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Concurrent IgG4-related tubulointerstitial nephritis and IgG4 myeloperoxidase-anti-neutrophil cytoplasmic antibody positive crescentic glomerulonephritis: A case report.

Abstract IgG4-related disease (IgG4-RD) is a newly recognized systemic disease. The typical pathological finding in the kidney is abundant IgG4-positive plasma cell infiltration with characteristic storiform fibrosis in the interstitium. Antibodies of the IgG4 subclass have been linked to certain autoimmune diseases including antiproteinase 3 (PR3) anti-neutrophil cytoplasmic antibody (ANCA) of the IgG4 subclass. Here, we report a rare case of kidney injury with concurrent typical IgG4-related tubulointerstitial nephritis and IgG4 subclass of myeloperoxidase (MPO) ANCA-positive necrotizing crescentic glomerulonephritis.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28514287
OWN - NLM
STAT- In-Process
DA  - 20170517
LR  - 20170517
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 20
DP  - 2017 May
TI  - Concurrent IgG4-related tubulointerstitial nephritis and IgG4
      myeloperoxidase-anti-neutrophil cytoplasmic antibody positive crescentic
      glomerulonephritis: A case report.
PG  - e6707
LID - 10.1097/MD.0000000000006707 [doi]
AB  - RATIONALE: IgG4-related disease (IgG4-RD) is a newly recognized systemic disease.
      The typical pathological finding in the kidney is abundant IgG4-positive plasma
      cell infiltration with characteristic storiform fibrosis in the interstitium.
      Antibodies of the IgG4 subclass have been linked to certain autoimmune diseases
      including antiproteinase 3 (PR3) anti-neutrophil cytoplasmic antibody (ANCA) of
      the IgG4 subclass. Here, we report a rare case of kidney injury with concurrent
      typical IgG4-related tubulointerstitial nephritis and IgG4 subclass of
      myeloperoxidase (MPO) ANCA-positive necrotizing crescentic glomerulonephritis.
      PATIENT CONCERNS: A 42-year-old Chinese man presented with repeated epigastric
      pain, sausage-shaped pancreas observed morphologically in computed tomography,
      effectiveness of prednisone therapy and was diagnosed with autoimmune
      pancreatitis. He subsequently developed acute kidney injury. DIAGNOSES: The
      patient had an elevated serum IgG4, eosinophilia, and positive MPO-ANCA of
      IgG4-dominant subclass. Renal biopsy revealed necrotizing crescentic nephritis
      and typical IgG4-related tubulointerstitial nephritis. INTERVENTIONS: The patient
      was treated with a combination of corticosteroids and cyclophosphamide, and a
      course of rituximab was later added to deplete peripheral B cells. OUTCOMES: The 
      patient responded well and his renal function improved. LESSONS: This is the
      first case report of an IgG4-RD with concurrent IgG4-related tubulointerstitial
      nephritis and IgG4 MPO-ANCA-associated necrotizing crescentic glomerulonephritis.
      It raises the difficulty in differentiation diagnosis of the two separate
      diseases that is worthy of further study.
FAU - Su, Tao
AU  - Su T
AD  - aRenal Division, Department of Medicine, Peking University First Hospital
      bInstitute of Nephrology, Peking University cKey Laboratory of Renal Disease,
      Ministry of Health of China dKey Laboratory of CKD Prevention and Treatment,
      Ministry of Education of China eDepartment of Pathology, Peking University First 
      Hospital fPeking-Tsinghua Center for Life Sciences, Beijing, China.
FAU - Yang, Li
AU  - Yang L
FAU - Cui, Zhao
AU  - Cui Z
FAU - Wang, Su-Xia
AU  - Wang SX
FAU - Zhao, Ming-Hui
AU  - Zhao MH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/05/18 06:00
MHDA- 2017/05/18 06:00
CRDT- 2017/05/18 06:00
AID - 10.1097/MD.0000000000006707 [doi]
AID - 00005792-201705190-00004 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 May;96(20):e6707. doi: 10.1097/MD.0000000000006707.

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