A Patient with MPO-ANCA-positive IgA Nephropathy Diagnosed with the Clinical Onset of Macrohematuria

Minoru Yasukawa; Sachiko Kitagawa; Ryo Togashi; Shinichiro Asakawa; Michito Nagura; Shigeyuki Arai; Osamu Yamazaki; Yoshifuru Tamura; Fukuo Kondo; Ryuji Ohashi; Shunya Uchida; Shigeru Shibata; Yoshihide Fujigaki

doi:10.2169/internalmedicine.2475-18

CASE REPORTS

A Patient with MPO-ANCA-positive IgA Nephropathy Diagnosed with the Clinical Onset of Macrohematuria

Minoru Yasukawa, Sachiko Kitagawa, Ryo Togashi, Shinichiro Asakawa, Michito Nagura, Shigeyuki Arai, Osamu Yamazaki, Yoshifuru Tamura, Fukuo Kondo, Ryuji Ohashi, Shunya Uchida, Shigeru Shibata, Yoshihide Fujigaki

Author information

Minoru Yasukawa
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Sachiko Kitagawa
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Ryo Togashi
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shinichiro Asakawa
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Michito Nagura
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shigeyuki Arai
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Osamu Yamazaki
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshifuru Tamura
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Fukuo Kondo
Department of Pathology, Teikyo University Hospital, Japan
Ryuji Ohashi
Department of Diagnostic Pathology, Nippon Medical School Musashikosugi Hospital, Japan
Shunya Uchida
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shigeru Shibata
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshihide Fujigaki
Department of Internal Medicine, Teikyo University School of Medicine, Japan

Keywords: acute kidney injury, corticosteroid, IgA nephropathy, macrohematuria, mycophenolate mofetil, myeloperoxidase-ANCA

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 14 Pages 2051-2056

DOI https://doi.org/10.2169/internalmedicine.2475-18

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Details

Abstract

A 21-year-old woman presented with renal dysfunction during macrohematuria. A kidney biopsy revealed IgA nephropathy with a small percentage of crescent formation and macrohematuria-associated tubular injury. Macrohematuria-associated acute kidney injury could explain her renal dysfunction. However, she was seropositive for myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA) and showed fibrin deposition around one arteriole. Corticosteroids and mycophenolate mofetil were administered as for ANCA vasculitis, and the serum creatinine, abnormal urinalysis and MPO-ANCA titer all gradually ameliorated. The presence of extra-glomerular vasculitis, which was probably induced by ANCA, suggested that MPO-ANCA was an exacerbating factor for her prolonged renal dysfunction. This condition has so far only rarely been addressed in ANCA-positive IgA nephropathy.

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