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

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-c...

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Bibliographic Details
Published in:Internal Medicine 2021/12/15, Vol.60(24), pp.3927-3935
Main Authors: Yoshida, Haruyoshi, Takahashi, Naoki, Horiguchi, Takayasu, Yasuhara, Hiroki, Tanaka, Tokuharu, Chen, Yuhao, Takasaki, Toshikazu, Tsukao, Hitokazu, Yoshida, Michiko, Kawakami, Satoshi, Ohta, Makoto, Naiki, Hironobu, Konishi, Satoshi, Ito, Isao, Iwano, Masayuki
Format: Article
Language:English
Subjects:
Aged
Antibodies, Antineutrophil Cytoplasmic
Antineutrophil cytoplasmic antibodies
Biopsy
Case Report
Glomerulonephritis
Glomerulonephritis - complications
Glomerulonephritis - diagnosis
Glomerulonephritis, Membranous
Humans
Hypercalcemia
IgG4-RKD
immune senescence
Immunoglobulin G
Internal medicine
Kidney
Kidney diseases
Leukocytes (neutrophilic)
lymphoid aggregates
Male
Membranous nephropathy
Nephritis
Nephropathy
Neutrophils
Peroxidase
Sarcoidosis
Senescence
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Summary: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.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.7252-21