Abstract
IgA nephropathy is the most common glomerulonephritis, in which less than 10% of patients have a rapid decline of renal function. The histological findings of this group
resemble those of vasculitis, with presence of crescents and fibrinoid necrosis. The coexistence of IgA nephropathy and neutrophil anti-cytoplasmic antibodies is infrequent, and the pathogenic role of these antibodies in IgA nephropathy is unclear. Here we describe a case of a patient with IgA nephropathy, rapidly progressive glomerulonephritis and neutrophil positive anti-cytoplasmic antibodies, and literature review is presented.
References
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2. Coppo R, D’Amico G. Factors predicting progression of IgA nephropathies. J Nephrol. 2005;18(5):503-12.
3. Rojas-Rivera J, Fernandez-Juarez G, Praga M. Rapidly progressive IgA nephropathy: a form of vasculitis or a complement-mediated disease? Clin Kidney J. 2015;8(5):477-481. Disponible en: https://doi.org/10.1093ckj/sfv095
4. Bantis C, Stangou M, Schlaugat C, Alexopoulos E, Pantzaki A, Memmos D, et al. Is presence of ANCA in crescentic IgA nephropathy a coincidence or novel clinical entity? A case series. Am J Kidney Dis.2010;55(2):259-68. Disponible en: https://doi.org/10.1053j.ajkd.2009.09.031
5. Huang X, Wang Y, Xie L, Zhang Y, Tang S, Yin S, et al. IgA nephropathy with anti-neutrophil cytoplasmic antibody seropositivity.Clin Nephrol. 2015;84(3):156-64. Disponible en: https://doi.org/10.5414/CN108571
6. Ozaltin F, Bakkaloglu A, Ozen S, Topaloglu R, Kavak U, Kalyoncu M, et al. The significance of IgA class of antineutrophil cytoplasmic antibodies (ANCA) in childhood Henoch-Schönlein purpura. Clin Rheumatol. 2004;23(5):426-9. Disponible en: https://doi.org/10.1007s10067-004-0910-y
7. Ronda N, Esnault VL, Layward L, Sepe V, Allen A, Feehally J, et al. Antineutrophil cytoplasm antibodies (ANCA) of IgA isotype in adult Henoch-Schönlein purpura. Clin Exp Immunol. 1994;95(1):49-55. Disponible en: https://doi.org/10.1111/j.1365-2249.1994.tb06013.x
8. Ara J, Bonet J, Rodríguez R, Mirapeix E, Agraz I, Romero R. IgA nephropathy with crescentic glomerulonephritis and ANCA positive. Nefrologia. 2005;25(6): 712-7.
9. Martin SJ, Audrain MA, Baranger T, Moreau A, Dantal J, Testa A, et al. Recurrence of immunoglobulin A nephropathy with immunoglobulin A antineutrophil cytoplasmic antibodies following renal transplantation. Am J Kidney Dis. 1997;29(1):125-31.Disponible en: https://doi.org10.1016/S0272-6386(97)90019-6
10. Bollee G, Noel LH, Suarez F, Royal V, Gilardin L, de Serre NP, et al. auci-immune crescentic glomerulonephritis associated with ANCA of IgA class. Am J Kidney Dis. 2009;53(6):1063-7. Disponible en: https://doi.org10.1053/j.ajkd.2008.10.039
11. O’Donoghue DJ, Nusbaum P, Noel LH, Halbwachs-Mecarelli L, Lesavre P. Antineutrophil cytoplasmic antibodies in IgA nephropathy and Henoch-Schönlein purpura. Nephrol Dial Transplant. 1992;7(6):534-8.
12. Allmaras E, Nowack R, Andrassy K, Waldherr R, van der Woude F, Ritz E. Rapidly progressive IgA nephropathy with anti-myeloperoxidase antibodies benefits from immunosuppression. Clin Nephrol. 1997;48(5):269-73.
