De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

Abstract

A 61-year-old woman was admitted to our hospital because of an unexpected rise in serum creatinine (sCr) level with proteinuria and microhematuria. She had undergone living-donor kidney transplantation 31 years before for end-stage renal disease caused by chronic glomerulonephritis (GN). On admission, her sCr was 1.27 mg/ dL which was increased from 0.6 mg/dL, urinary protein/ creatinine ratio was 1.39 g/gCr, and urinary red blood cell count was more than 100 per high power field. The allograft biopsy revealed crescentic glomerulonephritis with moderate to severe tubulointerstitial inflammation. Immunofluorescence staining yielded only a minimal staining for immunoglobulin A, and negative C4d in peritubular capillary. Since increased myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titer of 45.5 U/mL was detected, we made the diagnosis of post-transplant MPO-ANCA-associated GN. She was treated with three doses of bolus methylprednisolone (500 mg) followed by oral prednisolone therapy. Her sCr was stable at 1.20 mg/ dL thereafter. ANCA-associated GN should be considered in older kidney transplant patients with new-onset urinary abnormalities because typical systemic symptoms and vasculitis in other organs might be masked by maintenance immunosuppression.

De novo pauci-immune glomerulonephritis in renal allografts

“…The renal biopsy showed crescentic glomerulonephritis with destruction of the Bowman's capsule and interstitial inflammation with peritubular capillaritis; no glomerular immune deposits were identified. A more recent case report by Haruyama et al [13] also described a 61-year-old woman who presented with presumed de novo renal-limited neutrophil cytoplasmic antibodies-associated glomerulonephritis 31 years after kidney transplant. The native kidney disease was attributed to a chronic glomerulonephritis.…”

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in Kidney Transplantation

“…She eventually lost her graft and returned to dialysis five years after diagnosis. Further information about post-transplant de novo ANCA-PIGN were obtained by Haruyama et al [57]. A 61-year-old female living donor KT recipient with ESRD secondary to chronic glomerulonephritis and 31 years of follow-up was admitted to investigate an unexpected raise in SCr (from 0.6 to 1.39 mg/dL) associated with abnormal urinary protein/creatinine ratio (1.39 g/g) and microscopic hematuria (>100 RBC/HPF).…”