Chonnam Med J.  2015 Aug;51(2):102-105. 10.4068/cmj.2015.51.2.102.

A Case of Membranous Glomerulonephritis with Superimposed Anti-Neutrophil Cytoplasmic Antibody-Associated Rapidly Progressive Crescentic Glomerulonephritis

• Kim YH
• Kim HR
• Ham YR
• Jeon JW
• Chung S
• Choi DE
• Lee KW
• Na KR

• KMID: 2172139
• DOI: http://doi.org/10.4068/cmj.2015.51.2.102

Abstract

Idiopathic membranous glomerulonephritis (IMGN) is commonly diagnosed in adults with proteinuria. Rapid deterioration of renal function is a rare complication of IMGN, except when accompanied by renal vein thrombosis, malignant hypertension, or other underlying disease, including lupus nephritis. Here, we present a case of rapid deterioration of renal function in a patient with MGN superimposed with anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive crescentic glomerulonephritis (RPGN). Overall, about 20 cases of MGN with ANCA-associated RPGN have been reported. This case of biopsy-proven MGN with ANCA-associated RPGN is the first to be reported in Korea.

Keyword

Glomerulonephritis; Membranes; Antibodies; Anti-neutrophil cytoplasmic antibody-associated vasculitis

MeSH Terms

Adult
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Antibodies
Antibodies, Antineutrophil Cytoplasmic
Cytoplasm*
Glomerulonephritis*
Glomerulonephritis, Membranous*
Humans
Hypertension, Malignant
Korea
Lupus Nephritis
Membranes
Proteinuria
Renal Veins
Thrombosis
Antibodies
Antibodies, Antineutrophil Cytoplasmic

Figure

• 

  FIG. 1 The glomeruli were segmentally involved with epithelial crescentic proliferation. The remaining glomerular capillaries appeared thickened (Periodic acid-Schiff stain, ×400).

• 

  FIG. 2 (A) Direct immunofluorescence (IF) revealed granular IgG deposits along the capillary walls (anti-human IgG, ×200). (B) Direct IF revealed granular IgA deposits along the capillary walls (anti-human IgA, ×200). (C) Direct IF revealed granular C3 deposits along the capillary walls (anti-human C3, ×200).

• 

  FIG. 3 The glomerular capillary walls showed epimembranous (long arrow) and intramembranous (short arrow) electron-dense deposits. The overlying epithelial foot processes were diffusely effaced (uranyl acetate and lead citrate, ×4,000).

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