Abstract
Juvenile dermatomyositis (JDM) is the most common childhood idiopathic inflammatory myopathy (IIM). It is characterized by the classic skin rash in the form of Gottron papules and heliotrope rash, and symmetric proximal muscle weakness. Renal involvement in JDM is rare which includes acute kidney injury and glomerulonephritis. We report a 10-year-old boy with juvenile dermatomyositis and IgA nephropathy. Child responded dramatically to the conventional therapy with steroids and methotrexate for the primary disease, and did not require any additional treatment for his renal disease. Child’s primary disease is in remission and has normal urinalysis with normal renal function at 6-month follow-up. We reviewed the literature and found 11 cases of IIMs with renal involvement. Four patients (one JDM, two polymyositis, and one dermatomyositis) had IgA nephropathy out of which three patients responded to the conventional therapy of primary disease and only one patient with polymyositis needed hiking immunosuppression targeted for renal condition. Therapy targeting the underlying disorder is usually sufficient in patients with JDM and secondary IgA nephropathy.
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References
Shah M, Mamyrova G, Targoff IN, Huber AM, Malley JD, Rice MM et al (2013) The clinical phenotypes of the juvenile idiopathic inflammatory myopathies. Medicine (Baltimore) 92:25–41
Peloro TM, Miller OF, Hahn TF, Newman ED (2001) Juvenile dermatomyositis: a retrospective review of a 30-year experience. J Am Acad Dermatol 45(1):28–34
Rider LG, Lindsley CB, Cassidy JT (2011) Juvenile dermatomyositis. In: Cassidy JT, Petty RE, Laxer RM et al (eds) Textbook of pediatric rheumatology, 6th edn. Saunders, Philadelphia, p 410 (Table 24–20)
Bohan A, Peter JB (1975) Polymyositis and dermatomyositis. N Engl J Med 292:344–347 (403–407)
Yen T-H, Lai P-C, Chen C-C, Hsueh S, Huang J-Y (2005) Renal involvement in patients with polymyositis and dermatomyositis. Int J Clin Pract 59(2):188–193
Cucchiari D, Angelini C (2017) Renal involvement in idiopathic inflammatory myopathies. Clin Rev Allergy Immunol 52(1):99–107
Nickavar A, Mehrazma M (2012) Nephrotic syndrome and juvenile dermatomyositis. Rheumatol Int 32(9):2933–2935
Civilibal M, SelcukDuru N, Ozagari A, Durali K, Elevli M (2009) Immunoglobulin A nephropathy associated with juvenile dermatomyositis. Pediatr Nephrol 24(10):2073–2075
Ronco P, Debiec H (2009) Pathophysiological lessons from rare associations of immunological disorders. Pediatr Nephrol Berl Ger 24(1):3–8
Suzuki H, Kiryluk K, Novak J, Moldoveanu Z, Herr AB, Renfrow MB et al (2011) The pathophysiology of IgA nephropathy. J Am Soc Nephrol JASN 22(10):1795–1803
Saha MK, Julian BA, Novak J, Rizk DV (2018) Secondary IgA nephropathy. Kidney Int 94(4):674–681
Suzuki K, Honda K, Tanabe K, Toma H, Nihei H, Yamaguchi Y (2003) Incidence of latent mesangial IgA deposition in renal allograft donors in Japan. Kidney Int 63(6):2286–2294
Wyatt RJ, Julian BA (2013) IgA nephropathy. N Engl J Med 368(25):2402–2414
Barros TBM, Souza FHC de, Malheiros DMAC, Levy Neto M, Shinjo SK (2014) Nefropatiapor IgA e polimiosite: umararaassociação. Rev Bras Reumatol 54(3):231–233
Oh Y-J, Park ES, Jang M, Kang EW, Kie J-H, Lee S-W et al (2017) A case of polymyositis associated with immunoglobulin A nephropathy. J Rheum Dis 24(4):241
Machado NP, Camargo CZ, Oliveira ACD, Buosi ALP, Pucinelli MLC, Souza AWS (2010) Association of anti-glomerular basement membrane antibody disease with dermatomyositis and psoriasis: case report. Sao Paulo Med J 128(5):306–308
Yuste C, Rapalai M, Pritchard BA, Jones TJ, Amoasii C, Al-Ansari A et al (2014) Overlap between dermatomyositis and ANCA vasculitides. Clin Kidney J 7(1):59–61
Xie Q, Liu Y, Liu G, Yang N, Yin G (2010) Diffuse proliferative glomerulonephritis associated with dermatomyositis with nephrotic syndrome. Rheumatol Int 30(6):821–825
Couvrat-Desvergnes G, Masseau A, Benveniste O, Bruel A, Hervier B, Mussini J-M et al (2014) The spectrum of renal involvement in patients with inflammatory myopathies. Medicine (Baltimore) 93(1):33–41
Akashi Y, Inoh M, Gamo N, Kinashi M, Ohbayashi S, Miyake H et al (2002) Dermatomyositis associated with membranous nephropathy in a 43-year-old female. Am J Nephrol 22(4):385–388
Makino H, Hirata K, Matsuda M, Amano T, Ota Z (1994) Membranous nephropathy developing during the course of dermatomyositis. J Rheumatol 21(7):1377–1378
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We acknowledge Dr Ayush for giving critical inputs in the preparation of manuscript.
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MRM: prepared the manuscript. SKT: collected data of patient and reviewed the literature. RHP: pathological part of manuscript was prepared along with review of current and old cases. NKB: edited the manuscript and gave critical inputs for preparation of manuscript. PH: reviewed the draft and final revision of the manuscript. AB: analysis and interpretation of pathological findings of cases and inclusion in the main draft. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Mantoo, M.R., Tripathy, S.K., Phulware, R.H. et al. Juvenile dermatomyositis with IgA nephropathy: case-based review. Rheumatol Int 39, 577–581 (2019). https://doi.org/10.1007/s00296-018-4229-4
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DOI: https://doi.org/10.1007/s00296-018-4229-4