Anti-neutrophil cytoplasmic antibody-associated glomerulonephritis with detection of myeloperoxidase and phospholipase A 2 receptor in membranous nephropathy-lesions: report of two patients with microscopic polyangiitis.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100967793 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2369 (Electronic) Linking ISSN: 14712369 NLM ISO Abbreviation: BMC Nephrol Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2000-
    • Subject Terms:
      Antibodies, Antineutrophil Cytoplasmic/*metabolism ; Glomerulonephritis, Membranous/*metabolism ; Microscopic Polyangiitis/*metabolism ; Peroxidase/*metabolism ; Receptors, Phospholipase A2/*metabolism; Antibodies, Antineutrophil Cytoplasmic/analysis ; Female ; Glomerulonephritis, Membranous/complications ; Glomerulonephritis, Membranous/diagnosis ; Humans ; Male ; Microscopic Polyangiitis/complications ; Microscopic Polyangiitis/diagnosis ; Middle Aged ; Peroxidase/analysis ; Receptors, Phospholipase A2/analysis
    • Abstract:
      Background: Podocyte phospholipase A 2 receptor (PLA 2 R) is a major target antigen in idiopathic adult membranous nephropathy (MN). Histological PLA 2 R staining in the renal tissue has proven to be useful for the detection of idiopathic MN. However, glomerular PLA 2 R deposits have also been recently observed in several patients with secondary MN, such as hepatitis B virus-associated, hepatitis C virus-associated, and neoplasm-associated MN. Certain inflammatory environments have been suggested to lead to abnormal expression of PLA 2 R epitopes, with the resulting production of PLA 2 R autoantibodies.
      Case Presentation: We report two patients diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis with MN-lesions, in whom ANCA titers for myeloperoxidase (MPO) were persistently positive. The first patient was a 52-years-old man who presented with interstitial pneumonitis. Microscopic hematuria and proteinuria were found when the interstitial pneumonitis became more severe. Renal biopsy findings yielded a diagnosis of ANCA-associated glomerulonephritis (mixed class) with MN-lesions. The second patient was a 63-years-old woman who had been treated for relapsing polychondritis. Her renal tissue showed evidence of focal ANCA-associated glomerulonephritis with MN-lesions. Interestingly, both MPO and PLA 2 R were detected in the glomerular subepithelial deposits of both patients. Immunoglobulin G (IgG) 1 and IgG2 were positive in the glomeruli of patient 2, and all subclasses of IgGs were positive in patient 1.
      Conclusion: The present cases suggest that ANCA-associated glomerulonephritis could expose PLA 2 R, leading to the development of MN-lesions.
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    • Contributed Indexing:
      Keywords: Anti-neutrophil cytoplasmic antibody; Membranous nephropathy; Myeloperoxidase; Phospholipase A2 receptor
    • Accession Number:
      0 (Antibodies, Antineutrophil Cytoplasmic)
      0 (Receptors, Phospholipase A2)
      EC 1.11.1.7 (Peroxidase)
    • Publication Date:
      Date Created: 20180525 Date Completed: 20190527 Latest Revision: 20190527
    • Publication Date:
      20221213
    • Accession Number:
      PMC5966893
    • Accession Number:
      10.1186/s12882-018-0922-5
    • Accession Number:
      29792176