J Rheum Dis.  2015 Aug;22(4):260-262. 10.4078/jrd.2015.22.4.260.

A Case of Bad Prognosis for Membranous Nephropathy in a Patient with Mixed Connective Tissue Disease

• Kim MY
• Koo HS
• Seo YK
• Min JH
• Lee KJ
• Jo SY
• Koh HI

• KMID: 2222859
• DOI: http://doi.org/10.4078/jrd.2015.22.4.260

Abstract

Incidence of renal involvement in mixed connective tissue disease (MCTD) is low. In the presence of glomerulonephritis, membranous nephropathy (MN) in MCTD is common. A 47-year-old woman presented with hypothyroidism. She developed Raynaud's phenomenon, arthralgia, and incomplete lupus erythematosus, diagnosed with MCTD. One year after then, the patient developed persistent proteinuria (1+) without hematuria. Following diagnosis with MCTD, her renal function began to deteriorate. The renal biopsy showed late stage MN. For the treatment of MN with mild proteinuria and MCTD, we prescribed an angiotensin II receptor blocker and 7.5 mg of methotrexate per week and 300 mg of hydroxychloroquine daily. The patient had a reduced estimated glomerular filtration rate of 55% for the subsequent eight years. The MN in MCTD is known to show good renal prognosis. Here, we report on a rare case of MN in MCTD in Korea with a bad prognosis.

Keyword

Mixed connective tissue disease; Glomerulonephritis; Membranous glomerulonephritis

MeSH Terms

Arthralgia
Biopsy
Diagnosis
Female
Glomerular Filtration Rate
Glomerulonephritis
Glomerulonephritis, Membranous*
Hematuria
Humans
Hydroxychloroquine
Hypothyroidism
Incidence
Korea
Methotrexate
Middle Aged
Mixed Connective Tissue Disease*
Prognosis*
Proteinuria
Receptors, Angiotensin
Hydroxychloroquine
Methotrexate
Receptors, Angiotensin

Figure

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  Figure 1. (A) Glomeruli sclerosis of 23.1% involves mesangial cells and endothelial cells (H&E, ×400). (B) Immunoglobulin G was slightly stained in the periphery (IF, ×400). (C) Electron-dense deposits were in some subepithelial and intramembranous deposits. The diffuse effacement of podocyte foot process and a dome and spike formation were evident (EM, ×10,000).

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