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Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis as a Complication of Home Parenteral Nutrition
Patients on long-term home parenteral nutrition (HPN) occasionally develop glomerulonephritis due to chronic central venous catheter (CVC)-related infection. Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN...
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| Published in: | Case reports in nephrology and dialysis 2022-03, Vol.12 (1), p.22-30 |
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| container_title | Case reports in nephrology and dialysis |
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| creator | Flogelova, Hana Karaskova, Eva Bouchalova, Katerina Rohanova, Marie Latalova, Vendula Tichy, Tomas Tesar, Vladimir |
| description | Patients on long-term home parenteral nutrition (HPN) occasionally develop glomerulonephritis due to chronic central venous catheter (CVC)-related infection. Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. Chronic bacteremia as a complication of long-term HPN may cause various types of glomerulonephritis including, rarely, AAG requiring immunosuppressive therapy. |
| doi_str_mv | 10.1159/000522150 |
| format | article |
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Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. Chronic bacteremia as a complication of long-term HPN may cause various types of glomerulonephritis including, rarely, AAG requiring immunosuppressive therapy.</description><identifier>ISSN: 2296-9705</identifier><identifier>EISSN: 2296-9705</identifier><identifier>DOI: 10.1159/000522150</identifier><identifier>PMID: 35433845</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Anemia ; Antibiotics ; Biopsy ; Blood ; Case and Review ; Case reports ; Catheters ; chronic bacteremia ; Creatinine ; Gastroenterology ; Hematuria ; Hemoglobin ; home parenteral nutrition ; Immunosuppressive agents ; Immunotherapy ; Infections ; Kidneys ; Laboratories ; Monoclonal antibodies ; Nutrition ; Parenteral nutrition ; Patients ; pr3-anca-associated glomerulonephritis ; Proteins ; Sepsis ; Small intestine ; Steroids ; Thrombosis ; Urine</subject><ispartof>Case reports in nephrology and dialysis, 2022-03, Vol.12 (1), p.22-30</ispartof><rights>2022 The Author(s). Published by S. Karger AG, Basel</rights><rights>Copyright © 2022 by S. Karger AG, Basel.</rights><rights>2022 The Author(s). Published by S. Karger AG, Basel . This work is licensed under the Creative Commons Attribution – Non-Commercial License http://creativecommons.org/licenses/by-nc/3.0/ (the “License”). 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Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. 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Most previously reported cases were membranoproliferative glomerulonephritis (MPGN). This is a case report of a 16-year-old girl receiving HPN for short bowel syndrome. After 11 years on HPN, she developed acute kidney injury with macroscopic hematuria, nephrotic-range proteinuria, and a reduced glomerular filtration rate (GFR). Initially, MPGN associated with chronic bacteremia was suspected with the assumption that the condition would be treated with antibiotics and CVC replacement. However, her kidney biopsy revealed antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis (AAG). This was consistent with the fact that the patient tested positive for proteinase 3-ANCA. Immunosuppressive therapy with methylprednisolone pulses (followed by oral prednisone) and rituximab led to remission. Her GFR and protein excretion returned to normal. Chronic bacteremia as a complication of long-term HPN may cause various types of glomerulonephritis including, rarely, AAG requiring immunosuppressive therapy.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>35433845</pmid><doi>10.1159/000522150</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5076-0927</orcidid><orcidid>https://orcid.org/0000-0003-0175-7921</orcidid><orcidid>https://orcid.org/0000-0001-9580-2302</orcidid><orcidid>https://orcid.org/0000-0001-6982-0689</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Anemia Antibiotics Biopsy Blood Case and Review Case reports Catheters chronic bacteremia Creatinine Gastroenterology Hematuria Hemoglobin home parenteral nutrition Immunosuppressive agents Immunotherapy Infections Kidneys Laboratories Monoclonal antibodies Nutrition Parenteral nutrition Patients pr3-anca-associated glomerulonephritis Proteins Sepsis Small intestine Steroids Thrombosis Urine |
| title | Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis as a Complication of Home Parenteral Nutrition |
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