title: Recovery of renal function in a dialysis-dependent patient with microscopic polyangiitis and both myeloperoxidase anti-neutrophil cytoplasmic antibodies and anti-glomerular basement membrane antibodies.
abstract: A 40-year-old man with microscopic polyangiitis developed both myeloperoxidase anti-neutrophil cytoplasmic antibodies (90 EU) and anti-glomerular basement membrane antibodies (134 EU)-positive rapidly progressive glomerulonephritis and heparin-induced thrombocytopenia. Although the patient initially showed no signs of improvement, persistent therapy including 1 g/day intravenous methylprednisolone, 50 mg/day oral prednisolone, plasma exchange, and 900 mg/day intravenous cyclophosphamide resulted in the normalization of both titers, recovery of renal function, and discontinuation of dialysis. Though previous studies showed poor outcomes in such "double-positive" patients, aggressive immunosuppression in younger patients may result in the recovery of renal function, even in those with severe renal dysfunction.
authors.affiliation: Department of Nephrology, Yokosuka Kyosai Hospital, Japan. smandai@hotmail.co.jp
authors.forename: Shintaro
authors.initials: S
authors.lastname: Mandai
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Nagahama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tsuura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Hirai
authors.forename: Wakako
authors.initials: W
authors.lastname: Yoshioka
authors.forename: Daiei
authors.initials: D
authors.lastname: Takahashi
authors.forename: Shota
authors.initials: S
authors.lastname: Aki
authors.forename: Makoto
authors.initials: M
authors.lastname: Aoyagi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Teiichi
authors.initials: T
authors.lastname: Tamura
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001323:Autoantibodies / Q000097:blood*; D003520:Cyclophosphamide / Q000008:administration & dosage; D050533:Glomerular Basement Membrane / Q000276:immunology; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D055953:Microscopic Polyangiitis / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy*; D009195:Peroxidase / Q000276:immunology; D010951:Plasma Exchange; D011239:Prednisolone / Q000008:administration & dosage; D006435:Renal Dialysis; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D007166:Immunosuppressive Agents; C051951:antiglomerular basement membrane antibody; D003520:Cyclophosphamide; D006493:Heparin; D011239:Prednisolone; D009195:Peroxidase; D008775:Methylprednisolone