scholarly journals A Case of Myeloma Kidney with Perinuclear Anti-Neutrophil Cytoplasmic Antibody and Anti-Myeloperoxidase Positivity: The Importance of Determining the True Cause of Renal Impairment

2020 ◽  
Vol 10 (2) ◽  
pp. 79-85
Author(s):  
Tayeba Roper ◽  
Robert Elias ◽  
Satish Jayawardene
Keyword(s):  
Renal Biopsy ◽  
Crescentic Glomerulonephritis ◽  
Kidney Injury ◽  
Rare Condition ◽  
Cast Nephropathy ◽  
Anca Associated Vasculitis ◽  
Myeloma Kidney ◽  
Perinuclear Anca ◽  
Rare Situation

Acute kidney injury (AKI) is a common presentation which can result from a number of different underlying pathological processes. Haematological malignancies, particularly multiple myeloma (MM), are known to frequently present with AKI. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare condition which can cause crescentic glomerulonephritis (GN), resulting in AKI. We present the case of a 60-year-old man who presented with clinical features suggestive of AAV in the context of blood tests which demonstrated AKI and positive perinuclear ANCA (p-ANCA) and anti-myeloperoxidase (anti-MPO) titres. Further investigations demonstrated an underlying diagnosis of MM. A renal biopsy was ultimately required to determine the cause of AKI, a cast nephropathy. This case is the first to our knowledge which demonstrates a rare situation in which myeloma kidney is associated with positive p-ANCA and anti-MPO titres, without any evidence of a crescentic GN. It highlights the importance of following up on all investigations sent in the context of AKI, even when a potential diagnosis seems evident. Furthermore, it demonstrates the role of renal biopsy in confirming a diagnosis in the context of AKI with multiple differential diagnoses.

Acute kidney injury secondary to renal large B-cell lymphoma: role of early renal biopsy

2010 ◽  
Vol 43 (1) ◽  
pp. 237-240 ◽  
Author(s):  
Suhail Al-Salam ◽  
Ahmad Shaaban ◽  
Maha Alketbi ◽  
Naveed U. Haq ◽  
Samra Abouchacra
Keyword(s):  
Acute Kidney Injury ◽  
B Cell ◽  
Renal Biopsy ◽  
Cell Lymphoma ◽  
Kidney Injury ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

scholarly journals Acute kidney injury as first presentation of lymphoma: the role of renal biopsy

2013 ◽  
Vol 2013 (nov29 1) ◽  
pp. bcr2013202196-bcr2013202196 ◽  
Author(s):  
W. On ◽  
M. Udberg
Keyword(s):  
Acute Kidney Injury ◽  
Renal Biopsy ◽  
Kidney Injury

scholarly journals Acute Kidney Injury due to Anticoagulant-Related Nephropathy : A Suggestion for Therapy

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Letizia Zeni ◽  
Chiara Manenti ◽  
Simona Fisogni ◽  
Vincenzo Terlizzi ◽  
Federica Verzeletti ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Kidney Injury ◽  
Cast Nephropathy ◽  
Anca Associated Vasculitis ◽  
A Prospective Study ◽  
The Relationship ◽  
Gross Haematuria ◽  
Strong Suspicion

The relationship between kidneys and anticoagulation is complex, especially after introduction of the direct oral anticoagulants (DOAC). It is recently growing evidence of an anticoagulant-related nephropathy (ARN), a form of acute kidney injury caused by excessive anticoagulation. The pathogenesis of kidney damage in this setting is multifactorial, and nowadays, there is no established treatment. We describe a case of ARN, admitted to our Nephrology Unit with a strong suspicion of ANCA-associated vasculitis due to gross haematuria and haemoptysis; the patient was being given dabigatran. Renal biopsy excluded ANCA-associated vasculitis and diagnosed a red blood cell cast nephropathy superimposed to an underlying IgA nephropathy. Several mechanisms are possibly responsible for kidney injury in ARN: tubular obstruction, cytotoxicity of heme-containing molecules and free iron, and activation of proinflammatory/profibrotic cytokines. Therefore, the patient was given a multilevel strategy of treatment. A combination of reversal of coagulopathy (i.e., withdrawal of dabigatran and infusion of its specific antidote) along with administration of fluids, sodium bicarbonate, steroids, and mannitol resulted in conservative management of AKI and fast recovery of renal function. This observation could suggest a prospective study aiming to find the best therapy of ARN.

scholarly journals Renal biopsy teaching case: A patient with scleroderma, hypertension, acute kidney injury and PR3 ANCA positivity

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Sam Kant ◽  
◽  
Avi Rosenberg ◽  
Fred Wigley ◽  
Duvuru Geetha D ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Biopsy ◽  
Kidney Injury ◽  
Scleroderma Renal Crisis ◽  
Disease Course ◽  
Common Cause ◽  
Teaching Case ◽  
Anca Associated Vasculitis ◽  
Renal Crisis

Scleroderma Renal Crisis (SRC) is the most common cause of Acute Kidney Injury (AKI) in scleroderma and occurs early during the disease course while ANCA Associated Vasculitis (AAV) is a rare cause of acute kidney injury occurring late in the disease course. We report a case of AKI with positive PR3 ANCA serology late in the disease course with a renal biopsy revealing findings of SRC.

