title: Distribution of IgG subclasses in a biopsy specimen showing membranous nephropathy with anti-glomerular basement membrane glomerulonephritis: an uncharacteristically good outcome with corticosteroid therapy.
abstract: 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.
authors.affiliation: Kidney Center, Department of Pathology, and Health Management Center, Toranomon Hospital, Tokyo, Japan. jhoshino-ind@umin.ac.jp
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Shigeo
authors.initials: S
authors.lastname: Hara
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takaya
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Tagami
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Katori
authors.forename: Fumi
authors.initials: F
authors.lastname: Takemoto
authors.forename: Shigeko
authors.initials: S
authors.lastname: Hara
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: 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
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011239:Prednisolone; D008775:Methylprednisolone