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MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature
BACKGROUND: Renal involvement in rheumatoid arthritis (RA) is common and has a negative impact on patient survival. Only few cases have been reported of necrotizing glomerulonephritis (GN) associated with myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) in patients with RA. CASE PRESE...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Society of Diabetic Nephropathy Prevention
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418071/ https://www.ncbi.nlm.nih.gov/pubmed/28491854 http://dx.doi.org/10.15171/jnp.2017.10 |
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author | Góis, Mário Messias, Ana Carvalho, Dulce Carvalho, Fernanda Sousa, Helena Sousa, João Nolasco, Fernando |
author_facet | Góis, Mário Messias, Ana Carvalho, Dulce Carvalho, Fernanda Sousa, Helena Sousa, João Nolasco, Fernando |
author_sort | Góis, Mário |
collection | PubMed |
description | BACKGROUND: Renal involvement in rheumatoid arthritis (RA) is common and has a negative impact on patient survival. Only few cases have been reported of necrotizing glomerulonephritis (GN) associated with myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) in patients with RA. CASE PRESENTATION: We report a patient with RA who developed a necrotizing GN associated with ANCA-MPO, treated with rituximab (RTX). A 55-year-old man with a 27-year history of RA under secukinumab was referred to our nephrology clinic with worsening renal function associated with microhematuria and proteinuria. Our laboratory evaluation showed hypocomplementemia and positive titers for MPO-ANCA (615 U/mL). A renal biopsy demonstrated pauci-immune necrotizing GN. The patient was treated with 3 consecutive pulses of methylprednisolone followed by oral prednisolone (1 mg/Kg) and rituximab (1000 mg, repeated 14 days later). After a 10-month follow-up, the arthritis remains well-controlled, renal function stabilized, proteinuria improved and MPO-ANCA titer normalized (6.3 U/mL). CONCLUSIONS: Necrotizing GN is a rare but a serious condition and an early diagnosis is essential to treatment. This is the first case of necrotizing GN (without extra-renal manifestations of vasculitis) in a patient with active RA, successfully treated with RTX. |
format | Online Article Text |
id | pubmed-5418071 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Society of Diabetic Nephropathy Prevention |
record_format | MEDLINE/PubMed |
spelling | pubmed-54180712017-05-10 MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature Góis, Mário Messias, Ana Carvalho, Dulce Carvalho, Fernanda Sousa, Helena Sousa, João Nolasco, Fernando J Nephropathol Case Report BACKGROUND: Renal involvement in rheumatoid arthritis (RA) is common and has a negative impact on patient survival. Only few cases have been reported of necrotizing glomerulonephritis (GN) associated with myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) in patients with RA. CASE PRESENTATION: We report a patient with RA who developed a necrotizing GN associated with ANCA-MPO, treated with rituximab (RTX). A 55-year-old man with a 27-year history of RA under secukinumab was referred to our nephrology clinic with worsening renal function associated with microhematuria and proteinuria. Our laboratory evaluation showed hypocomplementemia and positive titers for MPO-ANCA (615 U/mL). A renal biopsy demonstrated pauci-immune necrotizing GN. The patient was treated with 3 consecutive pulses of methylprednisolone followed by oral prednisolone (1 mg/Kg) and rituximab (1000 mg, repeated 14 days later). After a 10-month follow-up, the arthritis remains well-controlled, renal function stabilized, proteinuria improved and MPO-ANCA titer normalized (6.3 U/mL). CONCLUSIONS: Necrotizing GN is a rare but a serious condition and an early diagnosis is essential to treatment. This is the first case of necrotizing GN (without extra-renal manifestations of vasculitis) in a patient with active RA, successfully treated with RTX. Society of Diabetic Nephropathy Prevention 2017-03 2016-10-27 /pmc/articles/PMC5418071/ /pubmed/28491854 http://dx.doi.org/10.15171/jnp.2017.10 Text en © 2017 The Author(s) Published by Society of Diabetic Nephropathy Prevention. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Góis, Mário Messias, Ana Carvalho, Dulce Carvalho, Fernanda Sousa, Helena Sousa, João Nolasco, Fernando MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature |
title | MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature |
title_full | MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature |
title_fullStr | MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature |
title_full_unstemmed | MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature |
title_short | MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature |
title_sort | mpo-anca-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report and review of literature |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418071/ https://www.ncbi.nlm.nih.gov/pubmed/28491854 http://dx.doi.org/10.15171/jnp.2017.10 |
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