13. Ramirez SB, Rosen S, Niles J, Somers MJ. IgG antineutrophil cytoplasmic antibodies in IgA nephropathy: a clinical variant? Am J Kidney Dis. 1998;31(2):341-4. Disponible en: https://doi.org/10.1053ajkd.1998.v31.pm9469508
14. Haas M, Jafri J, Bartosh SM, Karp SL, Adler SG, Meehan SM. ANCA-associated crescentic glomerulonephritis with mesangial IgA deposits. Am J Kidney Dis. 2000;36(4):709-18. Disponible en: https://doi.org10.1053/ajkd.2000.17615
15. Bantis C, Stangou M, Schlaugat C, Alexopoulos E, Pantzaki A, Memmos D, et al. Is presence of ANCA in crescentic IgA nephropathy a coincidence or novel clinical entity? A case series. Am J Kidney Dis. 2010;55(2):259-68. Disponible en: https://doi.org/10.1053j.ajkd.2009.09.031
16. Yang YZ, Shi SF, Chen YQ, Chen M, Yang YH, Xie XF, et al. Clinical features of IgA nephropathy with serum ANCA positivity:a retrospective case-control study. Clin Kidney J. 2015;8(5):482-8. Disponible en:https://doi.org/10.1093/ckj/sfv078
17. Lv J, Yang Y, Zhang H, Chen W, Pan X, Guo Z, et al. Prediction of outcomes in crescentic IgA nephropathy in a multicenter cohort study. J Am Soc Nephrol. 2013;24(12):2118-25. Disponible en: https://doi.org10.1681/ASN.2012101017
18. Tumlin JA, Hennigar RA. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol.2004;24(3):256-68. Disponible en: https://doi.org/10.1016j.semnephrol.2004.01.006
19. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012;2(2):139-274. Chapter 10, Immunoglobulin A nephropathy; p. 209-17. Disponible en: https://doi.org/10.1038/kisup.2012.23
20. Xie X, Lv J, Shi S, Zhu L, Liu L, Chen M, et al. Plasma Exchange as an Adjunctive Therapy for Crescentic IgA Nephropathy. Am J Nephrol. 2016;44(2):141-9. https://doi.org/10.1159/000448767
21. Espinosa M, Ortega R, Sanchez M, Segarra A, Salcedo MT, Gonzalez F, et al; Spanish Group for Study of Glomerular Diseases (GLOSEN). Association of C4d deposition with clinical outcomes in IgA nephropathy. Clin J Am Soc Nephrol. 2014;9(5): 897-904. Disponible en: https://doi.org/10.2215/CJN.09710913
22. Gherghiceanu M, Penescu M, Mandache E. The predictive value of peritubular capillaries C3d deposition in IgA glomerulonephritis. J Cell Mol Med. 2005;9(1):143-52. Disponible en: https://doi.org/10.1111j.1582-4934.2005.tb00344.x
23. Coppo R, Peruzzi L, Amore A, Martino S, Vergano L, Lastauka I, et al. Dramatic effects of eculizumab in a child with diffuse proliferative lupus nephritis resistant to conventional therapy. Pediatr Nephrol.2015;30(1):167-72. Disponible en: https://doi.org/10.1007/s00467-014-2944-y
24. Jayne DRW, Bruchfeld A, Schaier M, Ciechanowski K, Harper L, Jadoul M, et al. Glomerulonephritides. Phase 2 randomised trial of oral C5a receptor antagonist CCX168 in ANCAassociated renal vasculitis. Nephrol Dial Transplant. 2014;29(Suppl 3):iii27–9. Disponible en: https://doi.org/10.1093/ndt/gfu120
25. Ring T, Pedersen BB, Salkus G, Goodship TH. Use of eculizumab in crescentic IgA nephropathy: proof of principle and conundrum? Clin Kidney J. 2015;8(5):489-91. Disponible en: https://doi.org/10.1093ckj/sfv076
2. Coppo R, D’Amico G. Factors predicting progression of IgA nephropathies. J Nephrol. 2005;18(5):503-12.
3. Rojas-Rivera J, Fernandez-Juarez G, Praga M. Rapidly progressive IgA nephropathy: a form of vasculitis or a complement-mediated disease? Clin Kidney J. 2015;8(5):477-481. Disponible en: https://doi.org/10.1093ckj/sfv095
4. Bantis C, Stangou M, Schlaugat C, Alexopoulos E, Pantzaki A, Memmos D, et al. Is presence of ANCA in crescentic IgA nephropathy a coincidence or novel clinical entity? A case series. Am J Kidney Dis.2010;55(2):259-68. Disponible en: https://doi.org/10.1053j.ajkd.2009.09.031
5. Huang X, Wang Y, Xie L, Zhang Y, Tang S, Yin S, et al. IgA nephropathy with anti-neutrophil cytoplasmic antibody seropositivity.Clin Nephrol. 2015;84(3):156-64. Disponible en: https://doi.org/10.5414/CN108571
6. Ozaltin F, Bakkaloglu A, Ozen S, Topaloglu R, Kavak U, Kalyoncu M, et al. The significance of IgA class of antineutrophil cytoplasmic antibodies (ANCA) in childhood Henoch-Schönlein purpura. Clin Rheumatol. 2004;23(5):426-9. Disponible en: https://doi.org/10.1007s10067-004-0910-y
7. Ronda N, Esnault VL, Layward L, Sepe V, Allen A, Feehally J, et al. Antineutrophil cytoplasm antibodies (ANCA) of IgA isotype in adult Henoch-Schönlein purpura. Clin Exp Immunol. 1994;95(1):49-55. Disponible en: https://doi.org/10.1111/j.1365-2249.1994.tb06013.x
8. Ara J, Bonet J, Rodríguez R, Mirapeix E, Agraz I, Romero R. IgA nephropathy with crescentic glomerulonephritis and ANCA positive. Nefrologia. 2005;25(6): 712-7.
