Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease
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- Yoshida Haruyoshi
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Takahashi Naoki
- Department of Nephrology, University of Fukui, Japan
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- Horiguchi Takayasu
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Yasuhara Hiroki
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Tanaka Tokuharu
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Chen Yuhao
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Takasaki Toshikazu
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Tsukao Hitokazu
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Yoshida Michiko
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Kawakami Satoshi
- Department of Diagnostic Radiology, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
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- Ohta Makoto
- Department of Pathology, Hikone Municipal Hospital, Japan
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- Naiki Hironobu
- Department of Molecular Pathology, University of Fukui, Japan
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- Konishi Satoshi
- Department of Respiratory Medicine, Kyoto University Hospital, Japan
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- Ito Isao
- Department of Respiratory Medicine, Kyoto University Hospital, Japan
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- Iwano Masayuki
- Department of Nephrology, University of Fukui, Japan
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Abstract
<p>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. </p>
Journal
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- Internal Medicine
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Internal Medicine 60 (24), 3927-3935, 2021-12-15
The Japanese Society of Internal Medicine
