The increase of antiglomerular basement membrane antibody following pauci-immune-type crescentic glomerulonephritis

Clin Exp Nephrol. 2005 Mar;9(1):69-73. doi: 10.1007/s10157-004-0334-7.

Abstract

A 50-year-old woman was admitted because of high fever and fatigue. Proteinuria, hematuria, and elevated BUN (47.8 mg/dl) and creatinine (3.4 mg/dl) suggested rapidly progressive glomerulonephritis. The serological study revealed all negative results for rheumatoid factor, antinuclear antibody, serum cryoglobulins, MPO-ANCA, PR3-ANCA, and anti-streptolysin O. Antiglomerular basement membrane (GBM) antibody, as assessed by ELISA, was 11 EU (normal, <10). Kidney biopsy on the eighth hospital day demonstrated pauci-immune-type crescentic glomerulonephritis without ANCA. Methylprednisolone pulse therapy (500 mg/day, 3 days) and 45 mg/day prednisolone orally were started. At 3 weeks after kidney biopsy, the anti-GBM antibody value increased from 11 EU/ml to 116 EU/ml, and MPO and PR3-ANCA were still negative. HLA type was DR8 and DR 15(2), with a genotype of HLA-DRB1*08021 and HLA-DRB1*15011. The present case suggests that HLA-DR15 plays an important role on antibody production against alpha 3(IV) NC1 autoantigen after severe nephritis or tissue damage.

Publication types

  • Case Reports

MeSH terms

  • Anti-Inflammatory Agents / adverse effects*
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies / blood*
  • Autoantibodies
  • Drug Therapy, Combination
  • Female
  • Glomerulonephritis / diagnostic imaging
  • Glomerulonephritis / drug therapy
  • Glomerulonephritis / immunology*
  • Glomerulonephritis / pathology*
  • Glucocorticoids / adverse effects*
  • Glucocorticoids / therapeutic use
  • HLA-DR Antigens / blood
  • HLA-DR Serological Subtypes
  • Humans
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Prednisolone / adverse effects*
  • Prednisolone / therapeutic use
  • Radionuclide Imaging

Substances

  • Anti-Inflammatory Agents
  • Antibodies
  • Autoantibodies
  • Glucocorticoids
  • HLA-DR Antigens
  • HLA-DR Serological Subtypes
  • HLA-DR15 antigen
  • antiglomerular basement membrane antibody
  • Prednisolone
  • Methylprednisolone