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis with membranous nephropathy treated using thiamazole

et al. 2013

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“…MPO, for example, has been shown to co-localize with IgG and C3 along anionic glomerular capillary walls in crescentic AAV with MN [45,46] . However, any significant injury to the GBM theoretically would result in significant pan-glomerular IC which would not be typically seen [40] .…”

Section: Discussionmentioning

confidence: 99%

ANCA Associated Vasculitis Secondary to Levamisole-Adultered Cocaine with Associated Membranous Nephropathy: A Case Series

Collister¹,

Sathianathan²,

Ryz³

et al. 2017

Am J Nephrol

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Background: Cocaine is a risk factor for acute kidney injury and chronic kidney disease with progression to end-stage renal disease. Levamisole is an adulterant that is added to cocaine to enhance its euphoric effects. Levamisole-adulterated cocaine (LAC) is associated with the distinct clinical syndromes of agranulocytosis, leukocytoclastic vasculitis, cocaine-induced midline destructive lesions (CIMDL), and ANCA-associated vasculitis (AAV) with pauci-immune necrotizing glomerulonephritis. Methods: We reviewed all cases of AAV secondary to LAC at our institution. Results: We report 3 cases of AAV secondary to LAC and associated membranous nephropathy (MN). The first and second cases are concurrent AAV secondary to LAC and associated MN while the third case involves the development of MN after AAV secondary to LAC. Conclusions: Clinicians should be aware of this novel association of LAC with MN.

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“…Matsumoto et al reported an interesting hypothesis that MPO demonstrated in epimembranous deposits (this lesion is anionic) is highly cationic. Because BPI, elastase, and lysozyme are all cationic, ANCAs for these minor antigens might be related to the formation of immune complexes [ 15 ]. Because of the lack of renal biopsy material, we were unable to demonstrate the presence of epimembranous deposits composed of ANCAs including BPI, elastase, and/or lysozyme, which might have revealed a correlation between ANCA-associated vasculitis and MGN in this case.…”

Section: Discussionmentioning

confidence: 99%

A Case of Concurrent MPO-/PR3-Negative ANCA-Associated Glomerulonephritis and Membranous Glomerulopathy

Nakada

Tsuboi

Takahashi

et al. 2015

Case Reports in Nephrology

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We report a case in which antineutrophil cytoplasmic antibody- (ANCA-) associated glomerulonephritis and membranous glomerulopathy (MGN) were detected concurrently. The patient showed rapidly progressive renal deterioration. A renal biopsy showed crescentic glomerulonephritis, together with marked thickening and spike and bubbling formations in the glomerular basement membranes. Indirect immunofluorescence examination of the patient's neutrophils showed a perinuclear pattern. Enzyme-linked immunosorbent assays revealed that the ANCA in this case did not target myeloperoxidase (MPO) or proteinase 3 (PR3) but bactericidal-/permeability-increasing protein, elastase, and lysosome. The relationship between these two etiologically distinct entities, MPO-/PR3-negative ANCA-associated glomerulonephritis and MGN, remains unclear.

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MPO-ANCA crescentic glomerulonephritis complicated by membranous nephropathy: MPO demonstrated in epimembranous deposits

Cited by 13 publications

References 14 publications

Antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis with membranous nephropathy treated using thiamazole

Antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis with membranous nephropathy treated using thiamazole

ANCA Associated Vasculitis Secondary to Levamisole-Adultered Cocaine with Associated Membranous Nephropathy: A Case Series

A Case of Concurrent MPO-/PR3-Negative ANCA-Associated Glomerulonephritis and Membranous Glomerulopathy

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