Membranous Glomerulonephritis With Crescents.
McAdoo, Stephen P
Griffith, Megan E
Cook, H Terence
Pusey, Charles D
Kidney international reports, volume 4, issue 11
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Nikolopoulou, A., Huang-Doran, I., McAdoo, S. P., Griffith, M. E., Cook, H. T., & Pusey, C. D. (2019). Membranous Glomerulonephritis With Crescents.. Kidney international reports, volume 4, issue 11 https://doi.org/10.1016/j.ekir.2019.07.021
Introduction:Membranous glomerulonephritis (MGN) is rarely associated with necrotizing and crescentic glomerulonephritis (NCGN). Methods:We report the clinical and pathologic findings in 15 patients with MGN and NCGN associated with anti-neutrophil cytoplasm antibodies (ANCAs), anti-glomerular basement membrane (GBM), or anti-phospholipase A2 receptor (PLA2R) antibodies. Results:The cohort consisted of 15 patients: 7 males and 8 females with a median age of 63 years (range: 18-79). In 12 of 15 patients, MGN and NCGN were diagnosed at the time of the biopsy, and in 3 cases, MGN predated the NCGN. ANCA was positive in 7 cases (6 MPO myeloperoxidase (MPO)-ANCA and 1 PR3-ANCA), anti-GBM antibodies were detected in 5 cases, and anti-PLA2R antibodies were found in 2 cases. One case was negative for all antibodies. Microscopic hematuria was present in all but one patient who was anuric, and median urinary protein-to-creatinine ratio was 819.5 mg/mmol (range: 88-5600). Pathologic evaluation revealed MGN and NCGN with crescents involving 28% of glomeruli (median; range: 5%-100%). Follow-up was available for all 15 patients; all were treated with steroids; 10 with cyclophosphamide, and 6 also received rituximab. At a median follow-up of 72 months, 9 had stabilization or improvement of renal function, 6 had progressed to end-stage renal disease, and 4 died during the follow-up period. Conclusion:MGN with crescents associated with ANCAs or anti-GBM antibodies is a rare dual glomerulopathy. Patients present with heavy proteinuria, microscopic hematuria, and acute kidney injury and should be treated for a rapidly progressive glomerulonephritis. Prognosis is variable, and 40% of patients progress to end-stage renal disease.
Membranous Glomerulonephritis, Crescentic Glomerulonephritis, Anti-gbm Disease, Anti-pla2r Antibody, Anti-neutrophil Cytoplasm Antibodies
External DOI: https://doi.org/10.1016/j.ekir.2019.07.021
This record's URL: https://www.repository.cam.ac.uk/handle/1810/301626
Attribution-NonCommercial-NoDerivatives 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc-nd/4.0/