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Open Access Case report

A case of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis and concurrent membranous nephropathy

Michiko Shimada1*, Takeshi Fujita1, Norio Nakamura2, Ikuyo Narita1, Yuko Shimaya1, Reiichi Murakami1, Hideaki Yamabe1, Hiroshi Osawa1 and Ken Okumura1

Author Affiliations

1 Graduate School of Medicine, Division of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

2 Graduate School of Medicine, Community Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

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BMC Nephrology 2013, 14:73  doi:10.1186/1471-2369-14-73

Published: 28 March 2013

Abstract

Background

Myeloperoxidase anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (MPO-ANCA-GN) and concurrent membranous nephropathy (MN) are very rare combination. Their causal relationship has been suggested, but not determined.

Case presentation

A 73-years-old male with 5-year history of proteinuria underwent an operation for his sigmoid colon cancer. Seven months later, he was referred to a nephrology division due to an exacerbating renal function and hypoalbuminemia. Laboratory examination revealed positive MPO-ANCA in the serum. A renal biopsy revealed a necrotizing extracapillary proliferative glomerulonephritis with crescents, demonstrating MPO-ANCA-GN. Whereas, immunofluorescent staining documented granular deposition of immumoglobulin (Ig) G and C3 along the capillary wall and electron microscopy showed subepithelial deposits in the glomerular basement membrane demonstrating MN. Immunofluorescent staining of IgG subclass showed positive IgG1, IgG2, negative IgG3 and weak positive IgG4 suggested the possibility of malignancy-associated MN.

Conclusion

Combination of MPO-ANCA-GN and MN are rare. Although the causal relationship has been suggested in some cases, we should consider all the possibilities including idiopathic MN and secondary MN associated with malignancy, drug use or infection.

Keywords:
MPO-ANCA; Crescentic glomerulonephritis; Membranous nephropathy