title: A case of elderly-onset Crescentic Henoch-Schönlein purpura nephritis with hypocomplementemia and positive MPO-ANCA.
abstract: Henoch-Schönlein purpura (HSP) is common in childhood and often self-limiting. There have been limited studies on elderly-onset HSP nephritis (HSPN). A 76-yr-old man was transferred to our hospital with a 1-month history of oliguria, abdominal pain, edema and palpable purpura in the legs. Three months ago, he was admitted to another hospital with jaundice, and consequently diagnosed with early common bile duct cancer. The patient underwent a Whipple's operation. Antibiotics were administrated because of leakage in the suture from the surgery. However, he showed progressive renal failure with edema and purpura in the legs. Laboratory investigations showed serum creatinine 6.4 mg/dL, 24-hr urine protein 8,141 mg/day, myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA) 1:40 and C(3) below 64.89 mg/dL. Renal biopsy showed crescentic glomerulonephritis, as well as mesangial and extracapillary Ig A deposition. We started steroid therapy and hemodialysis, but he progressed to end-stage renal failure and he has been under maintenance hemodialysis. We describe elderly onset HSPN with MPO-ANCA can be crescentic glomerulonephritis rapidly progressed to end stage renal failure.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Yu
authors.forename: Kyu-Beck
authors.initials: KB
authors.lastname: Lee
authors.forename: Jae Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Hyang
authors.initials: H
authors.lastname: Kim
authors.forename: Kyungeun
authors.initials: K
authors.lastname: Kim
authors.forename: Ki-Seok
authors.initials: KS
authors.lastname: Jang
authors.forename: Moon Hyang
authors.initials: MH
authors.lastname: Park
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000601:surgery; D003176:Complement C3 / Q000032:analysis; D003404:Creatinine / Q000097:blood; D004487:Edema / Q000188:drug therapy; D004797:Enzyme-Linked Immunosorbent Assay; D005921:Glomerulonephritis / Q000473:pathology; D006801:Humans; D011695:IgA Vasculitis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D003176:Complement C3; D013256:Steroids; D003404:Creatinine