scholarly journals A Case of Concurrent MPO-/PR3-Negative ANCA-Associated Glomerulonephritis and Membranous Glomerulopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Yasuyuki Nakada ◽  
Nobuo Tsuboi ◽  
Yasuto Takahashi ◽  
Hiraku Yoshida ◽  
Yoriko Hara ◽  
...  
Keyword(s):  
Renal Biopsy ◽  
Indirect Immunofluorescence ◽  
Crescentic Glomerulonephritis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Basement Membranes ◽  
Proteinase 3 ◽  
Renal Deterioration ◽  
Membranous Glomerulopathy ◽  
Immunosorbent Assays ◽  
The Relationship

We report a case in which antineutrophil cytoplasmic antibody- (ANCA-) associated glomerulonephritis and membranous glomerulopathy (MGN) were detected concurrently. The patient showed rapidly progressive renal deterioration. A renal biopsy showed crescentic glomerulonephritis, together with marked thickening and spike and bubbling formations in the glomerular basement membranes. Indirect immunofluorescence examination of the patient’s neutrophils showed a perinuclear pattern. Enzyme-linked immunosorbent assays revealed that the ANCA in this case did not target myeloperoxidase (MPO) or proteinase 3 (PR3) but bactericidal-/permeability-increasing protein, elastase, and lysosome. The relationship between these two etiologically distinct entities, MPO-/PR3-negative ANCA-associated glomerulonephritis and MGN, remains unclear.

scholarly journals Lung adenocarcinoma and sequential antineutrophil cytoplasmic antibody-associated vasculitis: a case report

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052199331
Author(s):  
Chun-Yang Zhang ◽  
Ran Miao ◽  
Wei Li ◽  
Hao-Yong Ning ◽  
Xiang-En Meng ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Histological Examination ◽  
Crescentic Glomerulonephritis ◽  
Elevated Serum ◽  
Pulmonary Nodules ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Necrotizing Crescentic Glomerulonephritis ◽  
Transthoracic Biopsy ◽  
Nasal Inflammation ◽  
The Relationship

The relationship between antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and lung cancer remains unclear. A 66-year-old man presented with pulmonary nodules. Histological examination of a specimen from computed tomography-guided percutaneous transthoracic biopsy revealed adenocarcinoma. The patient was treated using cryoablation and systemic chemotherapy. Sixteen months later, the patient presented with fever, nasal inflammation, recurrent lung lesions, elevated serum creatinine levels, and high levels of ANCA. Histological examination of a specimen from ultrasound-guided percutaneous renal biopsy revealed pauci-immune necrotizing crescentic glomerulonephritis. The patient responded to treatment, but granulomatosis with polyangiitis recurred and he later died. This case highlights the possibility of sequential AAV with lung cancer. Although this is relatively rare, further research is needed to better understand the association or pathophysiological link between lung cancer and AAV.

scholarly journals A Case Report of Multiple Myeloma Associated With Myeloperoxidase and Proteinase-3 Antibodies Posing a Diagnostic Dilemma

2019 ◽  
Vol 7 ◽  
pp. 232470961984394 ◽  
Author(s):  
Jordana Cheta ◽  
Michael Binder
Keyword(s):  
Multiple Myeloma ◽  
Renal Biopsy ◽  
Plasma Cells ◽  
Case Reports ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Rapid Decline ◽  
Proteinase 3 ◽  
Diagnostic Dilemma ◽  
Clonal Proliferation ◽  
Invaluable Tool

