Two Cases of ANCA-associated Pauci-immune Glomerulonephritis with Rheumatoid Arthritis

Bon San Koo; Yong-Gil Kim; Jong Gi Choi; Yong Chul Ahn; Seung Geun Lee; Chang-Keun Lee; Bin Yoo

doi:10.4078/jkra.2010.17.3.311

Journal List > J Korean Rheum Assoc > v.17(3) > 1003744

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Koo, Kim, Choi, Ahn, Lee, Lee, and Yoo: Two Cases of ANCA-associated Pauci-immune Glomerulonephritis with Rheumatoid Arthritis

Original Article

J Korean Rheum Assoc 2010;17(3):311-315.

Published online: 23 September 2010

DOI: https://doi.org/10.4078/jkra.2010.17.3.311

Two Cases of ANCA-associated Pauci-immune Glomerulonephritis with Rheumatoid Arthritis

Bon San Koo, Yong-Gil Kim, Jong Gi Choi, Yong Chul Ahn, Seung Geun Lee, Chang-Keun Lee, Bin Yoo

¹Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Received 3 April 201026 May 2010 Accepted 20 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Renal involvement is one of the extra-articular manifestations found in patients with rheumatoid arthritis (RA). Membranous glomerulonephopathy, membranoproliferative glomeruonophritis, secondary amyloidosis, and focal segmental glomerulosclerosis are reported as pathologic diagnoses of renal involvement. However, reports of renal involvement in patients with RA and antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune glomerulonephritis are rare. Recently, we experienced two patients with RA who developed azotemia and were finally diagnosed with ANCA-associated pauci-immune glomerulonephritis. Because of the rarity of these cases, we report two cases in patients with RA with a literature review.

Keywords: Rheumatoid arthritis, Antineutrophilic cytoplasmic antibody, Glomerulonephritis

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Fig. 1.

The glomerulus reveals a crescent formation (white arrow). The mesangium is expanded due to an increase of matrix with segmental hypercellularity and focal neutrophilic infiltration. (silver stain, ×400).

Fig. 2.

The glomerulus is globally sclerotic (white arrow). Diffuse interstitial inflammatory cell infiltration (mostly lymphoplasma cells and occasional neutrophils) is seen, with severe interstitial fibrosis and tubular atrophy (black arrow) (silver stain, ×400).

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