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2013 ; 2
(2
): 165-169
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Antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis with
membranous nephropathy treated using thiamazole
#MMPMID28509295
Kakita T
; Nagatoya K
; Takimoto H
; Matsuda H
; Mori T
; Kawaguchi A
; Inoue T
CEN Case Rep
2013[Nov]; 2
(2
): 165-169
PMID28509295
show ga
A 21-year-old woman with nephrotic syndrome was referred to our hospital. She had
congenital diaphragmatic hernia, hypoxic ischemic encephalopathy, and mental
retardation, and had been treated for hyperthyroidism with thiamazole in another
hospital. Serum creatinine was 37.8 ?mol/L and antineutrophil cytoplasmic
antibody against myeloperoxidase (MPO-ANCA) was 39 EU. Urinalyses were 3+ for
proteins and 3+ for occult blood. A renal biopsy was performed. An examination
using light microscopy (LM) revealed necrotizing glomerulonephritis with crescent
formation. Immunofluorescence microscopy showed granular staining with
immunoglobulin G and complement component 3 along the capillary walls. Electron
microscopy (EM) disclosed subepithelial dense deposits. A renal biopsy suggested
necrotizing glomerulonephritis with membranous nephropathy (MN) in stages I or
II. Since many cases of drug-induced ANCA-associated glomerulonephritis (AAG)
have been reported, we stopped thiamazole and treated with corticosteroid. The
MPO-ANCA titer became negative 49 days after the initiation of treatment. Two
years after the first treatment, the MPO-ANCA titer became elevated again and was
82 EU. The patient was administered cyclophosphamide and prednisone. However, the
MPO-ANCA titer did not decrease. A renal biopsy was performed again 3 years after
the first renal biopsy. LM revealed no crescentic formation but demonstrated
spike formations along the glomerular basement membrane. EM also disclosed
subepithelial dense deposits, but less than the first biopsy. The renal biopsy
suggested MN in stages II or III. AAG was regarded as inactive after
corticosteroid treatment. Therefore, ciclosporin administration was started. In
conclusion, we experienced a rare case of AAG complicated with MN. The
histopathologic results showed that immunosuppressive therapy seemed to be
effective in treating crescentic glomerulonephritis; furthermore, it reduced
proteinuria but could not reduce the MPO-ANCA titer.