MPO-ANCA-positive crescentic necrotizing glomerulonephritis and tubulointerstitial nephritis with renal eosinophilic infiltration and peripheral blood eosinophilia

Yamamoto, Tatsuo; Yoshihara, Shu; Suzuki, Hajime; Nagase, Mitsumasa; Oka, Megumi; Hishida, Akira

doi:10.1053/ajkd.1998.v31.pm9631850

Cited by 21 publications

(18 citation statements)

References 14 publications

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“…However, it is thought to be similar to histologic involvement by HES on other organs by mass effect due to the proportion of eosinophils and eosinophil cytotoxicity (2). In fact, these reports are characterized by eosinophilic infiltration in renal biopsy, which does not occur in our patient (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). While focal segmental glomerulosclerosis and HES may be two coexisting diseases-yet unrelated in our patient-the low proportion of cases reported in the literature of glomerular involvement of HES, compels us to consider the possibility of physiopathological mechanisms not yet known may account for such coexistence.…”

Section: Discussionsupporting

confidence: 53%

“…While the histologic findings in some case reports of glomerular involvement in HES patients have been scarcely specific (12), membranous glomerulonephritis (4,5), IgA nephropathy (6), focal segmental glomerulonephritis (7), immunotactoid glomerulonephritis (8), endocapillary proliferation (9), and crescentic glomerulonephritis with deposition of immune complexes have also been identified (10,11). The pathophysiology of renal involvement in a HES patient has been scarcely studied.…”

Section: Discussionmentioning

confidence: 99%

“…Kidney involvement is related to vascular disorder, interstitial nephritis, electrolyte disturbances, CharcotLeyden crystals or glomerular diseases (2). Few cases of HES with glomerular lesions have been reported in medical literature (4)(5)(6)(7)(8)(9)(10)(11). We describe a case of HES with nephrotic syndrome secondary to focal segmental glomerulosclerosis.…”

Section: Introductionmentioning

confidence: 98%

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Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Herrera-Añazco¹,

Matias-tasayco

Arellano-Bravo

et al. 2017

J Nephropathol

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Background: Renal complication in hypereosinophilic syndrome (HES) is rare, with literature scarcely reporting association of this syndrome with glomerular involvement. While the direct effect of eosinophilic infiltration in tissues has been linked to histological damage of the HES, other mechanisms may account for renal involvement too. Case Presentation: We present a case of a 17-year-old male patient, with progressive edema, contact reactive erythematous skin lesions, acute kidney injury, nephrotic syndrome and progressive eosinophilia. His bone marrow biopsy revealed moderate hyperplasia with severe eosinophilia and atypical lymphocytes. His renal biopsy revealed glomeruli, enlarged in volume with mesangial expansion and hypercellularity and segmental thickening of capillary loops. Likewise, some glomeruli showed peripheral hyalinosis with synechiae to Bowman's capsule. Tubules showed cloudy swelling, mild tubular atrophy and hyaline cylinders. Interstitial area showed infiltrated lymphomononuclear cells, focal with no evidence of eosinophils. Blood vessels were unaltered. Immunofluorescence identified glomeruli with granular mesangial IgM deposition. After corticosteroid treatment, eosinophilia and creatinine values regress to normal range. Conclusions: While our case may suggest the coexistence of two unrelated diseases, further studies are required to assess the pathophysiology of glomerular involvement in HES. Given the possibility that mechanisms other than the direct effect of eosinophils are involved in certain patients

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Herrera-Añazco¹,

Matias-tasayco

Arellano-Bravo

et al. 2017

J Nephropathol

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“…Severe glomerulonephritis and cholecystitis have been considered to be relatively uncommonin ChurgStrauss syndrome (3). However, Churg-Strauss syndrome patients exhibit elevated levels of anti-neutrophil cytoplasmic antibodies directed against myeloperoxidase that is similar to patients with microscopic polyangitis who characteristically develop severe glomerulonephritis.…”

Section: Introductionmentioning

confidence: 99%

“…It is therefore of interest that many Churg-Strauss syndrome patients also exhibit elevated levels of MPO-ANCA but the development of glomerulonephritis and renal involvement is considered to be both less frequent and less severe (3,5).…”

Section: Introductionmentioning

confidence: 99%

Churg-Strauss Syndrome with Cholecystitis and Renal Involvement

et al. 2003

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A patient with bronchial asthma developed cholecystitis. Laboratory investigations revealed marked eosinophilia (6,615/mm3), an elevated anti-neutrophil cytoplasmic antibody level and renal dysfunction (blood urea nitrogen 14 mg/dl, creatinine 1.4 mg/dl). Following cholecystectomy, histopathological examination revealed a marked inflammatory cell infiltrate composed mainly of eosinophils with evidence of invasion of the wall of the gall bladder and granuloma formation of arterioles.A diagnosis of Churg-Strauss syndrome was made and she was treated with 60 mg of prednisolone per day. A renal biopsy was performed one year later in view of persistent renal dysfunction. Pathological analysis revealed a pauciimmuneglomerulonephritis with interstitial changes but no crescent formation. (Internal Medicine 42: 893-896, 2003)

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Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg‐Strauss syndrome

Sinico

Toma

Maggiore

et al. 2005

Arthritis & Rheumatism

606

368

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Objective. Churg-Strauss syndrome (CSS) is classified among the so-called antineutrophil cytoplasmic antibody-associated systemic vasculitides (AASVs) because of its clinicopathologic features that overlap with the other AASVs. However, while antineutrophil cytoplasmic antibodies (ANCAs) are consistently found in 75-95% of patients with Wegener's granulomatosis or microscopic polyangiitis, their prevalence in CSS varies widely and their clinical significance remains uncertain. We undertook this study to examine the prevalence and antigen specificity of ANCAs in a large cohort of patients with CSS. Moreover, we evaluated the relationship between ANCA positivity and clinicopathologic features.Methods. Immunofluorescence and enzymelinked immunosorbent assay were used to determine the presence or absence of ANCAs in 93 consecutive patients at the time of diagnosis. The main clinical and pathologic data, obtained by retrospective analysis, were correlated with ANCA status.Results. ANCAs were present by immunofluorescence in 35 of 93 patients (37.6%). A perinuclear ANCA (pANCA) pattern was found in 26 of 35 patients (74.3%), with specificity for myeloperoxidase (MPO) in 24 patients, while a cytoplasmic ANCA pattern, with specificity for proteinase 3, was found in 3 of 35 patients (8.6%). Atypical patterns were found in 6 of 30 patients with anti-MPO antibodies (20.0%). ANCA positivity was associated with higher prevalences of renal disease (51.4% versus 12.1%; P < 0.001) and pulmonary hemorrhage (20.0% versus 0.0%; P ‫؍‬ 0.001) and, to a lesser extent, with other organ system manifestations (purpura and mononeuritis multiplex), but with lower frequencies of lung disease (34.3% versus 60.3%; P ‫؍‬ 0.019) and heart disease (5.7% versus 22.4%; P ‫؍‬ 0.042).Conclusion. ANCAs are present in ϳ40% of patients with CSS. A pANCA pattern with specificity for MPO is found in most ANCA-positive patients. ANCA positivity is mainly associated with glomerular and alveolar capillaritis.

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MPO-ANCA-positive crescentic necrotizing glomerulonephritis and tubulointerstitial nephritis with renal eosinophilic infiltration and peripheral blood eosinophilia

Cited by 21 publications

References 14 publications

Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Focal segmental glomerulosclerosis in a patient with hypereosinophilic syndrome

Churg-Strauss Syndrome with Cholecystitis and Renal Involvement

Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg‐Strauss syndrome

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