title: [ANCA-related glomerulonephritis in an aged patient with diabetes mellitus successfully released from hemodialysis by low dose steroid therapy: a case report].
abstract: A 86-year-old man had been treated for hypertension, diabetes mellitus (DM), and dyslipidemia in Nihonkoukan Hospital. His renal function was within the normal range in August 2007. He showed common cold-like symptoms, which were not improved by anti-inflammatory drugs in December 2007. He was admitted to our hospital because of renal failure, urine protein and urine occult blood. He was also positive for anti-myeloperoxidase antibody (MPO-ANCA; 129 IU/mL). A renal biopsy revealed idiopathic crescentic glomerulonephritis of the pauci immune type. Considering his advanced age and DM, he was treated with the low dose of 20 mg/day of prednisolone. Although his symptoms, such as low grade fever and general fatigue, were improved after steroid therapy, renal failure accelerated, necessitating hemodialysis (HD), and insulin administration was needed for his DM. Subsequently, an AV fistule operation for HD was performed. Prednisolone was tapered to 17.5 mg/day after 4 weeks, and his MPO-ANCA titer decreased to 87 IU/mL. After steroid treatment and HD, his condition gradually recovered and he was discharged on March 5, 2008. Following about 6 months of treatment with prednisolone (3.5 months after HD administration), his renal function gradually recovered, allowing the discontinuation of HD. High-dose steroid therapy is very effective for ANCA-related glomerulonephritis. However, there is a high risk of infection, especially in aged and DM patients. Low-dose steroid therapy (PSL 20 mg/day) is safe and effective in such high-risk patients and in some cases, they can be released from HD.
authors.affiliation: Department of Internal Medicine, Nihonkoukan Hospital, Kanagawa, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kawamoto
mesh_terms: D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D048909:Diabetes Complications / Q000188:drug therapy; D004334:Drug Administration Schedule; D005921:Glomerulonephritis / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D009195:Peroxidase / Q000276:immunology; D011239:Prednisolone / Q000008:administration & dosage*; D006435:Renal Dialysis; D012306:Risk; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D007328:Insulin; D011239:Prednisolone; D009195:Peroxidase