Case Report

IgA Deposits Along Glomerular Basement Membranes in Rapidly Progressive Glomerulonephritis

Authors: Guangyan Cai, MD, Pu Chen, MD, Di Wu, MD, Suozhu Shi, MD, Zhong Yin, MD, Xueguang Zhang, MD, Ribao Wei, MD, Xiangmei Chen, MD

Abstract

This case presents a rare type of crescentic glomerulonephritis characterized as IgA deposits predominantly along the glomerular basement membranes (GBM). The patient clinically manifested with rapidly progressive glomerulonephritis (RPGN) without pulmonary hemorrhage or vasculitis-related systematic symptoms. No positive results were found on antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), or anti-GBM antibody detection. Therapy with pulse methylprednisolone and intravenous cyclophosphamide was less effective. This case does not belong to the present three categories of crescentic glomerulonephritis based on the clinical characteristics, serum test, immunofluorescence, and electron microscopic findings.


Key Points


* This case of rapidly progressive glomerulonephritis does not belong in the present categories of RPGN.


* Immunofluorescence of frozen and paraffin specimens showed predominant IgA deposits along the glomerular capillary wall with negative circulating IgA anti-GBM antibodies by indirect immunofluorescence.


* The patient was refractory to cytotoxic agents and steroid therapy.

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References

1. Nasr SH, Galgano SJ, Markowitz GS, et al. Immunofluorescence on pronase-digested paraffin sections: a valuable salvage technique for renal biopsies. Kidney Int 2006;70:2148–2151.
 
2. Shaer AJ, Stewart LR, Cheek DE, et al. IgA antiglomerular basement membrane nephritis associated with Crohn’s disease:a case report and review of glomerulonephritis in inflammatory bowel disease. Am J Kidney Dis 2003;41:1097–1109.
 
3. Troxell ML, Saxena AB, Kambham N, et al. Concurrent anti-glomerular basement membrane disease and membranous glomerulonephritis: a case report and literature review. Clin Nephrol 2006;66:120–127.
 
4. Tumlin JA, Lohavichan V, Hennigar R. Crescentic, proliferative IgA nephropathy: clinical and histological response to methylprednisolone and intravenous cyclophosphamide. Nephrol Dial Transplant 2003;18:1321–1329.