Anti-neutrophil cytoplasmic antibody-positive eosinophilic granulomatosis with polyangiitis: can it cause membranous nephropathy?

Mahmood, Salman Bin; Ahmad, Hafiz Badaruddin; Wu, Jingyi; Haselby, Danielle; Leclaire, M; Nasr, Rawad

doi:10.1080/03009742.2019.1580765

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…We compared the clinicopathological features described in the six previous case reports of EGPA complicated with MN, including both ANCA-positive [4][5][6] and negative cases [7,8], with our case (Table 1). We found that those with rapidly progressing renal deficiency demonstrated NCGN histologically, except for our case, and that renal function was recovered in almost all cases.…”

Section: Discussionmentioning

confidence: 99%

“…However, it was recently reported that 10% of EGPA was complicated with non-NCGN, such as membranous nephropathy (MN), of which most were ANCA negative [3]. Furthermore, MN complicated in EGPA has been previously reported for both ANCA-positive [4][5][6] and -negative [7,8] cases. Although ANCA is recognized as a useful marker to differentiate the heterogeneous clinical spectrum of EGPA [9], it is difficult to clarify all clinical findings from ANCA results given the aforementioned exceptions.…”

Section: Introductionmentioning

confidence: 99%

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ANCA-Negative Vasculitis in Eosinophilic Granulomatosis with Polyangiitis Complicated with Membranous Nephropathy: A Case Report and Brief Literature Review

Kasama

Ino

Iemura

et al. 2022

Case Reports in Nephrology

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Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA) typically occurs in anti-neutrophil cytoplasmic autoantibody (ANCA)-positive cases presenting with rapidly progressive renal insufficiency and urinary abnormalities induced by primarily necrotizing crescentic glomerulonephritis (NCGN). Recently, ANCA-negative EGPA has also been reported to manifest with renal involvement, such as NCGN or non-NCGN, including membranous nephropathy (MN). Herein, we report a 70-year-old female who presented with purpura on the lower legs, upper limb numbness, renal dysfunction (eGFR, 20.5 ml/min/1.73 m2), and eosinophilia (eosinophils, 37,570/μl). MPO-and PR3-ANCA were negative, and urinalysis revealed urine protein (0.63 g/day) but without red blood cells in the urine sediment. Thus, she was diagnosed with ANCA-negative EGPA with rapidly progressive renal dysfunction. A renal biopsy revealed vasculitis in the interlobular arteries without NCGN, with the vasculitis being complicated by MN. Micrograph findings on fluorescence immunostaining contained both primary and secondary characteristics of MN (dominance of IgG subclass 4 more than subclass 1 vs. negativity of PLA2R and THSD7A). After treatment with prednisolone, her eosinophil counts normalized, and renal dysfunction improved. Furthermore, urine protein did not increase above 1.0 g/day during the clinical course. This is a rare case of ANCA-negative EGPA presenting with acute renal dysfunction without NCGN and subclinical MN with unknown etiology. It is important to recognize that EGPA pathology varies widely throughout the disease course, and the clinical course of subclinical MN should be carefully assessed in further follow-ups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

ANCA-Negative Vasculitis in Eosinophilic Granulomatosis with Polyangiitis Complicated with Membranous Nephropathy: A Case Report and Brief Literature Review

Kasama

Ino

Iemura

et al. 2022

Case Reports in Nephrology

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“…Although the main histological feature of renal involvement in EGPA is a pauci-immune necrotizing crescentic form of glomerulonephritis and/or eosinophilic tubulointerstitial nephritis ( 20 ), these findings were not noted in the kidney biopsy specimen of the present case. However, a few previous reports have described the co-occurrence of EGPA and MN without crescents ( 21 , 22 ), although several cases of MN associated with RPF have also been reported ( 23 ). Even so, this is the first case report of MN simultaneously associated with both EGPA and RPF.…”

Section: Discussionmentioning

confidence: 99%

The First Case of Eosinophilic Granulomatosis with Polyangiitis Simultaneously Demonstrating Various Clinical Manifestations with Retroperitoneal Fibrosis and Membranous Nephropathy

et al. 2021

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The first case of eosinophilic granulomatosis with polyangiitis (EGPA) simultaneously demonstrating various clinical manifestations, including retroperitoneal fibrosis (RPF) causing hydronephrosis and membranous nephropathy (MN) leading to nephrotic syndrome, is presented. There have been no previous case reports demonstrating the simultaneous onset of these three disease categories with significant complex pathologies. This case was successfully managed by providing adequate combination therapies according to each disease category, leading to complete remission (CR) of all three diseases. In conclusion, we believe this case is extremely rare and clinically suggestive, and that these findings can be applied to a future phenotype-tailored treatment strategy for EGPA.

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Crescentic Glomerulonephritis and Membranous Nephropathy: A Rare Overlap

Ghandour

Osman

Alkassis

et al. 2022

Case Reports in Nephrology

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Background. Membranous nephropathy (MN) is a disease that affects the basement membrane of the glomeruli of the kidney resulting in proteinuria. The concurrent incidence of vasculitic glomerulonephritis and MN in the same patient is unusual. Herein, we report a case with this unusual combination. Case. Our patient is a 53-year-old Hispanic male with a medical history of tobacco use, type 2 diabetes mellitus, and hypertension who presented with hematuria and was found to have nephrotic range proteinuria and renal impairment. Blood workup revealed positive ANCA serology, which led to a renal biopsy that showed crescentic vasculitis in addition to membranous nephropathy. The patient was started on intermittent hemodialysis (HD) and treated initially with intravenous (IV) pulse steroids; subsequently, oral prednisolone and IV cyclophosphamide were initiated. The patient remained HD dependent at the time of discharge with the resolution of hematuria. A follow-up with an outpatient nephrology clinic was arranged. Conclusion. Membranous nephropathy complicated by crescentic glomerulonephritis has a more aggressive clinical course and decline in renal function compared to MN alone which can lead to initiating renal replacement therapy. However, immunosuppressive drugs can result in significant improvement of renal function if started early enough.

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Anti-neutrophil cytoplasmic antibody-positive eosinophilic granulomatosis with polyangiitis: can it cause membranous nephropathy?

Cited by 4 publications

References 7 publications

ANCA-Negative Vasculitis in Eosinophilic Granulomatosis with Polyangiitis Complicated with Membranous Nephropathy: A Case Report and Brief Literature Review

ANCA-Negative Vasculitis in Eosinophilic Granulomatosis with Polyangiitis Complicated with Membranous Nephropathy: A Case Report and Brief Literature Review

The First Case of Eosinophilic Granulomatosis with Polyangiitis Simultaneously Demonstrating Various Clinical Manifestations with Retroperitoneal Fibrosis and Membranous Nephropathy

Crescentic Glomerulonephritis and Membranous Nephropathy: A Rare Overlap

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