Membranous glomerulonephritis with crescents

Caroline M F Barrett, Megan Troxell, Christopher P. Larse, Donald Houghton

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: The coexistence of membranous glomerulonephritis (MGN) and necrotizing and crescentic glomerulonephritis (NCGN) is an unusual finding in a renal biopsy except in lupus nephritis. Little is known about whether these lesions are causally related in any clinical setting. Methods: We reviewed the pathology, presentation, and clinical course of 13 non-lupus patients with combined MGN and NCGN in native kidney biopsies (nine females, four males; median age 69 years), with particular attention to evidence of secondary MGN. Additional IgG subclass and phospholipase A2 receptor (PLA2R) immunofluorescence studies were conducted in seven cases. Results: Eight biopsies were pauci-immune other than the capillary wall deposits of MGN; one patient had a non-lupus immune complex disease, and four had mesangial deposits, including one with rare subendothelial deposits. None had anti-glomerular basement membrane disease. IgG4 was dominant or codominant in the capillary wall deposits in three cases and virtually absent in four; PLA2R was positive in two cases, and negative in five. Seven patients were judged to have secondary MGN, including five of eight ANCA+ patients. Twelve patients were treated with combinations of steroids, cyclophosphamide, rituximab, followed by durable response in seven and relentless progression to end stage renal disease in four. Conclusions: Secondary MGN occurs with higher frequency in ANCA-positive NCGN than in the general MGN population. A causal relationship between MGN and NCGN was not established in any patient, but circumstances suggest a common cause in several, including immune complex disease, drug reaction and paraneoplastic syndrome.

Original languageEnglish (US)
Pages (from-to)963-971
Number of pages9
JournalInternational Urology and Nephrology
Volume46
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Membranous Glomerulonephritis
Glomerulonephritis
Phospholipase A2 Receptors
Immune Complex Diseases
Antineutrophil Cytoplasmic Antibodies
Biopsy
Immunoglobulin G
Anti-Glomerular Basement Membrane Disease
Kidney
Paraneoplastic Syndromes
Lupus Nephritis
Clinical Pathology
Cyclophosphamide
Chronic Kidney Failure
Fluorescent Antibody Technique
Steroids

Keywords

  • IgG4
  • Membranous glomerulonephritis
  • Necrotizing glomerulonephritis
  • PLA2R

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Membranous glomerulonephritis with crescents. / Barrett, Caroline M F; Troxell, Megan; Larse, Christopher P.; Houghton, Donald.

In: International Urology and Nephrology, Vol. 46, No. 5, 2014, p. 963-971.

Research output: Contribution to journalArticle

Barrett, Caroline M F ; Troxell, Megan ; Larse, Christopher P. ; Houghton, Donald. / Membranous glomerulonephritis with crescents. In: International Urology and Nephrology. 2014 ; Vol. 46, No. 5. pp. 963-971.
@article{1f1633015fd34907a997f9534b501001,
title = "Membranous glomerulonephritis with crescents",
abstract = "Purpose: The coexistence of membranous glomerulonephritis (MGN) and necrotizing and crescentic glomerulonephritis (NCGN) is an unusual finding in a renal biopsy except in lupus nephritis. Little is known about whether these lesions are causally related in any clinical setting. Methods: We reviewed the pathology, presentation, and clinical course of 13 non-lupus patients with combined MGN and NCGN in native kidney biopsies (nine females, four males; median age 69 years), with particular attention to evidence of secondary MGN. Additional IgG subclass and phospholipase A2 receptor (PLA2R) immunofluorescence studies were conducted in seven cases. Results: Eight biopsies were pauci-immune other than the capillary wall deposits of MGN; one patient had a non-lupus immune complex disease, and four had mesangial deposits, including one with rare subendothelial deposits. None had anti-glomerular basement membrane disease. IgG4 was dominant or codominant in the capillary wall deposits in three cases and virtually absent in four; PLA2R was positive in two cases, and negative in five. Seven patients were judged to have secondary MGN, including five of eight ANCA+ patients. Twelve patients were treated with combinations of steroids, cyclophosphamide, rituximab, followed by durable response in seven and relentless progression to end stage renal disease in four. Conclusions: Secondary MGN occurs with higher frequency in ANCA-positive NCGN than in the general MGN population. A causal relationship between MGN and NCGN was not established in any patient, but circumstances suggest a common cause in several, including immune complex disease, drug reaction and paraneoplastic syndrome.",
keywords = "IgG4, Membranous glomerulonephritis, Necrotizing glomerulonephritis, PLA2R",
author = "Barrett, {Caroline M F} and Megan Troxell and Larse, {Christopher P.} and Donald Houghton",
year = "2014",
doi = "10.1007/s11255-013-0593-x",
language = "English (US)",
volume = "46",
pages = "963--971",
journal = "International Urology and Nephrology",
issn = "0301-1623",
publisher = "Springer Netherlands",
number = "5",

