The increase of antiglomerular basement membrane antibody following pauci-immune-type crescentic glomerulonephritis.
A 50-year-old woman was admitted because of high fever and fatigue. Proteinuria, hematuria, and elevated BUN (47.8 mg/dl) and creatinine (3.4 mg/dl) suggested rapidly progressive glomerulonephritis. The serological study revealed all negative results for rheumatoid factor, antinuclear antibody, serum cryoglobulins, MPO-ANCA, PR3-ANCA, and anti-streptolysin O. Antiglomerular basement membrane (GBM) antibody, as assessed by ELISA, was 11 EU (normal, <10). Kidney biopsy on the eighth hospital day demonstrated pauci-immune-type crescentic glomerulonephritis without ANCA. Methylprednisolone pulse therapy (500 mg/day, 3 days) and 45 mg/day prednisolone orally were started. At 3 weeks after kidney biopsy, the anti-GBM antibody value increased from 11 EU/ml to 116 EU/ml, and MPO and PR3-ANCA were still negative. HLA type was DR8 and DR 15(2), with a genotype of HLA-DRB1*08021 and HLA-DRB1*15011. The present case suggests that HLA-DR15 plays an important role on antibody production against alpha 3(IV) NC1 autoantigen after severe nephritis or tissue damage.
Kitagawa
Wataru
W
Department of Internal Medicine, Division of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195, Japan.
Miura
Naoto
N
Yamada
Harutaka
H
Nishikawa
Kazuhiro
K
Futenma
Arao
A
Imai
Hirokazu
H
D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000906:Antibodies / Q000097:blood*; D001323:Autoantibodies; D004359:Drug Therapy, Combination; D005260:Female; D005921:Glomerulonephritis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology*; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006684:HLA-DR Antigens / Q000097:blood; D059810:HLA-DR Serological Subtypes; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D011877:Radionuclide Imaging
D000893:Anti-Inflammatory Agents; D000906:Antibodies; D001323:Autoantibodies; D005938:Glucocorticoids; D006684:HLA-DR Antigens; D059810:HLA-DR Serological Subtypes; C106559:HLA-DR15 antigen; C051951:antiglomerular basement membrane antibody; D011239:Prednisolone; D008775:Methylprednisolone