排菌肺結核と心膜炎を続発した間質性肺炎合併ＭＰＯ　ＡＮＣＡ関連腎炎の１例

DOI PubMed 参考文献25件

書誌事項

タイトル別名
  • A case of MPO ANCA associated glomerulonephritis with interstitial pneumonitis complicated with lung tuberculosis and pericarditis.
公開日
2000
資源種別
journal article
DOI
  • 10.14842/jpnjnephrol1959.42.591
公開者
社団法人 日本腎臓学会

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説明

The main target organs of myeloperoxidase (MPO) antineutrophil cytoplasmic antibodies (ANCA) - related disease are the kidney and lung. This report describes a 71-year-old man with rapidly progressive glomerulonephritis (RPGN) and interstitial pneumonitis associated with MPO ANCA. The patient was admitted to our hospital because of bloody sputum, low grade fever and appetite loss on October, 1998. He was diagnosed as having interstitial pneumonitis from the findings of chest X-ray and CT examinations. Moderate proteinuria and hematuria, renal dysfunction (serum creatinine : 5.6 mg/dl, BUN : 58.0 mg/dl) and positivity for MPO ANCA were noted. He was negative for anti-glomerular antibody and PR3-ANCA. Renal biopsy was performed and revealed crescentic glomerulonephritis without deposition of immunoglobulins. Therefore, the diagnosis of pauci immune type RPGN was made. Pulse therapy with methylprednisolone (1.0g/day×× days) following oral administration of prednisolone (60 mg/day) found marked improvement of renal function maintenance and interstitial pneumonitis, respectively. However, he died because of lung tuberculosis and acute tuberculous pericarditis during treatment with prednisolone. In this case, MPO ANCA might have been directly associated with both RPGN and interstitial pneumonitis. Furthermore, chronic lung disease, such as interstitial pneumonitis, is important as a preceding disease of RPGN. MPO ANCA-relateddisease is more frequent in aged persons, therefore particular attention should be paid during their treatment with an immunosuppressant.

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