Distribution of IgG subclasses in a biopsy specimen showing membranous nephropathy with anti-glomerular basement membrane glomerulonephritis: an uncharacteristically good outcome with corticosteroid therapy.
Few occurrences of anti-glomerular basement membrane glomerulonephritis superimposed on membranous nephropathy have been reported; most reported cases began as membranous nephropathy. Little is known about the etiology, pathogenesis, or immunoglobulin G subclasses in glomerular basement membrane deposits in these combined cases. The authors report the case of an elderly patient with apparently simultaneous onset of both membranous nephropathy and anti-glomerular basement membrane glomerulonephritis who had an excellent outcome with only pulse corticosteroid therapy. Successive renal biopsy specimens showed occurrence and disappearance of immunoglobulin G4 deposits in the glomerular basement membrane. Immunoglobulin G subclass analysis was important in recognizing membranous nephropathy underlying the anti-glomerular basement membrane disease.
Hoshino
Junichi
J
Kidney Center, Department of Pathology, and Health Management Center, Toranomon Hospital, Tokyo, Japan. jhoshino-ind@umin.ac.jp
Hara
Shigeo
S
Ubara
Yoshifumi
Y
Takaya
Hisashi
H
Suwabe
Tatsuya
T
Sawa
Naoki
N
Tagami
Tetsuo
T
Katori
Hideyuki
H
Takemoto
Fumi
F
Hara
Shigeko
S
Takaichi
Kenmei
K
D000368:Aged; D001323:Autoantibodies / Q000032:analysis* / Q000145:classification; D001485:Basement Membrane / Q000276:immunology / Q000473:pathology*; D001706:Biopsy; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis* / Q000145:classification; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007678:Kidney Glomerulus / Q000276:immunology / Q000473:pathology*; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D001323:Autoantibodies; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011239:Prednisolone; D008775:Methylprednisolone