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De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

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Abstract

A 61-year-old woman was admitted to our hospital because of an unexpected rise in serum creatinine (sCr) level with proteinuria and microhematuria. She had undergone living-donor kidney transplantation 31 years before for end-stage renal disease caused by chronic glomerulonephritis (GN). On admission, her sCr was 1.27 mg/dL which was increased from 0.6 mg/dL, urinary protein/creatinine ratio was 1.39 g/gCr, and urinary red blood cell count was more than 100 per high power field. The allograft biopsy revealed crescentic glomerulonephritis with moderate to severe tubulointerstitial inflammation. Immunofluorescence staining yielded only a minimal staining for immunoglobulin A, and negative C4d in peritubular capillary. Since increased myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titer of 45.5 U/mL was detected, we made the diagnosis of post-transplant MPO-ANCA-associated GN. She was treated with three doses of bolus methylprednisolone (500 mg) followed by oral prednisolone therapy. Her sCr was stable at 1.20 mg/dL thereafter. ANCA-associated GN should be considered in older kidney transplant patients with new-onset urinary abnormalities because typical systemic symptoms and vasculitis in other organs might be masked by maintenance immunosuppression.

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Conflict of interest

Honoraria: Kazuhiko Tsuruya (Kyowa Hakko Kirin Co., Chugai Pharmaceutical Co.), Research funding: Kazuhiko Tsuruya (Kyowa Hakko Kirin Co., Chugai Pharmaceutical Co., Fuso Pharmaceutical Industries, MSD K.K., Takeda Pharmaceutical Co.), Endowed department: Kazuhiko Tsuruya (Baxter).

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Authors and Affiliations

  1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Naoki Haruyama, Akihiro Tsuchimoto, Kosuke Masutani, Hideko Noguchi, Takaichi Suehiro, Kazuhiko Tsuruya & Takanari Kitazono

  2. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hidehisa Kitada

  3. Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Kazuhiko Tsuruya

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  1. Naoki Haruyama
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  2. Akihiro Tsuchimoto
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  3. Kosuke Masutani
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  4. Hideko Noguchi
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  5. Takaichi Suehiro
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  7. Kazuhiko Tsuruya
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  8. Takanari Kitazono
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Correspondence to Kazuhiko Tsuruya.

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Haruyama, N., Tsuchimoto, A., Masutani, K. et al. De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation. CEN Case Rep 4, 14–19 (2015). https://doi.org/10.1007/s13730-014-0131-4

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  • DOI: https://doi.org/10.1007/s13730-014-0131-4

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