title: Successful Management of Lupus Nephritis with High Titers of Myeloperoxidase Anti-Neutrophil Cytoplasmic Antibodies Using Tacrolimus.
abstract: A 63-year-old Japanese woman with a 30-year history of systemic lupus erythematosus developed macrohematuria and massive proteinuria after seroconversion of myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA). A renal biopsy indicated focal proliferative lupus nephritis (class III A/C) with a fibrous crescent formation. Methylprednisolone pulse therapy (500 mg, 3 successive days) was administered because of progressive proteinuria. Steroid therapy did not suppress the progressive proteinuria; therefore, tacrolimus was added as an alternative immunosuppressive therapy, resulting in the improvement of proteinuria and renal impairment. This case report suggests that MPO-ANCA might play a pathogenic role in the exacerbation of immune-complex-type lupus nephritis.
authors.affiliation: Department of General Internal Medicine and Rheumatology, Nagasaki Medical Center, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Abe
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Shima
authors.forename: Yasumori
authors.initials: Y
authors.lastname: Izumi
authors.forename: Mineaki
authors.initials: M
authors.lastname: Kitamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Yoshika
authors.initials: Y
authors.lastname: Tsuji
authors.forename: Osamu
authors.initials: O
authors.lastname: Sasaki
authors.forename: Chie
authors.initials: C
authors.lastname: Maeda
authors.forename: Chieko
authors.initials: C
authors.lastname: Kawahara
authors.forename: Ai
authors.initials: A
authors.lastname: Torisu
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kurohama
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ito
authors.forename: Nozomi
authors.initials: N
authors.lastname: Iwanaga
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakayama
authors.forename: Takashi
authors.initials: T
authors.lastname: Taguchi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Migita
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic / Q000187:drug effects* / Q000276:immunology; D004396:Coloring Agents; D018450:Disease Progression; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D009195:Peroxidase / Q000276:immunology; D011507:Proteinuria / Q000188:drug therapy*; D051437:Renal Insufficiency / Q000188:drug therapy; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D004396:Coloring Agents; D007166:Immunosuppressive Agents; D009195:Peroxidase; D016559:Tacrolimus