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Pathol Int. 2017 Aug;67(8):419-424. doi: 10.1111/pin.12545. Epub 2017 Jun 4.

Myeloperoxidase-antineutrophil cytoplasmic antibody causes different renal diseases by immune-complex formation and pauci-immune mechanism: A case report.

Author information

1
Kidney and Vascular Pathology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
2
Department of Nephrology, Yokohama Rosai Hospital, Kanagawa, Japan.
3
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.

Abstract

Antineutrophil cytoplasmic antibody (ANCA) has been known to cause pauci-immune crescentic glomerulonephritis. In addition, several reports described membranous glomerulonephritis (MN) concurrent with ANCA-associated glomerulonephritis. Because the two glomerular diseases simultaneously appear in an ANCA-positive patient, the mechanisms whereby ANCA causes the two different glomerular diseases remain ambiguous. Herein, we report a case of 19-year-old man who presented with hematuria, pre-nephrotic proteinuria, and high titer of myeloperoxidase (MPO)-ANCA. The first renal biopsy revealed MN with chronic glomerular scar lesions of unknown etiology. Predominant immunoglobulin (Ig) G1 subclass and negative phospholipase-A2 receptor staining, together with granular-positive glomerular capillary co-localization of MPO and IgG staining, suggested secondary MN due to MPO-MPO-ANCA immune-complex. Five years later, the patient presented with fever, severe renal dysfunction, and alveolar hemorrhage with high titer of MPO-ANCA that indicated pulmonary renal syndrome due to ANCA-associated vasculitis. The second renal biopsy revealed pauci-immune crescentic glomerulonephritis without either apparent MN-lesion or glomerular IgG staining. This is the first reported case showing that MPO-ANCA caused two different glomerular diseases, MN and pauci-immune crescentic glomerulonephritis, in the same patient at the different time points. Our case indicated that common MPO-ANCA might cause different glomerular diseases by different immune mechanisms.

KEYWORDS:

anti-neutrophil cytoplasmic antibody-associated vasculitis; membranous glomerulonephritis; myeloperoxidase; pauci-immune crescentic glomerulonephritis; planted antigen

PMID:
28580649
DOI:
10.1111/pin.12545
[Indexed for MEDLINE]

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