MPO-ANCA-positive IgA nephropathy successfully treated with tonsillectomy.
A 20-year-old Japanese woman was admitted to a hospital because of gross hematuria. She was diagnosed with IgA nephropathy with a poor prognosis, based on the formation of many crescents in the glomerulus and monocyte infiltration in the interstitium in a renal biopsy specimen in February 2003. Myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) was not identified at that time. After treatment with high-dose steroid pulse therapy and heparin/warfarin, her urinary protein improved, to 0.5 g/day. However, 1 year after the steroid pulse therapy, urinary protein was increased to 1.2 g/day, associated with repeated episodes of tonsillitis. A second renal biopsy was performed, and showed an improving tendency, compared to the findings of the previous one, although some crescent formation and adhesions of Bowman's capsule remained. Interestingly, MPO-ANCA was positive in the serological examination done at this time. One month and a half after the second renal biopsy, she had a tonsillectomy, followed by a regimen of 5 mg oral prednisolone daily, in order to prevent the progression of IgA nephropathy. After the tonsillectomy, her urinary protein level was markedly improved, at 0.14 g/day. Her creatinine clearance was ameliorated, at 102 ml/min, and in addition, MPO-ANCA had disappeared. This case suggests that an inflammation such as tonsillitis may be associated not only with the activity of IgA nephropathy but also with the production of MPO-ANCA.
Ogawa
Noriko
N
First Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan. noriko.o@med.shimane-u.ac.jp.
Yano
Shozo
S
First Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
Yamane
Yuko
Y
First Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
Nishiki
Masateru
M
First Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
Yamaguchi
Toru
T
First Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
Tsukamoto
Tatsuo
T
Kitano Hospital, Osaka, Japan.
Muso
Eri
E
Kitano Hospital, Osaka, Japan.
Sugimoto
Toshitsugu
T
First Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006417:Hematuria / Q000209:etiology / Q000601:surgery; D006801:Humans; D009195:Peroxidase / Q000276:immunology*; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D014068:Tonsillectomy; D014069:Tonsillitis / Q000150:complications / Q000601:surgery* / Q000821:virology; D016896:Treatment Outcome
D019268:Antibodies, Antineutrophil Cytoplasmic; D005938:Glucocorticoids; D011239:Prednisolone; D009195:Peroxidase