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KMID : 0359920070260040475
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Korean Journal of Nephrology
2007 Volume.26 No. 4 p.475 ~ p.479
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A Case of Crescentic IgA Nephropathy with Positive ANCA Serology
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Park Young-Eun
Sol Young-Mi
Lee Hae-Jung
Ahn Seung-Jae
Song Sang-Heon
Lee Dong-Won
Lee Soo-Bong
Kwak Ihm-Soo
Sol Mi-Young
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Abstract
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Immunoglobulin A (IgA) nephropathy in patients with the clinical findings of rapidly progressive glomerulonephritis usually demonstrate crescentic glomerulonephritis (CrGN). It is characterized by mesangial immune complex deposits containing IgA and is rarely associated with ANCA. The following case report illustrates a CrGN with mesangial & capillary wall IgA deposits by immunofluorescence (IF) and mesangial & endocapillary electron dense deposits by electron microscopy (EM) in patient with positive ANCA serology.
A 54-year-old male visited due to the discomfort of right flank. Blood pressure was 150/90 mmHg. BUN and serum Creatinine was 40 mg/dL, 4.4 mg/dL respectively. Urinalysis revealed protein 2+, >30 RBC’s/ HPF (dysmorphic), 24hr urine protein 1,612 mg/day and creatinine clearance 19 mL/min/1.73m2. Serological P-ANCA was positive by indirect immunofluorescence & ELISA. The histologic findings showed global scleorsis and fibrocelluar crescent without hypercellularity on LM, mesangial IgA deposition on IF, mesangial and subendothelial electrone dense material depositions on EM. After treatment (Methylprednisolon 500 mg/day for 3 days and then prednisolone 60 mg/day), Serum creatinin level, proteinuria and ANCA titer were decreased.
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KEYWORD
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Glomerulonephritis, Immunoglobulin A (IgA), Antibodies, Antineutrophil cytoplasmic
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