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논문분류	춘계학술대회 초록집
제목	A Case of Concurrent Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody Associated Glomerulonephritis and Membranous Nephropathy
저자	Chan Ho Kim1, Woon Yong Jung2, Kwang Mo Kim1, Sung Jin Moon1, Soo Young Yoon1, Jong Hee Lee1, Seung Jun Kim1
출판정보	2015; 2015(1):
키워드	막성신병증,항중성구세포질항체,사구체신염
초록	The occurrence of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN) and membranous nephropathy (MN) in the same patient is rare, with only a few case reports in the literature. In the present case, a 58-year-old female with renal dysfunction was admitted to our hospital. She showed nephrotic-range proteinuria and hematuria with dysmorphic red blood cells. Laboratory test for myeloperoxidase (MPO)-ANCA was positive by enzyme-linked immunosorbent assay. Renal biopsy revealed cellular crescents and IgG/C3 granular depositions along with capillary walls on immunofluorescent staining. Electron microscopic examination exhibited interspersed electron- dense deposits in subepithelial, intramembranous and paramesangial area with minute intervening spikes. Patient was diagnosed as MPO-ANCA-associated GN with MN. She was treated with initially intravenous methylprednisolone (750 mg/day) for three days, followed by intravenous cyclophosphamide (800 mg, a total of 6 pulses) and oral prednisolone (60 mg/day, initial dose) with antihypertensive drug during 3 months as an induction therapy. And then oral azathioprine (100 mg/day) and minimum dose of prednisolone (10 mg/day) have been prescribed as a maintenance therapy. Through the course of induction therapy, renal function gradually improved and remained stable at a follow-up of 6 months. In the case of rapidly progressive GN and seropositive MPO-ANCA with heavy proteinuria, we should consider the coexistence of other types of GN, especially MN. Moreover, patient should be managed in accordance with the therapeutic strategy of ANCA-associated GN.
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