ASSOCIATION OF VASCULITIC GLOMERULONEPHRITIS WITH MEMBRANOUS NEPHROPATHY - A REPORT OF 10 CASES

Background. The concomitant occurrence of a vasculitic glomerulonephri tis and membranous nephropathy in the same patient is unusual. We repo rt data on 10 patients with this unusual combination. Methods. Ten pat ients (nine males/one female; median age 63.5 years, range 30-70 years ) presented between 1981 and 1995 with: acute renal failure (n = 3), n ephrotic syndrome (n = 4), non-nephrotic range proteinuria and renal i nsufficiency (n = 3). The median serum creatinine at presentation was 296 mu mol/l (range 65-1749 mu mol/l). One patient had a vasculitic tr ansformation from membranous nephropathy 5 years after the original pr esentation, coincident with an acute deterioration of renal function r equiring dialysis; in all other patients the two glomerular disorders were seen together at presentation. Treatment was with oral prednisolo ne and cyclophosphamide (eight patients), of whom one also had plasma exchange; and oral prednisolone and azathioprine (one patient). Specif ic immunosuppressive treatment was withheld in one patient with histol ogical evidence of chronic renal damage. Sera from four patients out o f nine tested were positive for ANCA. Results. After a median follow-u p of 3.5 years (range 2 months-10 years), renal function had improved in three patients and remained stable in two. Two patients required re nal replacement therapy. Three patients had died: one was ANCA-negativ e and died of a systemic vasculitis, and the other two died of sepsis. Conclusion, Membranous nephropathy complicated by a vasculitic glomeru lonephritis: (1) has a more aggressive clinical course than membranous nephropathy alone, (2) appears to have an association with ANCA, (3) should be considered in those patients with an accelerated decline in renal function, and (4) may respond to treatment with immunosuppressiv e drugs.