肾炎
肾病综合征
免疫学
蛋白尿
肾病
快速进行性肾小球肾炎
系统性红斑狼疮
肾小球膜炎
系膜增生性肾小球肾炎
肾
肾脏疾病
抗中性粒细胞胞浆抗体
血管炎
急性肾小球肾炎
内科学
作者
Rasha Alawieh,Anjali A. Satoskar,Eshetu Obole,Lee A. Hebert,Isabelle Ayoub
出处
期刊:Clinical Nephrology
[Dustri-Verlag Dr. Karl Feistle]
日期:2020-10-01
卷期号:94 (4): 212-214
被引量:2
摘要
The glomerulonephritis (GN) of granulomatosis polyangiitis is described as because the glomeruli show little or no evidence of immune complex deposition by immunofluorescence or electron microscopy. Here we describe a severe crescentic GN in which the patient was myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA) positive, and on renal biopsy the glomeruli were pauci immune (there were only a few electron-dense deposits). However, by immunofluorescence the glomeruli showed full-house staining (the glomeruli stained positive for C1q, C3, IgG, IgA, and IgM). The latter staining pattern would be consistent with that seen in patients with lupus-like GN or with severe crescentic GN as a result of bacterial infection. So, should this patient receive high-dose immunosuppressive therapy and steroid therapy to treat presumed autoimmune GN, or should the patient receive intensive antibiotic therapy to treat a presumed underlying severe infection? This dilemma was soon resolved because the patient's blood culture returned positive for Streptococcus mutans and cardiac echo showed evidence of bacterial endocarditis. This report provides further detail regarding the patient's clinical issues.
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