}

TY - JOUR

T1 - Membranous glomerulonephritis with crescents

AU - Barrett, Caroline M F

AU - Troxell, Megan

AU - Larse, Christopher P.

AU - Houghton, Donald

PY - 2014

Y1 - 2014

N2 - Purpose: The coexistence of membranous glomerulonephritis (MGN) and necrotizing and crescentic glomerulonephritis (NCGN) is an unusual finding in a renal biopsy except in lupus nephritis. Little is known about whether these lesions are causally related in any clinical setting. Methods: We reviewed the pathology, presentation, and clinical course of 13 non-lupus patients with combined MGN and NCGN in native kidney biopsies (nine females, four males; median age 69 years), with particular attention to evidence of secondary MGN. Additional IgG subclass and phospholipase A2 receptor (PLA2R) immunofluorescence studies were conducted in seven cases. Results: Eight biopsies were pauci-immune other than the capillary wall deposits of MGN; one patient had a non-lupus immune complex disease, and four had mesangial deposits, including one with rare subendothelial deposits. None had anti-glomerular basement membrane disease. IgG4 was dominant or codominant in the capillary wall deposits in three cases and virtually absent in four; PLA2R was positive in two cases, and negative in five. Seven patients were judged to have secondary MGN, including five of eight ANCA+ patients. Twelve patients were treated with combinations of steroids, cyclophosphamide, rituximab, followed by durable response in seven and relentless progression to end stage renal disease in four. Conclusions: Secondary MGN occurs with higher frequency in ANCA-positive NCGN than in the general MGN population. A causal relationship between MGN and NCGN was not established in any patient, but circumstances suggest a common cause in several, including immune complex disease, drug reaction and paraneoplastic syndrome.

AB - Purpose: The coexistence of membranous glomerulonephritis (MGN) and necrotizing and crescentic glomerulonephritis (NCGN) is an unusual finding in a renal biopsy except in lupus nephritis. Little is known about whether these lesions are causally related in any clinical setting. Methods: We reviewed the pathology, presentation, and clinical course of 13 non-lupus patients with combined MGN and NCGN in native kidney biopsies (nine females, four males; median age 69 years), with particular attention to evidence of secondary MGN. Additional IgG subclass and phospholipase A2 receptor (PLA2R) immunofluorescence studies were conducted in seven cases. Results: Eight biopsies were pauci-immune other than the capillary wall deposits of MGN; one patient had a non-lupus immune complex disease, and four had mesangial deposits, including one with rare subendothelial deposits. None had anti-glomerular basement membrane disease. IgG4 was dominant or codominant in the capillary wall deposits in three cases and virtually absent in four; PLA2R was positive in two cases, and negative in five. Seven patients were judged to have secondary MGN, including five of eight ANCA+ patients. Twelve patients were treated with combinations of steroids, cyclophosphamide, rituximab, followed by durable response in seven and relentless progression to end stage renal disease in four. Conclusions: Secondary MGN occurs with higher frequency in ANCA-positive NCGN than in the general MGN population. A causal relationship between MGN and NCGN was not established in any patient, but circumstances suggest a common cause in several, including immune complex disease, drug reaction and paraneoplastic syndrome.

KW - IgG4

KW - Membranous glomerulonephritis

KW - Necrotizing glomerulonephritis

KW - PLA2R

UR - http://www.scopus.com/inward/record.url?scp=84903718785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903718785&partnerID=8YFLogxK

U2 - 10.1007/s11255-013-0593-x

DO - 10.1007/s11255-013-0593-x

M3 - Article

VL - 46

SP - 963

EP - 971

JO - International Urology and Nephrology

JF - International Urology and Nephrology

SN - 0301-1623

IS - 5

ER -