Multiple myeloma (MM) is a clonal proliferation of antibody-producing plasma cells that can precipitate renal injury through multiple mechanisms. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an inflammatory condition that can result in renal failure through mononuclear cell infiltration and consequent destruction of glomeruli. Several case reports have identified clinical situations where differentiating these entities has been challenging. Renal biopsy is an invaluable tool in differentiating between MM and AAV when clinical uncertainty exists. We report the case of an 85-year-old man who presented with a rapid decline in renal function and serologies positive for both MM and AAV. Renal biopsy findings confirmed the diagnosis of myeloma kidney and excluded vasculitis. This case highlights an unusual clinical scenario in which both proteinase-3 (PR-3) and myeloperoxidase (MPO) antibodies are positive. While these antibodies are both individually associated with ANCA vasculitis, they are seldom simultaneously positive. Our case would suggest that positive PR-3 and MPO antibodies should raise concern for an alternative diagnosis. Indeed, ANCA, PR-3, and MPO antibodies can all be positive in patients with monoclonal gammopathy in the absence of vasculitis. Our case underscores the value of renal biopsy in the setting of MM.

scholarly journals Renal Manifestations of Common Variable Immunodeficiency

Kidney360 ◽  
2020 ◽  
Vol 1 (6) ◽  
pp. 491-500 ◽  
Author(s):  
Tiffany N. Caza ◽  
Samar I. Hassen ◽  
Christopher P. Larsen
Keyword(s):  
Renal Biopsy ◽  
Common Variable Immunodeficiency ◽  
Tubulointerstitial Nephritis ◽  
Case Series ◽  
Basement Membranes ◽  
Diabetic Glomerulosclerosis ◽  
Membranous Glomerulopathy ◽  
History Of ◽  
Common Variable ◽  
Chronic Tubulointerstitial Nephritis

BackgroundCommon variable immunodeficiency (CVID) is one of the most common primary immunodeficiency syndromes, affecting one in 25,000–50,000 people. Renal insufficiency occurs in approximately 2% of patients with CVID. To date, there are no case series of renal biopsies from patients with CVID, making it difficult to determine whether individual cases of renal disease in CVID represent sporadic events or are related to the underlying pathophysiology. We performed a retrospective analysis of renal biopsy specimens in our database from patients with a clinical history of CVID (n=22 patients, 27 biopsies).MethodsLight, immunofluorescence, and electron microscopy were reviewed. IgG subclasses, PLA2R immunohistochemistry, and THSD7A, EXT1, and NELL1 immunofluorescence were performed on all membranous glomerulopathy cases. CD3, CD4, CD8, and CD20 immunohistochemistry was performed on cases of tubulointerstitial nephritis.ResultsAKI and proteinuria were the leading indications for renal biopsy in patients with CVID. Immune-complex glomerulopathy was present in 12 of 22 (54.5%) cases, including nine cases with membranous glomerulopathy, one case with a C3 glomerulopathy, and one case with membranoproliferative GN with IgG3κ deposits. All membranous glomerulopathy cases were PLA2R, THSD7A, EXT1, and NELL1 negative. The second most common renal biopsy diagnosis was chronic tubulointerstitial nephritis, affecting 33% of patients. All tubulointerstitial nephritis cases showed tubulitis and a lymphocytic infiltrate with >90% CD3+ T cells. Other renal biopsy diagnoses within our cohort included acute tubular injury (n=1), amyloid light-chain amyloidosis (n=1), diabetic glomerulosclerosis (n=1), thin basement membranes (n=1), pauci-immune GN (n=1), and arterionephrosclerosis (n=1).ConclusionsMembranous glomerulopathy and tubulointerstitial nephritis were the predominant pathologic findings in patients with CVID. Membranous glomerulopathy cases in patients with CVID were IgG1 subclass dominant and showed mesangial immune deposits. Four of the membranous glomerulopathy cases had associated proliferation, with mesangial and/or endocapillary hypercellularity, with or without crescent formation. CVID should be considered as a potential cause when membranous glomerulopathy or chronic tubulointerstitial nephritis is seen in a young patient with a history of recurrent infections.

scholarly journals Top Differential Diagnosis Should Be Microscopic Polyangiitis in ANCA-Positive Patient with Diffuse Pulmonary Hemorrhage and Hemosiderosis

