Observation Association of vasculitic glomerulonephritis with membranous nephropathy : a report of 10 cases

itic glomerulonephritis and membranous nephropathy Membranous nephropathy is characterized histologiin the same patient is unusual. We report data on 10 cally by subepithelial deposits of immunoglobulins and patients with this unusual combination. complement [1]. Vasculitic or crescentic glomeruloMethods. Ten patients (nine males/one female; median nephritis is rarely seen in membranous nephropathy, age 63.5 years, range 30–70 years) presented between except in those cases associated with systemic lupus 1981 and 1995 with: acute renal failure (n=3), erythematosus [2,3]. Our knowledge of the immunopanephrotic syndrome (n=4), non-nephrotic range prothogenesis of this unusual combination of membranous teinuria and renal insu ciency (n=3). The median nephropathy and vasculitic or crescentic glomerserum creatinine at presentation was 296 mmol/l (range ulonephritis is limited. However, of the 19 cases of 65–1749 mmol/l ). One patient had a vasculitic transmembranous nephropathy and crescentic glomerformation from membranous nephropathy 5 years after ulonephritis reported in the literature, seven had antithe original presentation, coincident with an acute glomerular basement membrane (GBM ) antibodies deterioration of renal function requiring dialysis; in all [4–9]. Association with antineutrophil cytoplasmic other patients the two glomerular disorders were seen antibodies (ANCA) is rare, and there is only one case together at presentation. Treatment was with oral of a patient with Wegener’s granulomatosis who had prednisolone and cyclophosphamide (eight patients), the combination of membranous nephropathy and of whom one also had plasma exchange; and oral crescentic glomerulonephritis [10]. prednisolone and azathioprine (one patient). Specific Little is known about the clinical course, optimal immunosuppressive treatment was withheld in one treatment and renal outcome of patients with this patient with histological evidence of chronic renal unusual combination of nephritis. In the majority of damage. Sera from four patients out of nine tested reported cases, the prognosis had been poor with were positive for ANCA. progression to end stage renal failure; often despite Results. After a median follow-up of 3.5 years (range treatment with immunosuppressive drugs and steroid 2 months–10 years), renal function had improved in [5,6,8,11–15]. Over a 15-year period from 1981 to three patients and remained stable in two. Two patients 1995, 218 patients presented to our Nephrology Unit required renal replacement therapy. Three patients had with membranous nephropathy in the absence of sysdied: one was ANCA-negative and died of a systemic temic lupus erythematosus. Of these, we identified 10 vasculitis, and the other two died of sepsis. patients with the combination of membranous nephroConclusion. Membranous nephropathy complicated by pathy and vasculitic glomerulonephritis (all of whom a vasculitic glomerulonephritis: (1) has a more aggressalso had crescents). We present our observations on ive clinical course than membranous nephropathy these 10 patients, and compared our data with the alone, (2) appears to have an association with ANCA, previous reports of patients with membranous nephro(3) should be considered in those patients with an pathy and a crescentic glomerulonephritis. accelerated decline in renal function, and (4) may