HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.04060808v1 4/2/299    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nasr, S. H. Articles by Markowitz, G. S. Search for Related Content PubMed PubMed Citation Articles by Nasr, S. H. Articles by Markowitz, G. S.

Membranous Glomerulonephritis with ANCA-Associated Necrotizing and Crescentic Glomerulonephritis

Samih H. Nasr^*, Samar M. Said^*, Anthony M. Valeri, Michael B. Stokes^*, Naveed N. Masani, Vivette D. D'Agati^*, and Glen S. Markowitz^*

^* Department of Pathology, Columbia University, College of Physicians & Surgeons, New York, New York; Department of Medicine, Division of Nephrology, Columbia University, College of Physicians & Surgeons, New York, New York; and Department of Medicine, Winthrop University Hospital, Mineola, New York

Correspondence: Dr. Samih H. Nasr, Department of Pathology, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, VC14–224, New York, NY 10032. Phone: 212-305-7460; Fax: 212-342-5380; E-mail: sn386{at}columbia.edu

Background and objectives: Only rare cases of concurrent membranous glomerulonephritis (MGN) and antineutrophil cytoplasmic antibody (ANCA)-associated necrotizing and crescentic glomerulonephritis (NCGN) have been reported.

Design, setting, participants, & measurements: The authors report the clinical and pathologic findings in 14 patients with MGN and ANCA-associated NCGN.

Results: The cohort consisted of eight men and six women with a mean age of 58.7 yr. ANCA positivity was documented by indirect immunofluorescence or ELISA in all patients. Indirect immunofluorescence was positive in 13 patients (seven P-ANCA, five C-ANCA, one atypical ANCA). ELISA was positive in nine of 10 patients (five MPO-ANCA, three PR3-ANCA, one MPO- and PR3-ANCA). Clinical presentation included heavy proteinuria (mean 24-hr urine protein 6.5 g/d), hematuria, and acute renal failure (mean creatinine 4.4 mg/dl). Pathologic evaluation revealed MGN and NCGN, with crescents involving a mean of 32% of glomeruli. On ultrastructural evaluation, the majority of cases showed stage I or II membranous changes. Follow-up was available for 13 patients, 12 of whom were treated with steroids and cyclophosphamide. At a mean follow-up of 24.3 mo, five patients progressed to ESRD, seven had stabilization or improvement in renal function, and one had worsening renal function. Five patients, including three with ESRD, died during the follow-up period. The only independent predictor of progression to ESRD was serum creatinine at biopsy.

Conclusions: MGN with ANCA-associated NCGN is a rare dual glomerulopathy seen in patients with heavy proteinuria, acute renal failure, and active urine sediment. Prognosis is variable, with 50% of patients reaching endpoints of ESRD or death.

This article has been cited by other articles:

				K. Matsumoto, H. Honda, T. Shibata, D. Sanada, Y. Wada, E. Ashikaga, A. Kuroki, K. Kitazawa, and T. Akizawa MPO-ANCA crescentic glomerulonephritis complicated by membranous nephropathy: MPO demonstrated in epimembranous deposits NDT Plus, December 1, 2009; 2(6): 461 - 465. [Abstract] [Full Text] [PDF]