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Nicholas D. Ward ◽  
Diane E. Cosner ◽  
Colleen A. Lamb ◽  
Wei Li ◽  
Jacqueline K. Macknis ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Renal Biopsy ◽  
Lung Biopsy ◽  
Crescentic Glomerulonephritis ◽  
Microscopic Polyangiitis ◽  
Pulmonary Hemorrhage ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Giant Cells ◽  
Positive Patient ◽  
Neutrophil Aggregation

A rat model of antineutrophil cytoplasmic antibody (ANCA) associated vasculitides reveals crescentic glomerulonephritis as seen in human renal biopsies and diffuse lung hemorrhage that is not well documented in human lung biopsies. A 64-year-old male, with shortness of breath and mild elevation of serum creatinine, was found to have a positive serum test for ANCA, but negative antiglomerular basement membrane antibody. A renal biopsy showed pauci-immune type of crescentic glomerulonephritis and focal arteritis. The prior lung wedge biopsy was retrospectively reviewed to show diffuse hemorrhage and hemosiderosis with focal giant cells. In addition, small arteries revealed subtle neutrophil aggregation, and margination along vascular endothelium, but no definitive vasculitis. The pathology of ANCA associated vasculitides results from activated neutrophils by ANCA and subsequent activation of the alternative complement cascade with endothelial injury, neutrophil aggregation and margination. Our findings, after the correlation between lung biopsy and renal biopsy, imply that the top differential diagnosis in the lung biopsy should be microscopic polyangiitis when diffuse pulmonary hemorrhage and hemosiderosis are present in this ANCA-positive patient.

scholarly journals Proteinase 3-antineutrophil cytoplasmic antibody-positive necrotizing crescentic glomerulonephritis complicated by infectious endocarditis: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Katsunori Yanai ◽  
Yoshio Kaku ◽  
Keiji Hirai ◽  
Shohei Kaneko ◽  
Saori Minato ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Renal Injury ◽  
Crescentic Glomerulonephritis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Blood Analysis ◽  
Histological Evaluation ◽  
Proteinase 3 ◽  
Histological Findings ◽  
Necrotizing Crescentic Glomerulonephritis ◽  
Duke Criteria

Abstract Background Proteinase 3-antineutrophil cytoplasmic antibody has been reported to be positive in 5–10% of cases of renal injury complicated by infective endocarditis; however, histological findings have rarely been reported for these cases. Case presentation A 71-year-old Japanese man with a history of aortic valve replacement developed rapidly progressive renal dysfunction with gross hematuria and proteinuria. Blood analysis showed a high proteinase 3-antineutrophil cytoplasmic antibody (163 IU/ml) titer. Streptococcus species was detected from two separate blood culture bottles. Transesophageal echocardiography detected mitral valve vegetation. Histological evaluation of renal biopsy specimens showed necrosis and cellular crescents in glomeruli without immune complex deposition. The patient met the modified Duke criteria for definitive infective endocarditis. On the basis of these findings, the patient was diagnosed with proteinase 3-antineutrophil cytoplasmic antibody-positive necrotizing crescentic glomerulonephritis complicated by Streptococcus infective endocarditis. His renal disease improved, and his proteinase 3-antineutrophil cytoplasmic antibody titer normalized with antibiotic monotherapy. Conclusion Few case reports have described histological findings of proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis. We believe that an accumulation of histological findings and treatments is mandatory for establishment of optimal management for proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis.

scholarly journals ANCA-Associated Glomerulonephritis and Anti-Phospholipid Syndrome in a Patient with SARS-CoV-2 Infection: Just a Coincidence?

