Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease |
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| Authors: | Haruyoshi Yoshida Naoki Takahashi Takayasu Horiguchi Hiroki Yasuhara Tokuharu Tanaka Yuhao Chen Toshikazu Takasaki Hitokazu Tsukao Michiko Yoshida Satoshi Kawakami Makoto Ohta Hironobu Naiki Satoshi Konishi Isao Ito Masayuki Iwano |
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| Affiliation: | 1.Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan; 2.Department of Nephrology, University of Fukui, Japan; 3.Department of Diagnostic Radiology, Sugita Genpaku Memorial Obama Municipal Hospital, Japan; 4.Department of Pathology, Hikone Municipal Hospital, Japan; 5.Department of Molecular Pathology, University of Fukui, Japan; 6.Department of Respiratory Medicine, Kyoto University Hospital, Japan |
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| Abstract: | 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. |
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| Keywords: | hypercalcemia IgG4-RKD immune senescence lymphoid aggregates membranous nephropathy sarcoidosis |
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