Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy
Renal involvement in systemic lupus erythematosus (SLE) is usually immune complex mediated and may have multiple different presentations. Pauci-immune necrotizing and crescentic glomerulonephritis (NCGN) refers to extensive glomerular inflammation with few or no immune deposits that may result in ra...
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| Format: | Article |
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Wiley
2015-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2015/120762 |
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| author | Ryan Burkhart Nina Shah Michael Abel James D. Oliver Matthew Lewin |
| author_facet | Ryan Burkhart Nina Shah Michael Abel James D. Oliver Matthew Lewin |
| author_sort | Ryan Burkhart |
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| description | Renal involvement in systemic lupus erythematosus (SLE) is usually immune complex mediated and may have multiple different presentations. Pauci-immune necrotizing and crescentic glomerulonephritis (NCGN) refers to extensive glomerular inflammation with few or no immune deposits that may result in rapid decline in renal function. We report a case of a 79-year-old Hispanic male with a history of secondary membranous nephropathy (diagnosed by renal biopsy 15 years previously) who was admitted with acute kidney injury and active urinary sediment. P-ANCA titers and anti-myeloperoxidase antibodies were positive. The renal biopsy was diagnostic for NCGN superimposed on a secondary membranous nephropathy. A previous diagnosis of SLE based on American College of Rheumatology criteria was discovered via Veteran’s Administration records review after the completion of treatment for pauci-immune NCGN. ANCAs are detected in 20–31% of patients with SLE. There may be an association between SLE and ANCA seropositivity. In patients with lupus nephritis and biopsy findings of necrotizing and crescentic glomerulonephritis, without significant immune complex deposition, ANCA testing should be performed. In patients with secondary membranous nephropathy SLE should be excluded. |
| format | Article |
| id | doaj-art-41803f5dd6e84e04ac3013c19e68cec2 |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
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| series | Case Reports in Nephrology |
| spelling | doaj-art-41803f5dd6e84e04ac3013c19e68cec22025-02-03T06:11:09ZengWileyCase Reports in Nephrology2090-66412090-665X2015-01-01201510.1155/2015/120762120762Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous NephropathyRyan Burkhart0Nina Shah1Michael Abel2James D. Oliver3Matthew Lewin4Department of Internal Medicine, William Beaumont Army Medical Center, 5005 N. Piedras Street, El Paso, TX 79920, USADepartment of Nephrology, William Beaumont Army Medical Center, 5005 N. Piedras Street, El Paso, TX 79920, USADepartment of Rheumatology, William Beaumont Army Medical Center, 5005 N. Piedras Street, El Paso, TX 79920, USANephrology Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USAProPath Services, LLP, 1355 River Bend Drive, Dallas, TX 75247, USARenal involvement in systemic lupus erythematosus (SLE) is usually immune complex mediated and may have multiple different presentations. Pauci-immune necrotizing and crescentic glomerulonephritis (NCGN) refers to extensive glomerular inflammation with few or no immune deposits that may result in rapid decline in renal function. We report a case of a 79-year-old Hispanic male with a history of secondary membranous nephropathy (diagnosed by renal biopsy 15 years previously) who was admitted with acute kidney injury and active urinary sediment. P-ANCA titers and anti-myeloperoxidase antibodies were positive. The renal biopsy was diagnostic for NCGN superimposed on a secondary membranous nephropathy. A previous diagnosis of SLE based on American College of Rheumatology criteria was discovered via Veteran’s Administration records review after the completion of treatment for pauci-immune NCGN. ANCAs are detected in 20–31% of patients with SLE. There may be an association between SLE and ANCA seropositivity. In patients with lupus nephritis and biopsy findings of necrotizing and crescentic glomerulonephritis, without significant immune complex deposition, ANCA testing should be performed. In patients with secondary membranous nephropathy SLE should be excluded.http://dx.doi.org/10.1155/2015/120762 |
| spellingShingle | Ryan Burkhart Nina Shah Michael Abel James D. Oliver Matthew Lewin Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy Case Reports in Nephrology |
| title | Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy |
| title_full | Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy |
| title_fullStr | Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy |
| title_full_unstemmed | Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy |
| title_short | Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy |
| title_sort | pauci immune necrotizing and crescentic glomerulonephritis with membranous lupus nephritis fifteen years after initial diagnosis of secondary membranous nephropathy |
| url | http://dx.doi.org/10.1155/2015/120762 |
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