The increase of antiglomerular basement membrane antibody following pauci-immune-type crescentic glomerulonephritis |
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Authors: | Wataru Kitagawa Naoto Miura Harutaka Yamada Kazuhiro Nishikawa Arao Futenma Hirokazu Imai |
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Affiliation: | (1) Department of Internal Medicine, Division of Nephrology and Rheumatology, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195, Japan |
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Abstract: | A 50-year-old woman was admitted because of high fever and fatigue. Proteinuria, hematuria, and elevated BUN (47.8mg/dl) and creatinine (3.4mg/dl) suggested rapidly progressive glomerulonephritis. The serological study revealed all negative results for rheumatoid factor, antinuclear antibody, serum cryoglobulins, MPO-ANCA, PR3-ANCA, and anti-streptolysin O. Antiglomerular basement membrane (GBM) antibody, as assessed by ELISA, was 11EU (normal, <10). Kidney biopsy on the eighth hospital day demonstrated pauci-immune-type crescentic glomerulonephritis without ANCA. Methylprednisolone pulse therapy (500mg/day, 3 days) and 45mg/day prednisolone orally were started. At 3 weeks after kidney biopsy, the anti-GBM antibody value increased from 11EU/ml to 116EU/ml, and MPO and PR3-ANCA were still negative. HLA type was DR8 and DR 15(2), with a genotype of HLA-DRB1*08021 and HLA-DRB1*15011. The present case suggests that HLA-DR15 plays an important role on antibody production against alpha 3(IV) NC1 autoantigen after severe nephritis or tissue damage. |
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Keywords: | Anti-GBM antibody HLA-DR 15 Pauci-immune-type crescentic glomerulonephritis |
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