title: Rapidly progressive glomerulonephritis with D-penicillamine.
abstract: We present 3 cases of anti-myeloperoxidase, anti-neutrophil cytoplasmic antibody (MPO-ANCA)-positive rapidly progressive glomerulonephritis developed during the treatment with D-penicillamine (D-PC) for rheumatoid arthritis. Rheumatoid arthritis was diagnosed in these patients, and D-PC was administered to them at doses of 100, 200, and 300 mg per day for 32, 42, and 39 months, respectively. They developed proteinuria, hematuria, renal insufficiency, and anemia, and D-PC was stopped. On admission, MPO-ANCA was strongly positive in their sera. Renal biopsy showed glomerulonephritis with cellular crescents. Immunofluorescence examination revealed deposits of granular IgG, IgM, IgA, C1q, and C3 in the mesangium. The 3 patients were treated with steroid pulse therapy along with administration of anticoagulants, and cyclophosphamide was also used in 2 patients. Their renal function improved gradually and MPO-ANCA disappeared after immunosuppressive treatment.
authors.affiliation: Institute of Rheumatology, Tokyo Women's Medical University, Japan. ynn@ior.twmu.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Nanke
authors.forename: H
authors.initials: H
authors.lastname: Akama
authors.forename: C
authors.initials: C
authors.lastname: Terai
authors.forename: N
authors.initials: N
authors.lastname: Kamatani
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis / Q000276:immunology; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010396:Penicillamine / Q000009:adverse effects* / Q000627:therapeutic use; D009195:Peroxidase / Q000032:analysis / Q000276:immunology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D018501:Antirheumatic Agents; D009195:Peroxidase; D010396:Penicillamine