H. Arahata et al., Successful treatment of rapidly progressive lupus nephritis associated with anti-MPO antibodies by intravenous immunoglobulins, CLIN RHEUMA, 18(1), 1999, pp. 77-81
We report a case of systemic lupus erythematosus (SLE) associated with cres
centic glomerulonephritis and myeloperoxidase-specific anti-neutrophil cyto
plasmic antibodies (MPO-ANCA), A 34-year-old Japanese female patient diagno
sed with SLE developed rapidly progressive renal failure and nephrotic synd
rome, Haemodialysis was required to restore renal function. Methylprednisol
one pulse therapy followed by plasmapheresis did not suppress the progressi
on of renal failure, so she was treated with high-dose intravenous immunogl
obulin (IV-IG) therapy, which was well tolerated and effectively prevented
renal failure. A renal biopsy showed diffuse proliferative lupus nephritis
(WHO classification IVc) with predominant crescent formation and scant sube
ndothelial immune deposits. These findings indicate that, in addition to lu
pus nephritis, which usually results from the deposition of circulating or
locally formed immune complexes, MPO-ANCA may be involved in the pathogenes
is of crescentic glomerulonephritis, Furthermore, we propose that IV-IG is
an effective therapy for MPO-ANCA-related renal crisis in lupus nephritis.