Case Report

Crescentic Glomerulonephritis and Membranous Nephropathy: A Rare Overlap

Table 1

Clinical details of patients with membranous nephropathy and concomitant vasculitic glomerulonephritis.

Title/authorsPatient (age/sex)PLA2RANCA by IFANCA specificity by ELISATreatmentPrognosis

Membranous nephropathy with proteinase 3-ANCA-associated vasculitis successfully treated with rituximab; Shun Yoshida, Shunichiro Hanai, Daiki Nakagomi, Kei Kobayashi, Kazuya Takahashi, Fumihiko Furuya [7]73/FPR3Oral prednisolone and IV rituximabRenal function immediately improved, along with symptoms and urinalysis abnormalities
Association of vasculitis glomerulonephritis with membranous nephropathy: A report of 10 cases; Tse WY, Howie AJ, Adu D, Savage CO, Richards NT, Wheeler DC, Michael J [1]10 patients: 9 males/1 female, 30–70 yearsRenal function improved in 3 patients; 2 patients required RRT; 3 patients died: one of systemic vasculitis and 2 of sepsis
30/MC-ANCAOral prednisolone and cyclophosphamideStable renal function. Complication: squamous lung CA 10 years after presentation
39/MNegativeOral prednisolone and cyclophosphamideRecovery. Complication: steroid-induced DM. Duration of follow-up: 7 months
41/MNegativeOral prednisolone and cyclophosphamideStable renal function, duration of follow-up: 3 years
58/FNegativeOral prednisolone and cyclophosphamideDialysis, duration of follow-up: 7 years
63/MNAOral prednisolone and azathioprine for 3 years, followed by prednisolone and cyclophosphamideDeath, duration of follow-up: 6 years
64/MP-ANCAOral prednisolone and azathioprineDialysis, duration of follow-up: 2 years
65/MP-ANCAOral prednisolone and cyclophosphamideRecovery, duration of follow-up: 5 years
65/MNegativeOral prednisolone and cyclophosphamideDeath (after 4 months)
68/MNegativeOral prednisolone and cyclophosphamideDeath (after 2 months)
70/MC-ANCAOral prednisolone, cyclophosphamide, and plasma exchangeRecovery (duration of follow-up:4 years)
Membranous glomerulonephritis with ANCA-associated necrotizing and crescentic glomerulonephritis; Samih H. Nasr, Samar M. Said, Anthony M. Valeri, Michael B. Stokes, Naveed N. Masani, Vivette D. D’Agati, and Glen S. Markowitz [4]64/MC-ANCANAPrednisone and cyclophosphamideResolution of pulmonary lesions, normalization of Cr, diminution of proteinuria
68/FNAMPOPrednisoneNormalization of Cr
47/FP-ANCAMPOMethylprednisolone and then prednisone and cyclophosphamideDiminution of proteinuria and disappearance of crescents (on repeat bx)
67/MP-ANCAMPOPrednisone and azathioprineDialysis
69/MP-ANCAMPOPrednisone and cyclophosphamideNormalization of Cr
68/FN/AMPOPrednisone and cyclophosphamidePartial recovery
Co-occurrence of PLA2R-positive membranous nephropathy without crescents, and PR3-positive eosinophilic granulomatosis with polyangiitis; Yuexin Zhu, Qing Chang, Xiangyan Cao, Song Zheng, Peiling Li, Junjun Luan, Hua Zhou [8]??PLA2R positiveANCA positivePR3Prednisone and cyclophosphamideRecovery
Anti-neutrophil cytoplasmic antibody-positive eosinophilic granulomatosis with polyangiitis: can it cause membranous nephropathy? S B Mahmood, H Ahmad, J Wu, D Haselby, M M LeClaire, R Nasr [9]63/FP-ANCAMPORituximabRecovery
Primary membranous nephropathy presenting with crescentic glomerulonephritis 25 years after initial presentation: A case report; David Massicotte-Azarniouch, Sean Barbour, Paula Blanco, Edward G Clark [10]63/MPLA2R positiveNegative ANCANegativePrednisone and cyclophosphamide and then azathioprine for maintenanceDialysis and then partial recovery
Anti-neutrophil cytoplasmic antibody-associated glomerulonephritis with detection of myeloperoxidase and phospholipase A2 receptor in membranous nephropathy lesions: report of two patients with microscopic polyangiitis; Tominaga K, Uchida T, Imakiire T et al. [11]52/MPLA2R positiveNot reportedMPONot reportedNot reported
63/FPLA2R positiveNot reportedMPONot reportedNot reported