2021 ◽  
pp. 214-220
Author(s):  
Federica Maritati ◽  
Maria Ilaria Moretti ◽  
Valentina Nastasi ◽  
Roberta Mazzucchelli ◽  
Manrico Morroni ◽  
...  
Keyword(s):  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Hemodynamic Instability ◽  
Tubular Necrosis ◽  
Complex Processes ◽  
Anca Associated Vasculitis ◽  
High Incidence ◽  
New Diagnosis ◽  
The Relationship

Many reports have described a high incidence of acute kidney injury (AKI) among patients with COVID-19. Acute tubular necrosis has been reported to be the most common damage in these patients, probably due to hemodynamic instability. However, other complex processes may be involved, related to the cytokine storm and the activation of innate and adaptive immunity. Here, we describe a patient who developed an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with rapidly progressive glomerulonephritis and lung involvement and an antiphospholipid syndrome soon after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. After viral pneumonia was excluded by bronchoalveolar lavage, the patient has been treated with rituximab for amelioration of kidney function and resolution of thrombosis without any adverse event. We conclude that COVID-19 may trigger autoimmune diseases including ANCA-associated vasculitis. Thus, this diagnosis should be taken in consideration in COVID-19 patients, especially when they develop AKI with active urinary sediment. In addition, considering the relationship between these 2 diseases, SARS-CoV-2 infection should be excluded in all patients with a new diagnosis ANCA-associated vasculitis before starting immunosuppressive therapy.

The distribution of fibronectin, laminin and entactin in the neurulating rat embryo studied by indirect immunofluorescence

Development ◽  
1986 ◽  
Vol 94 (1) ◽  
pp. 95-112
Author(s):  
Fiona Tuckett ◽  
Gillian M. Morriss-Kay
Keyword(s):  
Extracellular Matrix ◽  
Indirect Immunofluorescence ◽  
Active Sites ◽  
Polyclonal Antibodies ◽  
Tube Formation ◽  
Basement Membranes ◽  
General Distribution ◽  
Rat Embryo ◽  
Structural Element ◽  
The Matrix

This paper forms part of our study of the extracellular matrix and its role in the morphogenesis of the brain during the period of neurulation in the rat embryo. Using indirect immunofluorescence with polyclonal antibodies, we present here a descriptive study of the distribution of the matrix glycoproteins fibronectin, laminin and entactin. The observed distribution of the fibronectin matrix implicates it in providing a structural element in several morphologically active sites; in addition our observations support the previously suggested involvement of fibronectin in the migration of neural crest cells. Entactin was present only in the basement membranes in conjunction with laminin which was not itself confined to these regions. Laminin was also identified within the mesenchymal extracellular matrix, and its general distribution confirms the previously documented role of laminin in maintaining epithelial structure and organization. No patterning in the distribution of these three glycoproteins could be correlated with the change in shape of the neural epithelium associated with either tube formation or neuromere morphogenesis.

The relationship between emerging neural crest cells and basement membranes in the trunk of the mouse embryo: a TEM and immunocytochemical study

Development ◽  
1986 ◽  
Vol 98 (1) ◽  
pp. 251-268
Author(s):  
J. Sternberg ◽  
S. J. Kimber
Keyword(s):  
Neural Crest ◽  
Neural Tube ◽  
Cell Shape ◽  
Type Iv Collagen ◽  
Neural Crest Cell ◽  
Basement Membranes ◽  
Type Iv ◽  
Transmission Electron ◽  
The Relationship ◽  
Crest Cell

The earliest stage of neural crest cell (NCC) migration is characterized by an epitheliomesenchymal transformation, as the cells leave the neural tube. There is evidence that in a number of cell systems this transformation is accompanied by alteration or depletion of associated basement membranes. This study examines the ultrastructural relationship between mouse NCCs and adjacent basement membranes during the earliest stages of migration from the neural tube. Basement membranes were identified by transmission electron microscopy (TEM) and immunofluorescence using antibodies to type-IV collagen. The ultrastructural features of NCCs and their relationship with surrounding tissues were also examined using TEM. In the dorsal region of the neural tube, from which NCCs originate, the basement membrane was depleted or absent, and with the immunofluorescence technique it was shown that this pattern was reflected in a deficit of type-IV collagen. TEM observations indicated that ultrastructurally NCCs differ from their neuroepithelial neighbours only in overall cell shape and their relationship to other cells and the extracellular matrix.

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