Acute tubulointerstitial nephritis with germinal centers in antineutrophil cytoplasmic antibody-associated vasculitis: A case report and literature review.

Abstract

RATIONALE:

Occasionally, tubulointerstitial lesions can be found in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, significantly isolated tubulointerstitial nephritis (TIN) with germinal centers is rare.

PATIENT CONCERNS:

A 17-year-old Chinese Han patient showed rapidly progressive glomerulonephritis, anuria, and serum creatinine of 19.4 mg/dL.

DIAGNOSIS:

He had positive ANCA targeting myeloperoxidase (55.0 RU/mL). The renal biopsy showed crescent formation in 100% of glomeruli. Of special note, the glomerular crescents were surrounded by granulomatous inflammation, extensive tubular destruction or disappearance, and massive interstitial infiltration. A diagnosis of AAV was thus made with the involved organ restricted to the kidney.

INTERVENTIONS:

The patient underwent 7 rounds of plasmapheresis, 3 pulses of methylprednisolone therapy (500 mg per pulse), and oral prednisolone (50 mg/d). Rituximab (500 mg) was used after the plasma exchange treatment.

OUTCOMES:

ANCA was negative, while anti-modified C-reactive protein (anti-mCRP) antibodies remained positive. The patient was dependent on hemodialysis. We found anti-mCRP antibody in the serum of the patient, with the major epitope on amino acids 35 to 47 of mCRP.

LESSONS:

We proposed that the anti-mCRP antibody might play an important role in this case of acute TIN in AAV.

• Authors: Zi-Shan Lin, Xiao-Ling Liu, Zhao Cui, Su-Xia Wang, Feng Yu, Fu-De Zhou, Ming-Hui Zhao
• Journal: Medicine (Medicine (Baltimore)) Vol. 98 Issue 48 Pg. e18178 (Nov 2019) ISSN: 1536-5964 [Electronic] United States
• PMID: 31770269 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Antineutrophil Cytoplasmic
• Glucocorticoids
• Immunologic Factors
• Rituximab
• C-Reactive Protein

Topics

• Adolescent
• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (diagnosis, immunology, physiopathology, therapy)
• Antibodies, Antineutrophil Cytoplasmic (blood)
• C-Reactive Protein (immunology)
• Disease Progression
• Germinal Center (pathology)
• Glucocorticoids (administration & dosage)
• Humans
• Immunologic Factors (administration & dosage)
• Kidney Function Tests (methods)
• Kidney Glomerulus (pathology, physiopathology)
• Male
• Nephritis, Interstitial (diagnosis, immunology, physiopathology, therapy)
• Plasma Exchange (methods)
• Plasmapheresis (methods)
• Rituximab (administration & dosage)
• Treatment Outcome