Crescentic glomerulonephritis and membranous nephropathy: A rare coexistence; Olga Balafa, Rigas Kalaitzidis, Georgios Liapis, Sofia Xiromeriti, Fotios Zarzoulas, Georgios Baltatzis and Moses Elisaf [5]58/Mp-ANCAPrednisolone, cyclophosphamide, and plasmapheresisRecovery, duration of follow-up: 3 months
Clinical and immunologic characteristics of patients with ANCA-associated glomerulonephritis combined with membranous nephropathy a retrospective cohort study in a single Chinese center; Zou, Rong; Liu, Gang; Cui, Zhao; Chen, Min; Zhao, Ming-Hui [12]27 patients with ANCA-GN and characteristics of MN on renal biopsy17 M and 10 F, with an age of 52.4 ± 17.7 years25 p-ANCA positive; 2 c-ANCA positive25 MPO positive and 2 PR3 positivePrednisone and cyclophosphamide11 of 27 (40.7%) died; 13 of 27 (48.1%) progressed to ESRD
17 M and 10 F, with an age of 52.4 ± 17.7 yearsANCA-GN patients with MN had significantly poorer renal outcome (P = 0.021) and patients’ survivals (P = 0.036) compared with the patients without MN
No significant difference in causes of death between ANCA-GN patients with and without MN.
Infection is the first cause of death in ANCA-GN patients with and without MN
Membranous nephropathy with crescents: A series of 19 cases; Erika F. Rodriguez, Samih H. Nasr, Christopher P. Larsen, Sanjeev Sethi, Mary E. Fidler, Lynn D. Cornell [13]19 patients with ANCA and crescentic MN38% PLA2R positiveAll negativeAll negative
No patient had positive anti-dsDNA, hep B and C, or HIV
22/MNegativeNegativePrednisone and cyclophosphamide and then cyclosporineRecovery, duration of follow-up: 138 months
76/FNegativeNegativePrednisone and cyclophosphamidePartial recovery, duration of follow-up: 26 months
80/FNegativeNegativeMycophenolate mofetil and prednisoneRecovery, duration of follow-up:6 months
69/FNegativeNegativePrednisoneESRD, duration of follow-up: 1.5 months
57/MNegativeNegativePrednisone and cyclophosphamide orally with remission; then azathioprine; then prednisone and cyclophosphamideDuration of follow-up: 56 months
41/MNegativeNegativePrednisone and cyclophosphamideWorsening renal function, duration of follow-up:5 months
20/FNegativeNegativeNoneESRD, duration of follow-up: 35 months
17/FNegativeNegativeEnalaprilRecovery, duration of follow-up: 3 months
50/MNegativeNegativePrednisone, cyclophosphamide, and mycophenolatePartial recovery, duration of follow-up: 16 months
5/FNegativeNegativePrednisone and mycophenolate (no response at 6 m); then, prednisone and cyclosporine; then, prednisone and tacrolimusRecovery, duration of follow-up: 32 months
86/MNegativeNegativePrednisonePartial recovery, duration of follow-up: 11 months
64/MNegativeNegativePrednisone and cyclosporineWorsening renal function, duration of follow-up: 2 months
72/FNegativeNegativePrednisone and cyclophosphamidePartial recovery, duration of follow-up: 27 months
62/MNegativeNegativeUnknownPartial recovery, duration of follow-up: 19 months
64/MNegativeNegativePrednisone and cyclosporine (no response at 2 m); then 4 doses rituximab; then mycophenolate and prednisone (no response)ESRD, duration of follow-up: 11 months
72/MNegativeNegativeLosartanPartial recovery, duration of follow-up: 9 months
58/MNegativeNegativePrednisone and cyclophosphamide orally for 2 m; then azathioprine for 1 yPartial recovery, duration of follow-up: 11 months
70/FNegativeNegativeUnknownDialysis within 1 month
56/MNegativeNegativePrednisone and cyclophosphamidePartial recovery, duration of follow-up: 3 months
A case of membranous glomerulonephritis with superimposed anti-neutrophil cytoplasmic antibody-associated rapidly progressive crescentic glomerulonephritis; Yoo Hyung Kim, Hae Ri Kim, Young Rok Ham, Jae Woong Jeon, Sarah Chung, Dae Eun Choi, Kang Wook Lee and Ki Ryang Na [14]65/MNot reportedp-ANCAMPOMethylprednisolone and cyclophosphamideESRD
Membranous glomerulonephritis with superimposed ANCA-associated vasculitis: Another case report; Antonio Granata, Fulvio Floccari [15]67/MNot reportedp-ANCANot reportedMethylprednisolone and cyclophosphamidePartial recovery