Bullous pemphigoid and glomerulonephritis

Membranous glomerulonephropathy in a patient with bullous pemphigoid

“…These are more characteristic of primary, rather than secondary MN, in which immunoreactants localize on the mesangium and subendothelium as well as subepithelium. However, the findings in our patient were similar to those of MN that develops in patients with BP [2][3][4]. Thus, immunoreactant deposition on the glomeruli of patients with BP might not be the same as that associated with secondary MN.…”

“…However, proteinuria decreased as the skin condition improved and levels of autoantibody to BP180 decreased. Thus, the two diseases might have been associated with the same immunological disorders involving the basement membrane as previously suggested [1][2][3][4]. Sonia et al speculated that several immunological mechanisms lie behind the two diseases, for example, circulating immune complexes of antibodies to BP that mediate secondary MN, such as lupus nephritis, immunological cross reactions to common epitopes in both cutaneous and renal basement membranes, such as Goodpasture's syndrome, and multisystem autoimmune triggering events that are associated with kidney disease [3].…”

“…Which IgG subclasses that were deposited along capillary walls were not estimated in previous studies [1][2][3][4], and thus, the typical deposition of IgG subclasses along the capillary walls in BP associated with MN has remained uncertain. Usually, IgG4 is predominantly deposited in primary MN, whereas IgG1, 2, and 3 are deposited in secondary MN [11,12].…”

“…The occurrence of immune disorders involving two basement membranes of the skin and kidney is not merely coincidental [4]. The cutaneous phenomenon of BP does not always occur ahead of MN, and in fact, it sometimes arises secondary to MN [2,4].…”

“…The etiology of BP is associated with immunological abnormalities that are characterized by a chronic course of subepidermal bullous skin lesions with linear IgG and C3 deposition at the cutaneous basement membrane zone [1,2] and frequently elevated serum basement membrane zone antibodies (BP180, 230) [3]. Patients with autoimmune diseases and malignancies often develop BP, and some are complicated by kidney diseases, such as membranous glomerulonephropathy (MN) [2][3][4].…”