Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease

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

doi:10.2169/internalmedicine.7252-21

CASE REPORTS

Development of Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Crescentic Glomerulonephritis in an Elderly Patient with Immunological Kidney Disease

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

Author information

Haruyoshi Yoshida
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Naoki Takahashi
Department of Nephrology, University of Fukui, Japan
Takayasu Horiguchi
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Hiroki Yasuhara
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Tokuharu Tanaka
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Yuhao Chen
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Toshikazu Takasaki
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Hitokazu Tsukao
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Michiko Yoshida
Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Satoshi Kawakami
Department of Diagnostic Radiology, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
Makoto Ohta
Department of Pathology, Hikone Municipal Hospital, Japan
Hironobu Naiki
Department of Molecular Pathology, University of Fukui, Japan
Satoshi Konishi
Department of Respiratory Medicine, Kyoto University Hospital, Japan
Isao Ito
Department of Respiratory Medicine, Kyoto University Hospital, Japan
Masayuki Iwano
Department of Nephrology, University of Fukui, Japan

Keywords: hypercalcemia, IgG4-RKD, immune senescence, lymphoid aggregates, membranous nephropathy, sarcoidosis

JOURNAL OPEN ACCESS

2021 Volume 60 Issue 24 Pages 3927-3935

DOI https://doi.org/10.2169/internalmedicine.7252-21

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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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