Author/Authors :
Kanodia, Kamal Department of Pathology - Laboratory Medicine - Transfusion Services and Immunohematology - G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences - Civil Hospital Campus - Ahmedaba, India , Vanikar, Aruna Department of Pathology - Laboratory Medicine - Transfusion Services and Immunohematology - G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences - Civil Hospital Campus - Ahmedaba, India , Patel, Rashmi Department of Pathology - Laboratory Medicine - Transfusion Services and Immunohematology - G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences - Civil Hospital Campus - Ahmedaba, India , Suthar, Kamlesh Department of Pathology - Laboratory Medicine - Transfusion Services and Immunohematology - G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences - Civil Hospital Campus - Ahmedaba, India , Nigam, Lovelesh Department of Pathology - Laboratory Medicine - Transfusion Services and Immunohematology - G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences - Civil Hospital Campus - Ahmedaba, India , Kute, Vivek Department of Nephrology and Transplantation Medicine - Ahmedabad, India , Trivedi, Hargovind Department of Nephrology and Transplantation Medicine - Ahmedabad, India
Abstract :
Introduction: Antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (GN) is characterized by necrotizing and crescentic GN with paucity of immunoglobulin (Ig) and complement deposition, which is also known as pauci-immune crescentic GN. Membranous nephropathy (MN) is characterized by the formation of subepithelial immune deposit with resultant changes in glomerular basement membrane (GBM), most notably spike formation.
Case Presentation: A 48-year-old man presented with marked proteinuria, hypoalbuminemia, and renal dysfunction with positive results for myeloperoxidase (MPO) and ANCA. Renal biopsy revealed crescents and thick GBM with subepithelial spikes along with IgG deposition on immunofluorescent staining. The condition was diagnosed as MN with MPO-ANCA-associated crescentic GN. He was treated with intravenous methylprednisolone and cyclophosphamide. After one-month follow-up, antibody level and renal function did not improve.
Conclusions: Coexistence of MN with MPO-ANCA crescentic GN is very rare and should be managed aggressively.
Keywords :
Glomerulonephritis , Membranous Nephropathy , Myeloperoxidase (MPO) , Antineutrophil Cytoplasmic Antibodies
