Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease.

Abstract

A 78-year-old man presented with hypercalcemia and renal disease with high serum IgG4 and positive myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), exhibiting sarcoidosis-like chest findings. A renal biopsy revealed tubulointerstitial nephritis, membranous nephropathy (MN), and sub-capsular lymphoid aggregates without fulfilling the diagnostic criteria of IgG4-related disease or sarcoidosis. Steroid therapy ameliorated the serological and renal abnormalities. After 5 years, following gradual increases in the neutrophil count and upper respiratory infection (URI), necrotizing crescentic glomerulonephritis (NCGN) developed with an increased serum MPO-ANCA level. These results suggest that in the presence of MPO-ANCA in immune senescence, the persistent neutrophil increase with URI may lead to the development of NCGN.

• Authors: Haruyoshi Yoshida, Naoki Takahashi, Takayasu Horiguchi, Hiroki Yasuhara, Tokuharu Tanaka, Yuhao Chen, Toshikazu Takasaki, Hitokazu Tsukao, Michiko Yoshida, Satoshi Kawakami, Makoto Ohta, Hironobu Naiki, Satoshi Konishi, Isao Ito, Masayuki Iwano
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 60 Issue 24 Pg. 3927-3935 (Dec 15 2021) ISSN: 1349-7235 [Electronic] Japan
• PMID: 34148959 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Antineutrophil Cytoplasmic
• Peroxidase

Topics

• Aged
• Antibodies, Antineutrophil Cytoplasmic
• Glomerulonephritis (complications, diagnosis)
• Glomerulonephritis, Membranous
• Humans
• Kidney
• Male
• Peroxidase