9. Martin SJ, Audrain MA, Baranger T, Moreau A, Dantal J, Testa A, et al. Recurrence of immunoglobulin A nephropathy with immunoglobulin A antineutrophil cytoplasmic antibodies following renal transplantation. Am J Kidney Dis. 1997;29(1):125-31.Disponible en: https://doi.org10.1016/S0272-6386(97)90019-6
10. Bollee G, Noel LH, Suarez F, Royal V, Gilardin L, de Serre NP, et al. auci-immune crescentic glomerulonephritis associated with ANCA of IgA class. Am J Kidney Dis. 2009;53(6):1063-7. Disponible en: https://doi.org10.1053/j.ajkd.2008.10.039
11. O’Donoghue DJ, Nusbaum P, Noel LH, Halbwachs-Mecarelli L, Lesavre P. Antineutrophil cytoplasmic antibodies in IgA nephropathy and Henoch-Schönlein purpura. Nephrol Dial Transplant. 1992;7(6):534-8.
12. Allmaras E, Nowack R, Andrassy K, Waldherr R, van der Woude F, Ritz E. Rapidly progressive IgA nephropathy with anti-myeloperoxidase antibodies benefits from immunosuppression. Clin Nephrol. 1997;48(5):269-73.
13. Ramirez SB, Rosen S, Niles J, Somers MJ. IgG antineutrophil cytoplasmic antibodies in IgA nephropathy: a clinical variant? Am J Kidney Dis. 1998;31(2):341-4. Disponible en: https://doi.org/10.1053ajkd.1998.v31.pm9469508
14. Haas M, Jafri J, Bartosh SM, Karp SL, Adler SG, Meehan SM. ANCA-associated crescentic glomerulonephritis with mesangial IgA deposits. Am J Kidney Dis. 2000;36(4):709-18. Disponible en: https://doi.org10.1053/ajkd.2000.17615
15. Bantis C, Stangou M, Schlaugat C, Alexopoulos E, Pantzaki A, Memmos D, et al. Is presence of ANCA in crescentic IgA nephropathy a coincidence or novel clinical entity? A case series. Am J Kidney Dis. 2010;55(2):259-68. Disponible en: https://doi.org/10.1053j.ajkd.2009.09.031
16. Yang YZ, Shi SF, Chen YQ, Chen M, Yang YH, Xie XF, et al. Clinical features of IgA nephropathy with serum ANCA positivity:a retrospective case-control study. Clin Kidney J. 2015;8(5):482-8. Disponible en:https://doi.org/10.1093/ckj/sfv078
17. Lv J, Yang Y, Zhang H, Chen W, Pan X, Guo Z, et al. Prediction of outcomes in crescentic IgA nephropathy in a multicenter cohort study. J Am Soc Nephrol. 2013;24(12):2118-25. Disponible en: https://doi.org10.1681/ASN.2012101017
18. Tumlin JA, Hennigar RA. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol.2004;24(3):256-68. Disponible en: https://doi.org/10.1016j.semnephrol.2004.01.006
19. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012;2(2):139-274. Chapter 10, Immunoglobulin A nephropathy; p. 209-17. Disponible en: https://doi.org/10.1038/kisup.2012.23
20. Xie X, Lv J, Shi S, Zhu L, Liu L, Chen M, et al. Plasma Exchange as an Adjunctive Therapy for Crescentic IgA Nephropathy. Am J Nephrol. 2016;44(2):141-9. https://doi.org/10.1159/000448767
21. Espinosa M, Ortega R, Sanchez M, Segarra A, Salcedo MT, Gonzalez F, et al; Spanish Group for Study of Glomerular Diseases (GLOSEN). Association of C4d deposition with clinical outcomes in IgA nephropathy. Clin J Am Soc Nephrol. 2014;9(5): 897-904. Disponible en: https://doi.org/10.2215/CJN.09710913
22. Gherghiceanu M, Penescu M, Mandache E. The predictive value of peritubular capillaries C3d deposition in IgA glomerulonephritis. J Cell Mol Med. 2005;9(1):143-52. Disponible en: https://doi.org/10.1111j.1582-4934.2005.tb00344.x
23. Coppo R, Peruzzi L, Amore A, Martino S, Vergano L, Lastauka I, et al. Dramatic effects of eculizumab in a child with diffuse proliferative lupus nephritis resistant to conventional therapy. Pediatr Nephrol.2015;30(1):167-72. Disponible en: https://doi.org/10.1007/s00467-014-2944-y
24. Jayne DRW, Bruchfeld A, Schaier M, Ciechanowski K, Harper L, Jadoul M, et al. Glomerulonephritides. Phase 2 randomised trial of oral C5a receptor antagonist CCX168 in ANCAassociated renal vasculitis. Nephrol Dial Transplant. 2014;29(Suppl 3):iii27–9. Disponible en: https://doi.org/10.1093/ndt/gfu120
25. Ring T, Pedersen BB, Salkus G, Goodship TH. Use of eculizumab in crescentic IgA nephropathy: proof of principle and conundrum? Clin Kidney J. 2015;8(5):489-91. Disponible en: https://doi.org/10.1093ckj/sfv076
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