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Prolonged membranous lupus nephritis with change of anti-ssDNA antibody titer and repeated renal relapse.

Abstract

We report a case of a 44-year-old woman with nephrotic syndrome who underwent renal biopsy three times. On each occasion, light microscopy showed membranous nephropathy with mild to moderate thickening of the glomerular capillary walls. Immunofluorescence microscopy showed predominant deposition of immunoglobulin (Ig) G, IgG1, IgG2, IgG3, and IgG4; C3; and C1q along the glomerular capillary walls and deposition of IgM and IgA in some parts of the walls. Electron microscopy revealed the accumulation of electron-dense deposits in the mesangium and the subepithelial area of the glomerular basement membrane. Virus-like particles were detected in the subendothelial cells in all three biopsy specimens. A definitive diagnosis of systemic lupus erythematosus (SLE) was made at the time of the second admission, when she was 31 years old. A diagnosis of membranous lupus nephritis was then made on the basis of the pathological and clinical findings. A change in anti-single-stranded (ss)DNA antibody titers was of particular interest in this patient. Occasional small increases in anti-double-stranded (ds)DNA antibody were found, but increased anti-ssDNA antibody titers occurred before there was any elevation of urinary protein during renal relapse, and a sustained increase in the titers was shown subsequently. Hypocomplementemia occurred in parallel with the increase of anti-ssDNA antibody. Immunosuppressive therapy with steroid promptly eliminated anti-dsDNA antibody, but anti-ssDNA antibody remained positive. The patient had normocomplementemia and proteinuria was absent. Later, anti-ssDNA antibody decreased. Renal function has remained in the normal range for 20 years.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. yumura@kc.twmu.ac.jp

    , , , ,

    Source

    MeSH

    Acute Kidney Injury
    Adult
    Antibodies, Antinuclear
    DNA, Single-Stranded
    Female
    Glomerulonephritis, Membranous
    Humans
    Kidney Glomerulus
    Lupus Nephritis
    Proteinuria
    Recurrence

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    15619038

    Citation

    Yumura, Wako, et al. "Prolonged Membranous Lupus Nephritis With Change of anti-ssDNA Antibody Titer and Repeated Renal Relapse." Clinical and Experimental Nephrology, vol. 8, no. 4, 2004, pp. 363-8.
    Yumura W, Suganuma S, Nitta K, et al. Prolonged membranous lupus nephritis with change of anti-ssDNA antibody titer and repeated renal relapse. Clin Exp Nephrol. 2004;8(4):363-8.
    Yumura, W., Suganuma, S., Nitta, K., Sano, Y., Uchida, K., & Nihei, H. (2004). Prolonged membranous lupus nephritis with change of anti-ssDNA antibody titer and repeated renal relapse. Clinical and Experimental Nephrology, 8(4), pp. 363-8.
    Yumura W, et al. Prolonged Membranous Lupus Nephritis With Change of anti-ssDNA Antibody Titer and Repeated Renal Relapse. Clin Exp Nephrol. 2004;8(4):363-8. PubMed PMID: 15619038.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prolonged membranous lupus nephritis with change of anti-ssDNA antibody titer and repeated renal relapse. AU - Yumura,Wako, AU - Suganuma,Shinya, AU - Nitta,Kosaku, AU - Sano,Yoshie, AU - Uchida,Keiko, AU - Nihei,Hiroshi, PY - 2004/04/20/received PY - 2004/07/08/accepted PY - 2004/12/25/pubmed PY - 2005/9/16/medline PY - 2004/12/25/entrez SP - 363 EP - 8 JF - Clinical and experimental nephrology JO - Clin. Exp. Nephrol. VL - 8 IS - 4 N2 - We report a case of a 44-year-old woman with nephrotic syndrome who underwent renal biopsy three times. On each occasion, light microscopy showed membranous nephropathy with mild to moderate thickening of the glomerular capillary walls. Immunofluorescence microscopy showed predominant deposition of immunoglobulin (Ig) G, IgG1, IgG2, IgG3, and IgG4; C3; and C1q along the glomerular capillary walls and deposition of IgM and IgA in some parts of the walls. Electron microscopy revealed the accumulation of electron-dense deposits in the mesangium and the subepithelial area of the glomerular basement membrane. Virus-like particles were detected in the subendothelial cells in all three biopsy specimens. A definitive diagnosis of systemic lupus erythematosus (SLE) was made at the time of the second admission, when she was 31 years old. A diagnosis of membranous lupus nephritis was then made on the basis of the pathological and clinical findings. A change in anti-single-stranded (ss)DNA antibody titers was of particular interest in this patient. Occasional small increases in anti-double-stranded (ds)DNA antibody were found, but increased anti-ssDNA antibody titers occurred before there was any elevation of urinary protein during renal relapse, and a sustained increase in the titers was shown subsequently. Hypocomplementemia occurred in parallel with the increase of anti-ssDNA antibody. Immunosuppressive therapy with steroid promptly eliminated anti-dsDNA antibody, but anti-ssDNA antibody remained positive. The patient had normocomplementemia and proteinuria was absent. Later, anti-ssDNA antibody decreased. Renal function has remained in the normal range for 20 years. SN - 1342-1751 UR - https://www.unboundmedicine.com/medline/citation/15619038/Prolonged_membranous_lupus_nephritis_with_change_of_anti_ssDNA_antibody_titer_and_repeated_renal_relapse_ L2 - https://dx.doi.org/10.1007/s10157-004-0306-y DB - PRIME DP - Unbound Medicine ER -