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Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?

BACKGROUND: The value of ANCA positivity in the setting of systemic lupus erythematous and their pathogenicity remains uncertain. CASE PRESENTATION: We report the case of a 48-year-old female with rapidly progressive kidney failure, arthro-myalgia and weight loss. Auto-immune screening showed anti-d...

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Autores principales: Lemerle, Marie, Garnier, Anne-Sophie, Croue, Anne, Chevailler, Alain, Saint-André, Jean-Paul, Subra, Jean-François, Augusto, Jean-François, Demiselle, Julien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712693/
https://www.ncbi.nlm.nih.gov/pubmed/31455233
http://dx.doi.org/10.1186/s12882-019-1531-7
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author Lemerle, Marie
Garnier, Anne-Sophie
Croue, Anne
Chevailler, Alain
Saint-André, Jean-Paul
Subra, Jean-François
Augusto, Jean-François
Demiselle, Julien
author_facet Lemerle, Marie
Garnier, Anne-Sophie
Croue, Anne
Chevailler, Alain
Saint-André, Jean-Paul
Subra, Jean-François
Augusto, Jean-François
Demiselle, Julien
author_sort Lemerle, Marie
collection PubMed
description BACKGROUND: The value of ANCA positivity in the setting of systemic lupus erythematous and their pathogenicity remains uncertain. CASE PRESENTATION: We report the case of a 48-year-old female with rapidly progressive kidney failure, arthro-myalgia and weight loss. Auto-immune screening showed anti-dsDNA antibodies, complement consumption and triple ANCA positivity. A first kidney biopsy done at presentation highlighted class IV-G glomerulonephritis with elective extra-capillary involvement and mainly C1q glomerular deposition at immunofluorescence study. After three months of a regimen combining steroids and cyclophosphamide, a second biopsy was performed and showed class IV-G glomerulonephritis with mainly endocapillary proliferation. CONCLUSION: This case is atypical in view of immunological profile and kidney histopathological presentation and evolution and gives rise to discussion in view of recent data on ANCA value in lupus nephritis, and suggests that different auto-immune pathways may be involved in lupus nephritis.
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spelling pubmed-67126932019-08-29 Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else? Lemerle, Marie Garnier, Anne-Sophie Croue, Anne Chevailler, Alain Saint-André, Jean-Paul Subra, Jean-François Augusto, Jean-François Demiselle, Julien BMC Nephrol Case Report BACKGROUND: The value of ANCA positivity in the setting of systemic lupus erythematous and their pathogenicity remains uncertain. CASE PRESENTATION: We report the case of a 48-year-old female with rapidly progressive kidney failure, arthro-myalgia and weight loss. Auto-immune screening showed anti-dsDNA antibodies, complement consumption and triple ANCA positivity. A first kidney biopsy done at presentation highlighted class IV-G glomerulonephritis with elective extra-capillary involvement and mainly C1q glomerular deposition at immunofluorescence study. After three months of a regimen combining steroids and cyclophosphamide, a second biopsy was performed and showed class IV-G glomerulonephritis with mainly endocapillary proliferation. CONCLUSION: This case is atypical in view of immunological profile and kidney histopathological presentation and evolution and gives rise to discussion in view of recent data on ANCA value in lupus nephritis, and suggests that different auto-immune pathways may be involved in lupus nephritis. BioMed Central 2019-08-27 /pmc/articles/PMC6712693/ /pubmed/31455233 http://dx.doi.org/10.1186/s12882-019-1531-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Lemerle, Marie
Garnier, Anne-Sophie
Croue, Anne
Chevailler, Alain
Saint-André, Jean-Paul
Subra, Jean-François
Augusto, Jean-François
Demiselle, Julien
Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?
title Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?
title_full Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?
title_fullStr Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?
title_full_unstemmed Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?
title_short Clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, ANCA-associated vasculitis or something else?
title_sort clinico-pathological considerations in a 48-years-old female with acute kidney injury: is it lupus nephritis, anca-associated vasculitis or something else?
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712693/
https://www.ncbi.nlm.nih.gov/pubmed/31455233
http://dx.doi.org/10.1186/s12882-019-1531-7
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