title: Diabetes mellitus associated with rapidly progressive glomerulonephritis with perinuclear antineutrophil cytoplasm antibodies.
abstract: A 55-year-old woman who had been treated for diabetes mellitus for twenty-five years developed interstitial pneumonia and rapidly progressive glomerulonephritis (RPGN). The findings of light microscopy revealed fibrocellular crescent formation in all glomeruli and infiltration of lymphoid cells in interstitium. There were no deposits in the intracapillary area and mesangial area on both immunofluorescence and electron microscopy. Her interstitial pneumonia improved with pulse therapy of methylprednisolone and her hematuria disappeared with mix treatment of cyclophosphamide and double filtration plasmapheresis (DFPP). Her serum creatinine level improved from 2.2 mg/dl to 1.5 mg/dl. Interstitial pneumonia and hematuria did not recur at twelve months after the first hospitalization. This report presents a rare case with RPGN associated with diabetes mellitus who recovered with combination therapy of cyclophosphamide, steroid and DFPP.
authors.affiliation: Department of Internal Medicine, National Sagamihara Hospital, Kanagawa.
authors.forename: Y
authors.initials: Y
authors.lastname: Takeshita
authors.forename: N
authors.initials: N
authors.lastname: Takagi
authors.forename: A
authors.initials: A
authors.lastname: Yamada
authors.forename: T
authors.initials: T
authors.lastname: Aikawa
authors.forename: S
authors.initials: S
authors.lastname: Umemura
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D048909:Diabetes Complications; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005920:Glomerular Mesangium / Q000648:ultrastructure; D005921:Glomerulonephritis / Q000209:etiology* / Q000276:immunology / Q000473:pathology / Q000628:therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D010956:Plasmapheresis; D014057:Tomography, X-Ray Computed
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide