MPO-ANCA-positive anti-glomerular basement membrane antibody disease successfully treated by plasma exchange and immunosuppressive therapy

Ren Fail. 2011;33(6):626-31. doi: 10.3109/0886022X.2011.581401. Epub 2011 May 20.

Abstract

Anti-glomerular basement membrane (GBM) antibody disease is clinically manifested as rapidly progressive glomerulonephritis (RPGN) with crescentic changes. The renal prognosis is poor. We report here the case of a 61-year-old woman with myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-positive anti-GBM antibody disease. This patient was referred to our hospital because of RPGN. Anti-GBM antibody was positive with a titer of 38 EU. The MPO-ANCA titer was 65 EU. Chest imaging examination revealed pulmonary multiple nodules. ANCA-associated vasculitis was suspected. Renal pathology revealed cellular crescents in 13 out of 17 glomeruli. Immunofluorescence with anti-IgG antibody, anti-C3 antibody, and anti-fibrin antibody showed linear staining along the glomerular capillary walls. Based on these findings, the patient was diagnosed with anti-GBM antibody disease. Hemodialysis was started because of uremic syndrome with elevated serum creatinine (6.84 mg/dL). In addition, treatment with plasma exchange using 3.6 L (90 mL/kg) of fresh frozen plasma combined with an oral dose of 40 mg of prednisolone was initiated. Within 3 weeks, both types of autoantibodies became undetectable. Subsequently, this patient achieved dialysis independence and remission of glomerulonephritis. No adverse effects were observed. In patients with MPO-ANCA-positive anti-GBM antibody disease, intensive therapy predominantly with plasma exchange might be operative, even though renal function is less likely to recover.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Anti-Idiotypic / immunology
  • Antibodies, Antineutrophil Cytoplasmic / immunology*
  • Autoantibodies / immunology*
  • Biopsy
  • Bronchoalveolar Lavage Fluid / cytology
  • Bronchoscopy
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Glomerulonephritis / diagnosis
  • Glomerulonephritis / immunology*
  • Glomerulonephritis / therapy
  • Hemorrhage / diagnosis
  • Hemorrhage / immunology*
  • Hemorrhage / therapy
  • Humans
  • Immunoglobulin G / immunology
  • Immunosuppression Therapy / methods*
  • Immunosuppressive Agents / therapeutic use
  • Kidney Glomerulus / immunology
  • Kidney Glomerulus / pathology
  • Lung Diseases / diagnosis
  • Lung Diseases / immunology*
  • Lung Diseases / therapy
  • Middle Aged
  • Peroxidase / immunology*
  • Plasma Exchange / methods*
  • Plasmapheresis / methods*
  • Tomography, X-Ray Computed

Substances

  • Antibodies, Anti-Idiotypic
  • Antibodies, Antineutrophil Cytoplasmic
  • Autoantibodies
  • Immunoglobulin G
  • Immunosuppressive Agents
  • anti-IgG
  • antiglomerular basement membrane antibody
  • Peroxidase

Supplementary concepts

  • Rapidly progressive glomerulonephritis with pulmonary hemorrhage