Clinical and Experimental Nephrology

, Volume 15, Issue 2, pp 281–284

An autopsy-proven case of myeloperoxidase-antineutrophil cytoplasmic antibody-positive polyarteritis nodosa with acute renal failure and alveolar hemorrhage

Authors

    • Department of Kidney Disease and HypertensionOsaka General Medical Center
  • Takuya Uehata
    • Department of Geriatric Medicine and NephrologyOsaka University Graduate School of Medicine
  • Hiroaki Kawabata
    • Department of Kidney Disease and HypertensionOsaka General Medical Center
  • Kakuya Niihata
    • Department of Kidney Disease and HypertensionOsaka General Medical Center
  • Akihiro Shimomura
    • Department of Kidney Disease and HypertensionOsaka General Medical Center
  • Akira Suzuki
    • Department of Kidney Disease and HypertensionOsaka General Medical Center
  • Tetsuya Kaneko
    • Department of Kidney Disease and HypertensionOsaka General Medical Center
  • Tatsuya Shoji
    • Department of Kidney Disease and HypertensionOsaka General Medical Center
  • Kohki Shimazu
    • Department of PathologyOsaka General Medical Center
  • Hiroaki Fushimi
    • Department of PathologyOsaka General Medical Center
  • Yoshiharu Tsubakihara
    • Department of Kidney Disease and HypertensionOsaka General Medical Center
Case Report

DOI: 10.1007/s10157-010-0386-9

Cite this article as:
Sakaguchi, Y., Uehata, T., Kawabata, H. et al. Clin Exp Nephrol (2011) 15: 281. doi:10.1007/s10157-010-0386-9

Abstract

An 80-year-old woman positive for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was admitted with a 3-month history of fever, general malaise, and weight loss, after unsuccessful treatment with antibiotics. Upon admission, her fever persisted, and there was concomitant deterioration of renal function without active urine sediments. Furthermore, she developed hemoptysis, and chest computed tomography (CT) scan revealed bilateral diffuse alveolar hemorrhage. Although a renal biopsy was not performed because of her dementia, we initially suspected microscopic polyangiitis (MPA) on the basis of her clinical course. Because of her poor general condition, she was administered a low dose of prednisolone. Although her fever subsided, she suffered from intractable alveolar hemorrhage and eventually died from respiratory failure. During the autopsy, fibrinoid necrosis was restricted to medium-sized arteries, including the arcuate arteries of the kidneys and the bronchial arteries, without necrotizing crescentic glomerulonephritis and alveolar capillaritis. Therefore, polyarteritis nodosa (PAN) was diagnosed. It is important to distinguish between MPA and PAN because they can lead to life-threatening complications, and their treatment strategies and prognosis are different. When a patient presents with MPO-ANCA, alveolar hemorrhage, and acute renal failure with little evidence of glomerulonephritis, a differential diagnosis of PAN should be made; however, it is difficult to do so without pathological findings. Therefore, pathological examination should be carried out whenever possible.

Keywords

Myeloperoxidase-antineutrophil cytoplasmic antibodyPolyarteritis nodosaAcute renal failureAlveolar hemorrhage

Copyright information

© Japanese Society of Nephrology 2010