Progression of Membranous Nephropathy to Acute Crescentic Rapidly Progressive Glomerulonephritis and Response to Pulse Methylprednisolone

Jd, Koethe; Js, Gerig; Jl, Glickman; Bc, Sturgill; Wk, Bolton

doi:10.1159/000167129

Cited by 14 publications

(11 citation statements)

References 7 publications

(7 reference statements)

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“…Recently, a case of ANCA-associated crescentic GN superimposed on a MG [13] has suggested that features of vasculitis can play a role in crescentic transformation. However, most patients with crescentic MG are as negative for anti-MBG [4,5,8,14,15] and for ANCA [16] as our case reports, which suggests the participation of other immune mechanisms.…”

Section: Discussionsupporting

confidence: 54%

Monoclonal Antibody Analysis of Crescentic Membranous Glomerulonephropathy

Arrizabalaga¹,

Boix²,

Rabassa³

et al. 1998

Am J Nephrol

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Idiopathic membranous glomerulonephropathy (MG) has a rather benign prognosis. Acute renal failure with cellular crescents superimposed on MG is unusual and its pathogenesis is not fully understood. We report 3 patients with crescentic MG who showed strong glomerular and interstitial infiltration of leukocytes (CD45), T lymphocytes (CD3), helper/inducer T cells (CD4), cytotoxic/suppressor T cells (CD8), and monocyte-macrophages (CD14). A similar number of CD4+ and CD8+ cells contributed to T cellularity within the glomerular tuft, whereas CD4+ cells were predominant over CD8+ cells in the crescents. Intercellular adhesion molecule-1 (ICAM-1) antigens (CD54) were found on renal vascular endothelium, interstitial cellular aggregates and proximal tubular epithelial cells. The case reports illustrate the contribution of macrophages and T cells bearing predominantly CD4+ phenotype to cellular crescents, and the abnormal expression of ICAM-1 antigens on proximal tubular epithelial cells. Both features suggest that cell-mediated immunity may play a role in the transformation of crescentic MG.

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Section: Discussionsupporting

confidence: 54%

Monoclonal Antibody Analysis of Crescentic Membranous Glomerulonephropathy

Arrizabalaga¹,

Boix²,

Rabassa³

et al. 1998

Am J Nephrol

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“…Several studies have suggested various histopathologic features on renal biopsy at diagnosis to be associated with a worse renal outcome [4,5,6,7,8,9,10,11,12]. Histopathologic findings that have been reported as meaningful predictors of outcome in i-MN include glomerular scarring and severity of tubulointerstitial disease.…”

Section: Discussionmentioning

confidence: 99%

“…For example, although smaller studies have suggested that several histopathologic features are associated with worse outcomes in i-MN [4,5,6,7,8,9,10,11,12], a large, collaborative study from Toronto found that pathology did not influence outcomes [13]. The literature contains similar discrepancies regarding the prognostic importance of clinical and laboratory parameters.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Membranous Nephropathy: Clinical and Histologic Prognostic Features and Treatment Patterns over Time at a Tertiary Referral Center

Sprangers¹,

Bomback²,

Cohen³

et al. 2012

Am J Nephrol

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Background: Idiopathic membranous nephropathy (i-MN) is a leading cause of nephrotic syndrome in adults and results in end-stage renal disease in approximately one third of patients. There are few large, long-term US studies evaluating clinical and histologic prognostic factors in i-MN. Methods: We describe 132 patients with biopsy-proven i-MN who were followed for a mean period of 68 months at our tertiary referral center from 1977 to 2009, and we analyzed clinical and histologic features that predicted renal outcomes. Results: The presence of hypertension and treating physician’s decision to institute immunosuppression were negative predictors of attaining complete or partial remission. Among clinical variables, impaired renal function (eGFR <60 ml/min/1.73 m²) at time of presentation was the only variable at presentation associated with an increased risk of reaching end-stage renal disease. The use of statins and RAAS blockers were protective. The choice of corticosteroids as the initial immunosuppressive agent by referring physicians decreased over time but even in the most recent era (2000–2008) was significant (33%). Conclusion: Renal function at presentation and non-white race were the main predictors of a worse renal outcome. Corticosteroid therapy is still being adopted as first-line therapy in a significant number of patients in this era. The development of guidelines may help clarify the treatment strategies of i-MN.

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“…Kasinath et al reported that renal disease other than diabetic nephropathy was found in 10 of 122 diabetic patients who underwent renal biopsy and that idiopathic membranous nephropathy was the most frequent non-diabetic renal lesion in diabetic patients (3). It has been reported that membranous nephropathy evolved into RPGN by means of immune complexes (18,19). RPGN is a rare renal lesion superimposed to diabetic nephropathy or in diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%