ANCA associated glomerulonephritis in tuberculosis: a paradoxical reaction

2021 ◽  
Vol 14 (6) ◽  
pp. e241904
Author(s):  
Shane OBrien ◽  
Brenda Griffin ◽  
Anne Marie McLaughlin ◽  
Joseph Keane
Keyword(s):  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Antituberculous Therapy ◽  
Tb Treatment ◽  
Anca Associated Vasculitis ◽  
First Case ◽  
Paradoxical Worsening ◽  
Perinuclear Anca ◽  
Hiv Negative

We present a case of antineutrophil cytoplasmic antibodies (ANCA)-associated rapidly progressive glomerulonephritis in the context of treatment of pulmonary tuberculosis (TB). A 42-year-old woman was treated for drug-susceptible pulmonary TB and represented with paradoxical worsening of symptoms and radiological features. She was HIV negative. A severe acute kidney injury with features of glomerulonephritis was evident on admission. Perinuclear ANCA and antimyeloperoxidase antibodies were present in serum and renal biopsy was consistent with ANCA-associated vasculitis. The patient was successfully treated with both antituberculous therapy and immunosuppression (corticosteroids and mycophenolate mofetil) with subsequent clinical improvement and amelioration of renal function. We propose this is the first case that describes the association between paradoxical reactions during TB treatment and ANCA-associated glomerulonephritis.

scholarly journals Pauci-Immune Necrotizing and Crescentic Glomerulonephritis with Membranous Lupus Nephritis, Fifteen Years after Initial Diagnosis of Secondary Membranous Nephropathy

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ryan Burkhart ◽  
Nina Shah ◽  
Michael Abel ◽  
James D. Oliver ◽  
Matthew Lewin
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Immune Complex ◽  
Lupus Erythematosus ◽  
Membranous Nephropathy ◽  
Crescentic Glomerulonephritis ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Rapid Decline ◽  
Secondary Membranous Nephropathy

Renal involvement in systemic lupus erythematosus (SLE) is usually immune complex mediated and may have multiple different presentations. Pauci-immune necrotizing and crescentic glomerulonephritis (NCGN) refers to extensive glomerular inflammation with few or no immune deposits that may result in rapid decline in renal function. We report a case of a 79-year-old Hispanic male with a history of secondary membranous nephropathy (diagnosed by renal biopsy 15 years previously) who was admitted with acute kidney injury and active urinary sediment. P-ANCA titers and anti-myeloperoxidase antibodies were positive. The renal biopsy was diagnostic for NCGN superimposed on a secondary membranous nephropathy. A previous diagnosis of SLE based on American College of Rheumatology criteria was discovered via Veteran’s Administration records review after the completion of treatment for pauci-immune NCGN. ANCAs are detected in 20–31% of patients with SLE. There may be an association between SLE and ANCA seropositivity. In patients with lupus nephritis and biopsy findings of necrotizing and crescentic glomerulonephritis, without significant immune complex deposition, ANCA testing should be performed. In patients with secondary membranous nephropathy SLE should be excluded.

scholarly journals Goodpasture’s Syndrome and p-ANCA Associated Vasculitis in a Patient of Silicosiderosis: An Unusual Association

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Amanjit Bal ◽  
Ashim Das ◽  
Dheeraj Gupta ◽  
Mandeep Garg
Keyword(s):  
Basement Membrane ◽  
Crescentic Glomerulonephritis ◽  
Pulmonary Haemorrhage ◽  
Goodpasture's Syndrome ◽  
Goodpasture’S Syndrome ◽  
Unusual Association ◽  
Anca Associated Vasculitis ◽  
Circulating Autoantibodies ◽  
Metal Dust

Introduction.Goodpasture’s syndrome is a rare clinical entity and is characterized by circulating autoantibodies which are principally directed against the glomerular/alveolar basement membrane. The etiology of Goodpasture’s syndrome is still unknown. Lung involvement occurs as a result of lung injury and the exposure of new epitopes to the immune system. Recently, several studies have suggested the role of silica as one of etiological factors in ANCA associated vasculitis and glomerulonephritis.Materials and Methods.We present a case of a 40-year-old welder with silicosiderosis, who developed anti-GBM disease with p-ANCA positivity.Case Report.Patient presented to an emergency with gradually increasing breathlessness along with renal failure and died after short hospital stay. Autopsy pathology findings revealed crescentic glomerulonephritis with linear glomerular basement membrane antibody deposition, splenic vasculitis, pulmonary haemorrhage, and pulmonary silicosiderosis.Conclusion.This case reinforces the role of environmental triggers like exposure to silica, metal dust, and tobacco in pathogenesis of Goodpasture’s syndrome and p-ANCA associated vasculitis.

scholarly journals Human leucocyte antigen-associated anti-glomerular basement membrane disease in siblings

2019 ◽  
Vol 13 (2) ◽  
pp. 261-262
Author(s):  
Martin E Durcan ◽  
Beena Nair ◽  
John G Anderton
Keyword(s):  
Acute Kidney Injury ◽  
Basement Membrane ◽  
Renal Biopsy ◽  
Glomerular Basement Membrane ◽  
Human Leucocyte Antigen ◽  
Crescentic Glomerulonephritis ◽  
Kidney Injury ◽  
Pulmonary Involvement ◽  
High Titre ◽  
Tissue Typing

Abstract We report a case of anti-glomerular basement membrane (GBM) disease in association with human leucocyte antigen (HLA) DRB1 15:01. A 71-year-old woman presented with oligoanuric acute kidney injury accompanied by high titre anti-GBM antibodies. Renal biopsy revealed a severe crescentic glomerulonephritis. Her brother had presented 6 years earlier with oligoanuric acute kidney injury. He was dual positive for MPO ANCA and anti-GBM antibodies. Renal biopsy was not performed. Both had an absence of pulmonary involvement. Tissue typing confirmed both were heterozygous for HLA DRB1 15:01 and DRB1 04:03.

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