Use of Immunosuppressive Therapy in the Treatment of IgA-dominant Infection-related Glomerulonephritis

A 51-year-old Japanese man who experienced colon cancer recurrence following primary and metastatic lesion resection was hospitalized due to facial cellulitis with febrile neutropenia and purpura on his lower extremities after chemotherapy. It was complicated by rapidly progressive glomerulonephriti...

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Published inInternal Medicine Vol. 61; no. 5; pp. 697 - 701
Main Authors Okumura, Motohiro, Sugihara, Shinnosuke, Seki, Kurumi, Nagaoka, Kanako, Okawa, Naoki, Ebihara, Masayuki, Inoue, Takahiro, Fukuda, Junko, Ohara, Mamiko, Imasawa, Toshiyuki, Kitamura, Hiroshi, Oda, Takashi, Suzuki, Tomo
Format Journal Article
LanguageEnglish
Published Japan The Japanese Society of Internal Medicine 01.03.2022
Japan Science and Technology Agency
Subjects
Biopsy
Case Report
Cellulitis
Chemotherapy
Colon cancer
Cyclophosphamide
Galactose
galactose-deficient IgA1
Glomerulonephritis
Glomerulonephritis - etiology
Glomerulonephritis, IGA - complications
Glucocorticoids
Humans
Immunofluorescence
Immunoglobulin A
Immunosuppression Therapy
Immunosuppressive agents
immunosuppressive therapy
infection-related glomerulonephritis
Infections
Internal medicine
Male
Metastases
Middle Aged
Neoplasm Recurrence, Local - complications
Nephritis
nephritis-associated plasmin receptor (NAPlr)
Neutropenia
Patients
Plasmin
Proliferative kidney disease
Purpura
Renal function
immunosuppressive therapy
nephritis-associated plasmin receptor (NAPlr)
galactose-deficient IgA1
infection-related glomerulonephritis
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Abstract A 51-year-old Japanese man who experienced colon cancer recurrence following primary and metastatic lesion resection was hospitalized due to facial cellulitis with febrile neutropenia and purpura on his lower extremities after chemotherapy. It was complicated by rapidly progressive glomerulonephritis. He was diagnosed with immunoglobulin A (IgA)-dominant endocapillary proliferative glomerulonephritis based on kidney histology. His glomeruli were positive for the nephritis-associated plasmin receptor, plasmin activity and galactose-deficient IgA1 (Gd-IgA1). A skin biopsy immunofluorescence study revealed IgA deposition within perivascular regions but no Gd-IgA1 deposition. The final diagnosis was IgA-dominant infection-related glomerulonephritis (IRGN). The patient's renal function returned to normal after receiving immunosuppressive therapy that consisted of a glucocorticoid and a cyclophosphamide. Immunosuppressive therapy should be considered in cases of IRGN if the patient's infection is completely under control.
AbstractList A 51-year-old Japanese man who experienced colon cancer recurrence following primary and metastatic lesion resection was hospitalized due to facial cellulitis with febrile neutropenia and purpura on his lower extremities after chemotherapy. It was complicated by rapidly progressive glomerulonephritis. He was diagnosed with immunoglobulin A (IgA)-dominant endocapillary proliferative glomerulonephritis based on kidney histology. His glomeruli were positive for the nephritis-associated plasmin receptor, plasmin activity and galactose-deficient IgA1 (Gd-IgA1). A skin biopsy immunofluorescence study revealed IgA deposition within perivascular regions but no Gd-IgA1 deposition. The final diagnosis was IgA-dominant infection-related glomerulonephritis (IRGN). The patient's renal function returned to normal after receiving immunosuppressive therapy that consisted of a glucocorticoid and a cyclophosphamide. Immunosuppressive therapy should be considered in cases of IRGN if the patient's infection is completely under control.
ArticleNumber 7404-21
Author Kitamura, Hiroshi
Okumura, Motohiro
Nagaoka, Kanako
Inoue, Takahiro
Fukuda, Junko
Ohara, Mamiko
Okawa, Naoki
Ebihara, Masayuki
Imasawa, Toshiyuki
Oda, Takashi
Sugihara, Shinnosuke
Suzuki, Tomo
Seki, Kurumi
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  fullname: Okumura, Motohiro
  organization: Post Graduate Education Center, Kameda Medical Center, Japan
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  fullname: Sugihara, Shinnosuke
  organization: Department of Nephrology, Kameda Medical Center, Japan
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  fullname: Seki, Kurumi
  organization: Department of Pathology, Kameda Medical Center, Japan
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  fullname: Nagaoka, Kanako
  organization: Department of Nephrology, Kameda Medical Center, Japan
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  fullname: Okawa, Naoki
  organization: Department of General Internal Medicine, Kameda Medical Center, Japan
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  fullname: Ebihara, Masayuki
  organization: Department of Nephrology, Kameda Medical Center, Japan
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  fullname: Inoue, Takahiro
  organization: Department of Nephrology, Kameda Medical Center, Japan
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  fullname: Suzuki, Tomo
  organization: Department of Nephrology, Kameda Medical Center, Japan
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Cites_doi 10.1093/ndt/gfz152
10.5414/CN109786
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10.1056/NEJMra1206793
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10.1155/2012/417675
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Keywords immunosuppressive therapy
nephritis-associated plasmin receptor (NAPlr)
galactose-deficient IgA1
infection-related glomerulonephritis
Language English
License The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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Correspondence to Dr.　Tomo Suzuki, suzuki.tomo@kameda.jp
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Snippet A 51-year-old Japanese man who experienced colon cancer recurrence following primary and metastatic lesion resection was hospitalized due to facial cellulitis...
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SubjectTerms Biopsy
Case Report
Cellulitis
Chemotherapy
Colon cancer
Cyclophosphamide
Galactose
galactose-deficient IgA1
Glomerulonephritis
Glomerulonephritis - etiology
Glomerulonephritis, IGA - complications
Glucocorticoids
Humans
Immunofluorescence
Immunoglobulin A
Immunosuppression Therapy
Immunosuppressive agents
immunosuppressive therapy
infection-related glomerulonephritis
Infections
Internal medicine
Male
Metastases
Middle Aged
Neoplasm Recurrence, Local - complications
Nephritis
nephritis-associated plasmin receptor (NAPlr)
Neutropenia
Patients
Plasmin
Proliferative kidney disease
Purpura
Renal function
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Title Use of Immunosuppressive Therapy in the Treatment of IgA-dominant Infection-related Glomerulonephritis
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