An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report
Abstract Background Microscopic polyangiitis (MPA), a kind of antineutrophil cytoplasmic autoantibody associated vasculitis (AAV), predominantly affects small-sized vessels. MPA is a significant cause of the pulmonary-renal syndrome. Pauci-immune necrotizing and crescentic glomerulonephritis is the...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-023-03134-0 |
| _version_ | 1797853966510325760 |
|---|---|
| author | Cihan Uysal Tugba Yilmaz Hafsa Kocyigit Hulya Akgun Murat Hayri Sipahioglu |
| author_facet | Cihan Uysal Tugba Yilmaz Hafsa Kocyigit Hulya Akgun Murat Hayri Sipahioglu |
| author_sort | Cihan Uysal |
| collection | DOAJ |
| description | Abstract Background Microscopic polyangiitis (MPA), a kind of antineutrophil cytoplasmic autoantibody associated vasculitis (AAV), predominantly affects small-sized vessels. MPA is a significant cause of the pulmonary-renal syndrome. Pauci-immune necrotizing and crescentic glomerulonephritis is the typical renal histological feature of AAV. Tubulointerstitial lesions may occur and mostly form with inflammatory cell infiltration in the interstitium. However, a few cases reported only tubulointerstitial involvement without glomerular lesions in patients with MPA. Case presentation We present an MPA case, a 70-year-old male patient diagnosed with acute kidney injury accompanying the dialysis requirement. Only acute tubulointerstitial nephritis was revealed in kidney biopsy without evidence of glomerular injury. Also, interstitial pulmonary fibrosis was determined on computerized tomography, and myeloperoxidase antineutrophil cytoplasmic autoantibody was positive. Consequently, we have considered the main diagnosis as MPA. We did not prefer a standard tubulointerstitial nephritis treatment regimen due to the presence of life-threatening systemic vasculitis. Treatment was established like crescentic glomerulonephritis. Induction therapy consisted of pulse steroid, cyclophosphamide, and plasmapheresis. Unfortunately, severe SARS-CoV-2 infection caused death during induction therapy in this case. Conclusions The lack of glomerular injury and solely interstitial inflammation is atypical regarding AAV involvement in the kidney. This diversity might be initially considered as only a simple histological elaboration. However, it is a significant entity for guiding the treatment of AAV. |
| first_indexed | 2024-04-09T19:59:18Z |
| format | Article |
| id | doaj.art-12f0478c37634093b84d1d7129e5a558 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-09T19:59:18Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-12f0478c37634093b84d1d7129e5a5582023-04-03T05:19:43ZengBMCBMC Nephrology1471-23692023-03-012411610.1186/s12882-023-03134-0An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case reportCihan Uysal0Tugba Yilmaz1Hafsa Kocyigit2Hulya Akgun3Murat Hayri Sipahioglu4Department of Nephrology, Erciyes University Medical SchoolDepartment of Nephrology, Erciyes University Medical SchoolDepartment of Internal Medicine, Kayseri State HospitalDepartment of Pathology, Erciyes University Medical SchoolDepartment of Nephrology, Erciyes University Medical SchoolAbstract Background Microscopic polyangiitis (MPA), a kind of antineutrophil cytoplasmic autoantibody associated vasculitis (AAV), predominantly affects small-sized vessels. MPA is a significant cause of the pulmonary-renal syndrome. Pauci-immune necrotizing and crescentic glomerulonephritis is the typical renal histological feature of AAV. Tubulointerstitial lesions may occur and mostly form with inflammatory cell infiltration in the interstitium. However, a few cases reported only tubulointerstitial involvement without glomerular lesions in patients with MPA. Case presentation We present an MPA case, a 70-year-old male patient diagnosed with acute kidney injury accompanying the dialysis requirement. Only acute tubulointerstitial nephritis was revealed in kidney biopsy without evidence of glomerular injury. Also, interstitial pulmonary fibrosis was determined on computerized tomography, and myeloperoxidase antineutrophil cytoplasmic autoantibody was positive. Consequently, we have considered the main diagnosis as MPA. We did not prefer a standard tubulointerstitial nephritis treatment regimen due to the presence of life-threatening systemic vasculitis. Treatment was established like crescentic glomerulonephritis. Induction therapy consisted of pulse steroid, cyclophosphamide, and plasmapheresis. Unfortunately, severe SARS-CoV-2 infection caused death during induction therapy in this case. Conclusions The lack of glomerular injury and solely interstitial inflammation is atypical regarding AAV involvement in the kidney. This diversity might be initially considered as only a simple histological elaboration. However, it is a significant entity for guiding the treatment of AAV.https://doi.org/10.1186/s12882-023-03134-0Tubulointerstitial nephritisMicroscopic polyangiitisAcute kidney injuryDialysisCase report |
| spellingShingle | Cihan Uysal Tugba Yilmaz Hafsa Kocyigit Hulya Akgun Murat Hayri Sipahioglu An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report BMC Nephrology Tubulointerstitial nephritis Microscopic polyangiitis Acute kidney injury Dialysis Case report |
| title | An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report |
| title_full | An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report |
| title_fullStr | An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report |
| title_full_unstemmed | An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report |
| title_short | An unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis: a case report |
| title_sort | unusual form of kidney injury without glomerulonephritis in microscopic polyangiitis a case report |
| topic | Tubulointerstitial nephritis Microscopic polyangiitis Acute kidney injury Dialysis Case report |
| url | https://doi.org/10.1186/s12882-023-03134-0 |
| work_keys_str_mv | AT cihanuysal anunusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT tugbayilmaz anunusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT hafsakocyigit anunusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT hulyaakgun anunusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT murathayrisipahioglu anunusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT cihanuysal unusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT tugbayilmaz unusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT hafsakocyigit unusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT hulyaakgun unusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport AT murathayrisipahioglu unusualformofkidneyinjurywithoutglomerulonephritisinmicroscopicpolyangiitisacasereport |