MPO-ANCA necrotizing glomerulonephritis related to rheumatoid arthritis

Messiaen, T; M’bappe, P.; Boffa, J.J.; Khayat, Rateb; Mougenot, B; Rossert, Jérôme; Ronco, Pierre

doi:10.1016/s0272-6386(98)70153-2

Cited by 18 publications

(7 citation statements)

References 19 publications

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“…The common renal disorders in patients with RA include amyloid A amyloidosis, membranous nephropathy, mesangial proliferative glomerulonephritis, and drug-induced nephropathy [16]. Although less common, there have been several case reports on MPO-ANCA associated glomerulonephritis in patients with RA [17][18][19][20][21][22][23]. We previously reported that renal dysfunction of MPO-ANCA associated crescentic glomerulonephritis in RA patients showed slower progression compared to typical rapidly progressive glomerulonephritis without RA [8].…”

Section: Discussionmentioning

confidence: 99%

AP-VAS 2012 case report: two patients with rheumatoid arthritis suspected of relapsed microscopic polyangiitis after initiation of dialysis

et al. 2013

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We report two patients with rheumatoid arthritis (RA) who were suspected of microscopic polyangiitis during maintenance dialysis. Case 1 was a 52-yearold woman with RA diagnosed at the age of 38 years and treated successfully with gold compounds. At the age of 43 years, she presented with progressive renal dysfunction and abnormal urine sediments, and a renal biopsy revealed crescentic nephritis with advanced glomerular sclerosis. Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) was not measured on that occasion. She reached end-stage renal failure within 4 months and started peritoneal dialysis. Eight years later, soon after she was switched to hemodialysis, she developed fever of unknown origin. MPO-ANCA was elevated to 37 EU, although there were no other signs or symptoms suggestive of vasculitis. After taking prednisolone orally (10 mg/day), her fever withdrew, and MPO-ANCA became undetectable. Case 2 was a 71-year-old woman with RA diagnosed at the age of 60 years and treated with gold compounds. She developed renal failure of unknown cause (no biopsy was performed), and started hemodialysis at the age of 69 years. One year later, she presented with fever and subsequently developed cough with hemoptysis. MPO-ANCA was elevated to 62 EU. Treatment with azathioprine 50 mg and prednisolone 35 mg daily brought remarkable clinical improvement, and MPO-ANCA became undetectable. These cases highlight the importance of measuring ANCA even in RA patients on dialysis who present with fever of unknown origin or with underlying kidney disease of uncertain etiology.

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Section: Discussionmentioning

confidence: 99%

AP-VAS 2012 case report: two patients with rheumatoid arthritis suspected of relapsed microscopic polyangiitis after initiation of dialysis

et al. 2013

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“…It is well known that various diseases such as anti-GBM antibody disease, systemic lupus erythematosus (SLE), systemic vasculitis (microscopic polyangiitis, Wegener's granulomatosis, and Churg-Strauss syndrome), renal-limited vasculitis, postinfectious GN, IgA nephropathy, and mixed cryoglobulinemia induce NCGN. RA-related nephropathy also induces NCGN, which correlates with disease activity [4,5]. Moreover, previous reports indicated that D-penicillamine and bucillamine rarely result in NCGN [6,7].…”

Section: Discussionmentioning

confidence: 99%

Etanercept-induced necrotizing crescentic glomerulonephritis in two patients with rheumatoid arthritis

Kaneko¹,

Nanki²,

Hosoya³

et al. 2010

Mod Rheumatol

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We present two patients with rheumatoid arthritis (RA) who developed necrotizing crescentic glomerulonephritis (NCGN) during etanercept therapy. Both patients developed proteinuria and hematuria, and one progressed to renal failure. Renal biopsy revealed NCGN. In both patients, nephritis improved following discontinuation of etanercept and administration of prednisolone. Physicians should be aware of etanercept-induced GN in patients with RA on anti-tumor necrosis factor therapy.

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“…4,5 Indeed, cases of RPGN in patients showing immune complex-mediated crescentic glomerulonephritis have been reported, 4,6,7 and ANCA-positive crescentic glomerulonephritis has been described in rheumatoid arthritis in the literature. 5,[7][8][9][10] The immunofluorescence studies were negative for staining in all but one of these cases, but the patient reported by Mathieson et al 7 was treated with penicillamine, and this may have the ability to induce systemic vasculitis. Although that patient was found to have C1q deposits in the glomeruli in an immunofluorescence study, SLE was ruled out because she did not have clinical symptoms, antinuclear antibody, or anti-DNA antibody.…”

Section: Discussionmentioning

confidence: 99%

Myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-positive microscopic polyarteritis (MPA) associated with Hashimoto's thyroiditis and increased serum rheumatoid factor

Kageyama

Hamaguchi

2000

Clinical and Experimental Nephrology

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An autopsy case of microscopic polyarteritis (MPA) associated with Hashimoto's thyroiditis that showed glomerular immunoglobulin and complement depositions and high titers of rheumatoid factor and myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) is reported. A 72-year-old woman was admitted to our hospital because of renal failure that had deteriorated from a serum creatinine value of 175.8 to 1874.1 µmol/l in 4 weeks. Laboratory studies on admission revealed proteinuria, numerous red blood cells, granular casts and red blood casts in the urine, increased serum blood urea nitrogen (47.8 mmol/l), anemia (hemoglobin, 60 g/l), and thrombocytopenia (platelets, 71 ϫ 10 9 /l). Emergency hemodialysis was started; however, the patient died on the fifth hospital day because of ventricular tachycardia, and an autopsy was performed. At autopsy, the patient was found to have had increased serum levels of immune complexes, rheumatoid factor, IgG rheumatoid factor, myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA), antithyroglobulin antibody, and anti-thyroid peroxidase antibody, and decreased serum complement levels. Microscopic examination revealed crescentic glomerulonephritis in almost all glomeruli, and positive granular deposits of IgG, IgA, IgM, C1q, C3, and C4 in the mesangium and along the capillary walls. Typical fibrinoid necrosis was found in the small arteries of the stomach, colon, small intestine, and bladder. Finally, Hashimoto's thyroiditis was noted. To our knowledge, this is the first case of MPO-ANCA-positive MPA associated with Hashimoto's thyroiditis and increased serum rheumatoid factor levels.

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MPO-ANCA necrotizing glomerulonephritis related to rheumatoid arthritis

Cited by 18 publications

References 19 publications

AP-VAS 2012 case report: two patients with rheumatoid arthritis suspected of relapsed microscopic polyangiitis after initiation of dialysis

AP-VAS 2012 case report: two patients with rheumatoid arthritis suspected of relapsed microscopic polyangiitis after initiation of dialysis

Etanercept-induced necrotizing crescentic glomerulonephritis in two patients with rheumatoid arthritis

Myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-positive microscopic polyarteritis (MPA) associated with Hashimoto's thyroiditis and increased serum rheumatoid factor

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