Myeloperoxidase anti-cytoplasmic antibody related crescentic glomerulonephritis in a patient with IgG3λ monoclonal immunoglobulin deposition disease with membranous features

Intern Med. 2012;51(17):2393-7. doi: 10.2169/internalmedicine.51.7900. Epub 2012 Sep 1.

Abstract

A 68-year-old woman showed rapidly progressive glomerulonephritis based on the fact that she had 1+ proteinuria (1.1 g/day), a 3+ occult blood reaction, blood urea nitrogen of 32.4 mg/dL, serum creatinine of 2.96 mg/dL, and myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibodies (ANCA) at 52 ELISA Unit (normal range: below 10). A renal biopsy demonstrated a bubbling appearance associated with cellular crescent formation with segmental necrosis. Immunofluorescence studies showed granular IgG3λ deposition along the basement membrane and in the mesangial area. This is the first English-language case report describing MPO-ANCA positive crescentic glomerulonephritis in a patient demonstrating monoclonal immunoglobulin deposition disease with mainly membranous features.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Antibodies, Antineutrophil Cytoplasmic / metabolism*
  • Basement Membrane / immunology
  • Basement Membrane / pathology*
  • Biopsy
  • Disease Progression
  • Female
  • Fluorescent Antibody Technique
  • Glomerular Mesangium / immunology
  • Glomerular Mesangium / pathology
  • Glomerulonephritis / drug therapy
  • Glomerulonephritis / etiology*
  • Glomerulonephritis / immunology*
  • Glucocorticoids / therapeutic use
  • Humans
  • Immune System Diseases / complications*
  • Immune System Diseases / drug therapy
  • Immune System Diseases / immunology*
  • Immunoglobulin G / metabolism*
  • Peroxidase / immunology*
  • Prednisolone / therapeutic use
  • Treatment Outcome

Substances

  • Antibodies, Antineutrophil Cytoplasmic
  • Glucocorticoids
  • Immunoglobulin G
  • Prednisolone
  • Peroxidase