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Open Access Case report

MPO-ANCA associated crescentic glomerulonephritis with numerous immune complexes: case report

Ryuji Morizane1*, Konosuke Konishi1, Akinori Hashiguchi2, Hirobumi Tokuyama1, Shu Wakino1, Hiroshi Kawabe3, Matsuhiko Hayashi4, Koichi Hayashi1 and Hiroshi Itoh1

Author Affiliations

1 Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan

2 Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan

3 Health Center, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan

4 Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan

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BMC Nephrology 2012, 13:32  doi:10.1186/1471-2369-13-32

Published: 1 June 2012

Abstract

Background

Antineutrophil cytoplasmic antibody (ANCA)-associated crescentic glomerulonephritis (CGN) is a major cause of rapidly progressive glomerulonephritis (RPGN). ANCA-associated CGN is generally classified into pauci-immune RPGN, in which there are few or no immune complexes.

Case Presentation

A 78-year-old man presented with RPGN after a 7-year course of chronic proteinuria and hematuria with stable renal function. A blood examination showed a high titer of myeloperoxidase (MPO)-ANCA. A renal biopsy showed crescentic glomerulonephritis with abundant subepithelial, intramenbranous and subendothelial deposits by electron microscopy, leading to the diagnosis of ANCA-associated CGN superimposed on type 3 membranoproliferative glomerulonephritis (MPGN).

Conclusions

This case is unique in that type 3 MPGN and MPO-ANCA-associated CGN coexisted, and no similar case has been reported to date. Because ANCA-associated CGN has a predilection for elderly individuals and primary type 3 MPGN is rarely seen in this age group, coincidental existence appears less likely. This case may confer valuable information regarding the link between immune complex and ANCA-associated CGN.

Keywords:
Myeloperoxidase-antineutrophil cytoplasmic antibody; Membranoproliferative glomerulonephritis; Immune complex; Rapidly progressive glomerulonephritis