[A case of necrotizing crescentic glomerulonephritis in which myeloperoxidase antineutrophil cytoplasmic antibodies (ANCA) reflect the disease activity and recognize various neutrophil cytoplasmic constituents].
This report describes a 50-year-old female with necrotizing crescentic glomerulonephritis (NCGN), associated with antineutrophil cytoplasmic antibodies (ANCA) recognizing various neutrophil cytoplasmic constituents. The patient was admitted to our hospital because of proteinuria. She had been well until seven months before admission, when she experienced fever and arthralgia. Tests for ANCA showed a p-ANCA pattern in indirect immunofluorescence, and high positivity for ANCA against myeloperoxidase (MPO) and lactoferrin in ELISAs. The renal biopsy on admission revealed crescentic glomerulonephritis with segmental necrosis. Therefore, we made the diagnosis of NCGN secondary to ANCA-associated renal disease. The second renal biopsy obtained after a period of 70 days with prednisolone and cyclophosphamide therapy displayed marked improvement indicating the disappearance of cellular crescents and necrosis lesions. Moreover, the levels of MPO-ANCA were correlated with the disease activity. We considered this patient to be a rare case of NCGN with ANCA recognizing various antigens. MPO-ANCA in this case might have been directly associated with the pathogenesis of NCGN.
Fujimoto
T
T
First Department of Internal Medicine, Nara Medical University, Japan.
Kimura
A
A
Ameno
M
M
Shiiki
H
H
Dohi
K
K
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D003593:Cytoplasm / Q000276:immunology; D005260:Female; D005921:Glomerulonephritis / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D009504:Neutrophils / Q000276:immunology; D009195:Peroxidase / Q000276:immunology*
D019268:Antibodies, Antineutrophil Cytoplasmic; D009195:Peroxidase