Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis
Hepatitis C (HCV) infection has a prevalence of 3 million infected individuals in the United States, according to recent Center for Disease Control reports, and can have various renal manifestations. Cryoglobulins, antibodies that precipitate at colder temperatures in vitro, are a relatively common...
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| Format: | Article |
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Karger Publishers
2018-08-01
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| Series: | Case Reports in Nephrology and Dialysis |
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| Online Access: | https://www.karger.com/Article/FullText/491629 |
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| author | Ramy M. Hanna Naomi So Marian Kaldas Jean Hou Farid Arman Michelle Sangalang Bishoy Yanny Umut Selamet Sammy Saab Niloofar Nobakht Anjay Rastogi |
| author_facet | Ramy M. Hanna Naomi So Marian Kaldas Jean Hou Farid Arman Michelle Sangalang Bishoy Yanny Umut Selamet Sammy Saab Niloofar Nobakht Anjay Rastogi |
| author_sort | Ramy M. Hanna |
| collection | DOAJ |
| description | Hepatitis C (HCV) infection has a prevalence of 3 million infected individuals in the United States, according to recent Center for Disease Control reports, and can have various renal manifestations. Cryoglobulins, antibodies that precipitate at colder temperatures in vitro, are a relatively common cause of renal disease in HCV infection. The cryoglobulin proteins can form occlusive aggregates in small glomerular capillary lumina or deposit in other areas of the glomerulus, resulting in hypocomplementemia, proteinuria, hematuria, and renal injury. The typical biopsy pattern is that of membranoproliferative glomerulonephritis (MPGN). There are, however, other HCV-related patterns of glomerular injury. Anti-neutrophil cytoplasmic antibodies (ANCA) are known to exist in HCV-infected patients. In many reported cases, ANCA serologic testing may appear positive due to cross-reactivity of the immune assays; however, the biopsy findings do not support ANCA-associated crescentic glomerulonephritis (GN)/vasculitis as the primary cause of glomerular injury. There are rare reports of microscopic polyangiitis (MPA) p-ANCA vasculitis, in patients with HCV infection. In comparison with the MPGN pattern of cryoglobulinemic glomerular injury, biopsies from these HCV-infected patients with concomitant MPA revealed a crescentic GN, associated with normal serum complement levels. We present a case of HCV-associated glomerular disease with the surprising biopsy finding of necrotizing and crescentic p-ANCA GN, with a background, low-grade mesangial immune complex GN. Thus, p-ANCA disease should also be considered in HCV-infected patients, in addition to the more typical lesions of MPGN or cryoglobulinemic GN. |
| first_indexed | 2024-12-10T22:37:17Z |
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| institution | Directory Open Access Journal |
| issn | 2296-9705 |
| language | English |
| last_indexed | 2024-12-10T22:37:17Z |
| publishDate | 2018-08-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Nephrology and Dialysis |
| spelling | doaj.art-e5a1c61a316c478ba7aca25238e7662e2022-12-22T01:30:51ZengKarger PublishersCase Reports in Nephrology and Dialysis2296-97052018-08-018216117010.1159/000491629491629Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA GlomerulonephritisRamy M. HannaNaomi SoMarian KaldasJean HouFarid ArmanMichelle SangalangBishoy YannyUmut SelametSammy SaabNiloofar NobakhtAnjay RastogiHepatitis C (HCV) infection has a prevalence of 3 million infected individuals in the United States, according to recent Center for Disease Control reports, and can have various renal manifestations. Cryoglobulins, antibodies that precipitate at colder temperatures in vitro, are a relatively common cause of renal disease in HCV infection. The cryoglobulin proteins can form occlusive aggregates in small glomerular capillary lumina or deposit in other areas of the glomerulus, resulting in hypocomplementemia, proteinuria, hematuria, and renal injury. The typical biopsy pattern is that of membranoproliferative glomerulonephritis (MPGN). There are, however, other HCV-related patterns of glomerular injury. Anti-neutrophil cytoplasmic antibodies (ANCA) are known to exist in HCV-infected patients. In many reported cases, ANCA serologic testing may appear positive due to cross-reactivity of the immune assays; however, the biopsy findings do not support ANCA-associated crescentic glomerulonephritis (GN)/vasculitis as the primary cause of glomerular injury. There are rare reports of microscopic polyangiitis (MPA) p-ANCA vasculitis, in patients with HCV infection. In comparison with the MPGN pattern of cryoglobulinemic glomerular injury, biopsies from these HCV-infected patients with concomitant MPA revealed a crescentic GN, associated with normal serum complement levels. We present a case of HCV-associated glomerular disease with the surprising biopsy finding of necrotizing and crescentic p-ANCA GN, with a background, low-grade mesangial immune complex GN. Thus, p-ANCA disease should also be considered in HCV-infected patients, in addition to the more typical lesions of MPGN or cryoglobulinemic GN.https://www.karger.com/Article/FullText/491629Necrotizing crescentic p-ANCA glomerulonephritisHepatitis C virus-associated glomerular diseasePerinuclear anti-neutrophil cytoplasmic antibodiesCryoglobulin antibodies |
| spellingShingle | Ramy M. Hanna Naomi So Marian Kaldas Jean Hou Farid Arman Michelle Sangalang Bishoy Yanny Umut Selamet Sammy Saab Niloofar Nobakht Anjay Rastogi Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis Case Reports in Nephrology and Dialysis Necrotizing crescentic p-ANCA glomerulonephritis Hepatitis C virus-associated glomerular disease Perinuclear anti-neutrophil cytoplasmic antibodies Cryoglobulin antibodies |
| title | Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis |
| title_full | Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis |
| title_fullStr | Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis |
| title_full_unstemmed | Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis |
| title_short | Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis |
| title_sort | case report patient with hepatitis c p anca and cryoglobulin antibodies presenting with necrotizing crescentic p anca glomerulonephritis |
| topic | Necrotizing crescentic p-ANCA glomerulonephritis Hepatitis C virus-associated glomerular disease Perinuclear anti-neutrophil cytoplasmic antibodies Cryoglobulin antibodies |
| url | https://www.karger.com/Article/FullText/491629 |
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