Polymyositis associated with focal mesangial proliferative glomerulonephritis with depositions of immune complexes

Abstract

A 58-year-old man concurrently developed polymyositis (PM), interstitial lung disease, and nephrotic-range proteinuria. Renal biopsy revealed focal mesangial proliferative glomerulonephritis (mesPGN) with depositions of immunoglobulin and complements. A combination therapy of corticosteroid, intravenous immunoglobulin, and cyclosporine was found very effective for the patient. Glomerulonephritis associated with PM/dermatomyositis (DM) is rare. In our review of related literature, mesPGN was exclusively observed in polymyositis while membranous nephropathy in DM. The mechanism underlying the association between myositis and glomerulonephritis remains to be elucidated.

The Spectrum of Renal Involvement in Patients With Inflammatory Myopathies

“…In the literature search we retrieved 15 published cases 1 , 3 , 4 , 6 , 9 , 14 , 15 , 21 , 22 , 25 – 29 , 31 of nephropathies documented by kidney biopsy in IM patients (Table 6 ). These cases include IgAN (n = 7), MN (n = 1), membranoproliferative glomerulonephritis (n = 1), pauci-immune crescentic glomerulonephritis (n = 2), minimal change disease (n = 2), focal segmental glomerulosclerosis lesions (n = 1), and acute tubulointerstitial nephritis (n = 1).…”

Nephrotic Syndrome as an Extramuscular Manifestation of Anti-EJ Antibody-Positive Dermatomyositis: A Case Report and Review of the Literature

“…Cases presenting with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis in the context of DM have also been reported [48][49][50]. As pointed out in previous studies [6,25], there is a tendency for mesangial proliferative glomerulonephritis to be more frequently observed in PM, while membranous nephropathy is more frequently observed in the context of DM.…”

“…As for the study by Couvrat-Desvergnes et al, they identified 14 patients who had undergone renal biopsy (6 PM, 5 DM, and 3 ASS), which revealed the presence of glomerulonephritis with various pathologic patterns including immune complex-related glomerulonephritis (n � 4), membranous nephropathy (n � 2), and IgA nephropathy (n � 2) [5]. We conducted an additional literature search and retrieved case reports describing the association of PM or DM with a variety of pathological glomerular lesions, including mesangial proliferative glomerulonephritis [21][22][23][24][25], membranous nephropathy [26][27][28][29][30][31], membranoproliferative glomerulonephritis [32], IgA nephropathy [33][34][35][36][37], diffuse proliferative glomerulonephritis [38], immune complex-type glomerulonephritis [39][40][41][42], acute interstitial nephritis [43], lipoid nephrosis and focal glomerulosclerosis [44], focal segmental glomerulosclerosis with evidence of acute tubular injury [45], sclerotic GN with fibrocellular crescent [46], and crescentic glomerulonephritis associated with malignancy [47]. Cases presenting with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis in the context of DM have also been reported [48][49][50].…”

Case Report: IgA Nephropathy in a Patient With Anti-Transcription Intermediary Factor-1γ Antibody-Positive Dermatomyositis

“…Yen et al (12) reported that 14 out of 65 patients with PM/DM had renal involvement. Takizawa et al (13) reported 21 cases of PM/DM-associated glomerulonephritis confirmed by biopsy. The diagnosis included 12 cases of glomerular proliferative glomerulonephritis, six cases of membranous glomerulonephritis, one case of minimal change g l o m e r u l o n e p h r i t i s a n d t w o c a s e s o f c r e s c e n t i c glomerulonephritis.…”

“…Case reports of PM/DM complicated with IgAN are not common. To date, 11 cases of SAMs with IgAN have been reported previously: two cases of juvenile DM (21,22), two DM (23,24), three PM (25)(26)(27), and four anti-synthetase syndrome (11,13,28). The details of the reported 11 cases are shown in Table 2.…”