Pauci-immune crescentic glomerulonephritis associated with ANCA of IgA class

Details

Serval ID
serval:BIB_ED2DAE9A9AD6
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Pauci-immune crescentic glomerulonephritis associated with ANCA of IgA class
Journal
Am J Kidney Dis
Author(s)
Bollee G., Noel L. H., Suarez F., Royal V., Gilardin L., de Serre N. P., El-Ghoul B., Lesavre P., Alyanakian M. A., Fakhouri F.
ISSN
1523-6838 (Electronic)
ISSN-L
0272-6386
Publication state
Published
Issued date
06/2009
Volume
53
Number
6
Pages
1063-7
Language
english
Notes
Bollee, Guillaume
Noel, Laure-Helene
Suarez, Felipe
Royal, Virginie
Gilardin, Laurent
de Serre, Natacha Patey-Mariaud
El-Ghoul, Balsam
Lesavre, Philippe
Alyanakian, Marie-Alexandra
Fakhouri, Fadi
eng
Case Reports
Am J Kidney Dis. 2009 Jun;53(6):1063-7. doi: 10.1053/j.ajkd.2008.10.039. Epub 2008 Dec 11.
Abstract
Pauci-immune renal vasculitis is associated strongly with antineutrophil cytoplasmic antibodies (ANCAs) of the immunoglobulin G (IgG) class, which are detected in 80% to 90% of affected patients. IgA ANCAs have been reported in association with various conditions, but never in the setting of pauci-immune vasculitis. A 28-year-old man with unexplained polyclonal hyper-IgA1 diagnosed in childhood presented with decreased kidney function, nephrotic syndrome, and microscopic hematuria. Kidney biopsy showed pauci-immune crescentic glomerulonephritis. Serum test results were negative for IgG ANCA by means of both indirect immunofluorescence and enzyme-linked immunosorbent assay techniques. Conversely, indirect immunofluorescence performed using anti-IgA antibody was strongly positive with a cytoplasmic ANCA pattern, and an enzyme-linked immunosorbent assay test had positive results for both antimyeloperoxidase and anti-proteinase 3 IgA. IgA ANCAs were not detected in 2 control serum samples from 1 patient with polyclonal hyper-IgA and 1 patient with monoclonal hyper-IgA. The patient received corticosteroids and 4 weekly perfusions of rituximab (375 mg/m2). After a 6-month follow-up, decreased kidney function and nephrotic syndrome persisted and IgA ANCA titers were unchanged. However, a control kidney biopsy showed a decrease in vasculitis activity. This first case of pauci-immune vasculitis associated with ANCA of the IgA class suggests the potential pathogenetic role of these peculiar antibodies. Additional studies are needed to determine whether IgA ANCAs, which are not routinely screened for, can be detected in patients with pauci-immune vasculitis either alone or in association with IgG ANCA.
Keywords
Adult, Antibodies, Antineutrophil Cytoplasmic/biosynthesis/*blood, Glomerulonephritis, IGA/diagnosis/*immunology/pathology, Humans, Immunoglobulin A/biosynthesis/*blood, Male, Vasculitis/diagnosis/immunology/pathology
Pubmed
Create date
01/03/2022 11:18
Last modification date
02/03/2022 7:36
Usage data