A Refractory Case of Secondary Membranous Nephropathy Concurrent with IgG4-related Tubulointerstitial Nephritis
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- Arai Hiroyuki
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan
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- Toda Naohiro
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan
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- Kamimatsuse Ryo
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan Department of Nephrology, Kyoto City Hospital, Japan
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- Nishioka Keisuke
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan Department of Nephrology, Osaka Red Cross Hospital, Japan
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- Endo Shuichiro
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan
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- Akiyama Shinichi
- Division of Nephrology, Department of Internal Medicine, Nagoya University, Graduate School of Medicine, Japan
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- Maruyama Shoichi
- Division of Nephrology, Department of Internal Medicine, Nagoya University, Graduate School of Medicine, Japan
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- Matsubara Takeshi
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan
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- Yokoi Hideki
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan
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- Yanagita Motoko
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Japan
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Abstract
<p>A 58-year-old man with type 1 autoimmune pancreatitis was referred to nephrologists for severe proteinuria. Laboratory data revealed a high serum IgG4 level, hypoalbuminemia, and massive proteinuria, which were compatible with nephrotic syndrome. The renal pathological findings confirmed the diagnosis of secondary membranous nephropathy concurrent with IgG4-related tubulointerstitial nephritis. Despite the improvement of interstitial markers, the proteinuria was refractory to prednisolone, requiring cyclosporine to achieve complete remission. Membranous nephropathy is a rare manifestation of IgG4-related kidney disease. This case shows that the therapeutic response to prednisolone significantly differs between glomerular lesions and interstitial lesions of IgG4-related kidney disease. </p>
Journal
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- Internal Medicine
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Internal Medicine 57 (19), 2873-2877, 2018-10-01
The Japanese Society of Internal Medicine