Abstract
Sarcoidosis is a multisystem disease related to helper T cell responses. We recently experienced the case of a 57-year-old woman with sarcoidosis complicated by crescentic glomerulonephritis with low levels of myeloperoxidase-antineutrophil cytoplasmic antibody. We herein describe the details of her clinical course and discuss the effectiveness of mizoribine, which has an immunosuppressive effect equivalent to that of mycophenolate mofetil, not only for urinalysis abnormalities but also for hilar lymph node enlargement.
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References
Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153–65.
Berliner AR, Haas M, Choi MJ. Sarcoidosis: the nephrologist’s perspective. Am J Kidney Dis. 2006;48:856–70.
Gobel U, Kettritz R, Schneider W, Luft F. The protean face of renal sarcoidosis. J Am Soc Nephrol. 2001;12:616–23.
van Uum SH, Cooreman MP, Assmann KJ, Wetzels JF. A 58-year-old man with sarcoidosis complicated by focal crescentic glomerulonephritis. Nephrol Dial Transpl. 1997;12:2703–7.
Auinger M, Irsigler K, Breiteneder S, Ulrich W. Normocalcaemic hepatorenal sarcoidosis with crescentic glomerulonephritis. Nephrol Dial Transpl. 1997;12:1474–7.
Sonda K, Takahashi K, Tanabe K, Funchinoue S, Hayasaka Y, Kawaguchi H, et al. Clinical pharmacokinetic study of mizoribine in renal transplantation patients. Transpl Proc. 1996;28:3643–8.
Kawasaki Y. Mizoribine: a new approach in the treatment of renal disease. Clin Dev Immunol. 2009;2009:681482.
Hirayama K, Kobayashi M, Hashimoto Y, Usui J, Shimizu Y, Hirayama A, et al. Treatment with the purine synthesis inhibitor mizoribine for ANCA-associated renal vasculitis. Am J Kidney Dis. 2004;44:57–63.
Ho LP, Urban BC, Thickett DR, Davies RJO, McMichael AJ. Deficiency of a subset of T cells with immunoregulatory properties in sarcoidosis. Lancet. 2005;365:1062–72.
Miyagaki T, Asano Y, Shibata S, Ohno Y, Tsunemi Y, Saeki H, et al. The development of Th1-mediated sarcoidosis improves the clinical course of Th2-mediated atopic dermatitis. Mod Rheumatol. 2011;21:406–9.
Tipping PG, Kitching AR. Glomerulonephritis, Th1 and Th2: what’s new? Clin Exp Immunol. 2005;142:207–15.
Wilde B, van Paassen P, Witzke O, Tervaert JW. New pathophysiological insights and treatment of ANCA-associated vasculitis. Kidney Int. 2011;79:599–612.
Gomez-Puerta JA, Bosch X. Anti-neutrophil cytoplasmic antibody pathogenesis in small-vessel vasculitis: an update. Am J Pathol. 2009;175:1790–8.
Franssen CF, Stegeman CA, Oost-Kort WW, Kallenberg CG, Limburg PC, Tiebosch A, et al. Determinants of renal outcome in anti-myeloperoxidase-associated necrotizing crescentic glomerulonephritis. J Am Soc Nephrol. 1998;9:1915–23.
Nakabayashi K. Slowly progressive, not rapidly progressive, MPO-ANCA positive glomerulonephritis and its characteristics. Intern Med. 2002;41:418–9.
Aoyama T, Shimizu T, Matsuo T, Sakamoto H, Kamata K, Higashihara M, et al. MPO-ANCA-positive slowly progressive glomerulonephritis with focal tuft necrosis and crescents. Intern Med. 2002;41:458–62.
Yoshida M. Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis: from molecular analysis to bedside. Intern Med. 2002;41:47–9.
Altschuler EL. The first case of sarcoidosis treated with mycophenolate mofetil. Br J Dermatol. 2003;149:442; discussion 442–443.
Moudgil A, Przygodzki RM, Kher KK. Successful steroid-sparing treatment of renal limited sarcoidosis with mycophenolate mofetil. Pediatr Nephrol. 2006;21:281–5.
Yumura W, Suganuma S, Uchida K, Moriyama T, Otsubo S, Takei T, et al. Effects of long-term treatment with mizoribine in patients with proliferative lupus nephritis. Clin Nephrol. 2005;64:28–34.
Kuroda T, Kobayashi D, Sato H, Oyanagi A, Wada Y, Murakami S, et al. Mizoribine therapy in a patient with lupus nephritis: the association between mizoribine concentration and peritoneal dialysis. Mod Rheumatol. 2010;20:296–300.
Kaneko T, Hirama A, Ueda K, Fujino T, Utsumi K, Iino Y, et al. Methylprednisolone pulse therapy combined with mizoribine following tonsillectomy for immunoglobulin A nephropathy: clinical remission rate, steroid sparing effect, and maintenance of renal function. Clin Exp Nephrol. 2011;15:73–8.
Ito S, Harada T, Nakamura T, Imagawa T, Nagahama K, Sasaki T, et al. Mizoribine for renal sarcoidosis: effective steroid tapering and prevention of recurrence. Pediatr Nephrol. 2009;24:411–4.
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We are grateful to Prof. Masatoshi Tateno (Department of Pathology, Asahikawa Medical University) for excellent support for making diagnosis.
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Kabara, M., Nakagawa, N., Matsuki, M. et al. Mizoribine for crescentic glomerulonephritis with sarcoidosis: effectiveness not only for urinalysis abnormalities but also for hilar lymph node enlargement. Mod Rheumatol 23, 146–150 (2013). https://doi.org/10.1007/s10165-012-0614-0
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DOI: https://doi.org/10.1007/s10165-012-0614-0